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The contested corridor: The cosmetic surgeon's futures lies in the longitudinal management of patients, pushing the scientific envelope, and knowing when to let go

Article-The contested corridor: The cosmetic surgeon's futures lies in the longitudinal management of patients, pushing the scientific envelope, and knowing when to let go

National report Big changes are in store in cosmetic surgery — changes fueled by evolutions in demographics, cultural factors, consumer and payer demands, technology and the transformation of the cosmetic surgery marketplace.

Dr. Morrison
"There are a number of demographic and cultural drivers that are going to increase the practice and the volume of business because the world is becoming old, fat and vain," observes J. Ian Morrison, Ph.D., president emeritus of the Institute for the Future, a founding partner of Strategic Health Perspectives, Menlo Park, Calif., and, notably, featured keynote speaker at the recent American Society of Plastic Surgeons' 75th Anniversary congress. "The other piece is that the field — particularly cosmetic surgery — is growing because more and more doctors are attracted to its retail environment to avoid insurance hassles. And technology is allowing a lot of new things to be done. I think there is a positive spin on the movement of payers looking for value — which may or may not be good depending on who you are in the field."

POSITION FOR GROWTH There is typically a close correlation between medical care and age. The need for general medical services generally peaks at around age 75 and diminishes in the 85-and-older population, according to Dr. Morrison. However, that's not true in plastic surgery, he says. Peak usage in cosmetic surgery is in the 35-to-50-year-old age range.

"That's a problem because the 35-to-50-year-old population is flat over the next 20 years. Baby boomers will be moving completely through the 50-year-old threshold and much of the growth in the future is in the 65-and-over population," Dr. Morrison says.

Thus, the big message to cosmetic surgeons on the demographic side, advises Dr. Morrison, is to focus on procedures that will make aging baby boomers happy. He stresses the importance of establishing long-term relationships with cosmetic surgery patients, what he calls their "longitudinal management." In his view, the patients who come in for less invasive procedures in their 40's are the prime candidates for the more extensive cosmetic surgery which these same patients may seek into their 60's and 70's. The obesity issue in the U.S., too, is at a critical stage, he notes, and surgeons should position themselves for the rising demands of post-bariatric surgery patients for total body recontouring procedures following massive weight loss. Cultural drivers are also feeding the cosmetic surgery frenzy. "Our culture of celebrity, appearance and the fact that pornography has been mainstreamed to the point that often celebrities look like porn stars is fueling the general acceptance of cosmetic enhancement," he says.

BATTLING FOR SHARE Beyond cosmetic surgery, government, insurance and consumer purchasers are looking for value — not just quality and not just low cost, Dr. Morrison contends.

"The old premise was the more expensive, the better it was and the more you got. That is being challenged across the board in medical care. What we are seeing is quite the reverse: more is not better; more is often worse," he says.

The bad news for the field, according to Dr. Morrison, is that medicine is becoming retail, with physicians of all types hopping on the fee-for-service bandwagon rather than deal with reimbursement bureaucracy and costs within their own subspecialties. As such, many are eyeing cosmetic surgery services, so that cosmetic surgeons and dermatologists will increasingly have to battle for market share.

Technology, too, is fueling the increased competition, with the rising popularity of less invasive procedures that are easier to perform, he says.

"Botox is a classic example of something that doesn't require seven years of surgical training to do," he adds. The fact that the aesthetic marketplace is also shifting from local to global is adding lighter fluid to the competitive coals, says Dr. Morrison. As a result, tomorrow's cosmetic surgeons will not only be competing with other physicians who do what they do in the same city or town, but also with an ever-broadening spectrum of primary care and specialist doctors worldwide.

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