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.
The sky is the limit. Every group or solo practitioner with an outpatient practice is a potentially successful cosmetic IR.
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,
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