A Dallas hospital has reasons for offering plastic surgery

Last week, amid the usual junk mail at my house, there was a flier pitching the latest procedures and "groundbreaking advancements" in plastic surgery.

"Find out what's fact and what's fiction, and the best ways to achieve the look you want, for the holidays and beyond," it read.

It touted a two-hour seminar with snacks, door prizes and the chance to talk one on one with doctors. Some of its surgeons, the ad noted, had appeared on Oprah, The View and Good Morning America.

What surprised me was the source of the hard sell: the University of Texas Southwestern Medical Center at Dallas.

This institution is one of the world's top-ranked teaching and research hospitals, renowned for its work on cancer, diabetes, neurology and much more. It's had four Nobel Prize winners since 1985.

And now it's canvassing for customers interested in tummy tucks and Botox injections?

Maybe I'm using a double standard here. Elective cosmetic medicine has been a booming niche, with the number of procedures growing 69 percent in the past decade. It brought in $10 billion nationwide last year, according to industry surveys, and because treatment is rarely covered by insurance, it's especially lucrative.

But doesn't UT-Southwestern have better ways to use its time and talent? With all the problems in healthcare, how does it justify drumming up this vanity business?

"This is an important part of our mission," said Dr. Rod Rohrich, chairman of the plastic surgery department at the medical center. "The public is bombarded with all kinds of hype -- the one-minute face-lift, for instance -- and we're trying to make sense of it. We know what works and what doesn't."

UT-Southwestern does research on the techniques and products in the field, so it knows the latest developments. In November, Rohrich said, it will add a 17th faculty member, making it the largest plastic surgery department in the country.

"We should be the ones talking about this," Rohrich said.

Other big names in medicine do similar work. The Mayo Clinic offers cosmetic procedures, and Johns Hopkins and the Cleveland Clinic have their own cosmetic centers.

"It's always a surprise when a major research institution offers more lightweight services, but they can be part of the mix and help underwrite the central mission," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "As long as it's an appetizer, not the main menu."

The high-dollar payoff is a positive contributor, too, because it subsidizes other treatment that doesn't get fully reimbursed. But UT-Southwestern said it's not drawn by the financial upside.

Rohrich said it's trying to serve a community that's interested in this field and may be poorly served by some. Dallas-Fort Worth is one of the largest markets in the country for cosmetic procedures, and many people are sold on things that aren't right for them or aren't done correctly.

UT-Southwestern doctors are often called on to help fix cosmetic work that didn't work out, he said.

Training doctors is also a key part of its mission. It has 924 medical students and 1,300 clinical residents. While cosmetic treatment may not be life and death, plastic surgeons need to know how to do an eyebrow lift and lip augmentation, as well as facial reconstruction.

UT-Southwestern became more aggressive in consumer marketing about three years ago, after opening an outpatient surgical center. Cosmetic procedures account for 20 to 30 percent of treatment in the department, Rohrich said, with reconstructive surgery still the dominant category by far. The school doesn't disclose revenue for individual specialties, because of competitive reasons.

Botox treatments start at $400. Fillers for laugh lines are twice as much. Treatment with a noninvasive laser, used to trim body fat, costs $1,300 for six 40-minute sessions.

For those who want extra pampering, UT-Southwestern has six Medallion Guest Suites, private recovery rooms that cost up to $650 a day and include a full-time registered nurse.

Pumping up that revenue may not be UT-Southwestern's primary goal, but it's a nice side effect. Caplan said that all hospitals offer concierge-type treatment for high-paying customers, especially donors, and they frequently shift funds from one department to another.

"It's a reality that helps make the system go," Caplan said. "I'd rather see universal insurance provide minimum coverage for all. But if that's not going to happen, why not shift what rich people will pay for to what poor people need?"

The key is keeping a proper balance. UT-Southwestern appears to be doing it right, limiting cosmetic work to far less than a third of its practice.

But its marketing pushes the line, Caplan said. In a brief article in its latest in-house magazine, Rohrich addressed "just-in-time" tuneups for the face: With a week before a special event, intense pulse light treatments can reduce sunspots, he wrote.

That's not what you'd expect from UT-Southwestern, but it may be the evolution of a better healthcare model.

UT-Southwestern is largely known for its research, spending $406 million on 3,500 research projects last year. But a broad range of clinical services accounted for hundreds of millions, too.

"It's like the best-kept secret in Dallas," Rohrich said.

That's changing, even if it's one small procedure at a time.

Mitchell Schnurman's column appears Sundays and Wednesdays. 817-390-7821