Core physicians must look ahead, participate, compete

New York - To stay ahead of non-core competitors dermatologists, plastic surgeons and other core aesthetic physicians must scan the horizon for future game-changers, one expert says.

Foad Nahai, M.D., tells core specialist that to thrive in the future, "We must be disruptive or be disrupted. We must be forward-thinking - lead and innovate. We shouldn't sit back and be reactive." He is professor of plastic surgery at Emory University, Atlanta.

Injectable treatments have been, by far, the most dramatic and disruptive rejuvenative technique of the past two decades, he says. However, "When injectables first came out, many plastic surgeons felt these treatments weren't going anywhere. They believed a plastic surgeon's time was more productively spent in the operating room, and that the demand for surgical cases would always be there."

Ultimately, though, Dr. Nahai says, injectables proved to be safe, and quite effective in properly chosen patients. This caused plastic surgeons as a specialty to realize that "not everyone who walks into your office needs surgery. We were disrupted because we didn't realize that the injectables would become as important in facial rejuvenation as they have become." Therefore, Dr. Nahai says, "Let's predict what's coming down the pike, so we can be a part of it."

Participate in product development

This will require participating in product development and clinical trials, he says. These activities will help core specialists stay abreast of what's under development, Dr. Nahai says, while also helping to ensure that the technologies are safe and efficacious.

In other words, "Are the manufacturers going to put their devices and drugs through trials published in peer-reviewed journals, where the science can be evaluated? Or are they just going to get products approved, put their direct-to-consumer ads out and sell them without ever providing any evidence regarding their efficacy?"

The Food and Drug Administration (FDA) approval process seems to be stricter for drugs than devices, he says. "The FDA looks at the safety of devices more than their efficacy. As long as a device is safe it may be approved. But with many of these skin-tightening devices, for example, not every patient has the same type of results."

As for the next aesthetic game-changer, he says, "Who knows? Radiofrequency technologies and ultrasound-based treatments such as Ultherapy (Ulthera Inc.) eventually will be safe and perfected. That's another area we need to keep an eye on. Some people believe that these skin-tightening modalities are mature, but I believe they still have a long way to go."

One day, Dr. Nahai adds, injectables may replace facelifts altogether. In fact, he says that for younger patients who don't want to undergo surgery, "They already have. If people start early enough with injectables, and if we ever get to the stage where we have skin and subcutaneous tightening devices that work consistently, then I believe facelifts will be in danger. I doubt if that will happen during my career, but for younger people in training, injectables and noninvasive devices may totally replace surgery."

Need to compete

Regarding plastic surgery, he says, the growth and competition in aesthetic procedures has brought the specialty "back to the surface." Decades ago, Dr. Nahai says, some observers thought plastic surgeons handled only superficial problems that were not life- or limb-threatening. "People thought what we did was superfluous."

However, he says, this viewpoint ignores the pioneering work that plastic surgeons have done in areas such as face and neck reconstruction after traumas, not to mention face and hand transplants.

But now, he says, the need to compete with noncore physicians - not to mention dentists and nurses - who offer aesthetic treatments has brought plastic surgery back to a focus on the skin's surface. However, Dr. Nahai says, that's hardly a negative development.

Because noncore injectors do not have the background and training that core specialists do, he explains, core specialists must continue providing these treatments not only to remain economically viable, but also to ensure that patients can get the best possible outcomes and care.

Of greater concern, he says, is the fact that, "The public thinks what we do is a commodity. It's not. It's a highly skilled, very personal service. No two surgeons, dermatologists or injectors have the same aesthetic sense, judgment and experience. Aesthetic medicine is different for each provider," Dr. Nahai says. Core specialists also must take the lead in conveying this message to the public, he says.

Disclosures: Dr. Nahai reports no relevant financial interests.