The Cosmetic Surgery Boom Changes the Face of Doctors' Offices

I just want a checkup!
Bad cosmetic surgery aside, where does this trend leave the woman who just wants to see a dedicated MD? “Part of the fundamental trust between a patient and doctor is the idea that the doctor has the patient’s best interest at heart, and that there is no financial incentive for the doctor to perform any procedure,” Hinsch says. “When doctors start adding cosmetic procedures, which they’re adding because they’re big moneymakers, there’s a corruption of that basic trust.” Many physicians sidestep this ethical quagmire by never directly hawking their fat-blasting, wrinkle-smoothing, and hair-removal services. But even a stack of brochures in the waiting room, Hinsch insists, sends the message to patients that looking younger is a matter of good health.

Even if you aren’t swayed by the literature, that stack of pamphlets may make you wonder: Am I still a priority around here? If your internist gets $20 co-pays from you and $500 cash from the patient he treats with Restylane, whose call will he return first? Who will he spend the most time with during appointments?

Some docs avoid becoming “jacks of all trades, masters of none” by slashing their patient loads or opting out of their original fields, which causes another problem. It’s a brain drain that could have major reverberations throughout women’s health care, Hinsch says. “There’s already a huge crisis in the shortage of obstetricians.” (Many OB-GYNs stopped delivering babies in the past 10 years, unable to keep up with sky-high medical-malpractice-insurance premiums.) Now, as the rejuvenation business surges, obstetricians may soon become more of an endangered species.

James Fairfield, MD, a derm in Lansdale, Pennsylvania, teaches newbies how to use lasers and fillers—and he counts gynecologists among his best customers. “The cost of malpractice-insurance premiums causes them to look elsewhere for money,” Fairfield says. “They drop the OB portion of their practices, buy a laser, and start doing Botox and fillers.”

(Health contacted the American College of Obstetrics and Gynecology (ACOG), but the organization declined to comment for this story. In their only statement on OB-GYNs doing cosmetic procedures, the group takes no position: “Because they are not considered gynecological procedures, it is inappropriate for the college to establish guidelines.”)

Should you trust your doc?
So, let’s say your doctor is hopping on the beautification bandwagon. Should you find a new doc? It comes down to a gut feeling. Do you sense that she’s focused on you—or that her head is somewhere else, say, on her burgeoning medispa down the hall? Here’s a big red flag: Your MD tells you she could do something about those bags under your eyes, turning your medical appointment into a beauty consultation. That may be a signal to change doctors.

If you are considering a cosmetic tweak your doc offers, remember, “It’s buyer beware,” says Northwestern’s Julius Few, MD, a leader of the Physicians Coalition for Injectable Safety. “If you go outside the classic specialty group, there is no guarantee that you’ll get someone who has any experience,” he says.

Yes, there are GPs who’ve done hundreds of cosmetic procedures and do high-quality work, Fairfield says, “just as there are plastic surgeons and derms who don’t take enough care and produce bad results.” But unless you find that rare primary care provider who is truly a subspecialist in aesthetics, you’re taking a risk.

That’s a gamble that Cortland—the woman who received Lipodissolve from a highly regarded OB-GYN—will never take again. “I wouldn’t go to my dentist for a gynecological exam,” she says now. “From now on, whatever a doctor specializes in is the only thing I’ll see her for.”