More doctors are providing both medical and cosmetic services

In 2005, close to 11.5 million surgical and nonsurgical aesthetic procedures were done in the United States, according to the American Society of Aesthetic Plastic Surgery.

But that figure is conservative; it is based on a survey of only plastic surgeons, dermatologists and ear, nose and throat specialists. Those specialties represent just a fraction of physicians who now offer cosmetic services. More than 80 percent of cosmetic procedures in 2005 were nonsurgical, and almost half were done in an office facility.

Dr. Stephen Izard, who runs First Care family practice in Columbia, S.C., said he started offering cosmetic procedures after several patients approached him.

"I saw that there was a need, and so I decided to give it a try," he said.

So did gynecologist Lilly Filler, who thought about cosmetic services after treating a young woman who had excessive hair growth on her face and body.

"I began to see that the care of the skin and the care of women overlapped a lot with what we were doing in our office," said Filler.

Miriam Harrison, a patient of Izard's for 21 years, turned to her doctor for treatment for wrinkles, enlarged pores and things "sagging a bit here and there."

"I came here because this is where I've always come," she said. "I trust these people. They won't do (something) to me if it's not right."

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Robert Austin, a businessman and seven-year patient of Izard's, also felt comfortable having brown spots removed from his face at his doctor's office.

"It made it very convenient. They were right there where I go for my medical needs," Austin said. "And it was discreet. No one knows what you're there for."

Filler's gynecology practice offers laser treatments for removal of unwanted hair, spider veins, scarring and discoloration.

"As a woman, I know what I want in a doctor's office," Filler said. "We try to provide that for our women."

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New Jersey gynecologist Marco Pelosi II, founder of the International Society of Cosmetogynecology, said, "The gynecologist is probably in the most ideal position to provide cosmetic service."

Gynecologists treat women through their various life stages and have surgical skills transferable to procedures such as those aimed at making scars inconspicuous, said Pelosi, who seven years ago started offering liposuction in his office. He also offers mesotherapy for "body-sculpting," as well as cosmetic fillers such as Restylane, and Botox injections for smoothing the skin.

Cosmetic services bring new patients and more money into doctors' offices. Americans spent $12.4 billion on cosmetic procedures last year, says the American Society for Plastic Surgery.

Insurance companies don't cover cosmetic services, so clients pay the full cost. Prices can range from $100 to more than $4,000, depending on the service. The cash flow helps keep doctors' bottom lines in good shape.

"I think as long as physicians have to work as long and as hard as they do," said plastic surgeon John D. Newkirk II, "the tendency is to do those things that give maximum revenue with minimal work."

The procedures being offered in doctors' offices are relatively quick and easy. In fact, many offices advertise them as "lunchtime" services since people are well enough to go right back to work afterward.

But for a good outcome, the person administering the treatment has to have good training and practice frequently.

"It's when something goes wrong, or something has to be modified, when the training comes into play," said Pelosi, who offers training courses for doctors, one of which Filler attended.

But plastic surgeons worry the short courses and field visits that other doctors take don't qualify them to practice cosmetic medicine.

"I'm not sure the public is well served by going to anybody whose residency does not include training in those areas," Newkirk said. "A weekend course in liposuction is inadequate training and experience to allow any physician to carry out that procedure in his or her office."