In the past 6 months, I have been contacted numerous times
by nurses, aestheticians, and non-plastic surgeon
physicians for cosmetic injector training. Some of these
folks I have known or interacted with in the past through
our local hospitals and other medical facilities, but most
of them I have no idea who they are. This represents a
disturbing trend that has developed over the past few
years, with the burgeoning medspa concept (and decreasing
medical insurance reimbursements), which has been largely
made possible by the number of injectable cosmetic
treatments which have become available in the past five
years. Since treatments such as Botox, injectable fillers,
lipodissolve and laser hair and anti-aging skin treatments
are fairly 'easy' to do (compared to real surgery), many
medical and allied health personnel as well as day spas and
hair salons want to jump on the bandwagon. They see these
treatments as cash up front, fun and interesting to do, and
part of the expanding public's desire for beauty and
anti-aging treatments.
While there are some concerning and adverse statements that
could be made as a plastic surgeon about this trend, our
commentaries are usually viewed as self-serving,
territorial, and economically repressive. Personally, I
don't care what others do, inside or outside of medicine. I
have enough to worry about in my plastic surgery and spa
practice and I prefer to focus on honing my own skills and
providing the best possible cosmetic care that I can. The
cosmetic marketplace is not like traditional medicine...it
is really let the buyer beware. There are few regulatory
agencies or guidelines for a burgeoning field that is not
behest to federal and private insurance rules of
reimbursement. In this market, only the attorneys and the
threat of malpractice and liability issues (and perhaps
one's good conscience ??) keep it from spinning completely
out of control.
What I find most troubling, however, is the complete
disregard or lack of concern about patient safety.....all
in the pursuit of the almighty dollar. Here in
Indianapolis, I know of aestheticians who regularly perform
Botox in their own home, cosmetologists doing injectable
fillers in hair salons, nurse assistants doing lipodissolve
injections, Internists performing threadlifts and ENT
surgeons doing breast augmentations in their own surgery
centers. Providers performing procedures for which they
have little training and and no formal background, not to
mention being well outside what their licenses and
certificates would permit, treating patients as study
subjects. (when you are training on someone without
supervision by a qualified provider in an educational
setting....you are a study subject!) And I wouldn't call
visiting someone for a few hours in their office or
watching a DVD by a manufacturer bona fide training either!
The providers aside, I am not sure exactly what some
patients are thinking.....is it the allure of a more
convenient or cheaper service.....or is it the appeal of a
well-crafted advertisement or website?
Equally disturbing....and the genesis of this rant
is......that physician (and yes some dentists too) and
other allied health and beauty care providers will contact
me in the hope of providing them with some training. The
very fact that this is done is highly reflective of some
deeper problematic issues........and not just that they
obviously don't respect my time and plastic surgery
experience. (I got my training the old-fashioned way...
what would be my motivation to give that knowledge away for
free for their benefit?) Such requests for quick and easy
on-site training indicate that they have no appreciation
for the subtle nuances and complexities of aesthetic
medicine. Just because you can take a needle and inject
something doesn't mean you know whether this is the
appropriate treatment for the patient's problem and whether
an injection or other more sophisticated form of treatment
might not be better. The simplicity of a treatment doesn't
always equate with overall effectiveness. Fortunately, most
of these aesthetic treatments don't carry high risks of
medical complications but they do carry significant risks
of poor 'value'. The concept of value is a very valuable
one in aesthetic medicine which is often unappreciated,
although it will ultimately be perceived by the patient.
What do you get...for what you are paying for? For example,
the use of injectable fillers, may not be so inexpensive if
poor results are obtained...and the patient later learns
that they would have been better off with a facelift from
the beginning. Several thousands dollars of lipodissolve
treatments for a 10% improvement in a body area is very
disappointing when twice that amount of money for
liposuction would have produced a much better result a lot
faster.
The point is.....aesthetic treatments, like traditional
medical therapies, require a diagnosis, treatment planning,
and a review of treatment options. That is not something
you can learn in a few hours of observation, reading a
manual, or watching a DVD.
----------------------------------------------------
Dr Barry Eppley runs a private plastic surgery practice
through his hospital-based medspa locations at Clarian
Health in Indianapolis. To learn more about the latest
trends in plastic surgery, spa therapies, or skin care, go
to his daily blog, http://www.exploreplasticsurgery.com .
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