Ob-gyns discover Botox

Doctors branch out into cosmetic medicine
Sofia Kosmetatos / The Detroit News

When Lynn Montemayor wanted sunspots on her nose removed this year, she turned to her obstetrician-gynecologist.

Ditto for microdermabrasion to rejuvenate her skin, and for Restylane injections to fill out smile lines.

It didn’t matter to Montemayor that her doctor wasn’t a skin specialist. “I trusted him to deliver my children, so I felt, who better to trust my face with?” she said.

Once the domain only of plastic surgeons and dermatologists, cosmetic medicine is a field increasingly practiced by doctors from other specialties offering Botox injections and laser hair removal along with Pap smears and flu shots. Some, in particular ob-gyns, are opening their own medical spas.

Doctors say cosmetic medicine offers them additional revenue as they are increasingly squeezed by declining insurance reimbursements and the rising costs of doing business. Ob-gyns, in particular, pay among the highest malpractice premiums of all doctors, because of the risks involved in their field.

For some doctors, the extra income from the cosmetic procedures, which typically aren’t covered by insurance, means they can see fewer patients and spend more time with them. But doctors also say their new ventures are driven by patients asking for more information about cosmetic treatments and for referrals to doctors who perform them.

“(Patients) feel very comfortable opening that dialogue with us,” said Dr. Michael Genord, a Royal Oak ob-gyn.

In addition to patient inquiries, doctors are inundated with advertisements and offers from equipment manufacturers to buy or lease lasers and other machines, he said. Genord contemplated offering laser hair removal in his office, but ultimately decided against it because he didn’t want to worry about marketing the service to patients in order to pay off costly equipment.

“I wanted to respect the sanctity of the visit,” he said.

It’s hard to track how many doctors offer cosmetic medical procedures in their offices and how many own or work for medical spas. Michigan requires doctors get a state license, but does not track what kind of medicine doctors practice.

The International Medical Spa Association estimates there are 2,000 to 2,500 medical spas in the United States, mostly in California, Arizona and Florida, followed by major metropolitan areas like New York City. Next to plastic surgeons, many spas are owned or medically supervised by ob-gyns, who are a “natural fit” because they service women, said Hannelore Leavy, the association’s founder and executive director.
Proper training required

Dr. Hamid Banooni, a Farmington Hills ob-gyn, opened Rejuvenation, A Medical Laser Spa, in 2005, just steps down the hall from his six-partner medical practice. His interest in cosmetic medicine developed several years ago while examining patients frustrated by the results of procedures like laser hair removal. In some cases, patients even had burns from botched jobs.

“There are a lot of people that aren’t properly trained” performing cosmetic medical procedures, he said.

That is a chief concern among dermatologists and cosmetic surgeons. Most doctors who buy laser hair removal equipment, for example, only get a few hours of training from the manufacturer, said Dr. Joel Schlessinger, past president of the American Society of Cosmetic Dermatology & Aesthetic Surgery.

But doctors who offer cosmetic medicine say they train thoroughly to give injections and use machines — and refer patients to skin specialists for issues beyond their expertise.

Banooni, for example, spent about 15 months studying procedures (including under the supervision of doctors) and researching equipment before opening his spa in October 2005. Ob-gyns are no stranger to lasers, which are used to treat vaginal and cervical diseases, among other conditions, he said.

“Everyone should and hopefully does operate within their area of expertise,” he said, adding that he has referred patients to dermatologists for care when needed.
Patients should be informed

Banooni’s client base has doubled this year from last to about 600 people, mostly women, and he is finally turning a profit on his investment of hundreds of thousands of dollars, he said. Banooni does have literature in his medical office about the spa, (which is how Montemayor learned about it), and sometimes he’ll talk about the spa with patients during exams. But mostly, the spa’s client base has grown through word of mouth. “Patients are our best source of referral.”

The most popular procedures include laser hair removal and removal of age spots, as well as injections of fillers and Botox to smooth out wrinkles. Banooni administers all injections, but other procedures are conducted by his staff under his supervision.

People seeking more information about medical spas should turn to friends and family first because referrals are the best source of information. But Leavy said that shouldn’t be the only way. Patients should ask about staff and doctor training, how often doctors and staff perform procedures, whether the doctor is on site, about complications, and more.

“The consumer needs to be very, very diligent and needs to ask as many questions as possible,” Leavy said.
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