Question: What are Beverly Hills Botox docs doing in Spokane?


Answer: Learning.


Spokane dermatologist Dr. Philip Werschler has found a niche in teaching other physicians the latest innovations in the emerging field of nonsurgical cosmetic procedures.


Nonsurgical facial restoration is an alternative to under-anesthesia, cut-and-sew surgeries, Werschler says. Its one of the fastest-growing medical areas. Thats really our specialty.


Werschler co-owns Aesthetic Image Inc., at 524 W. Sixth on the lower South Hill, and performs cosmetic procedures there. He also operates the Spokane Dermatology Clinic, with offices on Spokanes South Hill and in Spokane Valley.


Werschlers practice is certified as a national Botox training center by Botox manufacturer Allergan Inc., of Irvine, Calif., and Werschler is recognized by that company as a member of Botoxs national education faculty.


Botox is an injectable drug intended to smooth wrinkles and other lines, most frequently those that appear on a persons face.


Physicians who seek training from Werschler typically have been schooled on Botox procedures previously, but are learning new applications from him. For example, he says, a physician might use Botox routinely to make wrinkles between a patients eyes less noticeable, but might want to see how it would be used on wrinkles around a patients mouth or neck.


Linda Stokke, Werschlers partner in Aesthetic Image, says a physician who seeks training typically will spend day observing Werschler and assisting him with procedures. Werschler declines to disclose the charge to physicians.


On average, one physician a week comes to the center to shadow Werschler, and that portion of Aesthetic Images business has grown to the point that it now accounts for roughly 20 percent of the clinics total revenue, Stokke says.


That will be growing because of new procedures coming in the future, she says.


Werschler estimates that about a third of the physicians who come to him for training are from Southern California, a third are from the Pacific Northwest, and a third are from elsewhere in the U.S. or other countries.


Most of the doctors who offer nonsurgical cosmetic procedures are dermatologists, like Werschler. Others typically are in one of three specialties: plastic surgery; ophthalmology, with an oculo-plastic surgery focus; ear, nose, and throat facial-plastic surgery. Some dentists who specialize in oral surgery also offer the cosmetic procedures.


Botox is the most widely recognized of the nonsurgical facial reconstruction procedures, but Aesthetic Image offersand Werschler trains other physicians ona number of other procedures.


Some are injection procedures, as with Botox, in which a substance is injected via hypodermic needle just underneath the skin to create a desired effect.


For instance, another injectable substance is called Sculptra, which is intended to make a persons face look more full. The U.S. Food and Drug Administration recently approved the use of Sculptra for people who experience a condition called lipoatrophy, or facial fat loss.


Botox typically is administered once. Sculptra involves three treatments over the course of four weeks.


Other procedures are more involved. For instance, thermage is a procedure in which pulses of radiofrequency waves are transmitted into a patients facial skin, ultimately heating and shrinking it. This is referred to as a thermal facelift, Werschler says.


The cost of such procedures varies dramatically, and as with other cosmetic procedures, insurers wont pay for them in most cases. Stokke says an average Botox application is priced at $385, while a thermal facelift costs $2,400.


Werschler says Botox remains the most popular procedure at Aesthetic Image, and the company administers a lot of it. At a recent Botox convention, Allergan Inc., the Irvine, Calif.-based company that makes the substance, disclosed a list of the centers to which it distributes the most Botox. Aesthetic Image ranked in the top 35 such centers nationwide.


The popularity of Botox has opened the concept of having work done to a much broader swath of the population, than might have considered a more expensive and invasive surgical procedure, Werschler says.


Aesthetic Image is whats referred to as a medical spa, because it offers a mix of spa servicesmassages and facials, for instancealong with cosmetic medical procedures.


In addition to learning new techniques and sharpening skills, many physicians are coming to Aesthetic Image to see the clinics medical-spa business model, Werschler says.


Medical spas are growing in popularity, he says, but physicians often struggle to balance the cozy feeling of a spa with the more formal feel of a physicians office, he says.


In many cases, medical spas end up with the feeling of a beauty parlor with a doctors office to the side, or at the other end of spectrum, a sterile physicians office with a warm spa-like room to the side.


Werschler says visiting physicians see the medical operation, but they also want to see the integration.


Werschler previously had a spa-like room at his dermatology practice in the late 1990s, but in 2000, he and Stokke opened Aesthetic Image to focus specifically on cosmetic medicine and spa services. That clinic employs 23 people, some of whom split time between there and the Spokane Dermatology Clinic.