Image Maker

Image Maker

Medi spas and a tougher economy have affected plastic surgery, but physician Randall Harrell has adjusted to the industry's non-surgical growth and has thrived.

COMPANIES by Dave Szymanski | Tampa Bay Editor

He has the training and testimonials to make his case, but Dr. Randall Harrell, a Palm Harbor plastic surgeon and inventor, doesn't use the words "good medicine" when describing his successful 20-year practice on busy U.S. 19.

Instead, he defines the Fountain of Youth Institute through the eyes of his patients, 80% of whom are women.

"It's all about looking better," Harrell, 56, says. "We're in the self-esteem business."

Everyone seems to need that personal boost, even his international and sometimes famous roster of clients, several of them successful people who stay at the Innisbrook resort with their families during their visit.

But the ways they are doing it are changing. Facelifts, liposuction and breast enhancements remain the most popular surgical procedures.

But many patients today are turning to non-surgical services, such as lasers, dermal fillers and botox injections, faster, less-invasive procedures which require little to no down-time.

In fact, non-surgical work, some of which helps minimize wrinkles and skin damage from sun exposure, removes body hair, tightens skin or hides veins, is the fastest growth area for Harrell and accounts for about 80% of the firm's new revenue growth.

Instead of fighting it, he's embraced it, adding equipment, training staff and adding health products to his Web site.

"We've seen the whole transition from the 1980s to the 1990s and beyond," Harrell says. "Before 1989, this business always involved some kind of cutting. There was not much non-surgical. Today there is."

That's one of the reasons Harrell has also become an inventor and entrepreneur, developing an anti-wrinkle product he is trying to get a patent for.

Although his patient load has increased, the industry growth has leveled off in the United States, hovering between 11.3 million and 11.8 million surgical and non-surgical procedures a year.

Busy practice

Spanish explorer Ponce de Leon spent a lifetime searching for the legendary fountain of youth. Four hundred years later, Harrell created a clinic by that name.

A Georgia native, Harrell spent time in Florida with his Jacksonville grandparents when he was a boy. Jacksonville is an hour's drive from St. Augustine and the Fountain of Youth National Archaeological Park. Harrell loved the park. He loved the possibility of immortality.

After training in Houston at the Texas Medical Center, Harrell, who sports a Robert Goulet-like short-trimmed moustache and jet-black hair, opened the Fountain of Youth Institute in Palm Harbor in 1989. It has since grown into a busy plastic surgery practice.

The lobby and waiting room are very un-clinic like. More similar to a hotel, with comfortable chairs.

As word of the clinic's success spread, overseas patients began coming from Asia and Europe. Harrell set up a concierge service in his office, complete with a private limousine at Tampa International Airport, to help patients with travel plans. He gets their pictures and does consulting over the telephone before they arrive.

As non-surgical procedures grew, Harrell developed a formula for a dermal filler for facial wrinkles based on a natural human collagen. The FDA test trials for that product will be done in the second quarter.

According to the American Society of Aesthetic Plastic Surgery, an association for board-certified plastic surgeons, industry revenue came in at more than $13.2 billion in 2007.

This year, the society expects a decline in surgery revenue, but an increase in non-surgical.

The industry, in recent years, has gone through a "shakeout," Harrell says, as the non-surgical medi-spa business grew "like wildfire." Medi-spas are businesses that merge medical procedures, non-surgical work and a spa environment.

Unlike medical clinics, there are no barriers to entry for medi-spas, so they multiplied quickly.

Sensing potential health problems, Florida required that medi-spas be run by medical directors. That has led to some consolidation.

Big player

Although he has not seen a dropoff in patients this year, Harrell says the economy has affected plastic surgery practices. Less wealthy patients find it tougher to get financing. Others delay surgery.

One of the bright spots recently for the industry was a big endorsement in December.

Health-care products company Johnson & Johnson said it would buy cosmetic-product and breast-implant maker Mentor Corp. for $1.07 billion in a move to boost its presence in cosmetic and reconstructive medicine. Harrell, who spoke with Johnson & Johnson officials, said the company wanted to be a leader in the cosmetic surgery industry. The deal is expected to close in the first quarter.

That injected some name-brand stability into an industry that more and more doctors are getting into, partly because they can bypass insurance companies and get cash payments from wealthier clients.

That caused a slight image problem for this image-molding industry.

Plastic surgery is one specialty with the longest required training. After four years of medical school, plastic surgeons get three to five years of general surgical training, then two to three years of plastic surgery training. Then the surgeons have to take written and oral exams in front of their peers.

"It's a long road," says Harrell, who was 36 when he finally opened his practice. "You've got to really love what you do."

The fundamental difference in this business, compared to other physicians, is obvious. While other patients go to general practitioners and specialists because they have an acute problem, pain or ailment, patients shop around for the best plastic surgeon partly because of the way they are treated and their comfort level.

That's why Harrell says he is in the "retail medical business."

Despite a heavy load of patients, one patient who visited the clinic said he met with staff to discuss options and then got to meet with Harrell who examined him briefly in a private exam room to go over the possible procedures. A financial specialist went over financing options. Staff followed up days later with telephone calls.

The patient compared this with the 15 minutes he got with his primary care doctor that year.

Then, there's the marketing side of the business. Model-like former Tampa WFLA-TV Channel 8 anchor Marissa Morris, Harrell's wife, promotes the clinic all over Harrell's Web site with narration, still photos of herself and TV-like interviews with patients. Morris has also appeared on billboards, promoting her husband's clinic.

Looking ahead

Despite some concerns about complications from breast implants, Harrell says 14 years of extensive FDA trial studies have found no evidence of breast cancer or autoimmune disease. As the population ages, he expects this - and procedures to lift breasts - to continue to be a popular service. More than 300,000 American women get breast enhancements every year.

The future should bring more consolidation among medi-spas and clinics. Medi-spas compete more on price, than the surgical clinics. There are still allegations that some are run by unqualified people.

The mom-and-pop operations should give way to larger spas and clinics with expertise in finance and marketing. More corporate ownership should improve patient care, he says.

Harrell's biggest CEO lesson? The need for good training for employees. Not always technology training, but service training.

"We need people who can do customer service," Harrell says. "Patients expect good people. They want a good experience."

A softer economy has some doctors concerned, but Harrell recalls that in the Great Depression, Americans still went to movies and hair salons to get an emotional lift.

It's not an exact analogy to plastic surgery, which carries thousand-dollar price tags, but it illustrates a possible bright future for the industry, he says.

REVIEW SUMMARY

Business: Fountain of Youth Institute

Industry: Medicine

Key: Offering plastic surgery and non-surgical services and products to help an aging population feel and look younger.

2009 plastic surgery trends

The American Society for Aesthetic Plastic Surgery asked plastic surgeons to predict the leading industry trends for 2009. Here is a summary of their answers:

An increasing diversity of patients.

The growth and popularity of cosmetic fillers (Evolence, Juvederm, Restylane) will continue to increase.

Increased plastic surgery following dramatic weight loss.

Reloxin will gain FDA approval and compete with Botox (the most popular cosmetic procedure for the past five years).

Men will represent a growing segment of the aesthetic surgery market. According to a February 2008 consumer survey commissioned by the Association, 57% of men approve of cosmetic surgery, and 20% would consider having cosmetic surgery.

As the popularity of non-surgical and minimally invasive procedures continues to grow, surgeons and manufacturers will develop new techniques and products that advance the science, produce better results and lessen recovery time.

Experimental techniques for non-invasive fat removal (SonoScultpt, UltraShape) as a future alternative or adjunct to liposuction, will continue be tested in clinical trials.