It's not the usual staff for a new hospital program.
One is a personal trainer and state bodybuilding champion. Another is an aesthetician who also works in a Pikesville salon.
And it's not the usual hospital program. It offers a fairly typical range of cosmetic surgeries -- face lifts, breast enhancement, tummy tucks, fat suctioning, skin peels, eyelid shaping, injections to erase veins. But it also offers massages, "hair presentation," cosmetic advice and personal fashion shopping.
"A few years ago, I realized that a patient was coming in for a breast change or liposuction, and it wasn't giving them everything they were looking for," said Dr. Dean Kane, medical co-director of the new cosmetic surgery program at Mercy Medical Center. "They were looking for a lifestyle change, and that means more than bigger breasts or slimmer hips."
So Kane's wife, Lauri, got training in skin care, to help provide more help for his patients. She is now the program director for cosmetic surgery at Mercy. The Kanes next began to work with Melyssa St. Michael, the bodybuilding champion who develops exercise and nutrition programs. Gradually, they began to add the other services into their practice.
The Kanes then made a proposal to Mercy, and the program was established. Dr. Sheri Rowen, an eye surgeon who does cosmetic eyelid procedures as well as ophthalmological surgery, is medical co-director.
The Mercy program comes at a time when cosmetic surgery is growing and becoming more competitive.
Just from 1994 to 1996, the number of cosmetic procedures nationally jumped by 21 percent, from 2.6 million to 3.2 million, according to the American Academy of Cosmetic Surgery.
"Cosmetic surgery is definitely getting more competitive," said Dr. Richard Dolsky, a past president of the cosmetic surgery academy.
Dolsky, who practices in the Philadelphia area, said the rapid growth of managed-care insurance has made it harder for patients to get referrals to plastic surgeons and dermatologists for noncosmetic procedures. At the same time, reimbursement rates have been cut.
As a result, more of those physicians are turning to cosmetic procedures, which are paid for by the patient.
"You take an ophthalmologist who went into ophthalmology to do cataracts, Dolsky said. "He finds his reimbursement for cataracts is low, and he will be doing eyelid surgery and skin peels and laser resurfacing."
Pay out of pocket
Hospitals, too, are finding cosmetic surgery attractive, since the patient pays for it out of pocket (unless there is a medical reason, such as reshaping eyelids that are obstructing vision).
"They are looking to fill the operating rooms with people who are in and out and where the money is received upfront, as opposed to two or three or four months later when the insurance company pays," Dolsky said.
About a third of cosmetic surgeries are performed in hospitals, about a third in free-standing surgical centers and about a third in doctors' offices, according to the American Society of Plastic and Reconstructive Surgeons.
In this competitive environment, it is not unusual to find surgeons adding other services.
"They realize there is more to cosmetic surgery than just performing the surgery itself," Dolsky said. "It really does have ties with the makeup industry and the cosmetic industry and the weight-loss industry."
The market in this area is as competitive as any. The society of plastic and reconstructive surgeons says Maryland ranks third in the number of its members per capita.
Dr. Lawrence Pinkner, a plastic surgeon who practices in Owings Mills, says he has added an aesthetician to his own practice, to deal with skin problems that require more aggressive treatment than over-the-counter preparations but less than laser resurfacing or chemical peels.
But while some cosmetic surgical practices have been adding some of the services Mercy has, Pinkner added, "I don't think too many offices have that broad a spectrum."
Pinkner, who does his surgery at the free-standing SurgiCenter of Baltimore, of which he is president, said some other hospitals, such as Northwest Hospital Center, have been attempting to attract cosmetic surgery business by offering sophisticated equipment and operating space.
Mercy has been developing a strong program in women's health, and when the Kanes made their proposal, "it looked to all of us doing strategic planning that it would fit in very well with women's services," said Dr. Marcos J. Pupkin, chairman of obstetrics and gynecology at Mercy. He oversees the hospital's Center for Women's Health and Medicine.
Having the program in a hospital makes sense, Rowen said, because resources can be shared. For example, the surgical laser she can use for cosmetic eyelid work, which costs about $120,000, is also used by the hospital's obstetrics departments for other procedures.