Aesthetic Dermatology Update

Don’t discount your face


I admit it ... I am a victim too. The hype was real. Offer a service, at a hefty discount, and increase your patient volume. I didn’t need to increase my patient load. But with more overhead, getting the new providers in my practice busy fast was alluring. There are, however, so many inherent risks to discounting. So I offer you this column as my own version of a consumer alert on discount coupon sites.

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Cosmetic procedures are being done by everyone and anyone nowadays. Injectables, lasers, resurfacing, you name it; they can be done by nurses, physician assistants, non–board certified doctors of all specialties, and even dentists. And online discount sites offer a platform for marketing.

After falling victim to this fad myself, I realize that it was the worst business decision I have ever made – from the perspectives of the risks to the patient and the risks to the business.

The risks to the patient are transparent. The most obvious risk is the abundance of inexperienced injectors doing procedures. Self explanatory. Discount sites obtain medical license information prior to approving any medical treatment; however, not everyone with a medical license should be doing cosmetic procedures.

The second risk is a lack of proper evaluation and management, which leads to poor medical management and dissatisfaction. We should be approaching each cosmetic patient with treatments and procedures that are right for them, their skin, their medical history, their anatomy, and their specific needs. There is no screening through these sites. Patients buy the service, and even if the procedure is not right for them, they expect the service. Even if there is a statement on a site that services are contingent on screening, the promise of the service has already been made. If you do not provide the service, often the now-disgruntled patient will complain about you, your staff, your ethics, to anyone and everyone. If you do the procedure despite your best intentions, you are setting yourself up for disaster ... complications, unsatisfied patients, and unmet expectations. There is a reason consultations are necessary.

Third, the margins on this type of service are negligible. If a practice if offering injectable treatments at a too-good-to-be-true price, it probably is. Neurotoxins might be diluted, fillers could be mixed, products may be purchased from substandard overseas manufacturers, and subpar treatments and bad results can happen.

Dr. Lily Talakoub, in private practice in McLean, Va.

Dr. Lily Talakoub

The risks to the practice, while not as transparent, are often delayed and everlasting.

First, there are the legal implications of fee-splitting in some states, such as New York and California. The laws are set up to avoid conflicts of interest and kickbacks among health care organizations. An organization cannot be paid for referring a patient to a medical practice. Second, a customer who is willing to buy a discounted cosmetic procedure offers a reason enough not to do that treatment. Many online bargain shoppers are dissatisfied customers or patients that you do not want do a cosmetic procedure on in the first place. Finally, the cost of acquiring new patients through marketing is daunting for small businesses and what these discounters offer are “free” marketing tools. Through geolocation and search engine optimization, they increase brand visibility and deliver a steady influx of customers. However, very few of the massive surge of these initial clients become return customers and, given the hefty discount and processing fees involved, the business model may not prove to be worthwhile.

Dr. Naissan O. Wesley, a dermatologist who practices in Beverly Hills, Calif.

Dr. Naissan O. Wesley

This approach fosters disloyalty. If a customer can’t buy more than one deal, he or she will more than likely go elsewhere. If you are delivering substandard care, you are posing a risk to your own reputation, and those unsatisfied customers may be more likely to post negative reviews, dismantling the integrity of your practice. A study described in a 2011 article in MIT Technology Review looked at how businesses that did discount deals fared on Yelp. The study showed that, although the number of reviews increased significantly after the deal, the average rating scores from reviewers on Yelp were about 10% lower than others’ reviews. For a small business, this can be debilitating and could lead to the demise of the brand.

Everyone loves a deal, myself included. However, for your practice, there are health and ethical issues with these discount businesses. Good treatments aren’t cheap, and cheap treatments aren’t good.

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at [email protected] They had no relevant disclosures.


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