There are a couple of very troubling “styles” of medical care which have crept into our society over the past few years. One has become known as “Concierge Medicine”: the doctor who is employed to supply dangerous drugs or perform ill-advised procedures for a celebrity or wealthy individual and does so, without full or proper medical input, simply because he is being paid to do it. This can have disastrous consequences and usually does. We have seen a string of doctors on trial (one way or another) following the overdone nose, the overdone breasts, the overdose, and even the death. They are all variations of the same problem – a doctor not being a doctor.
A similar type of phenomenon is playing out today with the more advanced, non-surgical cosmetic office procedures that have become the dominant way to enhance or improve one’s appearance today. The public is being led to believe that these procedures, which use products collectively known as “injectables”, have results which are essentially completely based on the product itself. We call this “Commodity Medicine”. It implies that what you are paying for is a commodity – a product – not a procedure, not a skill, but simply a “something” that you can “purchase” to make you look better. Like a new lipstick color, or a new tie.
Many patients think of Botox® as a commodity – it’s $10.00 a unit here, $9.95 there, $8.50 downtown – just buy “it” wherever it’s the cheapest or the most convenient. Like a pack of gum. Popular wrinkle filler and lip plumper Restylane® is $500 for “a syringe” at the podiatrist’s office, why not get it there? Like a can of Pepsi. We’ve even seen reports of patients actually being sold a vial of Botox® or a box of Restylane® (which usually turns out to be counterfeit product) for them to take home and for them to get injected somewhere else or even on their own! How did this misguided perception – that these are “products” – come to spread through our culture? These are procedures, not merely “products”; the product represents only one ingredient of some fairly sophisticated procedures that depend on the artistry and skill of the injector to create beautiful results and limit risks.
The seeds of this “Commodity Medicine” mindset were initially sewn by the manufacturers themselves who have as their primary goal to simply sell as much of their product as possible. There are restrictions, FDA rules, laws and guidelines which limit how they can go about all this. So one strategy they employ is to attempt to get their product into any office and any practitioner’s hands that they can, regardless of training, expertise, or talent. This a numbers game – the more places that carry their product, the more “everywhere” their product is, the more places you can “buy” it, the more they will likely sell. It’s that simple. Limiting the sale of the latest wrinkle erasing botulinum toxin to only Board Certified Plastic Surgeons might help to ensure great patient care and good results, but you won’t move as many product units as you will by also selling it to all the family practice doctors looking to break into the business of aesthetic medicine. The bottom line is not patients’ results; it is the sale of product. This is the foundation and key first step in creating the “Commodity Medicine”mentality.
Now suppose that somewhat unknowingly you do decide to go “buy” your wrinkle filler from an inexperienced, non-aesthetically trained, and essentially unqualified practitioner. I use the word “practitioner” as a euphemism here because in some offices the treatment will not be provided by a doctor, a fact which they might have “neglected” to tell you when you made your appointment. You get your “product” treatment and, unfortunately, you end up not liking your result. You have a lump or a bump or asymmetry. It “shifted”. It doesn’t look right. It didn’t “work”. Often you will be told something that amounts to “it’s the product”. In other words, it’s not the way it was injected or how it was injected, it’s the “product’s fault”. Again, it isn’t a procedure, it’s a product, a commodity, and you either picked or got a bad product. Pick a different one. It happens. This scenario only further perpetuates the idea that these important procedures are just “products”. To the advantage of the doctor/office you chose, it also tends to let the doctor off the hook as well since it wasn’t him that caused the problem, it was the product. The pseudo-cosmetic surgeon has everything to gain by perpetuating “Commodity Medicine”. It helps drive the patients to his door because he knows that commodity price thinking will drive them there over expertise and credentials. The “Commodity Medicine” model favors him yet again when his bad job is perceived only as a bad product. Some patients do figure it all out sooner or later and realize that it’s not the product, but who injects it and how they do it that count for a whole lot more.
But all this is not just about a little wrinkle improvement here and there. This is really dangerous medicine. The “Commodity Medicine” philosophy promotes the performance of procedures that should be elegant, simple and safe but which can have serious and even devastating consequences when performed by the unqualified. It misleads the public into thinking “anyone” can do it. It trivializes medical care, opens the door for substandard practices, and puts the patient at unnecessary risk. It puts the sale of the product, and the income of “whomever” above the safety and well-being of the patient consumer. No one deserves to be a victim of “Commodity Medicine”. The performance of a procedure, from the most simple to the most complex, should always be provided by an expert. You have everything to gain with an expert in your corner. The opposite is always at work when “Commodity Medicine” is the guide.
So, how much do I charge for a wrinkle filler, anyway? Well, I think of the filler itself as being “free”. My charges are for your procedure – for my training, my qualifications, my skill, my style and my artistry which I strive wholeheartedly to accompany every procedure I do – no matter how “simple” it might appear.
Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art facial cosmetic surgery procedures and non-surgical cosmetic enhancement techniques available today.