According to a report by the American Society of Plastic Surgeons, patients underwent 15.6 million cosmetic procedures in 2020. Of those, 9.7 million were minimally invasive procedures such as Botox injections, tissue fillers, chemical peels and laser work—procedures that interventional radiologists could easily learn and absorb into their practices, according to Abbas A. Chamsuddin, MD, FSIR, and diagnostic radiologist Neda Vanden Bosch, MD.
Cosmetic IR is a fast-emerging field with many benefits and opportunities for IRs to pursue, from varicose veins to laser treatments. IR Quarterly spoke with Drs. Chamsuddin and Vanden Bosch about how they incorporated cosmetic procedures into their practice toolkit, as well as their recommendations for IRs interested in getting started.
Abbas Chamsuddin, MD, FSIR, has been performing cosmetic IR procedures since 2002. Inspired by laser operations for the treatment of varicose veins, Dr. Chamsuddin has expanded into laser liposuction. Over the last 14 years, Dr. Chamsuddin has published and spoken on cosmetic opportunities and the impact his procedures have on patients.
What makes IRs well-suited for performing cosmetic procedures?
AC: We are very well poised for laser liposuction because we know the anatomy of the body extremely well. We’re also familiar with laser ablation, laser physics, laser technology and how to handle quality assurance for a laser. A lot of IRs are shifting to an outpatient setting and opening their own varicose vein centers or outpatient interventional radiology centers. This would be a great set of procedures to offer, and I think that our results are going to be way better than other physicians who perform cosmetic procedures.
Also, as IRs, we are open to anything new. Though we might be skeptical about certain techniques, we sit and listen. That in itself is a virtue of our specialty.
What do you enjoy about working in cosmetic IR?
AC: When we perform procedures like a stent placement or a TIPS procedure, the last picture we take is a beautiful image to showcase our work on the inside of the body. But to me, it’s 10 times more rewarding to see your work on the outside. For certain patients, there’s a psychological effect. Delivering these results without having to cut—no sutures, everything done through a tiny hole—there’s a lot of improvement in the patient’s self-image and a lot of satisfaction on my side.
What aspects of cosmetic IR would you say are more approachable for IRs who are interested to learn?
AC: I’m biased toward laser liposuction because it deals a lot with anatomy, and anatomy is what we know. I also enjoy performing varicose vein treatments. IRs are used to working with handles, fibers, machines, radiofrequency ablation and things like that, so those would be nothing new to us.
What might be the benefits of learning cosmetic IR procedures?
AC: We expand more into our horizon and into our knowledge of anatomy, and there’s unlimited self-satisfaction. And, of course, the more procedures we provide to our patients, the more helpful we are. When someone comes to me a month after their laser liposuction procedure, they are so happy. Three or four months down the road, if they’ve complied with the aftercare suggestions, they look absolutely stunning and you can see how much more self-confidence they have.
Are there any training opportunities for IRs interested in learning cosmetic procedures?
AC: We are hopefully going to announce a training center in Florida for our colleagues who would like to come and learn, and we’re looking at an already-established cosmetic practice that wants to partner with us. They’ve already invested in the material, and we’ve said that we want to have the opportunity open to other colleagues, and they’re very excited for that.
What recommendations or advice do you have for IRs interested in getting involved?
AC: The sky is the limit. Every group or solo practitioner with an outpatient practice is a potentially successful cosmetic IR. For anyone interested, first of all, they have to read a lot about it and attend a meeting or two, just like they do for any other procedure they want to add. Plus, they should not be getting into it without the laser part since those who perform endovascular laser ablation already know the physics.
Second of all, they should not do it alone on the first try. I think they need to watch two or three procedures, scrub on a few, and then be proctored. And this is not a long shot—we’re talking 2, maybe 3 months.
Finally, because this is a new area, they have to approach it with an open mind, and they should not be discouraged. Talking from experience, there’s a learning curve, but when we reach the plateau of that curve, we will be very pleased.
Neda Vanden Bosch, MD, a diagnostic radiologist, first became involved in cosmetic work in 2006 as a response to the Deficit Reduction Act. Faced with cuts to outpatient imaging reimbursement, Dr. Vanden Bosch pursued her long-standing interest in cosmetics by offering the procedures as an additional revenue stream. Dr. Vanden Bosch started with basic cosmetic work such as facials, peels, vein procedures and Botox injections, and now has a dedicated cosmetic clinic with dozens of devices and providers.
What do you enjoy about working in cosmetic IR?
NVB: It creates a healthy balance between being in the darkroom and getting out and connecting with people. You can talk with your patients while providing them with a treatment that will provide instant gratification. That is very satisfying to me as a physician and caregiver.
It also satisfies my artistic and entrepreneurial side, as it’s an area with constant innovation. New devices always come to the market, and there are a lot of conferences to go to, things to learn and protocols to constantly develop. If you enjoy growing a business, there’s also tremendous opportunity to do that. Plus, it’s a nice revenue opportunity that is independent of insurance reimbursement.
What kinds of procedures do you do? Do you have a favorite?
NVB: I do all the injectables myself, which include neuromodulators such as Botox, fillers and collagen stimulators. For me, fillers are very satisfying. I find my artistic side through facial balancing, where I bring someone’s natural beauty out and help them achieve their goals while maintaining a natural look. I also really like educating patients about how to take care of their skin. We do all kinds of skin resurfacing procedures, microneedling, radiofrequency treatments, tightening and body contouring with lasers, chemical peels and vaginal rejuvenation. The new frontier is regenerative medicine with a lot of new treatments coming into the fold such as PRP injections, exosomes and stem cells, which are very powerful tools for antiaging.
What aspects of cosmetic IR would you say are more approachable for IRs who are interested to learn? What aspects do you think would be more challenging?
NVB: It depends on the setup they’re working in. If you’re in an outpatient center that is already doing invasive procedures, then you have a good opportunity for a number of different cosmetic procedures. PRP injections for hair restoration, joint and tendon repair or sexual wellness, vein treatments and gentle lasers require more medical knowledge, but are fairly accessible to learn and introduce to existing clinic patients. From there, Botox injections and other fillers and aesthetician services can be added.
What are the benefits of learning cosmetic IR procedures?
NVB: Strictly financially, it’s nice to have some independence from insurance companies because we’ve all experienced the sudden cuts. It’s nice to have that completely independent cash flow base that you can rely on to weather the storm. Patients also really enjoy these procedures. It’s very gratifying to be able to offer these services and further that relationship, which breeds additional referrals.
Are there any training opportunities?
NVB: There are training opportunities out there, but I think that we need our own training. That’s why I’ve been thinking about setting up some IR-specific training courses with Dr. Chamsuddin. We can use our combined 40 years of experience working as radiologists and aesthetic physicians who have successfully added cosmetic IR to our existing practices. We’ve learned so much in the past decades and have a unique replicable blueprint that can be utilized by radiologists without having to suffer through the many trials and errors that we did. There would really be a lot of time and money saved in the process.
What would that specialized training ideally look like?
NVB: I would start with a survey to see what radiologists’ interests and current practice setups are like. A great place to start is injectables like fillers and Botox and PRP because of the low overhead. A lot of people bury themselves by purchasing fancy laser devices without market research or understanding of how to make them profitable. Plus, we can teach you how to plan your future purchases carefully and how to negotiate the contracts with laser companies successfully.
Another avenue is hiring and training providers who can offer many cosmetic services to patients in a med-spa environment under radiologists’ direct supervision. The laws for this setting are different in states and need to be researched.
What recommendations do you have for IRs interested in getting involved?
NVB: Having navigated this long road the hard way, it’s important to focus on the IR community itself and try to establish our own cosmetic association and training. But overall, I just want to tell everyone to go for it. There’s a lot of fun to be had, patients to help and revenue to be earned. Your patients will love and thank you for it.
