nasbdy news: A Viable Future

By Brent Arends

Grant Stevens, MD, FACS, stops in midsentence to calculate the length of time he has worked in aesthetic medicine. After what he thinks is more than 2 decades in practice as a board-certified plastic surgeon and medical director of Marina Plastic Surgery in the Los Angeles area, Stevens stops calculating and quips, ?Certainly, it?s given me a chance to ponder the past. The first question is where did 25 years go? I still feel like a kid.?

As a member on the board of directors of the American Society of Aesthetic Plastic Surgeons (ASAPS), he functions as the chairman of media relations and is one of the society?s appointed traveling professors. He gets around, too?as a member of the American Society of Plastic Surgeons (ASPS) and a member of the International Society of Aesthetic Plastic Surgery (ISAPS).

In the Los Angeles area, Stevens is an active member at Marina del Rey Hospital, where he is a past chairman of the Department of Surgery. He is on staff at St John?s Medical Center in Santa Monica, Calif, and the Marina Outpatient Surgery Center. He is an associate clinical professor at USC, where he has recently taken on the role of co-director of the Aesthetic Surgery Division.

Stevens has persisted in being a leading voice for aesthetic medicine, not only as a mentor to other surgeons but their teacher. He stands in front of a long list of accomplishments, most notably the cohesive breast implant (aka, gummy bear breast implants), the Mentor CPG and the Sientra highly cohesive breast implants, the Mommy Makeover, the Laser Bra, and simultaneous mastopexy augmentation.

WATCHING EVOLUTION

Stevens holds as a priority the open discussion of what is in store for the future plastic surgeon. He actively promotes the viability and continuation of cosmetic plastic surgery by plastic surgeons.

?Turns out that 72% of board-certified plastic surgeons make the majority of their income from doing cosmetic plastic surgery,? Stevens notes. ?Now, there?s a disconnect here. If 72% of the surgeons are making more than half their income from cosmetic surgery, then why aren?t we teaching cosmetic surgery??

Stevens believes there is a legacy being created by his specialty, and he takes it personally. ?I want plastic surgeons to remain significant in this space,? he says, ?and the only way that we?re going to do it is by teaching the residents, even if they don?t do it for a lifetime. I?m not doing craniofacial surgery, but I had to do craniofacial training. I?m not doing neuro surgery but I did neuro training. And I respect the surgeons in the other divisions.

What about the practitioners against doing cosmetic surgery? ?They have this sort of distrust for it or contempt for it?or jealousy, in my opinion, for it. There?s turf war issues even within plastic surgery.? Stevens adds. ?Now, outside the division, we?re trying to embrace the core.?

THE CORE

Stevens is quick to says it is ?ophthalmic plastics, facial plastics, derm-surg, and then aesthetic plastics, and we?ve come together formally and met and had core meetings,? he says. ?There is still a fair amount of teeth gnashing and discontent, but at least we?re talking. I?m in favor of the core. I know that certain political people are not.?

He believes that, as a group, plastic surgeons need ?to turn our eyes on the noncore?the dentists doing Botox, breast surgery, and liposuction; the general practitioners doing laser surgery. There are a lot of very undertrained people in this space doing things that they really have no business doing. Ultimately, the Hippocratic Oath is first we do no harm. It seems part of that is first we have training, knowledge, and experience. If the training is coming from equally unqualified people, that?s not training. I can hit a million golf balls and I?m not Tiger Woods, just because I hit a million golf balls. Well, I?ve hit all million poorly. When you listen to some of these nontrained, noncore people, they?ll say, ?Well, I?ve done it this many times, or I?ve learned it from this guy who?s done it this many times.??I don?t think the number of times you do it is the sole criteria. I think it?s the quality in which you do it. We owe it to the patient, to the consumer, to provide the best service of everything. To have people dabble in it, jump in and say [that] because they went to a weekend course at a hotel, [and say] I?m now a cosmetic surgeon. It?s wrong. You walk into your dentist; they?re selling you Botox. That?s crazy to me.?

This is a positive step toward keeping the plastic surgery within plastic surgery, then? Yes, he says, but, ?The ultimate goal really is to educate. We?re educating residents to be better plastic surgeons. I want them to see what we offer and also hopefully stimulate interest in that division? of plastics. To just be better, well-trained, well-rounded plastic surgeons. Even if they say they?re not going to do cosmetic surgery when they?re training, when they?re idealistic, the statistics are they will make a significant income from cosmetic procedures,? if the past is any indication, he adds.

The majority of them will generate more than half of their income from cosmetic surgery procedures, Stevens remarks, ?even though they?re wonderful hand surgeons, or microsurgeons, or craniofacial surgeons, or pediatric surgeons, or reconstructive surgeons. These are all divisions we get tested on. There is a commitment to test, in terms of the boards, to test for cosmetic plastic surgery knowledge base both written and oral, or practical, and so with that commitment by the American Board of Plastic Surgery will come better training around the country.?

He is encouraged and enthusiastic because he is seeing so many physicians who hold a commitment to train their residents. ?It?s an economic commitment, a time commitment, a physical space commitment,? he says. ?There will be some that go slower than others. Change happens with pain, and it?s a little slow at first and then it will pick up, it will accelerate, and then it will happen. We still haven?t gotten to 50% yet. It?s still at the beginning. It?s terribly exciting.?

SPECIALISTS UNITEA

Stevens looks into the future of his field, he sees integration. ?I see specialization and subspecialization within cosmetic plastic surgery. The two biggest changes I see are integration of the various subspecialties of cosmetic plastic surgery. Under one roof, facial plastics, derm-plastics, ocular plastics, aesthetic plastics, and traditional board-certified plastic surgeons.?

The people that embrace this rethinking of aesthetic medicine to accommodate the noncore practitioner under one roof?for example, cosmetic dentistry and OB/GYN?will excel, Stevens says.

Looking at the growth of all nonsurgical cosmetic procedures?nonsurgical body contouring and facial rejuvenation, for instance?Stevens sees huge growth. ?In those two areas, if you look at the growth over the last 20 years, 10 years, 5 years, 3 years? the acceleration has been phenomenal.

?If you track our own development back from 1988, when I had my first aesthetician, starting a medispa with existing space, and had a nurse do collagen injections. Eventually, [I] hired a PA and everything was growing. But there was no dedicated space. Then the PA became three PAs and then two aestheticians, and then three aestheticians. Facials and then more lasers and more energy-based technologies were added.?

Half of the technology Stevens has in his practice is less than 3 years old. ?I have 23 lasers and light-based technologies now. That?s incredible to me. If you just look at income stream, it used to be you provided this to optimize your patients. The river used to run from my surgery practice to my nonsurgery practice. The river has turned directions and is running from my nonsurgery practice to my surgery practice. It?s happening before my very eyes. I?m watching evolution. I never thought about the other ramifications. It started with optimization but then it became acquisitions, because some people wanted to have some facials and laser treatments.

?I never thought about the retention part, but now it?s grown into retention. If I provide the service, you?re not going to go to another physician to get it, because now you?re my trusted patient. You come once a month for your facials, and you come three or four times a year for your neurotoxin and your filler. When you?re sitting there for a half an hour waiting to get your filler, you?re being educated about what?s out there. A lot of people don?t even know what?s out there. So, then there comes the conversion.?

As an example, Stevens describes his institute, the Stevens Institute Medical Spa, as consisting of five parts. ?Acquisition, retention, optimization, education, and conversion,? he says. The Institute is in Marina del Rey, Calif

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