The Future of In-Office Surgery
Cosmetic surgery offices are designed to provide a limited number of services to mostly healthy patients. “We’re geared toward one thing, and the select procedures I do, I do over and over and over again,” said Dr. Steiger. “I think this is what allows us to provide not only a better experience, but better care, for our patients.”
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September 2021
My patients are grateful for the transparency—they know what codes we use, and they know upfront what the insurance might pay. —Diana Ponsky, MD
As the trend toward more in-office surgery grows, proponents of the practice expect to see pushback from those who prefer the status quo. “Doctors tend to do the things that they’ve been taught and not stray from them—often for very valid reasons—but the fact is that you can do plenty of procedures, even face lifts, under local anesthesia with oral sedation,” said Dr. Vila. “People who have never done that might think, ‘Oh my God, that’s crazy,’ but I can tell you from firsthand experience that it is possible to do it and keep the patient comfortable. I think there’s a whole wide-open field out there.”
Others who may not be keen on the trend of in-office surgical options are hospitals. “I believe they tend to push toward non-office-based procedures for monetary reasons, because they can get a facility fee and anesthesia fee out of it, and that’s sad because hospital-based procedures aren’t always the most convenient thing for a patient,” said Dr. Ponsky. “No one wants to take a day off work for surgery and have their family take a day off for a simple procedure that can be done in an office setting. That’s why I think office-based procedures are going to increase in the future.”
Dr. Pham views the issue from a historical perspective, noting that when nasal and sinus surgeries first came about, everything was done in the office. “Then somewhere along the line, we transitioned to doing everything in the OR. Now, the pendulum is swinging back,” she said. “I think finding the balance in approaches is key—matching the patient to the appropriate procedure and approach.”
Linda Kossoff is a freelance medical writer based in Woodland Hills, Calif.
The COVID Bump
Among the many incidental consequences of the COVID-19 pandemic has been a rapid increase in patients requesting in-office surgical procedures, especially cosmetic ones. “Prior to COVID-19, our office-based procedures were primarily mole removal, nasal septum cauterization, incision and drainage of little abscesses or infections, injections for acne or inflammation, and subcutaneous cosmetic procedures like fillers and Botox injections,” said Diana Ponsky, MD. But once the pandemic hit, demand for eyelid lifts and removal of excess skin “took off,” she reported. The reason? “Because we were in quarantine, patients could work from home and recover from more procedures,” said Dr. Ponsky.
In addition, patients hoped to stay out of hospitals and hospital-based emergency rooms because that’s where COVID-19 patients were taken. “So, patients that we would have seen at the ambulatory surgical center or hospital were now willing to get their work done in the office setting with local anesthesia and oral sedation,” Dr. Ponsky explained. “They were motivated to stay out of the OR.”
An especially vivid example was the case of a 7-year-old girl who had just fallen off a horse and was brought directly to Dr. Ponsky’s office. “Her bone was exposed. I told her parents, ‘Gosh, she’s 7 years old; you should take her to the emergency room and have them fix it there, where they’ll take her into the OR.’ At that time, they would only allow one family member in with the ER patient. And they said, ‘No, she’s tough as nails, she rides horses, let’s try this and if it doesn’t work, we’ll go to the hospital and have it done under anesthesia.’ And she did it! She let me clean her and fix her right there in the office. It was amazing, and the parents were so thankful that they didn’t have to go to the ER.”