Inside the Plastic Surgery Boom

He offers both surgical and non-surgical treatments, the most typical being facelifts and facial fat injections to smooth wrinkles, as well as eye, neck and breast lifts, tummy tucks, breast augmentations (including male breast reductions), liposuctions, ear pinnings and rhinoplasties. Newer, non-invasive treatments have also been growing in popularity, such as a fat-freezing procedure, a non-invasive radio-frequency skin treatment, injectables, fillers and paramedical skin care.

“All of these are outpatient procedures,” explains Dr. Wojtanowski. “Technology has allowed that to happen. We have better anesthesia machines, better drugs and better techniques that have allowed patients to undergo surgery with far less recovery time.”

He credits technological innovations for creating a surge in plastics’ popularity, especially among new patients. For example, ablative and non-ablative lasers are being used to vaporize the top layer of skin or work deeper under the skin. These lasers can be used to treat fine lines and wrinkles, acne scars and age spots, or simply to tighten skin. But with basic laser machines costing between $20,000 and $250,000, facilities and surgeons need to perform enough procedures to justify the investment.

Dr. Wojtanowski says patients who begin with non-surgical procedures such as laser treatments and Botox often become surgical patients over time. “That has helped to really grow the business,” he says.

We have better anesthesia machines, better drugs and better techniques that have allowed patients to undergo surgery with far less recovery time.
— Michael H. Wojtanowski, MD, FACS

To stay on top of the specialty’s latest advances, Dr. Wojtanowski seeds profit into his own ongoing education by attending conferences and learning new techniques. He also invests in new machines and solutions that make sense for his demographic. The operating costs for an outpatient surgical center specializing in cosmetic surgery ultimately must be offset by the procedures themselves, especially with the platforms needed to perform new treatments such as the fat-freezing procedure costing six figures and up.

“It’s a formidable investment,” admits Dr. Wojtanowski. “I’m a cautious investor. I’ve seen many treatments come and go. When they were brand new, they were hot. It was a while before I even did Botox.”

He says owning the facility in which he operates is a definite advantage that allows him to control how it evolves. “It’s an expensive investment up front,” he explains, “but it’s the best investment I’ve ever made.”

At the Healing Hands of Nebraska Clinic in Norfolk, the focus is on peripheral nerve surgery, allergy and ENT treatments, and reconstructive procedures. Demetrio J. Aguila III, MD, FACS, an ENT, reconstructive and plastic surgeon and the clinic’s founder, says patients also undergo cosmetic procedures related to nasal airway surgeries, scar revisions and other facial reconstructions.

Each of the procedures is done in an outpatient setting where it’s not unusual for Dr. Aguila to work on skin flaps or even perform a rhinoplasty. “Patients come in because they have some kind of visual defect that they would like fixed,” he says.

In terms of demographics, the patients who undergo scar revisions tend to skew younger, while individuals seeking rhinoplasties tend to be over 40. Eyelid lifts are usually performed on patients who are 60 years old and up. “Historically, the procedure is more common among women than men,” he says, “but over the last year it’s been a mix — two-thirds women and one-third men.”

Most of the clinic’s focus is on reconstructions designed to repair a deformity of some kind. For instance, trauma to the nose could impact breathing, while other patients might want to repair skin that’s been affected by skin cancer and subsequent surgery. 

The COVID-19 pandemic certainly created some challenges for the clinic’s reconstructive patients, but as restrictions eased across the country Dr. Aguila was able to operate again — performing everything from burn and wound care to migraine treatments and craniofacial procedures.

Although some of Dr. Aguila’s patients will delay surgery if they feel that they can do so, many come to him in some sort of pain to discuss treatment options, making his work different from elective cosmetic surgery. 

When he’s not in the operating room, Dr. Aguila spends a good deal of his time researching the newest technologies. For instance, he’s recently added ultrasound scanning tech, which is an effective way to visualize soft tissue structures.

Because most of the reconstructive work Dr. Aguila does involves soft tissue, having a more effective imaging modality available can make a big difference in terms of time spent operating and the accuracy of the procedures. 

Ultimately, he’s always looking for less invasive ways to treat patients, which can mean making bigger upfront investments in newer solutions. Dr. Aguila is also seeing a resurgence in cosmetic and reconstructive surgery cases, even as the pandemic continues to rage on. “People have, in some instances, delayed care,” he says. “A lot has to do with where a surgery is being done.” 

That creates an inherent advantage for outpatient clinics, he says, especially for patients who want to have procedures performed while avoiding hospitals and inpatient stays out of fears about COVID-19.

Just recently, one of Dr. Aguila’s patients who was scheduled to have a rhinoplasty in a hospital decided to have it done at his outpatient clinic. He performed the surgery under local anesthesia within just a few hours. “Before the pandemic,” he says, “I would have never considered doing the procedure without heavy sedation.” OSM