Playing “Let’s Make a Deal” with Your Dermatologist


Aestheticians now offer competitive services that only doctors used to provide, giving you options in skin care.

Acne scar “revisions” and laser treatment of skin roughness and discoloration after acne heals can get really expensive. It is not at all unusual to want treatment before you can afford to pay cash. And it’s not at all unusual to feel like a contestant on TV’s Let’s Make a Deal as you politely tell your doctor that you will have to take a take it or leave it stance on treatment that simply costs too much.

In the United States it was once considered socially unacceptable—too vain—to spend large amounts of money on one’s appearance. For men, any investment in cosmetic treatment at all opened them to ridicule. For women, expenditures on beauty care that competed with mortgage payments, retirement savings, or sending the kids to college was also frowned upon.

Television programming has changed American attitudes about spending money on cosmetic procedures. The ABC series Extreme Makeover has caused many people to open up about how much they spend on skin care to fight aging, and increasing frequency of divorce, remarriage, and mid-life career change make many Baby Boomers “in the market” for cosmetic improvements of all kinds.

Aestheticians vs. Dermatologists

Another new development in the United States is the emergence of day spas that compete with dermatologist clinics. In the 1960’s and 1970’s, there were only a few dozen aestheticians operating skin rejuvenation salons in the whole of the United States, although hairdressers and nail salons often sold beauty products.

In 2011, there are thousands of aestheticians offering high-quality skin care that directly competes with many of the services only doctors used to provide. Only doctors can perform surgery, but licensed cosmetologists may offer dermabrasion, microdermabrasion, and skin peels that were once only available at the doctor’s office. Doctors of dermatology feel pressure both to house their practices in buildings that have a spa-like feel, and to lower their fees for certain procedures to match those charged by aestheticians.

What Can an Aesthetician Do For You That You Can’t Do for Yourself?

There are gentler, safer versions of many of the procedures offered by aestheticians and dermatologists that you can do at home. There are at-home chemical peels, microdermabrasion, and even laser treatments. While most home versions of popular skin treatments only require an initial investment of US $100 to $300, getting results from home treatments also takes months when treatments from either the aesthetician or the dermatologist only takes weeks.

You may spend $500 on home treatment and get visible results in a year, or $5000 at a day spa or dermatologist’s office and get better results in a month or two. Most people really do get a better look from professional skin care.

Where to Get Cash for Treatment

Many people borrow money for skin care. CareCredit, Citibank Health Card, GE Care Credit, and Chase Health Advance all finance dermatological procedures at a relatively low rate of interest, probably more than you would pay on your car loan but less than you would pay for a credit card. Doctors are encouraged to recommend these lenders to their creditworthy patients.

Not everyone qualifies for loans at low rates. If this is your situation, chances are that your doctor will also accept Visa, Mastercard, Discover, and American Express. But if your doctor accepts various forms of patients, he or she is likely to realize that other doctors do, too.

It’s probably more comfortable for you to have a discussion with the doctor’s office manager than with the doctor herself or himself. But if the doctor accepts payment plans, the doctor may also be willing to negotiate prices.

Walk Away from Sticker Shock

The Internet is not a good place to research the cost of most acne skin correction procedures. The low prices you see on the Internet may refer to treatment outside the USA, or they may be faked. Don’t assume that any doctor you consult will try to match them.

But don’t settle for sticker shock. If during the initial consultation the doctor or the office manager quotes you one price, say $1000, for a procedure, and you are presented with a bill for a much higher amount after the procedure is done, say $5000, make sure you have an acceptable explanation. (“Oops there was more bleeding than I anticipated” or “We did not anticipate your skin type would react violently with this medication” is not a reason to bill you more.) Even better, get terms of service in writing before you start treatment.

Realize that the Screening Process Works Both Ways

Sally had wanted to do something about the brown spots on her temples and cheeks ever since she had had acne as a teenager. Nothing she tried on her own worked, and she didn’t get good results from the aesthetician. Finally, she made an appointment with a dermatologist for an initial evaluation.

“I can treat your skin discoloration with CO2 laser,” the doctor said, “but the total cost of your treatment will probably be between $2500 and $10,000. Could you manage the cost if I arranged a no-interest payment plan of $200 a month.”

If Sally answers “no,” then the doctor is likely to be unavailable for further consultation or treatment. Doctors sometimes mention money as part of their own screening process to make sure they are spending their “free” consulting time profitably. You may be offered a payment plan during your initial consultation, or you may get a call from the office a week or two later offering a payment plan to encourage you to being acne revision treatments. You may also be offered a payment plan if you ask about other cosmetic procedures. Older adults are less likely to be offered payment plans because they are usually assumed to have more money.

Just don’t forget to consider the total price of your care. It’s great when doctors are able to accommodate your need for monthly payments, but it is critical for your financial health to consider the total cost of medical care, not just the monthly cost of medical care.

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