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.”
Lautin has just returned from lecturing in Mexico at a convention of plastic surgeons. A radiologist for nearly 30 years, he did procedures such as angiograms and biopsies with cat-scan guidance, and, until last summer, trained residents and medical students. When he hit 50 and was suddenly single after a divorce, he became fascinated with youth-enhancing lasers and injections and began trying them out on himself.
“I was back in the dating field, lonely and out there,” he recalls. “I related to people who wanted these new procedures. I actually meet women now through my patients, and we’ve introduced a fair amount of our patients to other people. We’ve ended up with a dating service as well as a practice.”
Jamé Heskett, a perky, L.A.-born 33-year-old who, with her blue eyes and blonde hair, looks more catalogue model than doctor, delivered more than 300 babies as a family practitioner in Seattle. She liked to integrate holistic therapies into her patient care, which did not go over well with her local hospital, she says. So she bought a spa on Madison Avenue that specialized in endermologie, the vacuumlike treatment meant to combat cellulite. She calls her office Wellpath and practices a female-focused mix of Western medicine, holistic therapies, nutrition, and anti-aging treatments in an environment that feels like a Middle Eastern caravan, with Arabian tents and wafting aromas. “Obviously, we use the endermologie cosmetically, but we also use it for therapeutic purposes. It really helps with arthritis, fibromyalgia, and circulatory problems,” she maintains. In addition to Pap smears, breast exams, nutritional counseling, and blood analysis, Wellpath will be adding facial laser resurfacing, to diminish wrinkles.
These added cosmetic services don’t always make a seamless fit. Jay Matut’s West 77th Street OB/GYN practice is filled with women in various stages of pregnancy and others there for their regular checkups. Matut is now offering a new cutting-edge product, but it has nothing to do with birth control or hormone replacement. The Brava system is a set of suction domes that fit into a bra-shaped contraption. If you wear it ten hours a day for ten weeks, your breasts are supposed to increase a full cup size. “We’ve got the patient profile,” says Matut defensively. He says that he and his partners are also considering providing laser hair removal.
Michael A. Boxer, a model-dating ophthalmologist, sits on a bench in East Hampton sunning himself after a recent spinning class. “I took a course in CO2 laser resurfacing of the skin, and I’m now certified to do it,” he says. “I see mostly cataract patients, and I can only charge what Medicare tells me. My cataract fees were between $2,500 and $3,500; now my reimbursement is $700 to $1,000, and that includes three months of postoperative care. I’m sitting in an office with very expensive equipment. There are lots of doctors who have a hard time saying no to giving a quick Botox injection when the remuneration is $400 to $500.”
Bobby DiPilla and Peter Rinaldi, partners of cosmetic dentist Larry Rosenthal, are at the bar of Bella Blu, fresh from a trip to London and flashing smiles as perfect as Christie Brinkley’s (she’s a patient). Their visit was co-sponsored by Q-Med Esthetics, a company that markets the wrinkle filler Restylane to dentists in England, with plans to expand into the U.S. “There’s a paradigm shift,” DiPilla says enthusiastically. “Who better to inject silicone, collagen, or fat into areas around the mouth than an aesthetic dentist who knows nerve intervention in the area. You get your teeth done and then the lines around your face.”
The two, along with Steven Victor and plastic surgeon Thomas Romo, are planning a network of rejuvenation centers. “We’re opening them in Moscow, Palm Beach, London, Paris, and Milan,” says DiPilla. “People can fly to a great locale and in a week look fifteen years younger. It’s really exciting. We’ll have cosmetic dentistry, plastics, anti-aging, and nutrition. We may also have connecting wellness centers with yoga and Pilates. Money is part of it, but it’s a good marriage.”
“Not all doctors are into this stuff,” Rinaldi points out. “We have one patient who is an old-school dermatologist in New Jersey. She just wants to cut out cancer. But there’s still a need for those people, too.”
Cheryl Ackerman, the doctor in question, is concerned about her profession and the fact that a lot of the big cosmetic dermatologists don’t even bother to become board certified. “I think it’s a big problem that a lot of these guys don’t know regular dermatology and don’t do body scans. I’m turning up a couple of melanomas a week.”
Ironically, it was the now-aggrieved plastic surgeons and dermatologists who blurred the borders of aesthetic medicine to begin with, as plastic surgeons edged into dermatological turf by launching skin-care lines and dermatologists started doing liposuction, formerly the realm of plastic surgery. Anyone with a medical license can perform procedures outside of his specialty, and there is no set guideline for qualifications.
“People are taking out ads, calling themselves ‘board certified,’ but they can be certified in a completely different area from the one in which they are working,” says Richard Palu, an ophthalmic plastic surgeon. “And since the environment has become more competitive, there’s so much mudslinging it’s like the Academy Awards.”
There’s even controversy over who can use the term “plastic surgeon.” Ear-nose-and-throat doctors are not technically board certified in plastic surgery, but some call themselves “facial plastic surgeons” – a move that’s infuriating some plastic surgeons, who are trying to pass a scope-of-practice bill in Albany to prevent them from doing so.
While the merits of training in some procedures can be measured by schooling, a lot of the techniques weren’t around when most of the top doctors now practicing went to school.
“When we did our residencies, Botox and cosmetic lasers didn’t exist,” says Barry Drucker, a Bayside, Queens–based ophthalmic surgeon who does cosmetic eyelid operations. “We are all learning these procedures at the same rate.”
“I was one of the first to get the liposuction machine from Paris back in the eighties,” recalls Rhoda Narins. “The plastic surgeons all gave me a hard time because I was a dermatologist, but they hadn’t learned liposuction in school. I started teaching a course, and they showed up. Now they send me their wives.”
“Dermatologists didn’t go the surgery route in school, and they don’t have real surgical training,” insists Thomas Romo, head of facial plastic surgery at Lenox Hill. “But now they think that anything under the skin is their domain.”
Paul Tanners, a dentist for 34 years, has actually invited a young plastic surgeon, Michelle Zweifler, to join his practice. She’s offering Botox and collagen injections to patients along with their cleanings, and Izamar Everett, who worked for over 25 years in a salon and spa, has come onboard to provide massage.
Tanners is a jolly man who wears a button bearing the photo of his 13-year-old son, as if the boy were running for office. “I would call this a mini-spa,” he says joyfully, sitting back in his chair, oblivious to the fact that flecked carpeting, bookshelves filled with dental texts, and sets of plaster choppers are not the stuff Bliss is made of.
Reconfiguring their offices as “spas” is increasingly common among doctors, and while it’s hard to argue with the impulse to make clients more comfortable, some of the services they offer – from facials to endermologie – don’t always have scientific backup. “If a service is done in a doctor’s office,” says Matarasso, “it should be medically sound. And I think a gym is not the proper environment for Botox. This is a medical treatment, not a haircut, and it comes with consequences.”
But on a bench overlooking the pool at Equinox on 63rd Street, casually dressed men and women seem to enjoy the setting. They’re waiting to enter one of the treatment rooms that have been converted into offices for plastic surgeon Stephen Bosniak and ophthalmic surgeon Marian Cantisano-Zilkha, who also have offices on East 64th Street. “At first, we thought this would be mostly for the club members,” says Bosniak. “But it turns out that our regular patients prefer coming here because the music and candlelight relax them. Now, except for surgery, we’re seeing most of our patients at this location.”
At Lana Rozenberg’s 54th Street dental office, candles are burning, softening the fluorescent lights, and the New Age track “Songbirds at Sunrise” plays in the background. Medicinal odors are masked by the scents of clove- and cardamom-filled herbal wraps, placed around the necks of patients to lull them into relaxation. Like so many dentists’ practices, Rozenberg’s has become increasingly cosmetic; Henri Bendel is even selling her skin cream for the neck and jaw area, and she’s working on a lip balm and a candle. In the back room, her aesthetician Polina does double duty, performing the Lift 6 facial with a mechanical gizmo designed to tone muscles and give the face a more youthful appearance. Rozenberg doesn’t seem bothered by the fact that her hard-earned dental degree now shares wall space with a diploma from Lift 6’s two-day training program.
“This isn’t a regular dentist’s office – it’s an extension into the next level,” says Rozenberg, an unlikely spa front woman with earth-colored hair wisping at the temples and no makeup to enliven her urban pallor. “We want to offer something more fun than having your teeth poked. I was apprehensive at first; I thought people might find it strange. That’s why we included only neck and face treatments. But people really like it – men in particular. They don’t say they’re going to a spa; they say they’re going to the dentist.”
“Everyone is vying for the same elective dollar,” points out Levine. And the race is just starting to heat up. As for his colleagues opening spas, Imber says, “In some ways, it demeans our primary mission, and in other ways, I suppose it’s a good fit. But I would no sooner be in the spa and beauty business than in construction. Everyone is trying to get there first, and there will be a glut of these services soon,” he continues. “There’s just so much business. A certain number of people will succeed at it, and others won’t. Then maybe doctors will get back to the business of being doctors.”