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Rush to Beauty

Urologists doing laser hair removal. Dentists giving Botox. All over the city, doctors are leaving their old practices for the promised land of cosmetic medicine.

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Change of heart: Lynn Dormer — an ex-chief of pulmonary critical care — at her Dormer-Lourence Medical Spa.  

Lynn Dormer is a 42-year-old doctor board-certified to practice pulmonary medicine, internal medicine, and critical-care medicine. A slight brunette whose accent betrays her North Carolina upbringing, she was chief of pulmonary critical care at Brooklyn's VA New York Harbor hospital, performing open-heart massages on gunshot victims, inserting tubes into collapsed lungs, and lasering tumors. Now she's the chief attraction at the Dormer-Lourence Medical Spa on 72nd Street off Madison Avenue, and the massages her office gives are strictly external. The suite of rooms, appointed with marble, gilded mirrors, and antiques and billed in its brochure as "New York's most exclusive spa," offers a range of services, from massage to collagen and cosmetic laser treatments. The practice has grown so quickly that Dormer's husband, Arnold, left his Wall Street job to be its business manager.

"My family was somewhat upset," she says pensively. "My mother said, 'Doesn't it bother you that you're not helping people anymore?' I have three medical board certifications, and they felt like I had wasted fifteen years. But, you know, it was very stressful. I would get Christmas gifts from patients, and by the time I received them, they had died. On top of that, hospital politics drove me crazy. I decided to do something lighter."

Dormer, who has been giving Botox to her patients for just over two years, was selected by Allergan, the manufacturers of the toxin, to help train others in the wrinkle-removing technique. The training takes about a day, she says.

Across town are the equally well-appointed offices of one of the pioneers of Botox, dermatologist Pat Wexler, who has been injecting patients with the paralytic agent for almost twelve years. Wexler is best known, however, for harvesting fat from her patients' butts and injecting it into their faces to plump up wrinkles, a method that inspired an episode of Sex and the City. In a sunny office at the back of her sprawling practice, past an area where Wexler keeps the fat of dozens of New York socialites and celebrities on ice, her husband, Eugene, sits stroking his fluffy white bichon and listening to Jim Morrison wail softly on his stereo. On his desk sits a mock-up he's made of a Harper's Bazaar cover, with his wife's face superimposed on Britney Spears's body. The headline reads SEX AND POWER. A practicing urologist at Beth Israel Medical Center for fifteen years, he quit performing cancer surgery last year to work in his wife's office, treating women with unsightly veins.

"My life has changed 100 percent for the better," says Eugene, padding across the room in Sergio Rossi mules. "I was good at what I did, but when you get to the point where you get up every morning not wanting to go to work, you can't give in the same way. Now I'm doing something which, although cosmetic, is important to people. And I don't have the stresses of dealing with life and death every day."

It's not particularly surprising that, as aesthetic dentist Irwin Smigel puts it, "everyone wants to be Pat Wexler now." What's surprising is how many physicians are doing something about it. "They're all going into beauty rather than what they were trained for," Smigel says.

David Narins, who was a cardiac-surgery resident before becoming the head of urology at White Plains Hospital, has also joined his wife's dermatology practice, where he works on veins, uses anti-aging lasers on patients' faces, and does hair transplants. He and Rhoda Narins actually share a desk, and they work facing one another in their office off Fifth Avenue. He wears a dark-blue suit with a bright Hermès tie, and a pair of dark laser-protection glasses hangs around his neck -- the only suggestion of a medical uniform. "It's not like doing cancer surgery," he admits. "But I'm still a doctor. I look at wrinkles as a clinical problem. And, you know, when I was doing cardiac catheterizations and invasive procedures, my patients were asleep; now they're awake. I get to have conversations with them, and they're so appreciative of what I do."

Challenged by declining fees for medical services, increased rates for malpractice insurance, and the enormous hassle of dealing with HMOs, doctors in all specialties have been joining the beauty gold rush, turning to aesthetic elective procedures in place of traditional medical ones. Some are abandoning existing practices and reinventing themselves; others are just adding lucrative cosmetic treatments to their practices to create medical-aesthetic hybrids -- ophthalmologists who do laser facials, dentists who do "smile lifts" and Botox. They're capitalizing on the boom in anti-aging technologies, answering the demand for vanity procedures, piggybacking on the spa trend. In the process, they're trading in their distinguished but spartan offices for posh, soothing, salon-inspired surroundings. Above all, they're opting for more money and less heartache.

Physician's Medical Law Letter recently sent out a questionnaire to 100,000 subscribing doctors nationwide, asking if they would be interested in expanding their practices into fields including spa medicine. The response was 70 percent positive. "Most of these people are surgeons with years of training; I didn't think they would be that interested," says publisher Bill Priest. "I see it as a backlash. Doctors' salaries in general have decreased by 10 percent over the last few years, even in the midst of inflation, and malpractice insurance is prohibitive. Some doctors have started selling creams and lotions to offset the losses."

"Why should a guy want to remove someone's gallbladder for $500 when he can get $500 for giving a shot of Botox?" asks Alan Matarasso, one of the city's top plastic surgeons. "When I went to college, someone who had a 3.8 went to medical school. They could be assured of a gratifying profession and financial security. Now a Wall Street guy in his first year out of college can make more than a doctor who gets out at 35 and has to pay back loans on $35,000-a-year tuition. And what does Medicare pay him, $10 a visit? That's what's inspiring everyone to give Botox."

"Unless you are a very, very dedicated person, it is too difficult to be in medicine nowadays," says Eugene Wexler. "There are no doctors sitting in their offices on Park Avenue anymore. They are running around to four or five different places, a clinic here, a clinic there, a union health facility. A doctor can do three boroughs a day, plus the operating room. It gets to you after a while -- you start to burn out. Almost everyone in New York is with an HMO, and you have to hire extra staff just to do the paperwork. I don't know one doctor I spoke to when making this change who wasn't jealous. In fact, I don't know too many doctors, aside from cosmetic doctors, who aren't looking to get out of medicine."

The aesthetic influx is even making Pat Wexler worry. "The romance has been taken out of medicine," says the bubbly redhead, who has designed cosmetics lines for Donna Karan, Calvin Klein, and Almay. "Physicians feel they are working for Big Brother. They can no longer make their own decisions about a patient because their course of treatment is rejected by HMOs. People involved in oncology and surgery have to deal with so many frivolous lawsuits that take years to litigate. In beauty, you are independent; you don't have to answer to anyone. In a few years, there aren't going to be doctors practicing who are in love with what they are doing. You and I are not going to be able to get good medical care. Eugene didn't leave because of the compensation. He left because he was frustrated with the system."

Not all doctors are welcoming the cosmetic newcomers. A turf war is brewing over the lucrative area of aesthetics. Dapper Madison Avenue dermatologist Steven Victor is not smiling when we encounter him at his "rejuvenation center," where he offers vitamin shots to eradicate cellulite, as well as Botox, collagen, and a full artillery of lasers. He used to give a postgraduate course in cosmetic dermatology but has decided to stop sharing his knowledge. "My enrollees were gynecologists, cardiovascular surgeons, pediatricians. I even had a psychiatrist," he rails, his face reddening. "I don't think it's ethical. Some of these guys are taking a course and watching -- not even doing -- the procedures. Then they go out and buy the instruments. It would be like me doing brain surgery. My medical license says I can."

Gerald Imber, a well-respected cosmetic surgeon who caters to a good chunk of New York society, tells how he recently got a call from a physician in Los Angeles, asking if he would be good enough to remove stitches from one of his patients who had received a hair transplant and would be in New York. "I looked into who this doctor was, and he turned out to be an eye doctor," says the incredulous Imber. "The best part was that he asked me not to steal his patient."

"You know what I'm doing today?" asks Suzanne Levine, a podiatric surgeon who looks something like Debbie Harry. She and her partner, Everett Lautin, a radiologist, call their office "Institute Beauté," where he offers Botox, laser hair removal, and facial rejuvenation, and she performs callus-blasting microdermabrasion and gives collagen injections to cushion the foot. "I'm at Bergdorf giving foot facials. I'm bringing my services to their Buff Spa two days a week. We also give out Orthochics -- inserts you wear with Manolos and Jimmy Choos. Very fashionable." She smiles. "My gynecologist is doing laser hair removal now. I find that strange, but, you know, when I was in for a checkup, it was right there, and I was tempted to do it. I'm busy, and I like one-stop shopping."


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