Eliza Cabana

AA: What did we learn in 2020 that will follow us into 2021?

Dr. Chilukuri: I think our safety protocols, especially into 2021, are going to continue [to be] similar to what we have today. We are still sterilizing the rooms. We're still asking our patients to text and let us know that they're outside so we can invite them in. There's still no waiting in anybody's waiting room or reception area. And in our aesthetic practice, it's always been like that. It's truly a greeting and meeting area, and then we invite the patient back.

In the past, every single one of our rooms has been sterilized in between patients anyhow. We're just spending a little bit more time and energy doing that. Some practices are using a UV light that's going to be emitted, and then sits there for five minutes to theoretically break down any bacterial and viral particles. Unfortunately, we haven't seen whether this actually makes a continued difference or not.

From the most recent guidelines from the CDC, what we're finding is that there are viral droplets in the air. The question becomes, how long are they lasting inside the air? What we've done for several years now is we've used a product called lasercyn and it contains hypochlorous acid. [All these hypochlorous acid product products are] not the same across the board. This particular one was tested in Australia and has been proven to actually kill or stop the progress of COVID-19. …upon contact, within less than 90 seconds, we're seeing that there's kill of the bacteria, the viruses, fungus, as well as yeast. So it's something that we spray on the patient, as well as what we do for our equipment immediately afterwards. We're now using that same product to spray down our tables.

Dr. Chilukuri: We’ve been talking about telehealth now for at least eight or nine years. We've had decent technology for it. We have better technology every single year… better Apple phones… better Android phones, our camera systems are better, so we're more accurate in what we're seeing. From a cosmetic perspective, it's nice to get an idea if we’re talking about [issues like] pigmentation and what can be done. But in terms of what we're doing for in-office procedures for anti-aging, it's still always better to have a physical exam.

I think that we're able to screen patients better. In our case, we're still using some virtual consults, but [seeing] a decrease in the number of patients that we're seeing virtually just by the sheer fact that we have a full clinic. But if you don't have a full clinic, or you're offering virtual consults afterhours, or on those days that you're not quite as busy, it is a neat opportunity to get a patient on a skincare regimen, so when that person comes in, their skin is going to be fully prepped and you're able to offer them that procedure.

The other thing that I think virtual consults have allowed us to do is to get rid of those no-shows. You can kind of gauge whether [prospective patients are] truly engaged in the procedure that you're offering or talking about. And you also get an insight into the patient him or herself. You see their surroundings. Are they in bed and their hair's a mess? Are they still wearing proper clothing? Or do they look, at least, less disheveled? And is it going to be a fit for your practice? So I think it's been an interesting way to weed out those patients, and really see whether it's a good fit for your practice.

AA: When will we see a return to live professional meetings?

Dr. Chilukuri: I don't know if we'll ever have those meetings like the AAD for a long time where you have more than 10,000 people congregating into one convention hall. I don't know when that's going to be allowed again and when people are going to feel safe doing that. But my second concern is really, what are we doing in terms of revenue loss? Many of us had to close for one, two, three, and even four months. And when you have… minimal revenue coming in, are we willing to take those Wednesday, Thursday, and Fridays away from our office to go to a meeting where, again, it's not just that you're not making money that day, but you're actually truly losing money depending on your overhead costs, and what else you're supporting in that space.

I can tell you right now, there's several technology-based companies that are offering both virtual as well as in-person gatherings. They're smaller gatherings. They're 25 to 50 people per room. They're very, very properly, socially distanced. People are wearing masks. They're very cautious about the whole thing. But what we're seeing in the industry is people are still buying their technology. They're still spending $200,000 to $300,000, on their lasers and energy-based devices.

AA: What are we going to see in terms of trends next year?

Dr. Chilukuri: I think that's the that's the crystal ball that we all want to know what's happening. In the U.S. there was definitely a pent-up demand for injectables. I think there's a lot of concern in the medspa industry about whether patients are going to be able to “afford” their Botox or fillers. To me Botox is still what we call the lipstick effect—[what] it was called in during the Great Depression. Even if they couldn't necessarily put tons of food on their table, [women] would still spend money on lipstick. And the reason was, when you put lipstick on, you just felt better.

Articles

What will the aesthetic medicine look like in 2021? Dr. Suneel Chilukuri offers his perspective on how the pandemic will influence the practice in the New Year. 

The Aesthetic Practice in 2021

Part 1: Finding Synergy With Service Providers

So what does Synergy offer the aesthetic practice? Schoenbart says they provide practice owners with practice management and growth guidance that fall into three categories: products, education, and marketing.

“What Brendan and I do, and what we're really instilling in our reps as well, is to speak with customers about those three categories and talk about practice management, asking questions such as, how are you going through your inventory management? How are you ensuring you're maximizing your profitability within your business? And try to gauge feedback from there,” says Schoenbart.

From a practice management standpoint, Synergy offers a hands-on support for getting financials in order and supporting a smart service offering strategy.

“We’ve looked at their financials and we've looked at the various competing products that they have, skincare, injectables, devices, and [we provide] an audit or summary to them, that have, for some practices, increased the profitability tremendously, and it’s not always in favor of our products. We want to do what's best for that specific customer,” says Schoenbart.

Specific to education, Synergy has support from Merz for on- and off-label training, as needed.

“From an education perspective through our partnership with Merz, we have Merz Aesthetics consultants through their medical affairs team. We’ll actually send a trainer into a practice… to really educate our customers and that’s at zero cost to the customer,” says Schoenbart.

In terms of marketing, Synergy has partnered with four different organizations in the aesthetic space: FriendMedia, HumazeMD, PatientPop, and Go Together Media.

According to Schoenbart, “Each of those four companies has various value propositions to our customer base…. Friend Media has TV displays and tablets for educational support for patients to really educate patients for additional procedures... HumazeMD is before-and-after technology. PatientPop helps with designing and developing websites [and] finding patients, and Go Together Media for social media support.”

To further foster relationships with their aesthetic practice clients, Synergy has a loyalty program that not only rewards practices with partner service costs, it also helps to monitor practice success.

“When we find a gap, rather than asking [our clients] to spend more money and try to go to another company, we work with them in their initiation fees or their starting fees with those various different partner companies,” says Schoenbart.

Schoenbart says they then works with their clients to monitor these new initiatives to ensure they’re a good fit. If not, they say, they’ll come up with something else.

“We want to really focus on being that kind of one-stop-shop for a Midwestern healthcare provider in the aesthetic space and really focus in on strategies and execution with a Midwestern-based team focused on Midwestern customer. I think that will really differentiate us and over time really help us with fostering relationships,” says Schoenbart.

Third-party provider Synergy Aesthetics offers practice support for products, education and marketing.

Practice Management and Growth Guidance

One of the biggest challenges a private practice owner faces is filling his or her role as both a physician and a business owner. Many product companies and service providers offer support, but one company is reinventing the way third-party providers work with the aesthetic practice.

Synergy Aesthetics co-founders, Joshua Schoenbart and Brendan Sheil, say their product sales model is less about selling products and more about filling the role of chief operating officer (COO). But Synergy’s not for everyone. They provide their services to a select region they say they know well—11 states across the Midwest: Arkansas, Iowa, Kansas, Minnesota, Missouri, Montana, Nebraska, North Dakota, Oklahoma, South Dakota, and Wisconsin.

“We really try to be very comprehensive… on the solutions front, and we’re continuing to refine that and build greater models focusing on marketing perspective, to allow these customers in the Midwest to know that Synergy isn’t just a product company," says Schoenbart. "We are not a distributor. We are not just that third-party 1099. We really are ingrained not only with our manufacturers, but we provide incremental value to our customer base as well.”

Driven by the desire to understand the aesthetic practice and fill an unmet need, Schoenbart and Sheil took to the roads themselves.

“We started traveling a significant amount in our first year, co-traveling with our reps and asking a lot of questions,” says Schoenbart.

Notably, their reps are full-time employees.

Looking at three specific areas of focus—practice management, education, and marketing—“We really identified some sizable gaps in the market,” he says.

Across all 11 states and market segments, Schoenbart says they heard similar responses to questions about inventory, education, and marketing:

‘Oh, I'll have to look at my books. I don't think we track that.’

‘We always have to take a week out of our schedule to go to Chicago or somewhere and we're paying thousands of dollars to sit in an auditorium, and it's not really working well for us.’

‘We're so inundated with our patients, I can't really think about social media, or my front desk staff is helping with that, but it's not very consistent.’

These insights ultimately helped to take their product sales model to one that more closely fits the role of COO, filling the need for aesthetic physicians without the time, acumen, or confidence in leaving critical practice growth management responsibilities to someone else in the practice.

Another thing they learned from their research is that in the Midwest, “They all want to be the best you can be, just like if you're living in LA in New York or Miami,” says Sheil. “But how they go about their choices and decisions and what they value is slightly different.”

Merz Aesthetics (Greensboro, N.C.), partnered with Synergy to take over the entire midwestern area.

Acknowledging Merz’s small U.S. share of market, Synergy believed it wasn’t a product issue but a consumer- and customer-facing one.

Also part of their portfolio are CAREstream, America’s Pro-Nox Device, and Neauvia North America’s Zaffiro, and NPURE devices.

In terms of what they’ve achieved for Merz in the Midwest, results have outpaced those nationally and Merz has extended their initial contract with Synergy into a multi-tier, multi-year agreement.

“... it's proving that manufacturers can work together through a third party,” says Sheil. “That's a lot of Neauvia’s products are going to help us get Merz products in the door. A lot of CAREstream products are going to help get Neauvia’s products in the door. And it's that we control that message through the front door to that consumer and to that health care provider and we figure out all the leverage points which benefits every manufacturer.”

NEXT: Practice Management and Growth Guidance

Synergy Aesthetics is redefining the product sales model by filling the role of COO for the midwestern aesthetic practice.

Finding 'Synergy' With Service Providers

Jeffrey Joseph, MD, FACS, says he takes a scarless lower blepharoplasty approach whenever possible, which he shared in his presentation, “Lower Lid Blepharoplasty: Which Procedures for Which Patients?” at the annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery (

, Dr. Joseph details the transconjunctival lower lid and orbicularis sling techniques, including approach, downtime, and patient selection.

Videos

Dr. Jeffrey Joseph explains his approach to lower blepharoplasty, with a preference for the transconjunctival and orbicularis sling techniques. 

Scarless Approaches to Lower Lid Blepharoplasty

Part 1: Introducing Regenerative Medicine to the Aesthetic Practice

PRP is the easiest place to begin incorporating regenerative medicine into the aesthetic practice, according to Dr. Chesnut.

“There's a lot of variability around [PRP] and that's a super simple place to start because you can get an off-the-shelf kit that makes things very simple, very low touch for staff,” he says.

Initially, the quality of PRP is likely to be variable, but “as you get better at it or get more comfortable with manipulating that PRP, [you will] get higher platelet concentrations for different types of things,” he says. “Then that will evolve into changing that PRP or PRF into matrices or something you might use for a wound-healing case.”

Cosmetic or reconstructive, every physician has a need for help with wound healing, he points out.

Once comfortable with fat transfer, then you can think about increasing stem cell content of the fat.

“There's lots of papers and publications about this, and this is where we get into in vitro versus real life. But we know that we can take these things we already have at our fingertips and… be more purposeful with them in ways to augment our practice.”

As for regulatory compliance, it’s different in the United States versus other countries, he says, admitting that it can be a little scary.

“What are stem cells? How are they regulated? Most of the modalities that plastic surgeons, facial plastic surgeons, and dermatologists are using are totally within bounds,” he says.

That’s because fat-based stem cells are minimally manipulated.

In terms of regulatory compliance around PRP, there is none, he says.

Marketing, on the other hand, is where it can get sticky, though Dr. Chesnut points out that this is less of an FDA issue and more a trade issue. You have to market stem cells based on inherent purpose.

“If you're using fat-based stem cells to restore fat volume in the face, no problem,” he says.

According to Dr. Chesnut, that’s the general spirit of performing simple regenerative medicine-based treatments.

“In reality doing PRP or stem cells with a procedure they are already doing is very low touch, very low extra effort time and energy on your staff’s end,” he says. “And it's really just getting more comfortable with them over time, and building them into your practice as part of who you are and, again, you have to be interested in passionate about these things but the benefit is real.”

Adding PRP and stem cells, along with learning to navigate regulation and marketing guidelines offer benefits to the aesthetic practice. 

PRP, Stem Cells & Regulation

Cameron Chesnut, MD, a facial plastic surgeon in Spokane, Wash., says regenerative medicine is evolving, and many physicians are either interested in or already incorporating it into their practices.

In his presentation, “Optimizing Outcomes and Recovery with Regenerative Medicine,” at this year’s virtual annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), Dr. Chesnut discussed regenerative medicine in terms of areas of promise, scientific hurdles, safety, risk, the FDA, and advertising considerations for platelet-rich plasma (PRP), platelet-rich fibrin (PRF), adipocytes, mesenchymal stem cells, wound healing, fat grafting, and more.

“Technically PRP is regenerative medicine, a lot of people are utilizing that in their practice, so what are the next levels? What does that mean? That's where you get into the PRFs and the stem cells and autologous versus allogeneic stem cells—all these kinds of different options that exist,” says Dr. Chesnut.

Dr. Chesnut says he uses regenerative medicine in his practice every day. It has broad application, from wound healing to hair restoration and post-procedural recovery.

“The more change that there is to have, the more that regenerative medicine can really shine,” says Dr. Chesnut, who emphasizes the benefits of being able to offer patients both better results and less downtime.

“And so one of our objectives is to use regenerative medicine to decouple that very direct relationship a little bit and decrease downtime while still being able to be as aggressive or get those same surgical results. And if we can improve the results that we're getting at the same time that we're decoupling the downtime, even better.”

A lot of the available data available is in vitro, says Dr. Chesnut.

“We know what defines a stem cell based off of surface markers and how that cell behaves.”

Thus, fat and bone marrow are both accessible and excellent sources for aesthetic physicians, he says.

“So there's that type of science. That's just defining what they are and what they do,” says Dr. Chesnut.

But what does it mean when these stem cells are used as a regenerative or rejuvenative modality? What’s going to happen?

“That's where things get a little bit trickier and that's harder to study because a lot of us know that with fat transfer, even years later we see improvements that we wouldn't have expected,” he says, for example, changes to overlying skin.

Such skin changes are the result of a stem cell-released paracrine effect that changes the surrounding tissues over time, but this is still not clearly defined, he says.

“We have ideas as to what's happening, but exact mechanisms are still out there.”

And it’s the same with PRP, a very basic regenerative medicine modality. It may have incredible growth factor capacity, but PRP changes based on nutrition, hydration, medications and more.

“It's difficult on a real-life scenario to say what something like PRP is doing on a consistent level because my PRP is changing, let alone how it's physiologically interacting with my tissue.”

Facial plastic surgeon Dr. Cameron Chesnut shares how he uses regenerative medicine in daily practice and explains how to begin incorporating it into your own. 