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The aesthetic for-profit practice

Article-The aesthetic for-profit practice

Several factors go into whether a cosmetic service will be profitable for a practice, including patient satisfaction, disposable costs, competition and marketing. We asked four physicians with established, successful cosmetic practices what they thought were among the most profitable treatments in their practices and why. Some also weighed in on money-losing propositions, as well as why profitability is a dangerous topic in cosmetic surgery.


To look at profitability, a physician has to look at demand, as well as the cost of obtaining and maintaining that service, according to dermatologist Tanya Kormeili, M.D., who has a private practice in Santa Monica, Calif.

Dr. KormieliFor a cosmetic service to be profitable, Dr. Kormeili says, it has to be in high demand and low supply by other doctors and spas. Botox (Allergan) is an example of a product in high demand, but so many practitioners are offering it that it’s not very profitable, she says.

“You also have to calculate the most important question: ‘Is this a safe, ethical and effective treatment for my patients?’” Dr. Kormeili says. “I think the worst mistake is to start offering a service that doesn't work or harms patients. In the long run, that is a financial disaster — not to mention terrible for you as a professional.”

In addition, providers have to consider the cost of obtaining certain technologies, including costs for associated consumables, Dr. Kormeili says.

“… if you have a high demand for a service that you can solve with a product that is cheap to obtain and does not have consumables, you have the most profitable service. This varies by the practice and expertise of the doctor,” she says.

Dr. Kormeili says her practice revenues are particularly high with lasers, such as the Vbeam (Syneron-Candela), which don’t have consumables. Those chemical peels that only dermatologists can offer are also profitable because they’re less likely to be offered by non-physicians or at spas.

While there is a growing demand for nonsurgical body contouring, devices like market-leader CoolSculpting come at a price to the practices offering them, Dr. Kormeili says.

Practices must buy the system and consumables needed to use the device. Providers also buy new applicator handpieces as the technology changes, which can be pricey. And patients may need many application cycles to get desired results, therefore, patients are encouraged to buy packages, she says.

“… profit margins decrease when you discount on your end to create packages for the patients,” Dr. Kormeili says.

There’s also the issue of time. Each fat reduction treatment can require the use of a treatment room for at least 35 minutes—even longer, if it’s more than one cycle.

Then, there’s competition.

“If there are many providers in your area offering the service, you might not have the demand,” she says. “Be mindful also that there are other body shaping technologies on the market that will be competing with your service, perhaps at a lower price since they don't all have consumable parts.”

NEXT: Patient Satisfaction Wins


Patient Satisfaction Wins

Dr. KontisBaltimore-based facial plastic and reconstructive surgeon Theda C. Kontis, M.D., assistant professor, Johns Hopkins Hospital, tells The Aesthetic Channel that the devices that make her practice the most money are those that offer the highest patient satisfaction.

Her top three most profitable devices:

1.     Laser hair removal, which she says offers great patient satisfaction and great results in dark-haired individuals.

2.     LaserGenesis [Cutera], a noninvasive Nd:YAG laser-based skin polishing, pore reduction system, which isn’t painful, with a quick treatment time and noticeably improves the treated skin, according to Dr. Kontis.

3.     Infini’s (Lutronic) radiofrequency with microneedeling device, which tightens the skin, according to Dr. Kontis who says, “It’s somewhat uncomfortable, but offers good results.”

Her worst purchase? The Picosure laser. “[It] costs a fortune, and we’ll never make a profit on it,” Dr. Kontis says.

For her practice, the problem with the device’s profitability is multifactorial, she says.

In Dr. Kontis’ experience, the device does not deliver the promise that patients would need fewer treatments; Cynosure offers poor customer support; patients do not schedule other cosmetic procedures as a result of having Picosure treatment; and Dr. Kontis says her practice has to compete with cheap Groupons because the competition’s price is set low.

NEXT: Fat and Wrinkle Treatments


Fat and Wrinkle Treatments

Princeton, NJ, plastic surgeon Adam H. Hamawy, M.D., says cryolipolysis with CoolSculpting (Zeltiq) is the most profitable noninvasive procedure he offers.

Dr. Hamawy“There are several reasons why this is the case,” Dr. Hamawy says. “First, who doesn't want to lose unwanted fat without having surgery or any downtime? Most people have a hard time believing it actually works, but it’s true. For most people, there's almost no pain involved and, if you set realistic expectations, [patients] are usually very happy. Another great thing about CoolSculpting is that the disposable costs are acceptable, and I can delegate it to other [staff]. This allows me to do other things at the same time. Finally, as a plastic surgeon, I have the added bonus of offering alternative treatments. Not everyone is a good candidate for Cryolipolysis. Many of my liposuction and abdominoplasty patients initially came in requesting CoolSculpting.”

Other noninvasive treatments that are bottom-line winners for Dr. Hamawy’s practice are neuromodulators.

“Botox [Allergan], Dysport [Galderma] and Xeomin [Merz] are fast,10-minute, procedures that are effective, well-tolerated, and keep patients coming back for more treatments,” he says. “It is recurring revenue, which also leads to more exposure for my practice about everything else I offer.”

Next: Results Are Everything


Results Are Everything

Profits are secondary to doing what’s best for cosmetic medicine patients, according to Chicago-based facial plastic surgeon Steven Dayan, M.D., a New York Times best-selling author for his 2014 book, Subliminally Exposed.

Dr. Dayan“If you only think about profits first, then you’re corporatizing and commoditizing aesthetic medicine,” Dr. Dayan says. “I can do Botox on someone and make it profitable and I can do Botox on someone and make it not so profitable. If my only motive is to make a sizable profit, I can alter my reconstitution of Botox. But that goes against our goals and mission as facial plastic surgeons. The best outcome possible should be our primary objective.”

Cosmetic medicine is so much more than a commodity, Dr. Dayan says.

“People’s emotions and lives are at play, as well as why they get these treatments. Every patient is different. One patient may need 30 units of Botox; another needs 15 units. It’s not just based on how they look; it’s based on how they feel, too. When you look at profits, you can say it’s profitable for this person but not for that person,” Dr. Dayan says. “Aesthetics is the last bastion where a doctor patient relationship exist because the patient chooses a physician based on reputation alone, not a preauthorized list of participating physicians. If profit motives overtakes a patient’s best-interest motive, then we risk destroying all that is good about aesthetic medicine.”

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