Lisette Hilton

Big spenders are not always big winners in hair practices. That’s because hair practices can be lucrative or draining, according to Dr. Linkov.

“You have to know your market, where you’re located and how much you can charge. Similar to Botox, with hair you can charge per area or per unit,” he says. “You have to decide what kind of machinery you want to use. Certain devices are very expensive.”

Some physicians think that if they buy expensive equipment and hire technicians, they don’t need to know all there is to know about hair.

“They find patients and get technicians to do the entire surgery. The patient doesn’t really know any better,” Dr. Linkov says.

In addition, allowing a technician to do such things as hair follicle extraction can land physicians in hot water.

“There has been a crackdown in the U.S. on who should be performing the actual follicular unit extraction (FUE) procedure because technically it’s surgery,” Dr. Linkov says.

Proper training on hair loss and treatment allows physicians to better determine if adding it to their practice fits their skillsets and interests. Dr. Linkov suggests providers have hands-on training with experts in the field, attend meeting sessions on hair, read relevant books, and keep up with the science.

“Then you can start to offer basic consultations and find some technicians. You can learn a lot from technicians who have been doing this for many years, too,” Dr. Linkov says. “The bottom line is, you don’t need to spend a lot of money to start a hair practice. You have to be smart about it and know what you’re doing.”

People often don’t know that hair loss is best treated early, and it’s the dermatologist’s job to educate them, according to Dr. Roberts.

“Explain to your patients why they don’t want to wait,” she says. “It is early intervention that is going to stop the hair loss and regrow hair.”

People often don’t think to mention their hair concerns during physician consultations. Aesthetic physicians and their extenders should ask every patient about their hair.

“People are not going to bring it up. But when you ask them how their hair is doing and if they’re having any problems or hair loss, most will say their hair is getting a little thinner. Boom! That’s your hair patient,” Dr. Roberts says.

Other tips for getting hair patients in the door, according to Dr. Roberts, include:

Sending letters to other providers informing them about your hair practice

Posting about hair treatments and successes on Instagram, your website, and other social media platforms

Promoting patient testimonials with people speaking about their experiences.

Even if they don’t want to be on social media, many patients will agree to doing a video testimonial that providers can share with patients who come to the office.

Importantly, setting realistic patient expectations is important, according to Dr. Linkov.

“Hair takes time to grow. People need to be patient. We judge a transplant result at about a year after surgery,” he says.

Finally, build a strong team. Most providers will find it necessary to have technicians on their team because hair transplantation can be a lengthy process. Providers should find good technicians and be hands-on throughout the process, according to Dr. Linkov.

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Hair practices can be lucrative, but smarts and know-how are essential for sustainability.

Strategies for A Successful Hair Practice

Hair is a big part of daily practice for dermatologist Wendy E. Roberts, MD.

“I have two or three hair cases a day and have had a hair practice for over 20 years,” Dr. Roberts says. “If you’re committed to hair, there is nothing but benefit. But you really do have to dig in at the outset and think through what you want to do.”

New York City facial plastic surgeon Gary Linkov, MD, offers facial plastic surgery and surgical and nonsurgical hair restoration. He says blending the two specialties make for an exciting and lucrative practice.

“Hair restoration is not unidimensional. There’s a lot to it, and it’s rewarding,” he says. “But to start a practice, you need to first learn how to do hair. Just like anything else, hands-on training is best with leaders in the field.”

Dr. Roberts, who practices in Rancho Mirage, Calif., says hair loss is a generational concern. Practices catering to 20-something patients don’t have the demographics for a hair practice. Practices on the other end of the demographic spectrum primarily with patients in their 70s and 80s aren’t the best hair practice candidates, either.

“But if you are in a demographic with Boomers, Gen Xers and Millennials, you have the makings of a great hair practice,” Dr. Roberts says. “Gen Xers are very interested in hair. Millennials are extremely interested in hair because they’re at that stage—especially the guys—when they are just starting to lose it and don’t like it.”

The local market also dictates what a provider who offers hair restoration services can charge, according to Dr. Linkov.

Hair loss is interesting because it’s a hybrid disorder, requiring a medical foundation in how to diagnose hair loss and skill sets in procedural treatments, according to Dr. Roberts.

For example, androgenetic alopecia is the most common cause of hair loss, according to the American Academy of Dermatology. The hereditary thinning or baldness affects an estimated 80 million Americans, including 30 million women with female pattern baldness. Treatment may include both medical and procedural treatments, such as FDA-approved topical minoxidil and platelet-rich plasma (PRP) or exosome scalp injections. Other causes of hair loss that are not androgenetic range from harsh hair care practices to diseases, such as thyroid disease or lupus, according to Dr. Roberts.

“The 55-year-old woman who has half the head of hair that she used to does not have an aesthetic condition. You have to do a very thorough medical exam because she may be on medicines that are contributing to her hair loss. Hormone therapy can be contributing. Emerging medical problems like iron deficiency anemia or connective tissue disorders might be the cause,” Dr. Robert says. “You do have to have a good knowledge base of medicine and medical dermatology.”

Dr. Roberts recently posted on Instagram about actress Alyssa Milano’s well-publicized hair loss due to COVID-19 infection. The diagnosis: Milano has telogen effluvium, meaning her hair cycle is out of sync. This can happen with the body is under extreme stress. It may occur in a variety of clinical situations. The aim is to treat the effluvium, but the provider would first have to diagnose the cause, Dr. Roberts says.

Providers should know how to do a good medical hair examination, including performing and analyzing hair pulls and imaging instrumentation, such as dermoscopy, she says.

Dr. Linkov, who offers hair services that range from medical management to surgical hair transplantation, says finding out why a patient is losing his or her hair is key. In addition to the examination, Dr. Linkov might do bloodwork or take a biopsy.

Once he has a diagnosis, Dr. Linkov will often start with nonsurgical or less invasive options, including vitamins and medications, steroid shots, or platelet-rich plasma (PRP) treatments for certain types of hair loss.

“With PRP, we do a blood draw and spin down the blood in a centrifuge to get the platelets from the blood. We put the platelets, which have growth factors, into the scalp. The growth factors help the hair grow. It’s not a permanent cure, it’s a medical therapy so you have to repeat it,” he says.

Providers can inject PRP or use a new device JetPeel, which according to Dr. Linkov is a needle-less technology for delivering PRP to the scalp.

Other options include scalp micropigmentation, a medical tattooing strategy, which can be used to camouflage areas of hair loss before or even after a transplant, according to Dr. Linkov.

“On the surgical side, I do hairline lowering surgery, which is not a transplant. It’s actually surgery to bring down the hairline,” he says. “Then, there are hair transplants. I do not just do scalp to scalp, but body hair, which involves taking hair from somewhere on the body and putting it on the scalp. In other cases, it’s actually transplanting to the eyebrows, the beard.”

The sign of a healthy hair practice is people return and patients refer, Dr. Roberts says.

Providers who are not committed to learning everything about hair, need not open a hair practice because patients will not come back and they will not refer, she cautions.

It’s important for providers to know that hair practices are cash services for the most part. Dermatologists can bill insurance for things like an office visit for alopecia but cannot bill insurance for PRP injections to treat hair loss, according to Dr. Roberts.

 Strategies for A Successful Hair Practice

Hair loss is a hybrid disorder, requiring a medical foundation in how to diagnose hair loss and skill sets in procedural treatments.

Starting a Hair Practice

About 60% to 70% of women and 50% to 60% of men report having sensitive skin, according to research published in 2019 in 

While differences in how people perceive skin sensitivity exist, most say they have sensory effects, such as itching, burning, stinging, tightness and dryness, according to the paper.

Dermatologists guide their patients on which products best address skin sensitivity symptoms, without making the problem worse or creating another problem. In some cases, the very products dermatologists recommend, like retinol for anti-aging, cause skin sensitivity issues.

“The biggest issue we have in treating patients who are sensitive is intolerance to the products themselves. The goal has been to come out with an anti-aging, skin strengthening product line that is tolerable, even to patients who can’t tolerate other products,” said Dermatologist Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital.

The problem of sensitive skin has risen dramatically in the last decade, highlighting the need for affordable, effective and scientifically-formulated and tested products designed especially for people with sensitive skin, said Hemali Gunt, Ph.D., head of clinical and scientific affairs at Burt’s Bees,

 a leader in evidence-based natural skin care. As a result of the need, Burt’s Bees developed its Sensitive Skin care line, including a daily moisturizer, facial cleanser, cleansing towelettes, night cream and eye cream.

The over-the-counter all-natural line of products earned the National Eczema Association Seal of Acceptance. Burt’s Bee’s Sensitive products have been shown clinically to improve overall skin appearance, while gently moisturizing and cleansing without causing redness or irritation.

Key ingredients that do good without harm

It’s not one ingredient, but rather a synergist effect of several ingredients of natural origin that address skin dryness, itching and more, according to Dr. Gunt.

For example, the Burt’s Bees Sensitive Skin Care line features:

Aloe, which has been shown in studies to help reduce visible redness and soothe skin while hydrating skin and restoring barrier function;

Honey, a natural moisturizer with phenolic acids and flavonoid antioxidants that helps defend against free radical damage and supports healthy skin;

Sunflower oil, which is rich in linoleic acid, an essential fatty acid in skin; and

Rice extract, known to help reduce damage from environmental stress.

Dermatologists want to see more than marketing claims before recommending skin care products to their patients, according to Dr. Zeichner.

“As with any products, I look for companies that provide data to show that the ingredients are effective,” he said.

In research presented in 2019 at the 24th World Congress of Dermatology, Dr. Gunt and colleagues presented data showing Burt’s Bees’ Sensitive Skin Care products reinforced the skin’s epidermal barrier and improved skin hydration in Asian women with sensitive skin in a highly polluted environment.

“Our most recent work involved testing our sensitive skin care products in subjects who were exposed to high environmental pollution, which damages the skin’s moisture barrier. We enrolled subjects with heightened sensorial symptoms of stinging, burning, itching. When those subjects used our sensitive skin care products, we were able to show that response to skin sensitivity was decreased. Our products are not just occluding the skin barrier to eliminate a response to sensory stimuli, but instead using the activities of these ingredients of natural origin over a period improve skin sensitivity,” Dr. Gunt said.

“We are continuing to study the products’ effects on skin sensitivity across many different populations to understand if the product line works and continues to work in a wide variety of conditions.”

The first published study on Burt’s Bees Sensitive products showed superiority in improving overall skin appearance when compared with a dermatologist recommended synthetic regimen in subjects with eczema, rosacea and cosmetic intolerance.

In another study published in 2019 in the 

dermatologist Zoe Draelos, M.D., and colleagues performed a study evaluating the safety and tolerability of Burt’s Bees Sensitive products when used as a daily skin care routine as an adjunct in patients who were treating their rosacea with metronidazole, a prescription antibiotic. Researchers compared the Burt’s Bees’ Sensitive Skin regimen to a synthetic dermatologist-recommended regimen. They reported that subjects in the Burt’s Bees’ group experienced greater improvements in investigator global assessment of rosacea measures, including erythema, telangiectasia and papules/pustules than the women using the synthetic skin care regimen.

In comparison to the synthetic brand, which is primarily composed of occlusive ingredients, Burt’s Bees Sensitive products contains natural extracts, which are known to be helpful in reducing the appearance of redness and fighting free radicals.

“The products were extremely well tolerated with no irritation. So, this is promising data and it reinforces our recommendations of these products in patients who cannot tolerate other types of anti-aging ingredients,” according to Dr. Zeichner.

Farage MA. The Prevalence of Sensitive Skin. Front Med (Lausanne). 2019;6:98.

Experience the proven power of nature. Burt’s Bees website .https://www.burtsbeesdermatology.com. Accessed August 2020.

Draelos ZD, Levy SB, Lutrario C, Gunt H. Evaluation of the performance of a nature-based sensitive skin regimen in subjects with clinically diagnosed sensitive skin. 2018;17(8):908.

Draelos ZD, Gunt H, Levy SB. Natural skin care products as adjunctive to prescription therapy in moderate to severe rosacea. 2019;18(2):141 .

The problem of sensitive skin has risen dramatically in the last decade, highlighting the need for affordable, effective and scientifically-formulated and tested products designed especially for people with sensitive skin.

The science behind skin care for sensitive skin

Patients still need and want abdominoplasty as part of the mommy makeover. That procedure has also evolved, thanks to technology that offers new options. Products, including BodyTite (InMode) and Renuvion (J-Plasma; Apyx Medical) are helping to make the traditional tummy tuck less invasive for some patients, according to Dr. Kluska.

 is dual-plane heat energy and radiofrequency device, which causes constriction and contraction of deep subcutaneous connective tissue. It externally heats the skin and causes skin contraction.

 is helium-based plasma energy combined with radiofrequency in a multiplanar approach that causes connective tissue shrinkage and deep dermal tissue contraction, according to Dr. Kluska, who says he’s been using Renuvion almost exclusively for skin contraction for mini-abdominoplasties. After liposuctioning the entire abdomen, he heats the upper abdomen with Renuvion, then trims excess skin below the belly button.

“This allows for a quicker recovery time and overall skin contraction of the upper abdomen without going in and invading the upper abdomen. It’s more instant gratification,” he says.

But this version of the mini abdominoplasty isn’t for every patient. While patients who have had bariatric surgery aren’t good candidates, a 26-year-old mom of two kids with stretchmarks and skin laxity below the belly button, with only a little or no skin laxity in the upper abdomen, might make a good candidate, he says.

Dr. Gallus also has added subdermal skin tightening to her practice and says it can be used in some cases to avoid the need for an abdominoplasty.

“Using some modality—laser, radiofrequency or plasma energy—to tighten the skin in areas that are liposuctioned can sometimes [help patients] avoid tummy tuck surgery. For people who are willing to deal with a little bit of extra fat and some skin laxity and aren’t committed to a tummy tuck operation, this provides an alternative,” says Dr. Gallus who uses Renuvion to augment SAFELipo liposuction.

Another trend is adding labiaplasty to the surgical line up, she says.

“… patients are already under anesthesia. I just recently did liposuction and fat transfer to the breast (she didn’t want implants) and labiaplasty for a young mom.”

The most common breast surgery done in conjunction with mommy makeovers had been augmentation mastopexy, according to Dr. Gallus. But she said that’s changing.

“I’ve seen a trend in my practice for implant removal and mastopexy, where women had an augmentation before they had kids and now that they’ve had kids their breasts have changed in shape and size. Although they want to do something to improve the look of their breasts, they don’t want implants put back in. They want the implants out and either a lift or a lift and fat transfer,” Dr. Gallus says.

Part of the motivation for breast implant removal could be due to breast implant illness concerns. Other patients say the large breasts they wanted years ago don’t fit their lifestyles anymore, according to Dr. Gallus.

“Implant removal and getting an aesthetic result is challenging. I think you have to consider a few factors. One of the most important factors is the implant-to-breast tissue ratio. A large implant with minimal breast tissue is the most challenging, where the breast tissue has been over-expanded. The easier patients have small implants and a large amount of breast tissue. They won’t miss the volume and maybe they need a small lift,” Dr. Gallus says.

And those mommy makeover patients who want breast lifts can benefit from today’s skin tightening devices, according to Dr. Kluska.

The breast lift in the mommy makeover generally requires surgeons make an incision, causing a scar, that helps to get the nipple-areola complex back up onto the breast’s equator, according to Dr. Kluska.

“With new technologies, such as the BodyTite and Renuvion, we are able to offer a scar-less breast lift,” he says.

Again, not every mommy makeover patient is a candidate. The best candidates are patients with a slightly low-riding nipple-areola complex.

“We now can lift, I would say, up to 1.5 cm maximum with just heating the deep subcutaneous tissues,” Dr. Kluska says.

Dr. Kluska often adds either a gummy bear implant or fat transfer to the breast to create lifted breasts in mommy makeover patients.

From tummy tucks to breast augmentations, Dr. Michael Kluska says newer technologies provide options for traditional mommy makeover procedures.

Author | Lisette Hilton

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