Baby boomers and lasers team up for financial win
Emphasis on healthy looks produce new market
(Editor’s note: In this second part of a four-part series on new procedures in same-day surgery, we target the growth in cosmetic procedures. They’re not just for plastic surgeons anymore! In last month’s issue, we told you about the expanding interest in pain management procedures. In the next two issues, we’ll highlight procedures such as laparoscopic Nissen fundoplication and stereotactic breast biopsy.)
Aging baby boomers and laser technology have come together to make plastic surgery financially attractive for ambulatory surgery programs to include in a menu of services.
"A lot of baby boomers are turning 50, and they are not accepting the wrinkles that their parents accepted," says Phil Haeck, MD, a plastic surgeon in Seattle. "These are the people who sat in the sun as teenagers, and they are now seeing wrinkles," he adds.
Haeck points out that baby boomers generally look at cosmetic surgery as a maintenance issue rather than a vanity issue, which is very different from the older generation.
Most women older than baby boomers will wait until they have a significantly wrinkled look, but younger women are seeking cosmetic surgery for earlier signs of wrinkling, says Haeck.
"In fact, I recently had a mother and daughter come to me for surgery. The mother is in her mid-60s and the daughter is in her mid-40s," he says. "The mother’s procedure was more extensive, and there is a dramatic difference in her appearance. The daughter’s procedure was less involved, and although the wrinkles were gone, the change in her appearance is subtle," explains Haeck.
The daughter explained to Haeck that she looked at her mother and saw how her face would look in twenty years if she didn’t do anything.
Technological advances have played a significant role in cosmetic surgery’s growth. Resurfacing lasers have increased physicians’ ability to eliminate wrinkles on all parts of the face, says Haeck.
"Before the resurfacing laser, I could perform a facelift and an eyelid lift to give the patient smooth cheeks, but there would still be lines above the lips," he says. "Now, it is rare to perform a facelift or eyelid lift without using a laser for lip lines."
The hottest growth areas for cosmetic lasers is hair removal, says Carolyn Rogalla, RN, clinical nurse consultant for Candela Corp., a dermatologic and cosmetic laser company based in Wayland, MA. Rogalla is not only seeing physicians add this service within their offices, but she also is seeing surgery centers dedicate procedure rooms to cosmetic procedures including hair removal. The average charge for laser hair removal is $300, says Rogalla.
"A big advantage in some states is that a physician does not have to operate the laser," says Rogalla. "This makes it possible to use physician time efficiently and generate more income from other staff members," she adds.
Another procedure that has become more popular in recent years is an endoscopic forehead lift. Using the same endoscope typically used by orthopedists, with some adaptive equipment, the plastic surgeon can make three small incisions in the forehead rather than one long incision, says Haeck. "This is much better for the patient because the risk of hair loss is decreased and recovery is easier."
The benefit to the surgery program is less operating room time to perform the procedure, about 1½ hours, so more procedures can be scheduled.
Liposuction is also benefiting from new technology, but it might not be right for every surgeon, says Haeck. "I evaluated ultrasonic liposuction but decided not to offer it because it is inappropriate for my typical patient."
Ultrasonic is most beneficial when the physician has to remove fat from fibrous areas such as the back or male breast; or when the patient is significantly overweight and large volumes of fat must be removed, says Haeck.
Research your market
Knowing your market and your competitors is essential before you add to or establish a cosmetic surgery service, says Rogalla. Evaluate your staff to see if new skills are needed, and check state regulations to see what procedures a physician must perform and what other staff members can perform. If you add new lasers, make sure the vendor trains all staff who will use them, Rogalla adds.
Staffing was not a problem when Dreyer Ambulatory Surgery Center (ASC) in Aurora, IL, added plastic surgery to its service mix. Jim Kuyper, RN, administrative director, says, "We perform 7,400 procedures a year in almost all surgical specialties, so our staff is well-trained and flexible."
The one surgical specialty not offered at the ASC until one year ago was plastic surgery. "Our physicians were referring an increasing number of patients to a plastic surgeon who was not a member of the group, so we recruited him to perform his surgery at our center," says Kuyper. "Facial procedures such as facelifts and laser resurfacing are the most commonly performed procedures to date, but we are also investigating liposuction and other procedures," adds Kuyper. (See Same Day Surgery, July 1998, supplement p. 2, for a list of the most popular procedures on a national basis.)
While Kuyper’s center already has most of the equipment the plastic surgeon needs, some lasers such as the CO2 laser used for resurfacing are leased on a single-use basis as needed. Once volume for any particular laser justifies a longer-term lease, it will be evaluated.
"We are pleased with the success of plastic surgery within our center, and we expect demand to continue to grow," says Kuyper.
"Plastic surgery is a natural addition to any ambulatory surgery center because it generally doesn’t require extended stays, your income from the procedure isn’t limited by managed care, and it is a service demanded by baby boomers," he adds.
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