Mixing Medical and Cosmetic Dermatology

Board-certified dermatologist Deborah Sarnoff, MD, said the most rewarding part of her job is making people happy, exceeding their expectations, and improving their self-esteem (Figure 1).

Dr Sarnoff, who is in private practice in Manhattan and Long Island, New York, has a passion for and specializes in both skin cancer treatment and cosmetic dermatology. She  has found a systematic—and fulfilling—way to work in both of these areas.

“Although these might seem like polar opposites, in reality, I bridge 2 worlds of medicine whose goals are the same: to help people stay healthy and to look as great on the outside as they feel on the inside,” she explained. She is also a clinical professor of dermatology at New York University.

Structured Days

How does one balance the world of insurance-based medicine and fee-for-service cosmetic treatments? Structured worked days with a set schedule help Dr Sarnoff achieve the goal of serving these 2 categories of patients and other dermatologists who are facing the very same situation in today’s ever-changing medical milieu can do it, too, she said.

“For example in the morning, I put on my sneakers and scrubs to treat my skin cancer patients with Mohs surgery, a skill I have continued to develop over the past 25 years,” said Dr Sarnoff, who is also senior vice president of The Skin Cancer Foundation, president-elect of the International Society of Dermatologic Surgery and co-editor-in-chief of The Journal for Drugs in Dermatology. “I care about curing the skin cancer, but also greatly care about the final cosmetic result of the reconstruction, and ultimately, how the patient will look.”

Later in the afternoon, Dr Sarnoff switches gears and transitions to heels and a white lab coat to treat her cosmetic dermatology patients. To accommodate occasional overlaps in timing—between Mohs patients finishing and cosmetic patients starting—Dr Sarnoff makes efficient use of her office space. Two private waiting areas (Figures 2 and 3) include one for cosmetic patients, the other for medical patients. “Staff members are well trained to communicate with and treat the needs of both medical and cosmetic patients,” she said.

 

Figure 2

 

 

 

 

 

 

Figure 3

 

Figures 2 and 3. Two private waiting areas include one for cosmetic patients, the other for medical patients.

 

 

 

 

 

 

 

Refreshments are provided in both waiting areas and educational materials are placed in each waiting area targeted to each audience. “Mohs patients read about the early detection and treatment of skin cancer, while cosmetic patients learn about the latest nonsurgical treatments available via videos and authentic before-and-after images. Of course, both waiting areas contain information about the importance of sun protection,” she said.

What Women Want

As a woman of a “certain age,” Dr Sarnoff said she identifies with her patients and knows what women want. “They want to look younger, refreshed, vibrant—a better version of themselves. They want to look natural, not plastic—and they don’t want a lot of downtime,” she explained.

Accordingly, she said she has adopted the mantra “anything but the knife.”

“So much of an aging woman’s confidence is intertwined with how she feels. And if she looks better, she feels better,” she said.

The practice services include injectables and laser as well as a procedure she introduced called AceLift, which is an acronym for the Augmentation of Collagen and Elastin via Lasers, Injectable neuromodulators, Fillers, and Topicals.

“AceLift is performed in a 90-minute treatment session, and it has become our most sought-after procedure for mothers of the bride and groom, second marriage brides, career women, and anyone who just wants a ‘pick me up’ rather than a surgical facelift,” she explained. “These treatments are used to skillfully enhance the appearance of my patients, nonsurgically, with the least amount of downtime.”
 

Figures 4 and 5. Before and after photos for AceLift, a 90-minute treatment that is used to nonsurgically enhance the appearance of the face with a short amount of downtime. Photos courtesy of Deborah S. Sarnoff, MD.

 

Treatment Evolution

Dr. Sarnoff began using lasers in the mid-1990s for problem-specific treatments such as keloids and port wine stains. However, with the advent of new laser technologies and modern injectables, she expanded her practice, diversifying, moving into the realm of cosmetic dermatology while at the same time, maintaining her expertise as a Mohs surgeon, to help patients with skin cancers and saving lives.

Can cancer and cosmetic treatments coexist under the same roof? “Absolutely,” Dr Sarnoff said. “They are both my passion. With a little juggling and a bit of multitasking, you can have it all.”