Ophthalmologists primed to offer highly sought after aesthetic procedures
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The global medical aesthetics market is projected to reach more than $45 billion by 2030, with an annual estimated growth rate of 12.2%.
Ophthalmologists are primed for adopting medical aesthetic procedures into practice as they are experienced in surgery and the anatomy of the eyelid and facial structures, and they know the importance of enhancing and optimizing the facial contour.
Source: Alexander Rodriguez
It is therefore no surprise that many ophthalmic practices now offer or are seeking to offer nonsurgical aesthetic procedures, including botulinum toxin injections, dermal filler injections and techniques such as lasers and light therapy.
“The aesthetic industry was once only focused on certain core specialties — oculoplastic surgery, facial plastic surgery, plastic surgery and dermatology. However, the pendulum has swung, and the focus is now on non-core specialties, with ophthalmology definitely on the radar as a growing clientele,” OSN Oculoplastic and Reconstructive Surgery Section Editor Wendy W. Lee, MD, MS, said.
Aesthetic procedures are a natural progression for ophthalmologists to add to their practices, as many of the procedures stemmed from ophthalmology. For example, Botox (onabotulinumtoxinA, Allergan Aesthetics) was invented and first used by Alan B. Scott, MD, a pediatric ophthalmologist, to treat strabismus and was later discovered to reduce wrinkles.
“Ophthalmologists are also very familiar with the periocular anatomy, which is key in the aesthetics space and of utmost importance when performing these types of procedures,” Lee said. “As ophthalmologists, we have learned laser technology through our residencies because we use lasers for certain eye procedures, and so there’s crossover there. The learning curve is less steep for ophthalmologists because of our background and what we already know. I encourage any ophthalmologist who is interested to add aesthetic procedures to their practice.”
Less taboo
After the rise of social media, aesthetic procedures became less taboo.
Social media has created a culture of how we look all the time, which has increased the awareness of aesthetic procedures, Lisa K. Feulner, MD, PhD, of Advanced Eye Care & Aesthetics in Bel Air, Maryland, said.
“Patients are coming into our offices asking for these procedures,” she said. “Individuals looking for spectacle independence are the same individuals wanting their wrinkles gone. We’ve taken away their glasses, and now they’re seeing the wrinkles on their face or the lines around their eyes, and they realize that there is an alternative to look younger and feel better.”
Colleagues are curious about adding aesthetic procedures to their practices, according to Caroline Watson, MD, of Alabama Vision Center in Huntsville, Alabama.
“From a surgical standpoint, we are around the eyes all day long, and the anatomy of the upper face is our expertise. Why not have someone who works around the eyes and operates around the eyes perform cosmetic procedures, which are a wonderful way to get more patients in the door,” Watson said. “Individuals become a referral source. Someone in their mid-30s may come into your office for Botox or dermal fillers and can turn into a refractive surgery patient, or they may even bring their parents in for cataract surgery. It ends up being a domino effect with a referral base, and I am noticing a lot more ophthalmologists performing these procedures.”
How to start
Ophthalmologists interested in adopting aesthetic procedures into their practices should begin their education by attending lectures, reading articles and books, and having hands-on experience via CME and non-CME avenues, according to Lee.
“We do a lot of hands-on training and virtual training through Palette Resources,” Lee said. “There are live demonstrations at many multispecialty aesthetic meetings, such as Vegas Cosmetic Surgery, Miami Cosmetic Surgery and the Aesthetic and Anti-Aging Medicine World Congress. We also have provided live demonstrations for years now at the American Academy of Ophthalmology, Pacific Coast Otolaryngological-Ophthalmological Society and American Society of Cataract and Refractive Surgery conferences. We’re starting to branch out and teach nonsurgical aesthetics to not only general ophthalmologists but ophthalmic subspecialists as well.”
Watson pioneered a quarterly seminar sponsored by Allergan during her residency at Tulane. This program allowed ophthalmology residents to begin learning how to perform these injectables safely under the guidance of an expert injector in the community.
“Allergan is able to connect ophthalmologists with local expert training injectors that either allow you to come into their practice and watch demonstrations, or they come into your practice and guide the surgeon through different procedures,” Watson said. “It is a really great, supportive strategy from Allergan, and I’m certain there are other companies that also provide local training.”
Learning and understanding all state-specific rules and regulations are essential when considering the addition of these procedures into an ophthalmic practice.
“The certification required to provide aesthetic procedures is state dependent, and state-specific certifications can impact the type of services an ophthalmic practice offers,” Feulner said. “Some states require an MD to provide all services regardless of what the aesthetic services are. Other states allow nurse practitioners to treat independently with a medical director supervising without direct care, while others require direct supervision for registered nurses and physician assistants, and some even allow estheticians to perform lasers and more invasive procedures.”
As ophthalmologists become more advanced in the aesthetic procedures space and expand their businesses, it is imperative that they continue to stay abreast of all state laws and keep in contact with their malpractice insurance company, Feulner said.
“It is critical to consult your malpractice insurance company because they have their own requirements and may also require certain approval measures, procedures and protocols to be set up in your office in order to stay protected from a malpractice perspective,” Feulner said.
Feasibility and profitability
Once primed with knowledge and expertise, ophthalmologists should take the time to consider which aesthetic procedures are most synergistic with their practices, according to Deborah G. Ristvedt, DO, of Vance Thompson Vision in Alexandria, Minnesota.
“For instance, if treating dry eye is your expertise, intense pulsed light (IPL) and BroadBand Light (Sciton) are platforms that can be utilized for dry eye as well as on the entire face to remove sunspots and vascularity and improve overall texture,” she said.
Feulner agreed.
“IPL is really big right now across many ophthalmic practices and is a great entry point into the aesthetic space because we’re using IPL to treat dry eye disease, but it can also be used to treat skin discoloration, pigmentation, vascular lesions, rosacea,” Feulner said. “It truly is an easy entry point for ophthalmologists to get into aesthetics.”
Platelet-rich plasma has also become popular in the aesthetic space.
“Platelet-rich plasma can be used to treat dry eye as injectables and to enhance other offerings such as microneedling or post-laser resurfacing,” Ristvedt said. “There are other nonsurgical options for aesthetic desires, such as Latisse (bimatoprost ophthalmic solution 0.03%, Allergan Aesthetics) and Upneeq (oxymetazoline hydrochloride ophthalmic solution 0.1%, RVL Pharmaceuticals) that ophthalmic offices can, and some already do, carry. Who better to drive this market than an ophthalmologist?”
For eyelid procedures, both full-field and ProFractional (Sciton) ablative lasers allow patients to experience deeper treatment while already under anesthesia, Ristvedt said.
“Patients are able to recover while healing from eyelid surgery,” she said. “Reducing wrinkles with laser and supporting the cheeks with filler can optimize surgical lid procedures.”
Regarding profit, botulinum toxin is both profitable and one of the easiest procedures to implement.
“Once you learn how to do botulinum toxin, those procedures are fairly quick injections, and the profit margin tends to be pretty high, whereas dermal fillers and devices take more time with the patient,” Lee said. “It’s important to note that once you add aesthetics to your practice, you should also consider adding skin care as well. It really should be a comprehensive offering. Learning about skin care and skin health is important and can be very profitable.”
Watson agreed.
“Dermal fillers are probably the most profitable, but really any aesthetic procedure will have a great return on investment,” she said. “Dermal filler is lucrative because the profit margin is around 60%. Botox pricing also varies by location and density of local injectors. There is rarely a deficit in the amount of patients who are interested in neuromodulators.”
Ophthalmologists can make a lot of money and quickly pay off equipment with these procedures, Feulner said.
“In my med spa, we offer noninvasive body fat contouring with CoolSculpting (Allergan Aesthetics), where we freeze the fat, and more invasive procedures like subdermal fat and tissue coagulation,” she said. “Some of this equipment can cost more than $100,000 and take time to gain a return on investment depending on how busy you are.”
Offering aesthetic procedures in ophthalmic practices is not all ease and profit, Watson said.
“If trying to get into the aesthetic industry just to make money, it can be a pain in the butt,” she said. “I like it because I like the artistic component of the procedure. I like the individualized approach, and I like restoring or establishing proportions of the facial structure. This patient base can be hard to please but will continue to return for treatments and refer their friends if you do a good job. However, trying to add these procedures to your practice strictly for a profit takes time. I don’t want to dilute my basic surgical offerings, but aesthetic procedures can be very additive to a practice. I perform a lot of advanced refractive cataract surgeries and other advanced surgeries for both young and older patients. I have a nice blend of the age range, and it’s something I enjoy doing.”
Transitioning to aesthetic procedures is also a great option for older ophthalmologists who may be tired of performing surgeries and are looking for other options to stay in practice, according to Watson.
“Older-aged ophthalmologists could have an extremely profitable cosmetic practice if they wanted to,” Watson said. “Aesthetic procedures could extend one’s career without having to perform surgeries, which is great.”
Time, space and staff
Certain factors need to be considered when adopting these procedures into practice, including time, office space and staffing.
“If an ophthalmologist’s schedule is at maximum capacity, looking to hire additional staff can help support their growing aesthetic business,” Ristvedt said.
Feulner agreed.
“Looking into hiring additional staff is truly important,” she said. “If you’re a busy comprehensive or refractive surgeon, you don’t really have time to perform some of these aesthetic procedures, and so you need to be able to have other people in the office do them. Aesthetic patients want to be seen when they want to be seen, so ophthalmologists must be all in and plan accordingly. Most of our patients want to come in after work or on their lunch hour or basically what’s convenient for them.”
Next is figuring out where the procedures will be performed in the office.
“Do you have an existing space that can be utilized, or do you have to move things around to create space, or are you planning to create an entire separate area within your practice that may require construction? Figure out what your space needs might be,” Feulner said. “These procedures can be performed anywhere in the office, but it does take a good business plan if you’re going to really grow this from just Botox and skin care into a full aesthetic division for any practice.”
At Hawaiian Eye 2023, Benjamin Burt, MD, said it is key to have a designated space and time to spend with patients when building an aesthetics practice.
“To do it well, you really need a special space,” Burt said. “It can be in the same clinic, but you need somewhere where people feel relaxed.”
Sound and lighting need to be considered when building an area for cosmetic procedures, and physicians should look to spas and high-end salons for ideas.
Creativity is also needed when finding ways to attract patients. Friends, as well as friends of friends, are useful when beginning a practice.
“A reputation is like a good virus. You spread your reputation through people you operate on,” Burt said.
A growing field
As financial constraints continue to add pressure on ophthalmic practices across the country, additional cash flow options, including the offering of aesthetic procedures, are projected to continue to grow.
“It is a natural progression to consider offering aesthetics options in ophthalmic practices,” Feulner said. “It’s an increasing area of interest. I get consulted fairly frequently by my colleagues on how to get started.”
Ristvedt said the aesthetic procedure field will only continue to grow in the ophthalmic space.
“There is a mindset shift toward preventive cosmetic care and maintenance, and it will be a way for our practices to branch out and create a new revenue stream, as we are well equipped to learn with our training,” Ristvedt said. “As a comprehensive ophthalmologist, I love new technology and being able to offer procedures that enhance the quality of life of my patients, whether it is glasses independence, fewer drops, less healing time or less risky surgeries. I enjoy offering oculoplastics to our patients and have found true joy in the art of it. With this passion, I branched out into laser skin rejuvenation, which has created a platform that enhances what I love to do and makes patients feel confident. There is a strong desire to feel and look more refreshed, to eliminate fine lines, wrinkles and sun damage, and to avoid a surgical face lift.”
Ophthalmologists are frustrated by poor reimbursement and the increase in documentation required by insurance companies and federal regulations, Feulner said.
“Ophthalmologists are looking for something that’s fulfilling and is financially rewarding. Aesthetic procedures offer all of the above,” she said.
- References:
- Burt B. Building an aesthetic practice in 4 minutes. Presented at: Hawaiian Eye 2023; Jan. 14-20, 2023; Koloa, Hawaii.
- Medical aesthetics market is expected to reach around USD 45.91 billion by 2030, grow at a CAGR of 12.2% during forecast period 2023 to 2030. www.globenewswire.com/news-release/2023/02/09/2605415/0/en/Medical-Aesthetics-Market-Is-Expected-To-Reach-around-USD-45-91-Billion-by-2030-Grow-at-a-CAGR-Of-12-2-during-Forecast-Period-2023-To-2030-Data-By-Contrive-Datum-Insights-Pvt-Ltd.html. Published Feb. 9, 2023. Accessed March 3, 2023.
- For more information:
- Lisa K. Feulner, MD, PhD, of Advanced Eye Care & Aesthetics in Bel Air, Maryland, can be reached at lisa.feulner@vipeyes.com.
- Wendy W. Lee, MD, MS, of Bascom Palmer Eye Institute at University of Miami Miller School of Medicine, can be reached at wlee@med.miami.edu.
- Deborah G. Ristvedt, DO, of Vance Thompson Vision in Alexandria, Minnesota, can be reached at deborah.ristvedt@vancethompsonvision.com.
- Caroline Watson, MD, of Alabama Vision Center in Huntsville, Alabama, can be reached at carolinewatsonmd@gmail.com.
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