When Teddie Kossof began advertising the addition of cosmetic dentistry to his salon on Chicago's affluent North Shore almost 15 years ago, he was a decade ahead of his time. The industry scoffed, and he couldn't even find a dentist who wanted to lease space in his building. Still, convinced that traditional salon services meshed with those of cosmetic surgeons and dentists, he began inviting plastic surgeons in to do client consultations. And just a few years after that, he successfully added a dental suite. Today, the Teddie Kossof Salon & Spa encompasses cosmetic dentistry and surgery, men's hair replacement, and a wellness center that includes nutritional counseling, hypnotherapy, acupuncture, medical aromatherapy, weight management, smoking cessation programs, and much, much more.
At about the same time Kossof began offering clients consultations with plastic surgeons, dermatologist Neil Sadick added a part-time esthetician to his practice hundreds of miles away in New York City. Like Kossof's, Sadick's peers also scorned the change, but he persevered because of the tangible results patients enjoyed. Today, Dr. Sadick's practice has grown from one esthetician in one office two mornings a week to 10 estheticians working in both of his offices six days a week. His wife, Amy Kamin, whose company, ARK Industries, oversees that part of his practice, also has opened two separate "serious" skin care facilities for clients with problem skin that doesn't necessarily require a doctor's oversight. And what do his peers think now? "In the beginning we got a lot of criticism for it, but today it is becoming a much more common practice," Kamin observes.
"This is the concept that has been evolving over the years," Kossof adds. "I saw it coming from the time I opened my salon. Consumers like me idea of coming to one place that presents the opportunity to do so many things that relate to personal wellness. People are looking for quality of life centers. We're offering inner and outer quality of life."
It's a Beautiful Life
While dentistry, surgery, and wellness treatments such as acupuncture seem to have about as much to do with artificial nails, hair color, and body wraps as fast-food joints do with gas stations, just look at the success quick-service restaurants like Burger King and Subway are already enjoying when co-located in a BP or Texaco station. Though still in its early stages, this merging of inner and outer health and beauty doesn't appear to be some short-lived fad destined to go the way of disco.
"Traditional beauty services, complimentary medicine, and cosmetic surgery are linked psychologically by the individual, who wants to feel good and look good," Kossof says.
"There's a grain of the medical side merging with the beauty side, and to a certain extent I think it makes sense because a lot of these procedures [like Botox and collagen injections, hair replacement therapy, and laser hair removal] supplement what people would normally go do in the salon," adds Dr. Suzanne Sergile, a physician with a background in both clinical medicine and public health who is the editor-in-chief of Form & Figure (a new consumer magazine providing "extensive, medically reliable information on aesthetic health").
"Doctors' offices have been slowly incorporating skin care lines and adding services that are one step shy of surgery because some people just don't want a facelift," she continues. "And now there are places where doctors are working with estheticians and other beauty professionals in traditionally consumer settings. That is going to be the next big thing going into the future."
A Winning Combination
Even though the baby boomer bulge has passed into middle-age, they aren't going gracefully. Young, old, or in-between, men and women are working hard to look and feel as young as they can by eating better, exercising more, shedding bad habits, and reducing (or at least controlling) their stress levels.
Nor are they averse to a little help by way of cosmetic dentistry and surgery, having grown almost as accepting of a renovated body as a re modeled house. According to the American Society for Plastic & Reconstructive Surgery, between 1992 and 1997, liposuction procedures surged by 215%; breast augmentations were up 275%, eyelid surgeries increased 86%, facelifts were up 52%, to name just a few cosmetic surgery procedures. And several newer procedures such as laser skin resurfacing, laser hair removal, and Botox injections are already quite popular.
"Every day, 50,000 people turn 50," says Dr. Mitchell Kaminski, Jr., med ical director of the North Shore Cosmetic Surgery and Wellness Center located in Teddie Kossof's Salon & Spa building. "They are just as sharp in their minds as when they were younger, but not in their looks. We just booked a 72-year-old tycoon for a facelift. He is a strong, healthy and active guy, but he looks old and tired. Why shouldn't he look like he feels, young and energetic?"
This attitude is a popular one: According to Form & Figure's premier Winter 1999 issue, more than 2 million Americans underwent some form of cosmetic surgery procedure in 1998, spending more than $ 15 billion. Yet Dr. Sergile says the aging population is only partly responsible.
"I look at it as a three-part equation," Dr. Sergile explains. "One, there are improvements in technology that soften the surgical edge of these procedures. Second, people are getting older and much more comfortable with technology overall, and medical devices in particular. Third is the whole change in medicine and managed care. Physicians are looking for ways to grow their practices outside HMO billings, and this has created an acceptance of cosmetic surgery in the medical community."
Improvements in technology and equipment have made procedures less painful and more effective as well as reducing costs and recovery times. For example, laser resurfacing nudges aside chemical peels that burn the skin or dermabrasion that scrapes the skin with a rotary sander. And lasers are versatile, too. They can be used to remove everything from wrinkles to spider veins as well as correct vision and more. Then there is the endoscope, which lets surgeons work through small, discreetly placed incisions, which vastly reduces visible scarring.
Location, Location, Location
If older patients and new technology are the kindling for this passion, however, then managed care is the flame that has spurred doctors to begin actively marketing their services to potential patients — something they've been forced to do, they say. No longer can a doctor set up practice in an anonymous medical building and just sit back and wait for new patients. "More than 80% of Sacramento is managed health care," says Dr. Godfrey Mix, a podiatrist and nail industry author who recently opened a podiatry and pedicure salon with his wife, Laura. "If I don't belong to a group then patients don't come to me."
And that puts doctors between a rock and a hard place because if they don't participate in managed care plans then they've drastically reduced their pool of potential patients, but if they do participate, their profit potential is severely limited by-lyhat the insurance companies decide they will pay.
"Managed care and Medicare have made it impossible to make a living saving lives," adds Dr. Kaminski. "I was a staff surgeon at a Chicago hospital and I used my surgical and nutrition skills to save a lot of lives. The problem was, the hospital couldn't collect and they told me to start making what I cost them. I looked around and asked,'How can I do that?'"
Having been interested in cosmetic surgery from the start of his career and already having had a number of conversations with Kossof, Dr. Kaminski decided to found a wellness center, and could think of nowhere better to locate it than in Kossof's spa. "There are many talented doctors facing the same pressures," he says. "If they've had an orientation toward cosmetic surgery before, there will be more of this. And everyone is opening up in salon and spa enterprises because they're all looking for patients. Kossof's sees 1,000-2,000 clients per week who are interested in looking good and feeling good. The same population buying his services potentially will buy ours."
In addition to an ideal location frequented by the exact demographics they're targeting, physicians' and salon professionals' areas of expertise are highly complementary. "[It] fits right in because it's on the feel-good side of medicine," adds Dr. Mix. "Plastic surgeons have been on the cutting edge of this, but they've been doing it in their own sphere. Now they see people out there who complement them because they don't know how to put on makeup, and they don't have time to work with scarring, etc." No more so than Dr. Mix would have the time — or the skill — to polish a patient's toenails after trimming them, or exfoliate the lower legs and feet and then apply a hydrating and detoxifying mask after, say, reducing calluses or removing a corn.
On the flip side, there are many things salon professionals can't do. Laura Walker, a nail technician- turned- esthetician who owns two Perfect 10 nail salons in Old Saybrook, Conn., formed a partnership with a plastic surgeon when she came to this realization last year.
"I'm a licensed nail technician who evolved into skin care and realized the gap between what I could do in the salon and what a physician could do in his office," she says. After interviewing many doctors to find a few she could refer clients to, she discovered that they, too, had a gap between what some patients wanted and what they could or would do in their practice.
"I narrowed my referral options down to a dermatologist and plastic surgeon, and we developed a great working relationship," she continues. "When the plastic surgeon built a surgical center last fall, I began doing the pre- and post-surgical treatments. Patients can come to my clinic for treatments before laser resurfacing, and then he comes and does presentations to clients in my salon, so it's been a great link."
“Give me the works”
For several years Laura Mix has been performing pedicures and other nail services in her husband's podiatry practice, but last winter the tables turned as she and Dr Mix celebrated the grand opening of Footworks, A Place for Body and Sole in Elk Grove, Calif. The pedicure and podiatry salon is located in an upscale shopping center in a new, master-planned community designed so that residents can walk to wherever they need to go.
The 1,500 square-foot salon offers pedicures performed in custom designed pedicure chairs, manicures, and fiberglass wrap overlays as well as skin care and massage therapy. On Monday afternoons and Wednesday mornings, Dr Mix also sees patients there in the two treatment rooms that he shares with the estheticians.
"On the nail trimming side there's been so much hocus pocus about how to cut nails, and the foot seems to be so mysterious," he says, "I've never had a patient who didn't think his or her feet were ugly. So then they come into this salon setting and see what we're doing, often they want to schedule with Laura. They can come in halfway between their appointments with me for a pedicure and nail maintenance."
Although the salon has only been open a few months, Dr Mix says the word-of-mouth referrals so far have been "phenomenal." He and Laura still face the challenges of a traditional salon, however "We've got estheticians coming out our ears, but we can't find nail technicians," he says, "We're trying to find established, successful ones, but we don't have a lot to offer as a new salon, so it's been hard. As soon as we can get another nail professional to provide coverage, then we'll begin advertising more."
The ads, he says, will emphasize the salon's medical connections. "I want to capitalize on its association with a doctor and emphasize that it's scrupulously clean and that we can refer back and forth with other physicians."
While Dr. Mix plans to cross-market his practice with the salon's clientele, he says he and the salon staff will not "push clients from one side of the aisle to the other' "When they need to refer someone to a podiatrist they will give clients a list of podiatrists in the area in addition to making them aware we have someone here," he explains.
Financially, the co-location of his practice and the salon makes good sense.
With his main practice located in downtown Sacramento, Dr Mix has long born the expense of a second office so that he could treat patients in his hometown, "When you look at businesses in general, often the owner can go away and still have an income, but because I'm the only one in my practice with a medical license, when I'm away no income is being generated," he says, By co-locating with the salon, he finally has the chance to at least cover that office's overhead when he's not there. And Laura benefits because some of the overhead expenses that otherwise would be a drain on her new salon's checkbook are being absorbed by Dr Mix's practice.
The client benefits, too. "I was there yesterday and one of Laura's clients had a small corn between her toes," Dr Mix remembers. "I trimmed it out and the client left much more comfortable than when she came in." Dr. Mix says he didn't charge the client, explaining that he views it as an aspect of the unique customer service Foot works offers.
In the future, Dr Mix plans to franchise Foot works and act as a consultant to the businesses, Already, he says several podiatrists from around the country have called expressing interest in the concept.
A New Face at Nordstrom
"Until recently, a woman seeking plastic surgery went to the doctor's office. If she wanted beauty products, she headed for the mall," says Nancy Northrop, president of The F.A.C.E. Company (King of Prussia, Pa.), "In either case, the options were overwhelming. How do you choose a qualified surgeon? Are collagen injections, Botox, and chemical peels the right treatments for you? Are these treatments compatible with the products you currently use?"
To answer all these questions and more, as well as provide access to the services and products women want in a setting that's comfortable to them, Northrop has founded The FACE. Company which she describes as a business venture that links advanced medical technologies and physicians with the accessibility of a retail environment.
Located in a private suite next to the cosmetics department on the first floor of the Nordstrom store in King of Prussia, Pa., The FACE, Company offers in store treatments for the face and body performed by estheticians and massage therapists, as well as consultations with board-certified plastic surgeons.
"These treatments are usually only found in medical centers: complimentary skin evaluations and health histories, glycolic peels for face and body, Oxy-Mist oxygen therapy for the face, Endermologie treatments to reduce the appearance of cellulite, and many other therapeutic services," she continues.
Soon The FACE. Company will also offer collagen injections, spider vein treatments, and various minor laser procedures. "Customers who have consultations with physicians here also can obtain prescriptions for the latest high-tech beauty products like Renova [an anti-wrinkle cream]."
"The idea for The FACE. Company occured to me in 1993 after I had developed a prescription-level facial muscle stimulation device that will be offered as a service in the store," Northrop explains, "Once I had FDA clearance for it, I realized that if I were the consumer I would rather not go to the doctor's office because so many people are intimidated going to a doctor for something esthetic. Then in 1995 I learned that Nordstrom had opened a mammography screening center in a Chicago store, and I realized they might be interested in providing customers with access to an esthetic health care service and this proved to be true."
Making the right impression
For the past seven years, Corky Dehorty's hair, nail, and cosmetic care salon has been located in a Wickenburg, Ariz., professional building with many doctors' offices, including the owner's, Dr Gerald Walman, an ophthalmic plastic surgeon who does laser vision surgery as well as spider vein and laser resurfacing treatments. Over the years, Dehorty had several discussions with Dr Walman regarding the connection between her salon, Impressions West, and his practice.
"He has told me he believes the business of beauty involves anyone in the position to make someone beautiful, whether that's a doctor or a cosmetologist," says Dehorty, who does permanent makeup, hair, and nails. Impressed with his credentials and patient feedback, Dehorty began referring interested clients to Dr Walman, and he, in turn, offered his services free of charge to her permanent makeup clients if anyone had difficulties.
At Dr.Walman's urging, Dehorty also has begun selling in her salon Physician's Choice skin care products, a line she learned about through him."It's a very informal relationship because we are in separate suites, but he is as available to me and my clients as if we worked in the same office," she notes, "For example, I had a permanent makeup client apply too much A&D ointment and it got in her eye, which caused some irritation. This was on a Sunday morning and he called her within five minutes."
It's all about health
In the 22 years since Karen Bryan opened Sterling, Va.-based Hair Port Salon & Day Spa, she has expanded from hair services to include nail care and, more recently, skin care and body services. "The movement toward more total body care and wellness are indicative of what direction our society is going in," Bryan explains. "I think that our consumers are becoming so well educated and are aware of things like the break-down of the skin because of the environment."
In Bryan's view, spa services are about health and education, "We try not to even use the word 'pampering,'" she notes. "What you have done may feel good, but the end result is that you are doing things beneficial to you internally and externally For example, we're now integrating seaweed-based products into our pedicures and other services because seaweed is detoxifying."
"We're seeing medical offices incorporating massage therapists, and most plastic surgeons have an esthetician on staff and are offering services that have traditionally been found in the salon, so as we're getting into their field, they're getting into ours," she continues. "That just adds credibility to our services."
For now, though, Hair Port is moving very carefully into these new waters. Currently, the plastic surgeon they work with comes one Saturday a. month for three hours to do pre-booked consultations with Hair Port clients. Clients can book the appointment through the salon or the doctor's office, and the doctor spends 15-30 minutes meeting with them in a private room. At the spa's front desk, Bryan also has a plastic literature holder filled with brochures on services like eye lifts, liposuction, and breast augmentation that clients can take and read at home. On the back is the doctor's name and number.
As for how Bryan found the plastic surgeon— she didn't. "They found us," she says with a laugh. "We had numerous plastic surgeons contact us about coming in, and it was something we were looking at so we talked. They scrutinized us even harder than we scrutinized them."