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Dermatologists deal with cosmetic competition

Best defense against unqualified injectors’ discounts involves patient education


National report — With “discount” injectable treatments here to stay, experts say, dermatologists must court sophisticated consumers willing to pay for the quality and expertise that only dermatologists and other core aesthetic specialists offer.

The problem of heavily discounted injectables dates back to unit pricing of neuromodulators and laser package deals, says Vic Narurkar, M.D. In the latter area, he says, “If someone only needs two treatments to get the desired results, selling them a package of five or six is unethical.” Dr. Narurkar is founder and director of the Bay Area Laser Institute, chairman of dermatology at California Pacific Medical Center, San Francisco, and a co-founder of Cosmetic Bootcamp.

John E. Gross, M.D., president of the Physicians Coalition for Injectable Safety (PCIS), adds that low-priced imported or otherwise illicit neuromodulators have been available to U.S. physicians for more than a decade.

“When the economy slid in 2007 to 2008, that encouraged many healthcare providers — including non-core specialists — to look for ways to augment their income,” Dr. Gross says.

The Affordable Care Act further spurred healthcare providers of all stripes to pursue cash-based aesthetic business — and perhaps cut corners, says Dr. Gross, who is also a plastic surgeon based in Pasadena, Calif.

As a result, says Jeanine Downie, M.D., non-core providers ranging from family doctors and OB/GYN's to “medispas that barely have a medical director over them are purchasing fillers and neuromodulators online and marketing them as the real thing. This cheapens our whole marketplace. People come in saying, ‘Dr. So-and-So is selling Botox (onabotulinumtoxinA, Allergan) for $5 a unit’ and expecting you to meet or beat the price.” She is a dermatologist in private practice in Montclair, N.J.

Economically, Dr. Downie says, “I call it a race to the bottom. Non-core competitors try to manipulate all the cosmetic dermatologists into decreasing our prices. And we cannot and should not. We need to maintain that we are board-certified and trained in all aspects of cosmetic and general dermatology; that we are the skincare experts. As a specialty, we should hold ourselves up as the skincare specialists that we are, and therefore should charge a premium for our services.”

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