After 17 years practicing radiation oncology, Anca Tchelebi, MD, left the field in 2005 and began practicing cosmetic medicine. “Radiation oncology was getting too depressing,” she says. “I was getting involved in many cases and suffered if I was not able to help. It was becoming difficult to detach and just remain a physician.” Today, her work at the Park Avenue Medical Spa in Armonk offers her a different experience: Patients generally leave her office feeling happy and satisfied.
Dr. Tchelebi is not alone. Increasingly, physicians are abandoning their original fields of training and establishing a foothold in the world of beauty. They’re administering aesthetic procedures that, though not medically necessary, require a doctor’s supervision. With more sophisticated and targeted aesthetic treatments available today, the field of cosmetic medicine, a gray area hovering between health and beauty, is a growing one.
With growth and rising demand, it’s not just plastic surgeons, facial surgeons, dermatologists, and ENTs who are in the appearance-changing game. Physicians from other fields are gravitating to the beauty biz.
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Just a decade ago, that might have seemed unlikely. Today, however, demand is surging as more people chase beauty and near-perfection. Minimally invasive treatments like Botox, fillers, and chemical peels are fueling the growth of the plastic surgery industry for the third consecutive year, accounting for some 13 million procedures in 2012, according to The American Society of Plastic Surgeons. In 2012, Americans spent over $4 billion on non-surgical cosmetic procedures.
Many of these treatments are performed in doctors’ offices; others in something known as a “med” or “medi-spa”, which are proliferating around the country. They offer everything from facials and hair removal to pharmaceutical injections and other medical procedures. They can be found in physicians’ offices or other locations like shopping malls, storefronts, and beauty salons, with mandates on the level of licensed medical supervision varying by state, according to the International Medical Spa Association.
There are approximately 4,500 self-described US-based med or medi-spa centers in the International Medical Spa Association’s database, says Allan Share, president of the Association. The overall growth of medi-spas has mirrored the evolution of cosmetic treatments: In 2008, just 800 existed.
Interni​sts Doing Injections?
In the US, all doctors with state medical licenses, regardless of their specialties, may dispense all kinds of treatments. The rules of the game are tough to follow, as they vary from state to state. New York State does not limit the administration of injectables to physicians only, although industry organizations such as the American Society for Dermatologic Surgery maintain that only physicians should administer injectable dermal fillers and neurotoxins.
Dr. Joseph Sozio, a cosmetic surgeon who practices at Skin Center Advanced Medical Aesthetics in Hartsdale, says that, in his practice, only MDs administer Botox and fillers. In fact, the rules vary so widely that in New Jersey, Dr. Sozio says that only a physician can perform laser hair removal, while, in New York, a wide array of practitioners including electrologists, cosmetologists, aestheticians, or nurse practitioners may perform the procedure without a medical license.
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After many years of practicing as a physician in general medicine, then managing and consulting at healthcare companies, Dr. Sozio re-assessed his goals and returned to practicing medicine, this time with a focus on beauty. Practitioners like Dr. Tchelebi and Dr. Sozio, whose original training was in another field, are known as “noncore” or “out of scope” physicians. It begs the question: Can a former radiologist, for example, understand the nuance of an arched brow; can an internist’s training enable him to visualize how to best “lift” sagging cheekbones without surgery? And why would a doctor, trained in the most traditional sense, abandon her medical practice for the world of beauty?
Noncore physicians generally consider their traditional medical backgrounds an asset. Dr. Tchelebi has taken some of her former skills and parlayed them into treating a patient from an aesthetic view. “As a radiation oncologist, I knew a lot about skin and deleterious effects of the sun,” she says. “I treated many skin cancers and had ample knowledge of anatomy. I also had to have knowledge of physics, as well as biology, so understanding lasers and any other energies is very easy for me.” Likewise, “there’s an art to cosmetic medicine,” Dr. Sozio says. “When I look at a patient, I see their whole face, not just one line on their face.”
Beauty Industry Backlash
Though it can be argued that delivering a baby via Caesarean section or performing heart surgery is much more risky and complicated than, say, erasing wrinkles, some “core” physicians resent the intrusion.
Julia Sabetta, MD, a practicing dermatologist in Greenwich and Westport, Connecticut, who did a fellowship in cosmetic, laser, and Mohs surgery (a specialized procedure to treat skin cancers), is not enthusiastic about the concept.
“These doctors may fulfill the letter of the law, but not the spirit of the law,” she states. “Would you want me delivering your baby?” she asks. Dermatologists, she says, are trained to do these procedures. Their extensive instruction precisely informs them of the intricate structure of the face, the draping of the skin. And their patients benefit by having someone who can spot other medical problems that another doctor might not pick up on, like a skin cancer or a bleeding disorder, a “value-added” service, says Dr. Sabetta.
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“It’s important to have adequate training and take more than just a one-day course, for instance, on Botox and fillers,” says Sharon DeChiara, MD, a board-certified plastic surgeon who designed and built Spa Chiara in Mount Kisco, an 1,800-square-foot facility housed in the Saw Mill Club East. She’s not in favor of the concept of things like “Botox parties that a lot of pediatricians do at people’s homes.”
Others take a different stance. Facial plastic and cosmetic surgeons and dermatologists are most appropriately suited for the field, but Dr. Sozio feels what is most important is a physician who is trained appropriately and has good medical insight. “The advances in medicine change very quickly,” he says. “Once you get out of training, you have the basis of understanding to be a good practitioner.” Education continues long after medical school, he says; doctors are constantly learning new techniques and new advances as medicine continues to evolve.
Adam Messenger, MD, who practices internal medicine in Greenwich, Connecticut, and is also the medical director of Eurolaser Services in Rye, agrees. As long as a medical professional goes the extra mile to learn the practical techniques—Dr. Messenger himself shadowed and worked alongside a number of experienced plastic surgeons to learn how to properly inject Botox and fillers—he or she can practice cosmetic medicine. “It’s important to have proficiency, volume, and experience, as well as to have the patient’s best interest in mind,” he says.
What Doctors Prefer
Besides personal satisfaction, declining insurance reimbursements are another driving force behind the exodus to cosmetic medicine. No muss, no fuss: Since cosmetic procedures are generally not covered by insurance, there is virtually no paperwork, and doctors can enjoy same-day payment, rather than waiting weeks, or more likely, months, for their money. Frankly, crossover physicians can make more money, too. “I recently performed a skin biopsy and billed the insurance company for $200. Guess what I got reimbursed for? Eleven dollars. Reimbursements are so low,” Dr. DeChiara says with a sigh. That’s a big reason that non-core physicians are trying to do more cosmetic procedures, she says.
The culture of medicine is another added incentive. The world of managed care brings more patients but less time for valuable patient-doctor interaction. “It’s an assembly-line model,” says Dr. Messenger. “Medicine is set up as a very time-consuming venture, with little reimbursement for many procedures.
Doctors are leaving the field completely, or are leaving their area of specialty. We’re losing good doctors—and it drives me crazy.” Dr. Messenger continues to straddle both worlds. After peaking at 90 hours some weeks as an internist, his work got him down—literally. “My body started to break down; I found myself with an autoimmune disease, where my body literally got tricked into attacking itself,” he says. It was that tragic turn of events that enabled him to reconcile his passion for medicine, a left-brained activity, with that of his artistic side, a right-brained one. After realizing that he needed better balance in his life, he channeled his frustration and passion for medicine into something new. While housebound for almost a year because of his illness, he dove into the study of dermatology and plastic surgery; once strong enough to leave his house, he gained practical, hands-on experience working one-on-one with skilled plastic surgeons and dermatologists, learning their injection techniques. He eventually created his own technique, and was asked by the manufacturers of the products to train other injectors.
Would Dr. Sabetta, who has a foot in both worlds, give up her medical practice to exclusively administer aesthetic treatments? “I love them both,” she says. “When I remove a skin cancer, I feel like a real doctor; but it’s also fun making someone pretty.” Dr. Messenger acknowledges that had he chosen dermatology or plastic surgery exclusively, he would not have received the foundation in medicine that he wanted. “Ultimately, both made me a very well-rounded physician,” he says. “Many times I end up assisting my cosmetic patients medically anyway.”
Ultimately, practicing cosmetic medicine gives many noncore physicians an opportunity to have a significant impact on a patient’s life by improving his or her appearance, which isn’t trivial. The mild sting of a needle or the pulsed energy of a light can change their outlook, restore their confidence, and maybe even help them find a new job or mate. “People come to see us not because they’re sick, but because they want to feel better about themselves,” says Dr. Sozio. And, in the end, you never know what other kinds of positive, healthy changes a little extra vanity can have on a person.
Sheryl Kraft is a health and fitness writer based in Fairfield Country, Connecticut. Her work has been published in AARP, Prevention, Woman’s Day, Weight Watchers and other print and online publications.
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