Cosmetic intervention - the next challenge

The opening symposium at this year’s SIR meeting held in Seattle, March 1-6, introduced the novel concept of cosmetic interventional radiology (IR). This emerging field is predicted to add a whole new innovative dimension to the specialty.

During the six-hour symposium, Chaired by Drs Ziv Haskal, Robin Gmyrek, and Rodney Raabe, interventionalists from around the globe listened to 22 presentations on such topics as ’Botox: Evidence and results’, ’My Way: Top five tips for Botox’, ’Cosmetic therapy of residual varicosities after ablation’, ’How do I build a vein practice: Economics, marketing and models’, plus many more.

According to Haskal, interventional radiologists have performed aesthetic treatments for some time, however, recently the demand for these services has increased. The concept of cosmetic IR illustrates a trend inspired by the minimally invasive treatment of varicose veins and other body imperfections that many people consider ugly.

"As The New York Times said ’...the business of beauty is big’. We treat patients with varicose veins because their legs are aching and also because they may be unsightly. And as you treat them, these patients ask for other cosmetic interventions, such as collagen fillers, botox injections, or maybe variations on liposuctions," explained Haskal.

The session attracted the highest pre-registered number of delegates seen at SIR thus far, and although some interventional radiologists believe that cosmetic work is not part of their every day practice, because they already have the skills and knowledge to perform such therapies, this field of IR could expand and therefore be incorporated into their core treatment areas.

"The concept that every interventional radiologist does everything is no longer necessarily true," said Haskal. "People are subspecialising. There are people who do only venous interventions. There are people who do primarily peripheral, who specialise in cancer, who are purely outpatient practices. So you are talking about a group that is becoming specialised in very heterogenous areas as well.

"Ten years ago I never would have thought that I would be doing fibroid embolisation," he continued. "In the same way that we perhaps wouldn’t have imagined doing endovenous ablation and sclerotherapy, we need to keep looking towards the next things that we may go on to."

According to researchers, the market for cosmetic intervention is undoubtedly buoyant, at least in the US. Between 1997 and 2005 there was a 444% increase in all cosmetic procedures. Within this, the rise in non-surgical cosmetic procedures increased by 726%.

Challenges
Some of the challenges of having a successful aesthetic practice relate to physicians working for corporations, such as HMOs and universities. Parker believes that physicians should have their own malpractice. Adding to an existing practice is another challenge as it is difficult to blend a reimbursed modality and fee for service. Physicians partnering with nurses or other business investors must be legally structured to avoid corporate practice of medicine laws, says Parker.

Having a successful aesthetic business requires the following: passion, patience, planning and money, she added. Understanding the industry and understanding the aesthetic client is also important. It is also crucial to understand the patient. Parker explained that the patient should not be suffering from pain or illness and is not sick, the treatment is an option - they are paying and it is their choice, not a necessity.

Parker then discussed how to manage expectations, explaining that the practitioner is most responsible for setting the expectation. Realistic expectations should be set and listening to the patient is crucial, as is educating staff and avoid over promising.

In Parker’s concluding comments, she emphasised that with increased redundancy and commoditisation in the aesthetic industry, the practitioner must deliver impeccable care and customer service.

Top five tips for fillers
Another presentation given in the ’Cosmetic IR’ session was by Dr Julide T Celebi, assistant professor of Dermatology, NY, who focused on top tips concerning fillers. Fillers are materials that are injected into deep lines and wrinkles, sunken cheeks and weak chins; and are also used to reshape lips.

"Choosing the right patient and assessing patient’s expectations is tip number one," explained Celebi. "Initial consultation is important." Once the right patient has been selected, the next step is to choose the appropriate filler to suit the need of the patient. The filler is a vital component to the procedure, as is the actual technique, which is Celebi’s tip number three.

The next tip, is achieving maximum correction. Satisfactory results are obtained if the correction is approximately 80-90%. Finally, using a combination of treatment modalities is Celeb’s final tip. For some patients combination of botox, lasers and fillers may be needed to achieve satisfactory results

Complications with this procedure do occur one of which is infection. Physicians who perform these procedures should be aware of the potential risks and complications.

Concluding remarks
There were many presentations given during the ’Cosmetic IR’ session, including talks by Drs Michael Dake (’Cosmotherapy, IR, Research, and Blue Sky’), Rodney Raabe (’How do I build a vein practice: Economics, marketing and models’), and Robin Gmyrek, who presented numerous discussions. This reinforces the fact that the subspecialty is indeed a growing field, in terms of both clinician delivery and patient need.