Last month, we presented some views on nonsurgical procedures on this page and in the editor’s message. Here are some additional opinions. – Ed.

Leave It to Surgeons

The advent of noninvasive aesthetic techniques has been a boon to the world of aesthetic plastic surgery, and has allowed many patients to take advantage of these techniques with less downtime, fewer recovery and healing problems, and, in many cases, less expense. This “technique revolution” has simplified or avoided some of the technical issues in aesthetic surgery, and therefore has enabled the nonsurgeon to become involved.

We currently see dermatologists, family practitioners, and general-medicine physicians adding aesthetic procedures to their practices. This trend answers the prayers of physicians who face ever-decreasing reimbursement from insurance companies and increases time-of-service payment—and, therefore, cash flow—to the practice.

As a board-certified plastic surgeon, with additional fellowship training in hands, burns, and microsurgery, I cannot help but wonder how all of these surgical concepts, techniques, and anticipation and care of complications could possibly be managed by a physician who does not have formal surgical training. Universal standardization would no doubt prevent some nonsurgeons from performing aesthetic procedures, but it could create friction among members of the various specialties involved. However, the most important objective is to keep patients safe.

This issue has been addressed by the American Society ofPlastic Surgeons via a massive educational campaign. An informed public will make intelligent decisions and receive good surgical—or nonsurgical—results. The market will take over from there. PSP

Peter E. Bentivegna, MD, FACS, is a board-certified plastic surgeon in private practice in West Yar­mouth, Mass. He can be reached at [email protected] andhandsurgery.com.

Stick to What You Do Best

I have practiced aesthetic surgery for more than 30 years, and I am surprised to see how many of my colleagues have embraced the new mini-operations and nonsurgical procedures. Of course, the motivation has to be economic—through direct income from these procedures or through an effort to develop a patient base.

There is another side, however. My practice has remained entirely surgical, and I would have it no other way. At age 67, I still take pleasure in every day of work because I do what I love. I still operate 4days per week, and love every minute of it. I gain pleasure not only from performing surgery, but also from dealing with the patients who choose me to perform their surgery.

By sticking to what I know best, my patients understand that I am a surgeon and not an aesthetician or a dermatologist. Furthermore, my day is not crowded from dealing with these nonsurgical procedures, allowing me to spend much more quality time with my patients.

I have no problem referring patients to an aesthetician or dermatologist when this is indicated, and I feel quite confident that they will return to me when they need major surgery. I also have no problem telling patients that it is too early for surgery without offering some mini-procedure that will cost them a good deal of money for a short-term fix. My advice to patients is usually to simply save the money until they are ready to spend it on what they need. Most appreciate the honesty.

Furthermore, as a result of sticking to my true profession, I receive many referrals from aestheticians and spas because they see me not as a competitor but rather an ally.

I also share the same concern over the voguish transition to these so-called new mini-procedures. Those of us with years of experience are aware that many of these procedures are not really new, but have been tried and discarded years ago because of their short-lived effects.

Sure, we do occasional injections of botulinum toxin Type A and fillers, but these procedures are pretty much limited to our established patients who prefer to have me do the injections. We rarely schedule consultations for this type of treatment, because patients understand that my practice is a surgical practice.

I recognize that I have the major advantage of an established practice that allows me to work almost exclusively with repeat patients and direct referrals, but I think that physicians who start out by building their practice on the basis of heavy marketing and adjunct procedures will find that they will have to continue this practice to support their overhead. It’s a difficult dilemma in this day of heavy competition, but I think that the overall result is detrimental to the specialty of aesthetic plastic surgery. PSP

Howard A. Tobin, MD, FACS, is a board-certified plastic surgeon in private practice in Abilene, Tex. He can be reached at [email protected]