Dermatology: Looking Good

Dermatology remains an attractive segment for private equity investment. An aging population (driving medical dermatology use), the presence of an out-of-pocket cosmetic segment (with a 2010–2019 procedural growth rate of 3.5 percent),¹ the use of ancillary services (dermatopathology labs and Medical Spas (“Med Spa’s”), a diversified revenue mix, increased awareness of skin health, practice fragmentation and a growing shortage of dermatologists contribute to its attractiveness. Total investment peaked in 2018; subsequent acquisitions were mostly add-ons reflective of a “buy and build” strategy.²

Private Equity Deal Flow, 2014-2022

Source: Pitchfork

In this article, the authors highlight the medical and cosmetic segments, clinical innovation and emerging medical technologies, practice profitability and the role of Med Spas as an ancillary service.

Medical Dermatology: Rising Demand, Especially for Skin Cancer

Medical dermatologists diagnose and treat a wide range of skin conditions, including acne, eczema, psoriasis, rosacea, skin cancer and other diseases. They also provide care for common skin conditions such as warts, rashes, and infections.

A thorough evaluation of the patient's skin, medical history, and lifestyle factors is made to determine the most appropriate treatment plan. Treatment options may include medications, topical creams, light therapy, and other therapies, as well as advice on lifestyle changes that can help improve the overall health of the skin. The goal of medical dermatology is to help patients achieve healthy, radiant skin and to prevent or manage skin diseases and disorders.

Medical dermatology has multiple revenue streams, with Medicare accounting for 30 percent — 60 percent of practice revenue.³

Since 2001, Medicare physician reimbursement has risen only 11 percent, as compared to the CPI at 51 percent.⁴ An alternative fifteen-year study of Medicare fee schedules for 46 common dermatological procedures found a decline of 4.8 percent in the mean inflation-adjusted reimbursement.⁵ A proprietary FTI Consulting model utilizing the 2023 Medicare Physician Fee Schedule calculated a decline in the facility and non-facility reimbursement approximating 1.0 percent.

Demand for Medical Dermatology Services Driven by Skin Cancer, Psoriasis and a Wide Range of Incidental Conditions

Sources: Skin Cancer Foundation, Informed Health.org, American Academy of Dermatology, University Health Service, University of Michigan.

An estimated 187 thousand people will be diagnosed with melanoma in 2023; 48% non-invasive and 52% invasive. 5-year survival rate of 94%⁶
More than 5.4 million cases of non-melanoma skin cancer in 3.3 million people were treated in 2012. Basal Cell: 3.6 million. Squamous cell: 1.8 million. Five-year survival rate >99%⁷

At least one in five people will develop skin cancer by age 70⁸

Actinic keratosis represents a pre-cancerous lesion⁹
26.1 million people have eczema, 9.6 million children and 16.5 million adults. 40% have moderate to severe disease¹⁰
Approximately 10% of patients with acne or rosacea are treated by a dermatologist¹¹
Psoriasis affects more than 8.0 million people, 30% of whom have joint inflammation. Nearly 25% of cases are considered moderate-to-severe¹²

Aging Demographics Affecting Market Growth

The U.S. population is rapidly aging, with a projected increase of the >70 population from 38 million in 2020 to 53 million in 2030.¹³ Concurrent with the aging senior population is an increase in precancerous (Actinic Keratosis) and cancerous (Basal Cell, Squamous Cell) lesions.¹⁴

Aging is also associated with wrinkles, age spots, excessive cellulite and fatty tissue deposits and other conditions amenable to remediation. Cosmetic procedures are concentrated in the 40–69 age cohort, accounting for 74.9 percent of the total, whereas 30–39-year-olds account for another 15.7 percent.¹⁵ The population of the 40–69-year-old cohort is projected to increase at a CAGR of 0.4 percent through 2030, as compared to that of the >70 population at 3.4 percent.¹⁶

The authors estimate medical dermatology market-growth approximating 4.0 percent reflecting population growth, a broad range of conditions needing treatment and an incremental increase in non-Medicare reimbursement.

Aging Population Driving Medical Dermatology Growth

Sources: American Society of Plastic Surgery Statistics Report, 2020, Census Bureau Projected 5-year Age Groups and Sex Composition of the Population

Minimal population growth in the cosmetic market implies limited procedure growth unless a new technology is introduced into the market, the number of procedures per person increases, male interest is heightened and the >70 population generates demand for cosmetic procedures.

Dermatology Market Remains Fragmented and Short-Staffed

Dermatologist practices are classified as solo (1 physician), small (2–5 physicians), medium (6–10 physicians) and large (>10 physicians).¹⁷ Most physicians are in solo and small practices; medium and large practices account for a disproportionate share of dermatologists., i.e., 14 percent of practices account for 43 percent of physicians.¹⁸ Opportunities exist for platform as well as add-on acquisitions.

There are 11,865 dermatologists involved with patient care; a shortage exists and is expected to worsen.¹⁹ 150 accredited dermatology programs graduate 530 residents each year.²⁰ In 2016, approximately 325 physicians left the field.²¹ The net surplus is expected to decrease as 44.8 percent (5,713) of dermatologists are currently over the age of 55 and subject to retirement.²² An aging population is increasing demand; approximately 20 percent of people will develop skin cancer by age 70.²³ Advancing cosmetic dermatology procedures, combined with emerging technology is also driving demand. The average wait time to see a dermatologist in major metropolitan areas is 35.4 days.²⁴ The influx of non-physician nurse practitioners and physician assistants partially alleviates the shortage.²⁵

The four largest dermatology practices — Advanced Dermatology and Cosmetic Surgery,²⁶ Forefront Dermatology Clinics,²⁷ Qualderm Partners,²⁸ and U.S. Dermatology Partners²⁹ — are estimated to employ 7 percent of the total.³⁰

Cosmetic Dermatology Leading with Sustainable Growth

Cosmetic dermatology focuses on improving the appearance of the skin, hair and nails through non-surgical and minimally invasive procedures. It involves the use of various techniques and technologies to enhance the skin’s texture, tone and overall appearance. These include:³¹

Botox injections to reduce the appearance of wrinkles and fine lines.
Dermal fillers to add volume to the face, lips and hands.
Chemical peels to improve skin texture and tone.
Laser treatments to address skin pigmentation issues, reduce hair growth and remove tattoos and scars
Microdermabrasion to exfoliate the skin and reduce the appearance of fine lines, wrinkles and acne scars.

Physician fees vary from $450–$850 for Botox and fillers to $1,400–$2,500 for non-invasive fat reduction, laser skin resurfacing and non-surgical skin tightening.³²

COVID-19 had a negative impact on the minimally invasive cosmetic market with 2020 revenues declining to $9.2 billion, -16.7 percent from the prior year.³³ Growth has subsequently rebounded.³⁴

COVID-19 Has Had a Detrimental Affect on Minimally Invasive Cosmetic Revenues

Source: American Society of Plastic Surgeons Plastic Surgery Statistics Report

Additional details on the chart:

Excludes skin cancer excision, including Mohs Surgery. 3.3 million people affected with 5.4 million non-Melanoma lesions
Body sculpting procedures includes cellulite treatment, injection lipolysis, non-invasive fat reduction and non-surgical skin tightening
Soft tissue fillers include hyaluronic acid, calcium hydroxylapatite, platelet rich plasma, polylactic acid, polymethyl-methacrylate microspheres, Fat face and allograft adipose matric
Laser procedures include Intense Pulsed Light (IPL), hair and tattoo removal, skin resurfacing, treatment of leg veins

Cosmetic Dermatology Market Growth of 8.5 Percent

In 2019, cosmetic dermatology revenues reached $11.1 billion, >25.7 percent after three years of limited revenue growth (CAGR: 2.6 percent).³⁵ A repetitive pattern in the market of stepwise growth every three years (after a period of limited growth) appears to occur. Revenues in 2019 from higher priced procedures, i.e., soft-tissue fillers, laser skin-resurfacing and IPL procedures more than offset a decline in Botox revenues of 17.3 percent.³⁶ Allergan (Abbvie), the Botox manufacturer, however, reported an increase in U.S. cosmetic revenues of 9.3 percent from 2018.³⁷ The magnitude of the Botox decline as defined by the American Society of Plastic Surgeons and the reasons for the decline have not been validated.

COVID-19 has had a negative effect on the cosmetic market due to a decline in demand, limited operations, temporary closures and supply chain disruptions. Paradoxically, the “zoom effect” increased eventual demand for services. A survey by the American Society of Plastic Surgeons in June 2022 — by inference applicable to cosmetic dermatologists — suggests a rebound in procedures with most physicians having a slight increase in procedures relative to pre-COVID levels; 29 percent have seen a doubling of volume.³⁸

Historical pre-COVID revenue growth (2010-19 CAGR: 10.7 percent) far exceeded procedure growth (3.5 percent) suggesting higher prices and/or a mix upgrade; revenue per procedure increased 7.0 percent. Adjusting for the decline in Botox injections results in a procedural CAGR of 6.3 percent.³⁹

Based on longer-term performance, the authors are assuming a procedural growth rate of 3.5 percent and higher prices/mix upgrade (inclusive of new indications and products) of 5.0 percent yielding an 8.5 percent market growth. Social media has been driving acceptance. Performance assumes a strong economy as minimally invasive cosmetic procedures are sensitive to economic conditions.⁴⁰

The procedure CAGR in cosmetic dermatology was 3.5% in 2010-2019

Source: American Society of Plastic Surgeons

Dermatopathology as an Ancillary Offering

Dermatopathologists specialize in the diagnosis and study of skin diseases using a combination of clinical and microscopic examinations. They are trained in both dermatology and pathology, which allows them to understand the structure and function of the skin at a microscopic level, as well as how diseases and disorders affect it. They may diagnose and treat skin cancers, infectious diseases, autoimmune disorders, and genetic conditions that affect the skin. Dermatopathologists work in hospitals, clinics or private labs.

Med Spas as a Consumer-Directed Offering

A Med Spa is a type of medical facility that combines traditional spa services with medical procedures and treatments. It offers a range of cosmetic and wellness services, such as facials, massages, body wraps, and other spa treatments, as well as more advanced medical procedures like laser hair removal, Botox injections, and other cosmetic treatments. Med Spas represent a “one-stop shop.”

According to the International Spa Association, there are 1,790 Med Spas in the United States as compared to 16,850-day spas.⁴¹ The American Med Spa Association claims that there are 8,841 Med Spas reflecting 45 percent growth since 2020.⁴² The number may possibly vary based on the applied definition.

Financial benchmarks from 2019 suggest a median revenue per FTE physician for medical dermatology of $1.3 million and for cosmetic dermatology of $1.8; operating margins range from 24.9 to 27.1%.⁴³ The practice revenue figure is higher for medical ($5.3M) than cosmetic ($4.9M) dermatology.⁴⁴

Regulations are complex and vary by state. Med Spas are typically treated as a medical practice; a medical director is required to supervise procedures either onsite or remotely within their scope of practice.⁴⁵ Employee certifications are required.⁴⁶

In several states, physicians are required to have majority ownership.⁴⁷ Non-physicians may participate in Med Spas via management services organization agreements.⁴⁸ Anti-kickback provisions apply.

A consumer orientation is required to focus on patient acquisition and retention, referrals and the upselling, when appropriate of high margin treatments. Social media has been instrumental to the growing acceptance of cosmetic procedures among females and increasingly, males. The consumer experience matters.

Opportunities for P&L Leverage

According to a recent benchmarking report based on 2019 pre-COVID data, the revenues per FTE physician for cosmetic dermatology (approximately $1.8 million) is higher than that of medical dermatology (approximately $1.3 million).⁴⁹

Operating expenses are estimated at 72.9 percent of net revenues for medical dermatology and 75.1 percent for cosmetic dermatology. Profitability is dependent upon payer mix (e.g., Medicare, out-of-pocket), procedure mix, organizational efficiency/operating expense levels, leverage of fixed overhead, and ancillaries such as dermatopathology and Med Spas.

Assuming practice revenues of $1.3 to $1.8 million and operating expenses of 72.9 percent–75.1 percent results in a range of profitability of $354 to $447 thousand. Opportunities exist to generate economies of scale through shared back-office functions, negotiate enhanced reimbursement contracts and increase availability of capital.

Impact of P&L leverage on Medical and Cosmetic Dermatology

A three-percentage point reduction in OpEx increases EBITDA by approximately 11-12%, whereas a six-percentage point reduction in OpEx increases EBITDA by approximately 21-25%.

Source: Practical Dermatology

Clinical Innovations Are Incremental

Clinical innovations are incremental and are occurring in imaging diagnostics, soft-tissue fillers and capital equipment (e.g., lasers). These technologies often drive procedural innovation focused on less-invasive interventions, shorter procedure time, fewer complications, and enhanced outcomes. Among the major developments include:

Advances in laser and light therapies

Requires light energy to target microscopic elements in tissue while leaving the surrounding tissue unharmed, i.e., more precise and effective treatments with fewer side effects.⁵⁰

New technologies use alternative forms of energy — including lasers, radiofrequency- and ultrasound-based devices.⁵¹
Broadening range of soft-tissue fillers⁵²

Includes hyaluronic acid, calcium hydroxyl apatite, polylactic acid and methyl methacrylate and platelet rich plasma.
Laser-assisted drug delivery⁵³

Used to improve the efficacy of local skin treatments; initial use is solar keratosis.

Potential applications include actinic cheilitis, non-melanoma skin cancer, rhytides, photoaging, onychomycosis, warts, hemangiomas and vitiligo.
Tele-dermatology⁵⁴

Asynchronous (“Store and forward” images) and synchronous (real-time).

Used for patient consultation and management, and medical support in remote locations.
Advanced biologics and other drugs used alone or in combination⁵⁵

“Monoclonal antibodies, JAK inhibitors, DMARDs, steroids, antibiotics, and chemotherapeutic agents whose administration may be topical, oral, intravenous, intralesional, subcutaneous or intramuscular.”
Use of genes, viruses and cells for skin treatment.⁵⁶

Regulatory Considerations

Investors in dermatology need to be mindful of sector evolution and regulatory complexity. A business review may indicate strong revenue and margins, but seemingly strong revenue might — under the surface — be supported by improper over-coding and billing as well as overpayments from payers, including Medicare.

Given the evolving focus of enforcement agencies, thorough due diligence of a dermatology practice’s billing, coding and documentation is essential before acquisition. Firms investing in the sector need to leverage data analytics and utilize benchmarking to understand macro-level billing practices:

Overall case volume should be evaluated by provider and CPT code, E&M leveling, surgery case mix (e.g., Mohs), volume and average complexity of wound closures, and frequency of lesion removal procedures, among other focus areas.

Metrics should be compared against CMS benchmarks to identify outlier-volumes or practices.Review of medical coding and underlying clinical documentation to ensure claims should be submitted in compliance with the requirements established by CMS, state agencies and other third-party payers — and requires adequate documentation to support the services rendered and billed. Lack of support for billed procedures or potential systematic “over-coding” of services and procedures can have implications to the quality of earnings.

Risks

Inordinate pressure on revenue generation. Private-equity dermatology practices generate a higher volume than traditional practices by 4.7 to 17.0 percent, charge 3–5 percent higher for routine medical visits and employ more nurse practitioners and physician assistants.⁵⁷
Regulatory complexity associated with (a) the corporate practice of medicine, i.e., laws intended to ensure that medical practices are in fact owned and controlled by licensed physicians, (b) physician-supervision requirements of nurse practitioners, physician assistants and aestheticians⁵⁸ and (c) billing and coding, particularly around proper usage of CPT codes and levels of service, global periods for surgical procedures, and Modifier usage.^59,⁶⁰
A weakening economy, specifically a decline in per capita disposable income, affecting the utilization of cosmetic procedures.⁶¹
Introduction of safe and efficacious at-home beauty products, including a self-injectable as a substitute for Botox and fillers; chemical peels, dermabrasion and elsewhere.⁶²
Negative perceptions that may hinder practice acquisition and/or resident recruitment. Approximately 65 percent of surveyed residents (n=137) were unwilling to work for PE-backed practices.⁶³

Bottom Line

Dermatology remains an attractive sector driven by an aging population and out-of-pocket cosmetic segment. The authors estimate a sustainable market growth of 6.5 percent, i.e., medical dermatology at 4.0 percent and cosmetic dermatology at 8.5 percent. Dermatopathology and Med Spa represent additional sources of operating income. Medicare reimbursement, involving MIPS quality requirements, remains a challenge.

Footnotes:

1: FTI Consulting, Inc. analysis of data and information sourced from: “Plastic Surgery Statistics.” American Society of Plastic Surgeons (last visited March 21, 2023). https://www.plasticsurgery.org/news/plastic-surgery-statistics.

2: Pitchbook.

3: Ashley Buehnerkemper. “Reimbursement Rates: How to maintain a good dermatology practice income.” VitalSkin Dermatology (March 10, 2020). https://join.vitalskinderm.com/news/dermatology-practices-face-flat-or-declining-reimbursement-rates/.

4: Medicare Updates Compared to Inflation (2001-2021).” American Medical Association, Economic and Health Policy Research (last visited June 30, 2023). https://www.ama-assn.org/system/files/medicare-pay-chart-2021.pdf.

5: Rishbah S. Mazmudar, et al. “Inflation-Adjusted Trends in Medicare Reimbursement for Common Dermatologic Procedures, 2007-2021.” JAMA Dermatology 157 (11) (November 2021). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8444060/.

6: Skin Cancer Facts and Statistics: What You Need to Know. Skin Cancer Foundation. (last visited June 15, 2023). https://www.skincancer.org/skin-cancer-information/skin-cancer-facts

7: Ibid.

8: Ibid.

9: “Actinic Keratosis. Cleveland Clinic. (last visited June 15, 2023). https://my.clevelandclinic.org/health/diseases/14148-actinic-keratosis

10: “Eczema Stats.” National Eczema Association. (last visited June 23). https://nationaleczema.org/research/eczema-facts

11: Tu Huynh. “Burden of Disease: The Psychosocial Impact of Rosacea on a Patient's Quality of Life.” American Health Drug Benefits. July-August 2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031723/

12: “Psoriasis Statistics.” National Psoriasis Foundation. (last visited June 15, 2023). https://www.psoriasis.org/psoriasis-statistics/

13: “2017 National Population Projections Tables: Main Series. Table 2: Projected age and sex composition of the population.” United States Census Bureau (last visited February 14, 2023). https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html.

14: “Actinic Keratosis Overview.” Skin Cancer Foundation (last visited March 15, 2023). https://www.skincancer.org/skin-cancer-information/actinic-keratosis/.

15: FTI Consulting, Inc. analysis of data and information sourced from: “2020 Plastic Surgery Statistics, Cosmetic Surgery Age Distribution.” American Society of Plastic Surgeons (last visited March 15, 2023). https://www.plasticsurgery.org/news/plastic-surgery-statistics.

16: “2017 National Population Projections: Main Series. Table 3: Detailed Age and Sex Composition of the Population.” United States Census Bureau (last visited March 15, 2023). https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html.

17: Imene Benlagha and Bichchau Michelle Nguyen. “Changes in dermatology practice characteristics in the United States from 2012 to 2017.” Journal of the American Academy of Dermatology Volume 3 (April 20, 2021). https://www.jaadinternational.org/article/S2666-3287(21)00019-5/fulltext.

18: Ibid.

19: “Physician Specialty Data Report.” American Association of Medical Colleges (last visited March 21, 2023). https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-age-specialty-2021.

20: “Residents and Fellows.” American Board of Dermatology (last visited March 22, 2023). https://www.abderm.org/residents-and-fellows.

21: Alex M. Glazer, Aaron S. Farberg, and Richard R. Winkelmann. “Analysis of Trends in Geographic Distribution and Density of US Dermatologists.” JAMA Dermatology 153(4) (April 2017). https://jamanetwork.com/journals/jamadermatology/fullarticle/2599761.

22: “Physician Specialty Data Report.” American Association of Medical Colleges (last visited March 21, 2023). https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-age-specialty-2021.

23: “Skin Cancer Facts and Statistics.” Skin Cancer Foundation (last visited March 22, 2023). https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/.

24: Rishabh Mazmudar, et al. “Practices in higher-income communities are associated with shorter dermatologist wait times: A cross-sectional simulated telephone call study.” Journal of the American Academy of Dermatology Volume 83, Issue 3 (December 24, 2019). https://www.jaad.org/article/S0190-9622(19)33319-5/fulltext.

25: Alex M. Glazer, Aaron S. Farberg, and Richard R. Winkelmann. “Analysis of Trends in Geographic Distribution and Density of US Dermatologists.” JAMA Dermatology 153(4) (April 2017). https://jamanetwork.com/journals/jamadermatology/fullarticle/2599761.

26: “Advanced Dermatology and Cosmetic Surgery: About Us.” Advanced Dermatology and Cosmetic Surgery (last visited March 23, 2023) https://www.advancedderm.com/about-us.

27: Forefront Dermatology (last visited March 23, 2023). https://forefrontdermatology.com/.

28: Qualderm Partners (last visited March 23, 2023). https://www.qualderm.com/about/.

29: “U.S. Dermatology Partners: About Us.” U.S. Dermatology Partners (last visited March 23, 2023). https://www.usdermatologypartners.com/about-us/.

30: FTI Consulting, Inc. analysis of data and information sourced from Advanced Dermatology and Cosmetic Surgery, Forefront Dermatology, Qualderm and U.S. Dermatology Partners.

31: “Cosmetic Surgery and Dermatology Center.” Michigan Medicine. (last visited April 5, 2023). https://medicine.umich.edu/dept/cosmeticderm/cosmetic-dermatology-procedures

32: FTI Consulting, Inc. analysis of data and information sourced from: “Plastic Surgery Statistics Report, Average Surgeon/Physician Fees.” American Society of Plastic Surgeons (last visited March 16, 2023). https://www.plasticsurgery.org/news/plastic-surgery-statistics

33: “Plastic Surgery Statistics Report.” American Society of Plastic Surgeons. (2020). https://www.plasticsurgery.org/news/plastic-surgery-statistics

34: “Cosmetic Surgery and Procedure Market Size, Share & Trends Analysis Report by Type (Invasive, Non-invasive), Region (North America, Asia Pacific, Middle East & Africa, Latin America, Europe), And Segment Forecasts, 2022 – 2030.” Grand View Research (last visited March 21, 2023). https://www.grandviewresearch.com/industry-analysis/cosmetic-surgery-procedure-market.

35: FTI Consulting, Inc. analysis of data and information sourced from: “Plastic Surgery Statistics Report, 2010-2020.” American Society of Plastic Surgeons (last visited March 15, 2023). https://www.plasticsurgery.org/news/plastic-surgery-statistics?sub=2019+Plastic+Surgery+Statistics.

36: Ibid.

37: “Allergan Reports Fourth Quarter and Full-Year 2019 Financial Results.” Provided by Allergan to Cision PR Newswire (February 10, 2020). https://www.prnewswire.com/news-releases/allergan-reports-fourth-quarter-and-full-year-2019-financial-results-301001646.html.

38: “Inaugural ASPS Insights and Trends Report: Cosmetic Surgery 2022.” American Society of Plastic Surgeons. (last visited March 23, 2023).

39: FTI Consulting, Inc. analysis of data and information sourced from: “2020 Plastic Surgery Statistics.” American Society of Plastic Surgeons (last visited March 15, 2023). https://www.plasticsurgery.org/news/plastic-surgery-statistics.

40: Jeannette Y. Wick. “Plastic Surgery Procedures Fluctuate with the Economy.” HCP Live. (August 19, 2013) https://www.hcplive.com/view/plastic-surgery-procedures-fluctuate-with-the-economy

41: “Now You Have the Advantage.” ISPA (International Spa Association) U.S. Spa Industry Study. 2022.

42: Madilyn Moeller. “AmSpa CEO Featured on TODAY Consumer Confidential Segment on Growing Popularity of Medical Spas.” American Med Spa Association (September 22, 2022). https://americanmedspa.org/news/amspa-ceo-featured-on-today-consumer-confidential-segment-on-growing-popularity-of-medical-spas.

43: Edward Wynne. “2020 Financial Benchmark Report: How Dermatology and Aesthetic Practices Fared in the COVID Era.” Practical Dermatology (April 2022). https://practicaldermatology.com/articles/2022-apr/2020-financial-benchmark-report-how-dermatology-and-aesthetic-practices-fared-in-the-covid-era.

44: Ibid.

45: Madilyn Moeller. “Medical Spa Legal Requirements.” American Med Spa Association (December 8, 2021). https://americanmedspa.org/blog/medical-spa-legal-requirements.

46: Ibid.

47: Ibid.

48: Ibid.

49: Edward Wynne. “2020 Financial Benchmark Report: How Dermatology and Aesthetic Practices Fared in the COVID Era.” Practical Dermatology (April 2022). https://practicaldermatology.com/articles/2022-apr/2020-financial-benchmark-report-how-dermatology-and-aesthetic-practices-fared-in-the-covid-era.

50: Keren Setton. "Israeli Companies Leading the Way in Revolutionary Skin Treatments.” The Jerusalem Post (December 12, 2022). https://www.jpost.com/business-and-innovation/article-724637.

51: Ibid.

52: FTI Consulting, Inc. analysis of data and information sourced from: “2020 Plastic Surgery Statistics.” American Society of Plastic Surgeons (last visited March 15, 2023). https://www.plasticsurgery.org/news/plastic-surgery-statistics.

53: Andres M. Erlendsson, et al. “Laser-Assisted Drug Delivery.” American Society for Laser Medicine & Surgery, Inc. (last visited Mach 10, 2023). https://www.aslms.org/for-the-public/treatments-using-lasers-and-energy-based-devices/laser-assisted-drug-delivery.

54: Feroze Kaliyadan and Michael L. Ramsey. “Teledermatology.” Stat Pearls, National Library of Medicine (last update October 3, 2022). https://www.ncbi.nlm.nih.gov/books/NBK459382/.

55: Kaitlyn Bader, Editor. “Discover Dermatology Times: January 2023.” Dermatology Times (January 31, 2023). https://www.dermatologytimes.com/view/discover-dermatology-times-january-2023.

56: Carrie Nagorka, Senior Editor. “New Innovations That Could Change Dermatology.” Dermatology Times (January 25, 2023). https://www.dermatologytimes.com/view/new-innovations-that-could-change-dermatology/.

57: Robert Tyler Braun, et al. “Private Equity in Dermatology: Effect On Price, Utilization, and Spending.” Health Affairs, National Library of Medicine (May 2021). https://pubmed.ncbi.nlm.nih.gov/33939519.

58: Bradford E. Adatto and Michael S. Byrd. “123s of Private Equity in Dermatology.” Byrd Adatto. (August 22, 2022). https://byrdadatto.com/banter/123s-of-private-equity-in-dermatology/.

59: “Dermatologist Claims for Evaluation and Management Services on the Same Day as Minor Surgical Procedures.” U.S. Department of Health and Human Services – Office of Inspector General (last visited March 30, 2023). https://www.oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000577.asp.

60: John Fisher II. “Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices." JD Supra (April 5, 2017). https://www.jdsupra.com/legalnews/three-recent-fraud-cases-involving-46473/.

61: “Economic Indicators Affect Market for Aesthetic Procedures.” American Society of Plastic Surgeons (May 28, 2014). https://www.plasticsurgery.org/news/press-releases/economic-indicators-affect-market-for-aesthetic-procedures.

62: “Fillerina.” LovelySkin (last visited March 23, 2023). https://www.lovelyskin.com/c/fillerina.

63: Taylor Novice, David Portney, and Milad Eshaq. “Dermatology resident perspectives on practice ownership structures and private equity-backed group practices.” Clinical Dermatology, National Library of Medicine (May 2020). https://pubmed.ncbi.nlm.nih.gov/32563340/.

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May 04, 2023

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