Integrative Aesthetics describes the emerging trend of individualized, multi- disciplinary holistic approaches to care being embraced by practitioners across the country. Instead of offering the traditional armamentarium of aesthetic therapies, other factors and methodologies are included as part of the philosophy of care. In theory, these work synergistically to promote overall wellness.
For some, this methodology stems from the services offered and approaches taken by a single physician; for others, several specialists oversee the application of a wide variety of integrated care options.
As the more traditional, cookie-cutter approach yields to new thinking, the patient population is taking notice and, more importantly, driving this trend.
A natural evolution
According to Mark J. Tager, MD, CEO of ChangeWell Inc. (San Diego, Calif.) and co-author (with Stewart Gandolf) of Cash-Pay Healthcare: How to Start, Grow & Perfect Your Business, there are key factors driving the growth of this emergent paradigm in medicine.
“This is a natural evolution in the practice of medicine across multiple specialties, not just aesthetics,” he said. “Changes in the healthcare system make it harder to practice medicine profitably, so standing out in the crowd and offering something better, which brings in the money you need to grow your business, is more and more common.
“And, the rise of regenerative medicine is playing a huge role, with amazing new ways to harness the body’s own healing potential,” he continued. “Most of all there has been a dramatic shift in public interest toward total wellness and the impact of nutrition and lifestyle. Sales of health and beauty supplements have increased significantly. Statistics show that millennials think more about daily health and lifestyle than baby boomers and are more often looking for ways to be healthier. This is the generation coming up through the system right now.”
Orna Fisher, MD, a plastic surgeon and medical director of The Fisher Center in Las Vegas, Nev., is also a certified health coach. “This gives me a tool that other physicians don’t have for evaluating patients and helping them decide how to best achieve their health goals. Like any physician, my ultimate goal is for my patients to be well. If I don’t think a certain procedure they are interested in will improve wellness, I will not do it,” she stated.
This often includes changes in nutrition. “Regardless, some patients want what they want, and I respect that, but my philosophy is to bring wellness into every equation. I don’t accept every patient or perform procedures I think won’t contribute to that.”
Dr. Fisher shared that while she offers the same array of aesthetic therapies as everyone else, her approach is what sets her apart. “We take a thorough look at the patient’s lifestyle with an inside out perspective, because that ‘glow’ comes from within,” she shared. “This includes skincare regimens, vita- mins, nutrition and sun care, among other things.”
Dr. Fisher doesn’t have a proprietary skincare line. “The proprietary part of what I offer is me and my expertise. In fact, before I suggest any new skincare products I have them take a picture of their medicine cabinet. I want them to start with what they have that works and go from there, rather than just throw out what they have been using.”
A challenge for Dr. Fisher is that because she doesn’t just say yes to everything, she often suggests lifestyle changes that may be hard for some patients to swallow.
“Some patients need to lose weight before they’ll see much benefit from a particular procedure, and to improve their health and well-being as a whole, so we need to come up with sustain- able means to accomplish this goal; instead of temporary weight reduction, we are looking to acheive long-term success.
“Compliance is a challenge for all doctors, but because of my approach, it is less so for me,” Dr. Fisher continued. “But not everybody is responsive. It is not a one-size-fits-all approach, it is highly personalized. Other offices with a more traditional philosophy can maximize their throughput and profits, but I don’t look at my practice that way. Mine is a personal, compassionate approach. I love my patients, which is very fulfilling; it is why I became a doctor in the first place.”
As part of a larger New York City, N.Y. practice, with other partners, dermatologist Rita Linkner, MD, of Spring Street Dermatology is just five years out of residency. According to her, “the new generation of dermatologists takes more of a holistic approach, focusing not on specific issues but the face, body and overall wellness as a whole,” she stated.
“You have to look beyond the skin and see the person as a human being. What is their age, their lifestyle and nutrition, their environment, their budget and life stressors?,” she noted. “At the first consult I like to work with them to assess their needs, bring perspective to what we can do, and begin to form a game plan that will take a year or more to achieve. I make it a palatable and understandable thing the patient can explain adequately to others, such as their spouse. As they understand and invest in this fully, we can move forward.”
Dr. Linkner’s practice offers the expected suite of therapeutic options, but her personal focus combines both Western and Eastern medicine. “A lot of my clients are women like me, between the ages of 25 and 45, of childbearing age and with kids or trying to get pregnant, getting married/divorced; everyone wants to build their healthier lifestyle. So, where I see a need for treatment with lasers or injectables, for example, I recommend a clean diet with a lot of antioxidants, and when using inject- ables I employ homeopathic medications before and after to minimize downtime,” she expressed. “I’m of Indian descent and was taught a lot of Ayurvedic medicine when I was younger, so I try to incorporate those principles in my approach.”
To be successful, Dr. Linkner focuses on relationships from moment one. “This is my favorite part of practicing, getting to know people and investing in their lives.”
The personal touch pays off. “I person- ally reach out to them the day after treatment to learn how they’re doing, tell them what’s next, or deal with any issues or uncertainty they may be experiencing,” Dr. Linkner revealed. “You don’t often see this kind of personal touch. Patient feedback and referrals show that this sets me apart and draws in new patients.”
This relationship-based approach builds trust, improves understanding and compliance, and makes the experience positive for all. “Patients are more eager to take responsibility for their own care,” Dr. Linkner shared. “The trust patients feel leads them to bring their teenager with horrible acne, or other relatives to see me to do regular skin checks, which I think perpetuates the notion of diligence in one’s own care.”
The looking good-feeling good connection
J.D. McCoy, NMD, medical director of Contour Medical in Gilbert, Ariz., incorporates natural hormone therapy and nutrition into a wellness-based approach to aesthetic medicine. “There is a strong connection between looking good and feeling good. That is the focus of my practice,” he said. “Early on in my career I was working with hormone replacement therapy and I saw a lot of overlap in this patient population. The same people were into self-care, prevention and anti-aging, so they’re perfect cosmetic patients.”
Trained as a naturopathic physician, Dr. McCoy is the first doctor of naturopathy to attain membership in the American Academy of Cosmetic Surgery (AACS). “I understand this is a little outside the box, not like your traditional dermatologists and plastic surgeons, and even non-core physicians,” he noted. “The upside is that I’m trained to take an integrated, holistic, wellness-based approach to medicine.”
As a naturopathic physician, Dr. McCoy’s philosophy is about whole-person wellness, seeking and treating causes rather than symptoms, and starting with natural and non-invasive treatments. While the discipline is sometimes considered pseudoscience, Dr. McCoy and many others of his specialty do not shy away from traditional clinical treatments, they just don’t necessarily start there.
“My advantage is that my paradigm revolves around prevention and harnessing the healing power of your own body,” he shared. “When you look at non- surgical aesthetics, prevention and regenerative medicine is a big part of what we are all doing, and where we are going.”
Dr. McCoy’s armamentarium is almost strictly nonsurgical and non- or minimally invasive therapies, which is standard fare for many practices. “A lot of these procedures, like PRP, micronized fat, or injectable fillers (especially biostimulant fillers) work hand in hand with the environment of the human body,” he explained. My goal is to optimize this environment, which improves results and makes patients feel better as well as look better.
“Nutrition plays a role in how your body responds to these therapies,” Dr. McCoy continued. “Vitamin C, for example, is very important for collagen formation so if a patient is deficient, they won’t have an optimum wound healing response. But patients often come in with wellness issues such as gastroin-testinal problems or hormonal changes due to aging, or low energy and they cross over to the aesthetic side and I encourage this. Just like a healthier body yields better aesthetic outcomes, looking good is part of feeling good.”
A lot of times it is the simple things, he explained. “How is their nutrition, their hydration, their environment? These things can be handled with lifestyle changes that greatly impact quality of life, not to mention improving the final aesthetic outcome possible with non- invasive body sculpting or removal of unwanted vascularity.”
“True beauty is an outward sign of inner health and well-being,” said Derek Cooney, MD, of MedSpa Solutions (Syracuse, N.Y.), the aesthetic practice he co-operates with dentist Dorothy Kassab, DDS, and wife, Norma Cooney, MD.
“In order to achieve a comprehensive aesthetic improvement, you should start with wellness,” Dr. D. Cooney noted. “We built a practice that melds IV infusion therapy, body sculpting, inject- ables and PRP, laser- and light-based therapies, therapeutic massage, hair restoration, Hydrafacials and cosmetic dentistry, as well as nutrition. There is a synergy because an improved aesthetic appearance enhances inner wellness, and enhanced inner wellness maximizes aesthetic outcomes.”
“For example, if a person needs to lose weight but just wants a body con- touring therapy, we have to look at the co-factors,” Dr. D. Cooney pointed out. “Will the person be able to maintain the result with a healthy lifestyle? Will the result improve their sense of well- being? Or more importantly, will the person over eat and gain weight, cre- ating a disproportionate appearance? Our Slim Body Solutions program helps them achieve their goal, not only with nutrition, but health coach support and a personalized fitness regimen so they can succeed. They will look better and feel better about looking better, which improves their well-being.”
Aesthetic dentistry also plays a key role. “Studies have shown that when building first impressions, people look at the smile first and the eyes second,” explained Dr. Kassab. “We want to bring the perioral area in line with everything else the patient is having done. Proper bite and jaw alignment are important to shaping the face, which changes as we age. So, as we treat the aging face with traditional aesthetic therapies, we also want to restore that youthful smile and profile.
“Crowding and retroclined dentition comes with age as the muscles move differently and press on the teeth, changing the shape of the lower face and lips,” Dr. Kassab continued. “If you try to address these issues with fillers there are limits to what you can do, thus the result is unlikely to look truly natural.
Manipulating and improving teeth supports the facial structure. In addition, often we have teeth clenching and grinding, which builds jaw muscles and squares off the face. With neurotoxins we can relax those muscles and bring the face back toward its original shape. So, we can induce profound changes to the face just by manipulating the peri- oral region.”
The importance of team building
With a more extensive multispecialty practice, team building is crucial. A team-based approach is the hallmark of MedSpa Solutions. “Each of our team members is a specialist who shares our vision and practice philosophy – that we are treating the whole person,” said Dr. Kassab.
“We put the therapeutic aspect first,” Dr. Kassab added, “and every one of our treatments has a therapeutic component. We are not just improving the appearance of skin for example, we are improving its quality and addressing irregularities.”
Building your team is a key component to success, according to Dr. McCoy. “It is important that everyone involved understands and believes in the values and vision of the practice, of what you are trying to do and why. This enhances the overall patient experience – their safety, outcomes, happiness and confidence in us as a practice. The team must also have accountability to those values; even if someone makes a mistake, if we are accountable to each other, everyone is on the same page.”