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Minimally Invasive Facial Rejuvenation: Maximizing Practice Revenue with Dermal Fillers Susan R

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Minimally Invasive Facial Rejuvenation: Maximizing Practice Revenue with Dermal Fillers Susan R Study Minimally Invasive Facial Rejuvenation: Maximizing Practice Revenue With Dermal Fillers Susan R. Baskin, MD The use of dermal fillers, especially semipermanent collagen stimulators, for minimally invasive facial rejuvenation has grown exponentially. In addition, combination approaches to cosmetic treatment are emerging. This study evaluated practice revenue from patients treated with poly-L-lactic acid (PLLA) (Sculptra Aesthetic, Medicis, a division of Valeant Pharmaceuticals) or calcium hydroxylapatite (CaHA) (Radiesse, Merz Aesthetics, Inc). The additional revenue generated from conversion to other services and proceduresCOS also was analyzed. The results ofDERM this study indicate that treatment with PLLA generates higher revenue per patient and a broader scope of additional services and procedures being requested, resulting in 70% more total revenue per patient. Based on these data, profitability is likely to be greater with PLLA because the majority of conversion services can be administered by nursing staff and require minimal consultation time, unlike with CaHA. Because of differences in treatment practices, the addi- tionalDo revenue and profitability Not with PLLA observed in this Copystudy could be an underestimate for some cosmetic practices. kin aging is a complex multifactorial process. modalities such as dermal fillers, botulinum toxin Many patients require more than 1 type of aes- type A (BTX-A), and lasers to replace surgical procedures thetic treatment to address multiple etiologies as first-line cosmetic rejuvenation techniques. In the last and maximize treatment outcomes.1-3 Advances 30 years, dermal fillers have become more predominant in aesthetic medicine have allowed noninvasive in dermatology and cosmetic surgery4 with an exponen- S tial growth in their use in minimally invasive facial reju- venation procedures.5,6 In 2010, physicians in the United States performed more than 1.3 million procedures with From Baskin Aesthetic Medicine, Portland, Maine. injectable hyaluronic acid alone, with only BTX-A injec- Dr. Baskin is a physician trainer for Medicis, a division of tions being more frequently used for nonsurgical cos- Valeant Pharmaceuticals. metic rejuvenation.7 The global market for dermal fillers Correspondence: Susan R. Baskin, MD, Baskin Aesthetic Medicine, is estimated to be just under $850 million per year.8 As 195 Fore River Pkwy, Ste 150, Portland, ME 04102 a result, the practice of noninvasive cosmetic procedures ([email protected]). has become an important business model for physicians; www.cosderm.com FEBRUARY 2013 • A Supplement to Cutis® 29 Copyright Cosmetic Dermatology 2013. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. MaxiMizing Practice revenue With DerMal Fillers however, there are few data on how to maximize practice Inc). This extended period was chosen to include patients revenues accordingly. who would have come back for a second round of CaHA Patients continue to seek products that provide longer- treatment, providing a more accurate representation of lasting effects and minimize the need for repeat treat- comparable revenues for equivalent long-term patient ments.8 Convenience drives the use of more durable care. Any additional revenue from these additional (ie, semipermanent, permanent) soft-tissue fillers and courses of CaHA was included in the analysis, with some implants; however, because of continued facial aging patients having received more than 3 syringes of CaHA. following cosmetic procedures and the potential for Overall, the number of patients treated with PLLA and long-term complications, semipermanent effects may be CaHA represented approximately 75% of the patients preferable to allow for periodic augmentation of the face treated with fillers during this time frame; thus these find- to address ongoing morphologic changes.9 As a result, ings were important in evaluating the overall profitability the use of semipermanent fillers—more specifically the of the cosmetic practice. biologically active collagen stimulators poly-L-lactic To assess the potential to convert to other cosmetic ser- acid (PLLA) and calcium hydroxylapatite (CaHA)—has vices and procedures (eg, Thermage [Solta Medical], Laser grown in popularity. The main differences between these Genesis series [Cutera, Inc], intense pulsed light, Pearl longer-acting collagen stimulators are the onset and dura- laser [Cutera, Inc], yttrium-scandium-gallium-garnet frac- tion of their effects. Patients seeking immediate effects (last- tional laser resurfacing [Pearl Fractional, Cutera, Inc], laser ing approximately 12 months10) may be better suited for hair removal), 34 patients who received either 3 syringes treatment with CaHA, whereas patients interested in attain- of CaHA in 1 session (17 patients) or a PLLA treatment ing gradual, natural-looking results that could last for 2 to course of 3 injections (17 patients) from October 2010 to 4 years11,12 may be more satisfied with PLLA injections.13 October 2011 were randomly selected for a more detailed Combination approaches to cosmetic treatment also are study. Revenue was calculated from additional proce- emerging. Soft-tissue fillers may be more effective when dures that patients in the 2 groups received. Although used as part of a comprehensive strategy to address the onabotulinumtoxinA (Botox Cosmetic, Allergan, Inc) was underlying morphologic causes that produce signs of included in the overall revenue calculations, it was sepa- COS14 DERM facial aging. When combined with other treatments rated from the other procedures in this analysis because it (eg, BTX-A, radiofrequency tightening, resurfacing tech- required physician intervention, while the other adjunc- niques), longer-lasting correction for contour and volume tive procedures were administered by nursing staff. deficits may be possible compared to monotherapy. For example, the ability of PLLA to volumize and sculpt the RESULTS face make it an ideal complement to other types of facial A total of 276 patients were treated with CaHA and rejuvenationDo treatments, as it offersNot reliable and predict- 115 wereCopy treated with PLLA. The total revenue generated able results that are generally well tolerated. Poly-L-lactic and average revenue per patient are shown in Table 1. The acid can be used to treat the lower face and midface, while total practice revenue generated from all 391 patients was BTX-A can be applied to the signs of aging in the upper $601,764. On average, the revenue per patient with PLLA face, such as frown lines and fine lines around the eyes. In compared with CaHA was 52% higher ($694.68). some patients, laser resurfacing could be used to remove Conversion to other services and procedures and the the superficial layers of the dermis with subsequent PLLA additional practice revenue generated among the smaller treatment to sculpt and provide volume. Radiofrequency cosmetically matched sample of 34 patients are shown in treatment also could be used to tighten the tissues in the Table 2. All of the patients from the CaHA group who neck and face to complement the effects of PLLA.15 converted to other procedures chose onabotulinumtoxinA This study evaluated 2 important aspects over 2 years (n10; 59%). In the PLLA group, a similar number of that are related to the use of collagen stimulators PLLA patients converted to other procedures (n11; 65%), and CaHA for facial rejuvenation: practice profitability but only half of them (6/11) chose onabotulinumtoxinA, and conversion rates for other services and procedures. while the others opted for more lucrative and profitable services and procedures. The average revenue per patient METHODS among those undergoing other procedures was 70% The study followed 391 patients over 23 months higher ($1650) with PLLA compared with CaHA. (January 7, 2010, to December 7, 2011) to analyze and compare practice revenues generated from treatment with COMMENT PLLA (Sculptra Aesthetic, Medicis, a division of Valeant Data from this analysis indicate that a substantial increase Pharmaceuticals) or CaHA (Radiesse, Merz Aesthetics, in practice revenue is possible from offering PLLA 30 A Supplement to Cutis® • FEBRUARY 2013 www.cosderm.com Copyright Cosmetic Dermatology 2013. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. MaxiMizing Practice revenue With DerMal Fillers table 1 Total Revenue and Average Revenue Per Patient From CaHA and PLLA Treatments (January 2010–December 2011) No. of Patients Average Revenue Filler Treated Total Revenue Per Patient CaHAa 276 $368,383 $1334.72 PLLAb 115 $233,381 $2029.40 Abbreviations: CaHA, calcium hydroxylapatite; PLLA, poly-L-lactic acid. aRadiesse (Merz Aesthetics, Inc). bSculptra Aesthetic (Medicis, a division of Valeant Pharmaceuticals). table 2 Revenue Per Patient From Additional Services/Proceduresa Total No. of Patients Average Revenue Per No. of Patients Treated Converting to Patient Including COS b DERM With OnabotulinumtoxinA, Additional Services/ Additional Services/ Filler n (%) Procedures, n (%) Procedures CaHAc 10 (59) 10 (59)d $2350 PLLAe 6 (35) 11( 65) $4000 Abbreviations: CaHA, calcium hydroxylapatite; PLLA, poly-L-lactic acid. aMatched sample of 17 patients per group. bBotox Cosmetic (Allergan, Inc). c Do Not Copy Radiesse (Merz Aesthetics, Inc). dAll 10 patients treated with CaHA only chose onabotulinumtoxinA as an additional service/procedure. eSculptra
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