Across all specialties, personalized medicine or "bespoke treatment" approaches to health and wellness are quietly emerging as a trend in the medical field. While most physicians currently take a reactive, one-size-fits-all approach to patient care, many are starting to discover the bespoke method.
In the world of aesthetics, customized therapies may include a diverse range of modalities, such as energy-based systems, aesthetic procedures (facial injectables, thread lifts, microneedling, etc.), topical skincare regimens, nutraceuticals and/or cell-based remedies, which are integrated into a patient’s holistic, long-term health and wellness treatment plan.
This approach is ideal for both male and female patients, with the entire objective being to deliver the most effective tailored treatments, specific to the particular patient.
In aesthetics, for instance, the physician treats the patient’s outward appearance, but may or may not actively respond to unrelated health issues that are discussed during the consult, or later. In some situations, the patient might be referred to various specialists.
Conversely, bespoke patient plans often involve collaborating with other specialists for certain tasks. While the aesthetic practitioner focuses solely on rejuvenation of the face or body, other physicians address the other issues.
Everyone, including the patient, designs or takes part in creating a tailored plan that adjusts to the patient’s evolving medical and cosmetic needs.
It comes down to managing a patient’s health based on their specific char- acteristics, including age, gender, height and weight, diet, environment, etc., during all stages of care, and then pursuing treatment plans that address problems holistically.
“Every procedure should be personalized, and any treatment plan done well is a bespoke treatment,” stated Doris Day, M.D., F.A.A.D., a board certified dermatologist in New York City, N.Y., who specializes in laser, cosmetic and surgical dermatology. “At our practice, we always say one-size-fits-none.”
Currently, the individualized therapy approach has not been well communicated to the public. To most patients, terms like “personalized medicine” and “bespoke therapies” don’t have much meaning, although that is likely to change, noted Dr. Day.
“For now, these are concepts. Sometimes practices will use phrases like ‘our proprietary treatment’ and ‘only available here’ as a marketing ploy, but this is intended to make a patient worry they aren’t receiving the best treatment.’”
At Dr. Day’s practice, a bespoke treatment may begin with addressing dermatological and aesthetic-related needs, but then expands to include many related and / or unrelated conditions.
“For example, in a skincare bespoke treatment, the task is to create a personalized plan for someone who just wants their skin rejuvenated,” she reported. “Then you talk with them further and start planning the comprehensive treatment. The practice of treating a single indication without taking the entire person into account is going away.”
In the process of developing a treatment plan, Dr. Day watches for complaints or illnesses that might affect the outcomes. “I look for pathology and problems, and take into account different injections and treatments the patient has received,” she said.
“We bring in multi-disciplinary approaches more and more, and have created a network of specialists that understand the individualized approach.
It is a way to collaborate with other experts to really provide the best outcomes,” she continued.
Jason Emer, M.D., a cosmetic dermatologist in Beverly Hills, Calif., feels the modern bespoke methodology is likely to transform medicine. “Deep down everybody wants individualized medicine,” he said. “They want to know that it is not a cookie-cutter approach.”
In order to expand his practice and also cultivate a suitable “bespoke” office environment, Dr. Emer has brought many outside specialists into his practice, either full or part-time.
“We are set up to handle a variety of concerns, both aesthetic and medical,” he emphasized. “When my patients come in to get a treatment plan they talk to my aestheticians about skincare, peels, microneedling, facials and spa services. They talk to my P.A. about laser treatments and fillers. They talk to my consultants and plastic surgeons about surgeries and different options.
“We have a new facial plastic surgeon that even does male-female transition surgery,” he added. “Altogether, around five of us will go into the consult. People feel so important and so empowered by that.”
The consult ends up resembling a panel discussion, Dr. Emer described. “When prospective patients see you as an expert team, they come into the consult willing to tell you about everything going on with them. We bring up the sensitive issues, and we offer a solution, or at least some sort of shortterm satisfaction and/or immediate gratification so that they can feel good about themselves.
“Patients see that we are trying new things and consider us progressive and innovative. Long story short, they see us as a luxury brand,” Dr. Emer stated.
While creating a comprehensive health and wellness center is beyond most physicians’ capability, bigger practices may employ enough staff and specialists to keep at least a portion of bespoke treatments routinely in-house.
Also, if there is a surgery center and rooms devoted to energy-based aesthetic platforms, then the task of selling long range treatment plans might be easier.
“I explain to my patients that while I may have just about every device, I’m going to do what is right for them and not just use what I have,” Dr. Day expressed.
“In our consult, the patient and I talk about his or her best features, as well as what I can and cannot address,” she continued. “If I don’t have a particular service that is needed, then I will refer them out to the right physician. It is important to be honest about the things you can take care of and the things you can’t, and then help them find the best resource for those services.”
Developing strong professional relationships with those outside physicians is key to developing a bespoke approach, Dr. Day expressed.
“When you send the patient to them, they will know to stick to their portion of the treatment plan. I have relationships with a host of other specialists that I respect and trust.”
Increasingly, patients want that continuity of care and are willing to adopt a holistic view of wellness, too, stated Dr. Emer.
“They desire to have a menu of services where they can choose the treatments today that will be gratifying to them right now, as well as those procedures or regimens that are long-term, in order to keep them looking good and to prevent the aging process. That is the bespoke approach defined,” he said.
To Evan Goldstein, D.O., a cosmetic surgeon in New York City and Beverly Hills, the emergence of bespoke treatments is a natural evolution in patient care. Specializing in concierge-style medical services, Dr. Goldstein offers niche treatments that mostly attract gay clientele.
“Both physicians and patients have been conditioned to accept medi- ocrity in healthcare,” stated Dr. Goldstein. “That shouldn’t be the case. If people are willing to pay for quality care, when and what does that entail? Ultimately, the patient has to walk away from the experience feeling that they are a king or queen.
“In medical school you’re trained a specific way,” he continued. “Basically, it is a corporate way. Then you start practicing in the real world and realize the quality of medical care is average, to say the least. While mediocrity might be acceptable to most of the world, my wishes are to deliver the best care possible. With the bespoke method, one is tailoring their skills and care to make sure that people get the service that they want.”
Personalized medicine obliges the provider to be degreed and board certified, Dr. Day opined. “This is because we are physicians doing medical treatments for beauty. We are not doing beauty treatments. Getting BOTOX is not the same as getting a blow dry. Getting Voluma injections is not a beauty treatment, it is a medical procedure to make you more beautiful. These are medical treatments whether they are done by M.D.’s that are properly trained or not.”
In any case, the emphasis should always be on delivering high-touch customer service, Dr. Goldstein maintained.
“The patient experience should be seamless. When you look at hospitals they are about volume-based models. It is very hard to do bespoke treat- ments in that environment,” he said.
“This is what led me down the path of opening up a boutique aesthetic practice, in which people get 40 minutes per visit and have full access to my staff and me. It is more like creating the narrative that I know I would want when I see a physician. It also helps me build my business,” Dr. Goldstein added.
The office environment should help to define the nature of the personalized services available, as well as show off some flair.
“Right when people walk into my practice they say it is completely dif- ferent from any other physician’s office,” Dr. Goldstein shared.
“It is made up like my house. I’ve created a high-end environment that isn’t threatening. I don’t even call myself Dr. Goldstein. I’m Evan, and we communicate and become friends. In making sure that people feel okay and safe from the get go, they feel comfortable enough to dictate how we approach their treatment.”
Dr. Emer’s elaborate practice environment in his new offices, speaks to success and expansion, and his treatment offerings seem to cover many of the procedures that typify a “bespoke physician.”
A large majority of clinics that boast bespoke treatments are usually referring to facial rejuvenation procedures or skincare regimens (or both). In addition to neurotoxins – BOTOX, Dysport and Xeomin – to correct lines and wrinkles, energy-based options, such as Thermage and Ultherapy are available for facial contouring, skin tightening and additional wrinkle therapy.
Thread-lifting procedures offer a non-surgical alternative to the face- lift. For instance, Dr. Emer uses PDO absorbable sutures preloaded into delivery syringes, as well as Silhouette InstaLift for immediate lifting of the mid-face area.
In the area of body shaping, including fat reduction, contouring and tightening, Dr. Emer has a reputation for achieving superior body sculpting results on male abdomens using the VASERLipo system from Solta Medical, Inc. (Bothell, Wash.).
For the face, Dr. Emer relies on workhouse systems like the Fraxel DUAL fractional laser system for non-ablative resurfacing, and Clear + Brilliant (both from Solta), a low-level laser-based skin rejuvenation procedure that improves texture and delivers softer, glowing skin.
In addition, Dr. Emer employs cutting edge topical products, “Some of which include placental stem cells and human growth factors, foreskin or fibroblast stem cells,” he noted.
“In the future, I think we’re going to be addressing the actual radiance of the skin much more with topical products, utilizing stem cell therapies and other regenerative medicine elements,” he indicated.
To address women’s sexual health and wellness, he uses the energy-based Fractora V system from InMode Aesthetic Solutions.
“Women want to improve the cosmetic appearance of their vaginas,” Dr. Emer began. “Fractora V allows us to perform radiofrequency (RF)-based microneedling on the vagina, to plump it up, as well as skin tightening or wrinkle reduction. There’s also ThermiVa, which is more for internal treat- ments, to address moisture issues and orgasms.”
Personalized medicine approaches in aesthetics will also embrace advancements like fillers with movement, such as Restylane Refyne and Defyne from Galderma, and skin boosters, Dr. Emer noted. “Skin boosters are now popular in other countries. They soften and hydrate the skin.
“In addition, individualized treatment programs will increasingly use cell-based therapies that make use of a person’s own blood and tissue,” he continued.
“For instance, we’ve begun taking the stem cells from the patient’s fat and re-injecting them into the body, to build muscle and regenerate tissue, help joints, etc.,” Dr. Emer noted.
“There are some amazing treatments out there that deliver a more subtle, natural look, as well as really enhance the overall look of the face and body.”