Your practice may involve the treatment of fine lines and wrinkles, pigmented spots, and blemishes, which requires an understanding of skin care and skin care products.

Skin care products have become an essential part of the process of rejuvenation and restoration for those practicing aesthetic surgery and for most who offer cosmetic surgical procedures, too.

Providing a spectrum of services to treat the skin—including deep peels, laser-based treatments, pulsed light, and so forth—is also a necessity when indicated, but that is a topic for another day.

Product Selection

Different skin types and skin care goals require different products. When examining a patient’s skin, it is important for you to formulate what may be the best product for treating it.

For example, localized areas of dry or oily skin may call for regional applications of specific products. In addition, ethnic skin and aging skin should be considered.

The benefit of carrying skin care products in your office is that patients can walk out with exactly those products you think will best suit him or her.

Problems can arise when choosing what products to have available in your office. Many people follow specific product lines. Converting them entirely to your recommended line of products is often quite impractical.

For the hesitant patient, I often suggest that they use their own products until they run out and then try your skin care products. Samples of their new suggested regimen will often be given to the patient.

What I have found practical in determining which skin care line(s) to carry in the office is to solicit and use as much advice and suggestions as possible.

A word of caution, though. What is new is not always what is best for the patient and the practice. Patient feedback, especially in cases where a product is touted as being a breakthrough, is very important.

The feedback from users quickly becomes more important than the hype.

Your staff will also provide input. Listen to your nurses, aestheticians, and even secretaries and greeters who have tried the products. All information is needed to factor into product sales.

A satisfied patient, as usual, is your most cost-effective promotion. From this amalgam of individual inputs comes a decision to carry one or more products or the entire product line in your office.

Marketing Savvy

After deciding on the products, it is important to display them appropriately.

Expensive products should be kept in enclosed cases, as the box will be sufficient for the display. The product can be stored in a hard-to-find location in the office or even off-site in order to decrease the possibility of theft.

Internal marketing is the most important, cost-effective marketing method.

Advertisements, even when strategically placed in newspapers, on the radio, or on television, are rarely cost-effective for the average practice. Very large practices, when purchasing volume advertisements, can make this approach work. Web-based advertising, when part of a package from an order-fulfillment company, may be helpful.

It is important that you have a good relationship and understanding with your skin care representative when you carry products in your office.

You should not allow multiple units of expensive product to sit, expiring on your shelf. While the product may be new, a purported breakthrough, or scientifically proven to be wonderful, word gets around quickly when it is too harsh or too expensive for the result. A product can “die on the shelf” even if it does not have an appealing fragrance.

Check the vendor’s policy about returned goods, especially if high-power retailing pressure is involved. Even accepting a credit on your account for an expired or returned product is a positive.

In-office retailing, with all its inherent problems and the need for attention to many details, is a service to your patient. While the markup can be profitable, the administrative headaches may significantly decrease profitability.

The Internet Channel

Web-based retail is a better way to provide skin care products to your patients, as it decreases administrative headaches and the concomitant cost.

Web-based order fulfillment, as a do-it-yourself process, is not advised. Web-based order fulfillment involves a significant number of variables, all of which have to be done correctly and consistently to produce success.

Procurement, current stock tracking, product expiration dates, anticipating current demand, marketing, retailing, restocking, disposal of outdated or unsold products, complaint, resolution, state tax payments, Web site maintenance, photo and narrative, computer hardware and software, Web hosting, etc., are administrative burdens.

Unless you are part of a very large practice that would warrant such an expense, Web-based order fulfillment by your practice is not recommended. Essentially, you would be starting another business within your own business.

The approach I recommend is to profit share with a Web-based order-fulfillment company, which is an e-commerce company that specializes in getting high-quality products reliably to your patients via your Web site.

Your patients will appreciate your newfound ability to get practically any product that is commercially available.

Choosing the right company for your practice becomes the critical decision you must make, as poor-quality products abound on the Web.

Almost any product that you can think of is available from the best order-fulfillment companies, including the recently popular “green” and organic cosmeceuticals.

You can choose from multiple lines, and you are not beholden to carry the stock of one particular manufacturer or vendor. You can recommend the “best of the best,” as you see it. Your patients will appreciate your newfound ability to get practically any product that is commercially available.

Choosing the Right Company

Early on, I was fortunate to have found an order-fulfillment company that was very reliable. Don’t be fooled by that statement, though—your mileage will vary, and you may have to do some legwork to find the best company for you.

There is no Better Business Bureau on the Web to check for reliable skin care product vendors. Therefore, take care to choose a vendor who will supply your patients with fresh products and a money-back guarantee (or credit).

In addition, the vendor should supply software that tracks an individual patient’s use. It is prudent to make sure that your vendor has been in business for more than a few months and that it will build a Web-based retail store that is specific to your practice at a reasonable cost. The “right” vendor should offer readily available aestheticians to answer patients’ questions.

The major players in this niche of millions usually advertise and make themselves known to family physicians, dermatologists, plastic surgeons, and obstetricians. You might see their booths at specialty meetings. This may be one place to start searching for your first or next order-fulfillment vendor.

Also, you can look around for referrals from people who have been Web-based retailing and are happy with their order-fulfillment firm.

You might choose to Google or Yahoo! “e-commerce Web sites for physicians.” This could yield reasonable choices. If you get the right company, you may be able to get a turnkey operation, but this approach can be costly.

Your apparent margin of profit is certainly not the same via the order-fulfillment vendor as it is when you do your own in-office retail business.

For instance, you pay the administrative costs of handling your orders and customer service tasks in the form of a fee levied against your profits from the sale of skin care products. However, the burden of those tasks is no longer yours. The order-fulfillment vendor, of course, passes those costs back to you, at least in part.

Some vendors say that they can help you grow your retail and increase your bottom line by using the Web. This is often called a “pay-per-click” strategy, and some of them are very sophisticated.

I do not have time to invest in working out such strategies, and it is too expensive to hire an expert in e-commerce to do it for me. The approach here is keeping it simple.

Personalized Product Lines

Several cosmeceutical companies have available mixtures of ingredients that can be branded with your chosen appellation for various skin types, conditions, etc. These companies will help design your label, print it, affix it to the packaging of your choice, and mail several thousand dollars’ worth of product to you.

You have to make choices, however. You might further maximize your profit if your choices are good.

Consider which product types are used frequently in your practice so that they will sell. Try to assure yourself that the products you choose from the cosmeceutical manufacturer meet the quality, price, and effectiveness of high-profile companies.

Try to be fair and reflect upon whether you really understand the label’s agents (such as percentages, esterified, nonesterified, acid-base adjustment, buffered, un-buffered, effective product at the selected tissue level, etc).

If you consider expanding your label sales to the Web without the help of an order-fulfillment house, then the complexity of the process is increased.

Are you ready to ship within a day or two? Will you keep a record of individual sales? Do you have the capacity to be cognizant of the taxes for many US states and pay those entities what they are due?

You could ask your order-fulfillment vendor to do that for you; however, there go those large profit margins.

At this time, I prefer to carry a limited amount of in-office products that are made by nationally known companies. I also work with an order-fulfillment company to make products available on my Web site.

The company I chose carries a large stock of items, will answer the phone, take the order, expeditiously get the order to the patient, collect taxes (both local and nationwide), answer complaints, keep fresh products on my shelves, and send me a check each month.

It may not be as large a check as I would get if I had done all of those tasks myself, but the hassle is practically nonexistent 99% of the time. However, in my scenario, the company is a reputable one.

The Latest Trend

If order-fulfillment vendors wish to keep their fate in their own hands and avoid government intervention, they must stop offering and stocking outdated products. If ethical standards are not applied, then customers will go to the manufacturers directly, and direct manufacture Web retail will be on the rise.

Maximizing the bottom line for manufacturers, as for nearly all businesses, is what’s important. Manufacturers are a little late into the game, but they are targeting patients directly and bypassing the middleman. This trend may not only take the order-fulfillment vendor out of the sales equation—it could take you out, too.

They intone that your practice will benefit from them selling directly to your patients, for whom you may have taken the time to counsel about a product—namely, their product.

Only time will tell if manufacturer-based direct order fulfillment will be the next method of distribution. If so, it will cut out the order-fulfillment vendor or your practice, or both.

Donald J. Capuano, MD, is a fellow of the American College of Surgeons and a member of the American Society of Plastic and Reconstructive Surgery. His practice is based in Rochester, NY, and he can be reached at (585) 225-0680.