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Medical Aesthetics

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Once considered a luxury for the rich and famous, Botox, dermal fillers and today's growing menu of medical aesthetic procedures have become much more commonplace in mainstream America. Medical aesthetics is one of the most lucrative business opportunities for nurse practitioners today. Industry experts say that only 10% to 15% of the current demand for medical aesthetic services is being met, meaning that entrepreneurial NPs can build fulfilling and profitable practices in this specialty.1 Couple the escalating demand with diminishing health care and family practice dollars, and the answer is clear: Learning how to effectively perform medical aesthetics procedures will enhance your practice, increase your income and provide widespread patient satisfaction. I call it "Happy Medicine."

Benefits to Practice

The benefits of adding medical aesthetics to a practice are numerous. Medical aesthetics sets the tone for a more positive work environment because you are treating healthy patients who want to look as good as they feel. The baby boomer population between the ages of 51 and 64 is driving this market. Every 8 seconds, someone in the United States turns 50.2 The proliferation of people entering later life will continue for the next 20 years, and the buying power of this age group is projected to exceed $2 trillion dollars by 2007.1

One of the sociological forces fueling interest in medical aesthetics is work force competition. As baby boomers age, they will work longer alongside the younger population. To stay competitive, they are demanding to feel and look better.

In addition, medical aesthetics treatments are much less expensive than plastic surgery. The procedures produce minimal pain and less downtime than plastic surgery, and patients tend to be happier with their appearance after medical aesthetics.

I have been working in the medical aesthetics field for more than 25 years, performing dermal filler injections and chemical peels in the offices of plastic surgeons. Nine years ago, I opened the Aesthetic Enhancement Institute in Hollywood, Fla. I travel throughout the country to train nurse practitioners, physicians and RNs in how to perform the most popular medical aesthetic procedures. I also have my own private practice.

Based on usage rates documented by the American Society of Aesthetic Plastic Surgery, 7 million people are projected to receive medical aesthetic procedures in 2006. U.S. residents make 145 million visits for medical aesthetics procedures each year, and that number is expected to triple in the next 10 years.

And the field is not limited to the middle-aged and older. Younger people are seeking procedures to treat, prevent and slow the aging process. For the more than 1 million women in the 23- to 35-year-old range who seek medical aesthetic procedures, a limited number of suppliers of these services are available.

Nor is medical aesthetics a service sought only by women. Just a few years ago, men accounted for 11% of people receiving treatments. That number has risen to 25% and is expected to grow.1 These facts strongly predict success; the return on an educational investment in this field is virtually guaranteed.

Why Nurse Practitioners?

Besides the financial potential, practice autonomy is a compelling reason for entering the medical aesthetics field. NPs can perform medical aesthetics procedures independently or with limited involvement by a collaborating physician. The majority are now performed by RNs under the direct supervision physicians who are on site. In almost every state, nurse practitioners are not supervised by physicians, and collaborating physicians are not required to be on site at all times. (Check your state's scope-of-practice regulations for specific collaboration and independent practice requirements.) In addition, NPs can independently develop and recommend treatment plans because they are fully credentialed primary care providers.

For nurse practitioners who work in an existing practice, the potential patient population is already established, the comfort level is in place, and most patients will prefer being treated by a provider they already know.

The medical aesthetics specialty can be added to your current professional services without dramatic overhaul or spending. For example, if 100 women in your current patient database are interested in Botox and dermal fillers and they each purchase $2,000 in services (the typical annual investment), you can increase your revenue by more than $100,000 annually. Botox and dermal fillers require no capital equipment to get started, and the only overhead is your product.

Getting Started

Nurse practitioners already have the clinical and scientific background to perform medical aesthetics procedures. To learn the actual procedures, take a reputable course with a qualified trainer. It is imperative that the workshop or course provide hands-on experience on live models. With this type of training, you will be able to achieve a return on investment immediately. You can be up and running within 2 weeks of taking a comprehensive live course.

The most popular procedures are Botox injection and dermal filler injections, and these represent the simplest way to start your new specialty. Restylane is one of the most widely used dermal filler materials today. Gaining additional knowledge in other procedures will ensure that you become a one-stop shop for your clientele.

As you create your medical aesthetics practice, reflect on and answer the following questions: Who am I serving? What treatments will I offer? Where will I practice and what setting am I going to choose? Why have I decided to add this or to or change the direction of my career? These answers will lead to your mission statement and help you focus your business plan.

A business plan provides initial projections and data to assist you in planning or obtaining financing. Writing a business plan can be an arduous process, and software can help with the mechanics. Set 1-month, 3-month, 6-month, 1-year and 5-year goals. Do competitive research. Who are your competitors, and how much do they charge? Decide how often you will integrate aesthetics into your practice - 1 day a week, evenings or even weekends? If you negotiate some sort of profit sharing with a collaborating physician, make sure you receive a proportion that fairly represents your skills and work. Consult an attorney to develop documents that protect your financial interests and your stake in the practice.

Once you have completed your first courses, get to work immediately by becoming proficient and confident in providing treatments. Practice on family or loyal friends, and follow up with them to determine the effectiveness of your technique. By the fifth or sixth time you get the desired results, you should be ready for your first clients.

Start out with a few procedures and minimal cash outlay, and move forward from there. A credit card system is beneficial for you and your clients. People typically spend more if they can use their credit cards.

If you don't have a relationship with a medical supply company, set up accounts quickly. Physician Sales and Service (PSS, www.pssd.com), McKesson Corp. (www.mckesson.com) and Henry Schein (www.henryschein.com) are reputable choices. A certificate of training may be required to set up an account.

Among your materials you should maintain a binder for procedure manuals. Include pertinent information such as injection locations and the wrinkle-rating scale for dermal fillers. Keep this binder in your treatment area. Create and photocopy consent forms for patients, as well as an outline of policies and procedures. Prepare instruction handouts for patients and staff.

Office Space and Setting

It is imperative that your procedure setting be warm, elegant and inviting - very different from the sterile medical setting. Inspire and comfort your clients starting with the moment they walk in to see you. Brochures, products and information must be visible and at their fingertips. A no-wait policy is essential; these people are enhancing their appearance, and they are willing to spend cash to do it.

The aesthetics portion of your practice must have its own separate identity. If you are using existing office space in a medical practice, dedicate a treatment room exclusively to aesthetic services. A 10-foot-by-10-foot room is usually sufficient unless you are using equipment such as lasers, which require more space. It is not good policy to commingle the sick with the well. Consider establishing separate aesthetic practice days or hours to set this element of your offerings apart.

Staff

Your staff must be educated and knowledgeable. Staff members must be able to counsel potential clients and sell services. Your scheduling person is the key to your income. His or her effectiveness can make you or break you. Confirm appointments, and overbook 20% to 30%, the approximate rate at which people will cancel or not show.

Make reminder calls to avoid having cancellations or no-shows. Before each client leaves your office, your staff should schedule the next visit. Your front desk staff should be prepared to take cash payments. All payments should be collected at the time of service.

Treatment Area

The treatment area should be nonthreatening and pleasant. Your supplies for the various procedures should be organized for quick location. A medical assistant can make your client comfortable and prepare him or her, have the required forms signed and ready, take pictures, discuss pre- and postprocedure instructions, and even provide a little hand holding afterward. Some treatment substances, such as Botox, require refrigeration. A locked refrigerator is a necessity because Botox has a habit of walking out the door!

Spreading the Word

Marketing will be essential to your success. Advertising your services and your qualifications as an NP with additional training in medical aesthetics will interest customers. Your interpersonal skills and clinical expertise will keep them coming back.

References

1. Buckingham J. As quoted in press releases and industry reports by Solana MedSpas, a consulting firm for medical spa development. http://www.solanamedspas.com. Accessed March 3, 2006.

2. Stoltz-Loike M, Madison D. Making full use of the maturing workforce. The Five O'clock Club Web site. Available at: http://www.fiveoclockclub.com/articles/2003/2-03-mature.htm. Accessed March 8, 2006.

Popular Medical Aesthetics Procedures

Botox

Botox injection is in high demand. This 10- to 20-minute treatment is usually administered to the average patient about four times a year. It is one of the most profitable of all medical aesthetic procedures. No special equipment is required, and the risk is minimal.

Typical charge to the patient: $250-$550, depending on area treated

Dermal Fillers

The most commonly used dermal filler substance is Restylane. It also has a high patient demand because the results are immediately visible to the patient. In this procedure, the NP fills in soft tissue volume in the lower part of the face and uses advanced injection techniques in the upper face. The treatment time is approximately 20 to 30 minutes. The recommended schedule for treatment is four times a year. The profitability is moderate, and the risks involved are minimal.

Typical charge to the patient: $450-$800

Sclerotherapy

Sclerotherapy injections minimize or erase small spider veins on the legs and face. The more expensive laser has thus far not been able to correct this problem. The demand is moderate - but only because most patients do not know that this treatment is available and effective, let alone where to find it. This is a 15- to 20-minute procedure. Risk and profitability are also moderate.

Typical charge to the patient: $175-$350

Chemical Peel

After patients have spent thousands of dollars on Botox and fillers, flawless skin is the next step. Although the actual procedure isn't lengthy, making a chemical peel comfortable for the patient should take about 30 minutes. This procedure can be performed six to 10 times a year. The profitability is low, but adding this to your list of services keeps your clientele in your office. The risk is moderate to high, since you must monitor times and patient sensitivity accurately. Selling cosmeceutical skin care products will increase your profit margin substantially. One hundred percent mark-ups allow for an excellent source of passive income.

Typical charge to the patient: $125-$150

Microdermabrasion

Microdermabrasion is a mechanical exfoliation of the skin. It takes about 30 minutes and can be performed six to 10 times a year. The risk and profit are low, but it is something that keeps your clients coming back. Hydrodermabrasion is a less invasive version of this technique.

Typical charge to the patient: $125-$150

Mesotherapy

Intradermal injections of mesoderm break up cellulite and dissolve fat. Mesotherapy is a relatively new procedure, so the demand is still moderate. Each body area can handle about six treatments a year. The profit is moderate, and the risk is low.

Typical charge to the patient: $350

Laser

Laser treatment for hair removal and photorejuvenation is the one medical aesthetics procedure that requires huge startup costs. A laser machine can cost in excess of $100,000. This is not the ideal way to get started, but once a laser is in place, it can be extremely profitable.

Typical charge to the patient: $100-$1,000 or more, depending on the area treated




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