Mildly ostentatious was the phrase that came to mind when I first heard the term, key opinion leader (KOL). Its ubiquitous now, and I guess you eventually get used to anything, but it initially struck me as so odd. What key did these individuals hold? Why were their opinions so coveted? Whom or what were they leading exactly?
I wanted to find out the answers to those questions for myself, so years ago I arrived early at a lecture to be given by one of the aesthetic industry-touted “KOLs” to get a good seat. Afterall, it was bound to be spectacular, right? Moreover, since I had just completed my dermatology residency, I felt like the aesthetic space, to me personally anyway, was chaotic. I wanted to see what kind of opportunity this area of subspecialization potentially held for me, and I felt optimistic that this KOL would help clear things up. Right off the bat, the speaker rattled off a shockingly lengthy list of disclosures. How could I trust this opinion when the speaker acknowledged being financially compensated by so many competing aesthetic injectable companies and energy-based device manufacturers? The curriculum vitae noted that this KOL was perpetually traveling for speaking opportunities and scientific advisory board meetings at aesthetic-focused conferences. How great of a clinician could they be if they were constantly speaking instead of treating actual patients?
It took a mere 15-minute lecture for me to realize that this individual was not a true thought leader by any stretch of the actual definition. This traditional KOL lecture made me feel that the world of aesthetic dermatology was more confusing and chaotic than I had ever even realized. I walked out of that conference room feeling empowered, though not because the traditional KOL had imparted wisdom. In fact, it was in spite of that. I left that lecture emboldened because I recognized that there was tremendous opportunity to help reframe the KOL landscape.
So, how did we get here? Why does the aesthetic industry—conferences, industry, publications—continue to promote sometimes seemingly similar lectures from the same individuals? To get more granular, how exactly does one become a KOL? Candidly, I am not sure, but this article will dive a little deeper into those questions to hopefully shed some light on the answers.
Impact of COVID-19
The good news, however, is that the traditional aesthetic dermatology KOL paradigm appears to be evolving quickly, and I do not believe the fact that this change is occurring during the COVID-19 pandemic is a coincidence. The following paragraphs discuss some of the top reasons why we may be witnessing the forced attrition of the concept of a traditional KOL.
Medical conferences. In-person aesthetic conferences, where KOLs lectured and would be available for questions and networking afterwards, and in some instances paid to promote injectables, devices, and topical preparations, have screeched to halt. Since late February, in-person conferences simply do not exist out of an abundance of caution for attendees. Whether due to “Zoom fatigue” or the two-dimensional nature of a virtual, all-day lecture, attendance of a virtual conference simply cannot engage the same ways as in-person attendance.
Virtual attendance numbers may also demonstrate a serious possibility that conference organizers should consider going forward: the current traditional KOLs and scientific advisory board members cannot and do not actually drive paid participation in these virtual events. Despite the more efficient opportunity to attend in a virtual manner (ie, no travel required), numbers talk and attendance is declining. One might suggest that the need to be seen and the personal experience of travel and dining in a favorable location is more of a driver of attendance than the out-dated content itself. That is not to say that the subject matter is not important for attendees, as learning novel techniques or pearls and discussing anatomy should be a focus of continuing education. However, if this speculation is true, we may see fresh names and hear new perspectives in upcoming conferences sooner rather than later.
Continuing medical education (CME). Many health care professionals (HCPs) are constantly frustrated by CME requirements, as these vary by locale and board certification. In a not-too-distant past, the only way to obtain CME was through live meeting participation. These were, of course, conferences where the traditional KOLs were oftentimes paid or compensated with hotel/attendance to speak. As we get more comfortable working remotely because of COVID-19, we are also finding ease in the technological advantages that electronic possibilities offer. CME credits are now not only easily obtainable virtually, but there are also more overall CME opportunities available. Again, the ability to collect electronic CME via a mobile device while sitting on a beach or at home with a coffee or over lunch in the office has removed many of the eyeballs that would have normally been directed to a traditional KOL, in-person, on a podium. Moreover, pharmaceutical companies sponsoring certain CME events are now acutely monitoring expenses to confirm that payment to traditional KOLs on an in-person podium. Just as with live events, shorter webinar-style CME opportunities place the onus on the content being engaging and interesting.
Contenders vs pretenders. While we have seen aesthetic practices reopen to a large, pent up patient demand after being shuttered during pandemic shutdowns, how long will this wave of business last? Are patients being more conscience with their wallets and spending now? Are they more oriented toward value and an aesthetics practice that delivers consistent results with little complications?
In asking those questions, I think we will soon reflect on how our aesthetic KOLs handle their practices coming out of COVID-19 shutdowns. Aesthetic professionals across the nation will need guidance and leadership based on real-world experience in a post-COVID world. Our traditional KOLs, who spent pre-COVID days lecturing more and practicing less, may take a back seat to up-and-coming success stories. These new knowledge contenders will get tapped to appear on the main billing by sharing their secrets and tips to bringing in new patients, keeping staff and patients safe from disease transmission, and more—information that will help shape how we continue to serve the strong patient demand to look and feel the best.
Trials on hold. Some new research studies are on hold due to COVID-19. How may this affect our view on the traditional KOL? Well, this ties in some of the previously discussed points. Traditional KOLs are often tapped to perform paid research for industry, and some of them are even asked to speak about that research at medical conferences. The momentary pause in some clinical trials transitions aesthetics KOLs to concentrate on practice, whereas industry that sponsors the research may reexamine their usual speaker lineups and look to physicians who have adapted to using their products with success in this new normal in aesthetic medicine.
New industry. Relatively newer players such as Endo, Revance, Prollenium, and Hugel America are a few of the seemingly trustworthy aesthetics companies launching new products and getting new indications in the near future. Some of the respected traditional powerhouses like Allergan Aesthetics and Cynosure are constantly offering new technology. Will these reputable companies want to continue to engage with traditional KOLs that already advise competitive businesses in the same space? This all remains to be seen, but if a new product launch strategy is hoping traditional KOL support constitutes meaningful sway among peers, these industry entities might want to rethink the concept of KOL influence on consumer or HCP purchasing trends. I suspect that the new companies and the existing groups with quality leadership have been watching market trends closely throughout the pandemic and will seriously reflect on how to better launch products and indications in a post-COVID medical sphere. When budgets are analyzed, companies will have to ask themselves a very important question: Is there quantifiable value in compensating traditional KOLs for advising their companies?
Diversity. I fully recognize that this next point is a hot topic of conversation, but I would be remiss if I ignored it. Historically, traditional KOLs tended to be older, white MDs. Does this reflect the population of patients seeking aesthetic dermatology services? Does this mirror the staff at aesthetic practices? The answer to both questions is obviously a resounding “no.”
Not all that long ago, KOLs came out of academic programs and, over time, they naturally put those who shared their same demographic and academic affiliations in positions of power. What happened next? They recommended their close network for other traditional KOL roles, and the cycle continued. Does this mean that all traditional KOLs shun diversity? Of course not. The good news is that, anecdotally, the industry is becoming much more diverse as we now see more women and Fitzpatrick phototypes represented, different sexual orientations embraced, and various academic qualifications included. But for a multitude of reasons, either subliminal or overt, many traditional KOLs still do not exemplify the patient populations who use the products or the professional clinicians that implement aesthetic treatments. COVID-19 in combination with the growing movement calling for equity, diversity, and inclusion might wake up a rather historically homogenous-minded industry, and the arbitrary emotional walls will crumble under the weight of the diverse possibilities that could be. (Full disclosure: I’m also an old[ish] white guy).
Educational opportunities for allied HCPs. It was once difficult to get a quality aesthetic education. Many dermatology residencies did not even teach cosmetics, and it seems to only be a recent trend to include such training in some programs. So, aesthetic education was taught at conferences by whom? You guessed it: traditional KOLs. So, the cycle continued, and the myth of allopathic physician superiority was perpetuated. Now there is a multitude of options for getting injectable and energy-based device training, and it caters (and is often lead by) allied HCPs (or, another commonly used phase that I personally detest, physician extenders) such as registered nurses, nurse practitioners, and physician assistants. These educational opportunities are only becoming more popular during the pandemic as new clinicians seek opportunities to expand their knowledge base and training.
The future of the aesthetic industry influence lies in the hands of educators. Physician insecurity seems to be slowly fading and bringing in novel clinical leaders with different educational experiences and varying academic degrees to foster fresh ideas, healthy discourse, and collaboration.
Social media. Traditional KOLs typically downplay the importance of social media. Why? Because it offers a quantifiable means by which to measure impact. Social media impressions pull back the curtain. Like Dorothy said in the Wizard of Oz, “if you were really great and powerful, you’d keep your promises!” Cursory research shows that several traditional KOLs do not have sizable social media followings, and thus have no true voice in that growing arena of patient and aesthetic clinician engagement. Social media is where younger dermatologists can shine—it is more innate, as the next generation uses social media earlier and more often than the HCP of yesteryear. Instagram and TikTok are proving to be massively influential during this time as well, giving new clinician voices a platform to educate patients seeking aesthetic services. This is also so incredibly important as misinformation is notorious, and reaching patients with evidence-based clinical advice is critical to keeping our patients—current and future—from skin damage.
While the COVID-19 pandemic has been massively destructive in countless ways, it has also been disruptive and has inspired some positive changes. I strongly opine that the outdated concept of a traditional KOL will be quietly ushered away to be stored in the vaults of a time gone by. Even the phrases key opinion leader and physician extender seem antediluvian. It is my robust personal contention that this last bastion of undeserved privilege will make way for a new generation of diverse aesthetic industry tastemakers with ethics and high morals, strong clinical experience, and demonstrable personal rectitude that I referentially call aesthetic influencers, or AIs.
In closing, the thoughts expressed in this article are mine alone; they are not representative of those of this publication, my colleagues, my friends, or my company. But am I on an island in thinking that the KOL is evolving at a rapid pace thanks in part to the pandemic? I strongly suspect that I am not. I think there are probably a lot of clinicians out there who agree with me, who applaud the future, and who can agree on one positive outcome of the COVID-19 pandemic: out of chaos comes opportunity.
Dr Kirby is the chief medical officer of LaserAway, the nation’s leader in aesthetic dermatology, with 61 clinics located in most major US markets.
Disclosure: The author reports no relevant financial relationships.