The Cosmetic Frontier: BOTOX and Beyond
According to data¹ from the American Society for Aesthetic Plastic Surgery (ASAPS), the number of cosmetic procedures performed in the United States has spiked in the past decade; ASAPS estimates that injections of botulinum toxin A (BOTOX®, Allergan, Inc, Irvine, California) increased by over 3,000% between 1997 and 2003, while collagen injections increased by a more modest 79%. In short: Beauty is big business, and Ziv Haskal, MD, professor of radiology and chief of vascular and interventional radiology at the University of Maryland Medical Center, Baltimore, believes that radiologists are uniquely positioned to take advantage of the rapidly expanding marketplace. 
Ziv Haskal, MD “We’re already treating patients for varicose veins, which has a cosmetic element to it,” Haskal says. “We have all the tools and skills in place, we understand anatomy, we have the right kind of space, and we’re already seeing the patients. In my experience, many of these patients are interested and looking for those opportunities.” In 2007, Haskal organized a day-long symposium on cosmetic interventional radiology at the annual meeting of the Society of Interventional Radiology; over 350 radiologists attended. He says that the addition of cosmetic services to radiology practices is more commonplace than one might assume. “We have interventional radiologists who do just BOTOX, who do BOTOX and fillers, who run their own medical spas, and who do limited liposuction; this is in addition to treating peripheral arterial disease or cancer,” he says. “I would suggest that there’s no medical subspecialty you could name that does not have practitioners who also do cosmetic interventions.” Is it time to put an end to the stigma associated with offering these procedures? Haskal thinks so. “The reverse snobbery of saying, ‘We don’t do cosmetics,’ has, in my mind, fallen completely by the wayside,” he says. “It’s a valuable service to patients who already come to interventional radiologists for treatment of painful leg veins, and they can get it at the same location, from the physicians they already trust.” For centers interested in adding cosmetic procedures to their rosters of services, Haskal offers a few tips. “You need trained and interested practitioners to do this,” he says. “Breast radiologists who do needle localizations could readily learn these skills, or an interventional radiologist could come during certain hours to offer cosmetic vein work, BOTOX, and (with experience) fillers.” He adds that imaging centers should not feel as if they need to “eat the whole thing: You can do a lot for patients with just BOTOX, but you must be committed to excellence. It is being explored for excessive sweating, there are new formulations that may have longer actions, and there are companies that are now developing topical versions.” At the end of the day, offering cosmetic interventions is another way that radiologists can better understand and adapt to patients’ needs, Haskal says. To that end, “there’s a need for both education and a clear desire for a very satisfied patient,” he cautions. “It’s not something you should simply bolt on to an existing center.” For centers willing to go the distance, however, ample returns could be waiting. “The overwhelming majority of women getting venous procedures are self-referred,” Haskal notes. “Women are often the health-care decision makers for their families, and this is another way to expose us to them.”
Ziv Haskal, MD “We’re already treating patients for varicose veins, which has a cosmetic element to it,” Haskal says. “We have all the tools and skills in place, we understand anatomy, we have the right kind of space, and we’re already seeing the patients. In my experience, many of these patients are interested and looking for those opportunities.” In 2007, Haskal organized a day-long symposium on cosmetic interventional radiology at the annual meeting of the Society of Interventional Radiology; over 350 radiologists attended. He says that the addition of cosmetic services to radiology practices is more commonplace than one might assume. “We have interventional radiologists who do just BOTOX, who do BOTOX and fillers, who run their own medical spas, and who do limited liposuction; this is in addition to treating peripheral arterial disease or cancer,” he says. “I would suggest that there’s no medical subspecialty you could name that does not have practitioners who also do cosmetic interventions.” Is it time to put an end to the stigma associated with offering these procedures? Haskal thinks so. “The reverse snobbery of saying, ‘We don’t do cosmetics,’ has, in my mind, fallen completely by the wayside,” he says. “It’s a valuable service to patients who already come to interventional radiologists for treatment of painful leg veins, and they can get it at the same location, from the physicians they already trust.” For centers interested in adding cosmetic procedures to their rosters of services, Haskal offers a few tips. “You need trained and interested practitioners to do this,” he says. “Breast radiologists who do needle localizations could readily learn these skills, or an interventional radiologist could come during certain hours to offer cosmetic vein work, BOTOX, and (with experience) fillers.” He adds that imaging centers should not feel as if they need to “eat the whole thing: You can do a lot for patients with just BOTOX, but you must be committed to excellence. It is being explored for excessive sweating, there are new formulations that may have longer actions, and there are companies that are now developing topical versions.” At the end of the day, offering cosmetic interventions is another way that radiologists can better understand and adapt to patients’ needs, Haskal says. To that end, “there’s a need for both education and a clear desire for a very satisfied patient,” he cautions. “It’s not something you should simply bolt on to an existing center.” For centers willing to go the distance, however, ample returns could be waiting. “The overwhelming majority of women getting venous procedures are self-referred,” Haskal notes. “Women are often the health-care decision makers for their families, and this is another way to expose us to them.”