Dr. Avinash's Message

Dermatology is the branch of medicine (a medical specialty) that deals with the study of skin and it's diseases and concerned with the diagnosis and treatment particularly of skin diseases. There could not be a possible definition, sufficient enough, to convey the immensity of this wide ranging subject. It is therefore dermatologist cannot confine themselves merely to a study of dermatologic sciences but must also study other related aspects of the skin such as internal medicine, surgery and most recently the cosmetic dermatology that has emerged out as a desire aspect of dermatology.

Many of skin diseases in the past had fallen in the province of the quack or the surgeon. Physician at that time being least concerned with the skin. In the first half of 20th century dermatology, gradually started to evolve on the scientific line. Principally, the emphasis being limited to describe the name and clarify the various skin diseases only. In the second half of the said century there had been explosion of dermatological knowledge, mainly driven by the development of sophiscated research techniques in the field of biochemistry, as also, those related to cellular and molecular basis of immunology and genetics. Now that we have entered the molecular era of research, the possibility for true and faster accomplishes is greater than ever before. Skin research while until not too long ago dominated principally by dermatologists has become a favored playground for PHD scientists who are using skin as an easily accessible tissue / organ to study basic physiologic and / or pathologic process at a cellular and molecular level.

Excessive specialization is one the side effects to specialization. It is clearly understood that there is a core of basic knowledge centered to each specialty, as also, that specialty areas would expand their focus on different areas within a specialty. The process leads to focused examinations of certain changing areas which are called a subdiscipline or a subspecialty. Subspecialties of dermatology in general include, dermatopathology, immunodermatology, pediatric dermatology, cosmetic dermatology and teledermatology.

If interest is maintained in a subspecialty, journals and formal societies develop focused on this new area. Development of a new subdiscipline or a specialty is dependent upon uniqueness of the knowledge and skills in the new area as well as the intellectual vigor of the students and practitioners in the new area. Cosmetic dermatology is a relative, new comer in the stage of dermatologic specialties, but its growth has been highly explosive. In a matter of 15 years there is significant advancement in new informations relating to the art of cosmetic procedures. The specialty has gone from fledging group of founding members to the formation of international specialty societies, associations and academics with highly attended meetings and the formation of many international courses, trainings and programs.

However it is a hundred million dollar fact, always and ever due to recognize, that clinicians with minimal, if any, training in basic science can no longer communicate with basic scientists who, while technologically skilled, have little or no understanding of clinically relevant questions and problems. It is therefore trainees in dermatology and practicing dermatologists must have definite exposure to basic science in a way that allows them to understand fundamental principles of biology as well as the scope and power of new technologies and their translation into clinical medicine. It is therefore, strongly recommended to study and practice cosmetic dermatology always as an 'add on to study and practice of general dermatology. This approach, in fact, serves best to the quality of study and practice, as also, integrates well both general dermatology and cosmetic dermatology. Dr Werchester William Phillip, a renowned dermatologist and Assistant Clinical Professor of Medicine/ Dermatology of University of Washington ,in Seattle, in the year 2008 gave an in depth perspective about how best to integrate the practice of general dermatology to cosmetic dermatology. According to him there are 4 levels of cosmetic office practices. Level 1 is essentially a noncosmetic practice. This is the traditional disease-based medical dermatology or skin-cancer surgery practice. Level 2 means that there is a minor focus on cosmetic dermatology; this may be a limited number of procedures on a limited number of days of the week, or clinic hours that are devoted to cosmetic practice. This practice (which we sometimes call the evolving or the transitional practice in cosmetic dermatology) is one that typically will devote resources and collect revenues that show cosmetic dermatology to represent 25% or less of the practice. A level-3 practice is what we would call a blended or integrated dermatology practice; it is one in which there is a relative balance between the disease- and the desire of the patients in terms of days per week, number of patients seen, and revenue. These are moving definitions and working definitions, but the level-3 practice generally is highly evolved in cosmetic practice but still performs a great deal of noncosmetic, diseasebased medical and surgical dermatology. A level-4 practice is one in which there is really an abandonment of any kind of disease- or insurance-based reimbursement. It is completely and solely a cosmetic dermatology practice. In fact, in this practice they may not even offer any disease-based treatment. These practices may be solely dermatology, in a medispa setting, or may be integrated with plastic surgery.

Dr. Werchester found that the majority of dermatology practices that experience a great deal of success from a practice achievement standpoint are level 2 to level 3. That is, they have some limited focus in cosmetic dermatology, or they have a very integrated blended schedule of patients and procedures that are offered.

We at our clinic also have adopted a level 1 to level 2 integration of general dermatologic to a cosmetic dermatologic practice.


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