Dr. Bonnie Marting

Many factors determine the price of cosmetic dermatology procedures. Obviously we all want to keep our costs down when paying for injectable services- but careful consideration must be taken! Let’s be honest- we are talking about your face here. Generally if you pay for a KIA, you’ll get a car that looks, feels and drives like a Kia, not a Mercedes. Cosmetic Procedures aren’t much different. You get what you pay for and this is evident in not only the product itself, but also the provider, the overall office experience, and most importantly- the results you see in the mirror.

Now with that being said, it doesn’t mean that the most expensive prices net you the best service. So what’s a consumer to do? I simply suggest asking. There are Bargains to be found.

Because of increasing competition between vendors like Medicis and Allergan, deals are being offered. Also, due to today’s economy, plastic surgery services have been hard hit. This downturn in operative procedures has made injectible services more important in offsetting a Dr.’s losses in plastic surgery revenue. Some suppliers are partnering with offices to offer consumer incentives. My office does this frequently. Other times, an establishment may offer lower prices to simply undercut the competition. We never do this! If a practitioner wants to know what someone else is charging, and will base their price to you on that figure, RUN. They are desperate and care far more about their bank account than they do about how you are going to look.

So, how do you know what to do to get a fair price? Ask. Ask. Ask. Ask your friends who they have confidence in. Ask your family where they go to for beauty services. Then call those places and ask them if they have any specials going on. Some offices that do higher volume may get rebates from the vendors for selling their products. In many cases these rebates will be passed along to the patient, resulting in better discounts for you. Ask if that’s a possibility whenever you call regarding the procedure you’re wanting.
If you walk into an office loaded with information, you’ll be able to determine if the price you’re being quoted is a fair, and sometimes even Great deal. As long as you know what questions to ask about your procedure before you pull out your pocketbook, you can feel comfortable and safe in knowing you’ve picked the right technician and the right office.

Note- Beware of any receptionist who won’t give you a rate over the phone. If they tell you that you should come in to get a price, look elsewhere. Every reputable office should have published prices somewhere. And if they really have a special to give you, shouldn’t they be able to tell you what it is? They should at least be able to give you the discount percentage over their regular rates in a telephone conversation? Why should you have to waste your gas and time to go to their office just to discover what they charge?

Lastly, if you see prices from an unfamiliar or brand new office posted that simply look too good to be true, it would probably be smarter to stay away. We all read in the papers how medical locations are closed for operating without a license, using untrained staff, or (what’s even scarier) administering the wrong product- simply to save a buck. Don’t be one of those who find out from a news report. Stick with who you trust. This is your face after all. And some deals are just no deal at all!

Dr. Bonnie Marting

I know you realize that advertisers who use a celebrity, do so to gain product fame and notoriety. This tactic has been around for years- ever since marketers realized that the average consumer trusts and respects certain famous people. If you buy a product merely because you believe the spokesperson, then you have proven their point.

Remember how at one time everyone wanted Tiger Woods to endorse their product. It was like, if Tiger uses it, it must be great. But as soon as people read negative things about him in the paper, advertisers started dropping him from their campaigns. They felt his endorsements might actually hurt their sales if people aligned the image of their product up to the image of the Tiger Woods.

So what’s a consumer to believe? I mean seriously, did the leaders at Pepsi really believe that Gatorade drinkers would stop chugging Gatorade’s Tiger Focus drink because he was unfaithful?

I honestly don’t know what they thought privately, but I know he lost endorsements from some huge companies. The point is- advertising needs to be more honest. But- that is unrealistic. Great idea, but not very likely to happen overnight.

Don’t expect total transparency. It will never happen. Advertisers spend too much money to simply put the facts out there and expect you to make an informed decision as to whether to purchase or not. That would be too easy, right? But changes are coming.

A new regulation proposed by the Federal Trade Commission (FTC) will significantly affect the way advertisers and endorsers are allowed to operate. Once this is adopted, you can expect many subtle differences. According to Andrew Lustigman, a New York Attorney who represents direct marketers, media and internet companies, and advertisers as a whole, these changes are to be in effect to give further protection to the consumer from misleading testimonials and endorsements.

What that means in a nutshell is you may start hearing more disclaimers at the end of ads. They’ll be forced to report and describe typical results seen. Right now they’ve been allowed to show the most extreme examples of success and then flash words across a screen saying, “Results may vary” or have an announcer talk so fast that you can’t understand his disclaimer. Now they’ll be required to truly reveal a typical result. And typical will mean you, the average user, can expect to see.

The bottom line is expressed in the words “evidence based”. In other words, don’t just show me a photo of someone who looks better, show me the results from the study. And, the study needs to represent a cross section large enough to be meaningful and be performed by an independant source. That’s important.
Personally I’m all for more honesty in advertising- especially in skin care products – even it means I won’t be seeing as many of my favorite celebrities anymore.

Dr. Bonnie Marting

One thing I’ve noticed lately is how tired, angry or worried today’s working woman appears. Though I realize times are tougher than ever, it’s important to not look worn out, and thats what I see. I suggest investing in a little Botox. A little goes a long way and when done well, and no one can guess you had it done. Your face, especially those furrowed brows and crinkled crow’s feet, will appear relaxed and smooth. Where co-workers once saw a stressed-out, worried woman, they’ll now believe you’re relaxed and totally in control. Something you definitely want to portray before you go ask for that raise!

Another tell-tell sign easily fixed but often ignored are gray roots. We have all seen the “line of demarcation” when the color has grown out, and our real color-(washed out gray)- comes shining through. This is not a look that screams I’m confident and taking care of myself. Instead, it screams of apathy and disinterest in your personal appearance. If you can’t make it to your hairdresser when the roots start coming through, buy a leave-in color rinse, a root-touch up box, or a color stick until you can make an appointment. Remember, vibrant, beautiful women don’t have gray roots.

I also meet many women who are tired of living with old sun damage. I see more than most doctors do because I live in South Florida. Most of my patients are pleasantly surprised to discover there are relatively easy fixes to the uneven tone and multiple brown spots that have popped up on their face. Going to a cosmetic medical provider and getting some IPL (intense pulsed light) and some Retin-A or other retinoid will go a long way in reversing the sun damage and improving your skin tone. The retinoids actually make your skin look younger, not just more even!

Do you find your eyes are drooping more than you’d like? If surgery is not an option for those lids, consider some eye-lid strips from http://www.victoriamcgill.com/ContourStrips.php. These are easy to apply, and work like magic. Restore the youthful eyes of your past within seconds.

Lastly, practice physical exertion on a regular basis. If you want to look younger and feel better start exercising. It’s easy to recognize when someone takes care of their body with training. And I’m not talking muscles here. People who work out tend to move better, have less joint problems, a healthier glowing complexion and overall healthier skin. Usually even their mental state tends to be a little more relaxed, because they’ve found another outlet to relieve stress through running, biking, swimming or whatever keeps them active. If you’d like to get yourself a better toned, fit body- head to the gym or around your neighborhood track. You’ll be surprised at how much younger you can begin to look and feel if you just start working out!

Dr. Bonnie Marting

1. A good reputation. Reputations are like gold in every medical practice. If a provider is well respected, the community, and your friends, will know. If you are willing to share your plan for cosmetic enhancement with friends, ask them for there recommendations and opinions.
2. One that listens. People seek some form of enhancement, or as many of my patients jokingly say “maintenance”, for individual reasons. Sometimes an outside trigger, like an acquaintance telling you that you look “tired”, creates a desire for “SOMETHING! This is why the medical provider should listen to your personal desires in order to lead you in the right direction, rather than just deliver the BOTOX® you thought you needed and send you on your way.

3. One that lets YOU make the decisions. A good provider will recommend, but still let you be in charge. This is a bit of a continuation of point #2. After listening, they should recommend a treatment or a course of treatments that will get you closest to where you want to be. Then, let you decide how far you want to go based on your choices and your budget.

4. One that isn’t a “Hard Sell Advertiser”. If a medical providers office has a good reputation, they don’t have to hard sell themselves. They already have a strong patient referral base. Some advertising is normal, but if you see ad after ad from one office (think personal injury attorneys) it probably means that they’re not good enough to hang on to patients, much less receive referrals from them. This type of provider survives by hard sell advertising. They need to create a fresh supply constantly instead of relying on reputation to fill their waiting room.

5. One that isn’t priced significantly lower (or higher) than others. If someone has prices significantly higher than the local norm, that may mean they are the best and want to make certain they don’t waste their time seeing someone that can’t afford their services. It may also mean they only want the patient they can overcharge and get away with it. Go back to number one and see what their reputation is in the community.
On the other end of the spectrum are office prices that are “too low”. To me this has always suggested a desperation that announces “we will take anyone! Just come!” Discovering Too Late why their price was so low or their schedule was so flexible can be a crude experience. And one you may live to regret for a long time.

6.One who is knowledgeable about products, treatments and options. Some medical providers try to perform a wide range of services, both injectable and laser, by utilizing only a few different products or treatment procedures. In my office, we offer several fillers and I currently use two different muscle relaxers, depending on Patient Needs. And, I am testing new products all the time.
We also have different lasers with several heads each, depending on your skin type and procedure. Lasers are expensive to purchase, or even lease. If an office spent $70,000 to $100,000 on a laser, they want to see it continue to bring in income as long as possible. Unfortunately, their laser may be outdated. For instance, why subject yourself to more pain than you need for hair removal when a new laser is more comfortable and does a better job? Make sure the equipment in your providers office is state of the art. You would be surprised how fast this technology changes. Four years can mean several generations of improvements.

7. One who can prescribe medication. You might say “no kidding!” but there are multitudes of lower level nurses, estheticians, and “assistants” who take courses and learn the “art of cosmetic improvement”. The problem is this: what if something happens to you that requires medical attention? They are not educated to diagnose a condition that may cause you a great deal of harm. Nor are they able to prescribe anything to help. Often times these folks are “working under a doctor’s license” in order to be able to order the product in the first place. The doctor does not know you, nor perhaps do they even specialize in skin problems. You see this scenario in some medical offices with a large existing female patient base. They want to build a new profit center, so they section off a room or two, and hire an extra person. But they have very little (or no) experience in cosmetic dermotology. Their only real experience in this field has been a short course that was provided by a pharmaceutical company.

8. Know their credentials. Please seek your treatment from one of these providers: Nurse Practitioner (NP), Medical Doctor (MD) Doctor of Osteopathy (DO), or Doctor of Nursing Practice, (DNP). I recently (October of 2011) attended a conference in California with attendees from all over the United States. Some of our discussions were about the states allowing lower level medical personnel (or worse) to inject fillers and muscle relaxers as long as they are in the doctors office. In my state, (Florida) Registered Nurses, who are very well trained and knowledgeable, still aren’t even allowed to turn on a laser. But in some states, almost anyone in the office can perform a laser procedure with very little training. Always check who will be doing the actual treatment.

Quick Note: I did not include Physicians Assistants in the list above because I’m not certain how each state regulates P.A.’s. In our state they are highly respected and more than a “medical assistant” or assistant of the doctor. They have followed a course of study that allows them to diagnose conditions and prescribe medication. To my knowledge though, P.A.’s always have to be affiliated with a physician.

9. One who is a good teacher. Your provider should be able to provide good options for your concerns, and able to teach you about products and procedures. They should also be willing to advise you when something you want may not be in your best interest, and why. In addition, he or she should be able to help you learn how to maintain your desired results longer. Finally, they should be able to direct you to other practitioners (a plastic surgeon for example) if that is what’s needed to obtain the best results.

10. One who has your best interest in mind, not their income. This is somewhat related to point #3. Based on what your provider heard you say, he may recommend a course of treatment that could cost thousands of dollars. They may honestly feel these treatments are the best way to get you what you want. If you have some reservations about the costs, they should also be able to offer something a little less costly. They may have to tell you that you will not end up exactly at the point you want, but at least you will have a choice. I have heard multiple stories of innocent folks coming to an office for “a little work” then leaving with a bill that nearly made them lose consciousness. Guess who benefits from this? ALWAYS be clear if you have any questions BEFORE you allow treatment to be performed.

11. One who is surrounded by knowledgeable and likable staff. It’s an old axiom that happy offices have happy patients. A good staff is sometimes difficult to maintain, but if everyone seems happy (or miserable) every time you go in, there’s probably a good reason. Since it’s your goal to develop a relationship with a good medical provider, their staff should demonstrate they want you to be just as happy as they are.

12. You need a provider that doesn’t look over the top (“bizarre”). This may sound strange, but you have no idea how many people in my field have overdone their appearance. This should not even have to be said, but if your provider comes in looking like a weird, unmovable porcelain doll or has lips that enter the room considerably before she (or he!) does, simply excuse yourself and run.

13. They HAVE to be up to date. We talked about this in #6, but please let me elaborate on being up to date, not only in the equipment they use, but their knowledge. They don’t have to be using everything that was on Oprah last week, but should be aware of the trends in the ever-evolving medical cosmetic industry. That means knowing about, and passing on to you, new products that may be on the horizon. It also means advising you of problems we see such as biofilms, our latest challenge. Biofilms are bacterial colonies residing in the skin that have been found to be associated with “permanent type” fillers. This necessary learning is done through meetings, lectures, and constant study. Here is the final test of a great medical provider: Do some reading yourself, then ask the provider what they think of a particular product. If you find they are somewhat disinterested, they are probably not your best bet. If they become animated and truly enjoy discussing things, you have the beginning of a great relationship. If they offer a couple of other options and briefly tell you the differences, they probably love their job and you have a real winner. Hang on to them!