The body business |

The body business

Eben Harrell
Dr. Tim Kruse in his Glenwood Springs office. Dr. Kruse specializes in botox, and estylane applications as well as hair removal. Aspen Times photo/Paul Conrad.

Beauty is big business. From makeup to earrings to clothing, Americans spend billions of dollars each year trying to make themselves seem younger, fitter, more beautiful.Although it has existed for years, plastic surgery is making a strong case as the current fad in how to look fab. Larger breasts, glacially white teeth, pouted lips – the “enhanced” look is becoming increasingly mainstream. And while network television shows such as “The Swan” and “Extreme Makeover” have brought the spectacle of plastic surgery to the masses, the cost of procedures – often several thousands of dollars – mean that surgery often remains in the realm of the relatively wealthy. In some circles, you aren’t anyone until you’ve had the circles under your eyes removed, your breasts enhanced, your tummy tucked, or some part of you surgically altered.Yet there are a host of smaller, noninvasive procedures that are less expensive and can be performed in doctors’ offices rather than surgery suites. Botox injections, which smooth skin and decrease wrinkles, cost as little as a couple of hundred dollars, about the price of a day at an upscale spa.

These cheaper options have enticed many family practitioners to offer cosmetic procedures too.Here in the Roaring Fork Valley, elective plastic surgery is shaping the future to some degree. The financially struggling Aspen Valley Hospital is considering marketing itself as a destination plastic surgery clinic in an effort to attract well-to-do patients and bolster revenues. Local doctors are similarly expanding their offerings to include noninvasive cosmetic procedures in an effort to expand their coffers.But just how lucrative is plastic surgery? And who is making money through its practice? The answers might surprise you.At Aspen Valley HospitalStill recovering from a financial crisis that nearly forced it into bankruptcy, Aspen Valley Hospital is now looking for ways to increase income. It’s a challenging prospect. On the whole, the hospital has little control over its business – people either get sick or they don’t; they either need to be taken to the hospital or they take a couple of Advil and call the doctor in the morning.The one exception is “elective” procedures, noncritical surgeries that people choose to have done at Aspen Valley Hospital. The hospital makes money on elective surgeries through the use of its facilities – AVH charges for operating room rental time, surgical supplies, labor of its operating staff, etc. It’s not a complicated formula: The more elective procedures done at AVH, the more revenue.

So AVH recently announced it is in negotiations to partner with a local plastic surgeon in an effort to make Aspen a destination plastic surgery center. In this model, Aspen would be the destination out-of-town patients choose when shopping around for a place to have plastic surgery. Of all the changes AVH is currently considering, this one is creating the most buzz.Paradoxically, plastic surgery is no more lucrative than other elective procedures, at least according to hospital CEO David Ressler. In an interview last month, Ressler said the type of surgery being performed in the hospital’s operating theater has little impact on the hospital’s fees. Where plastic surgery stands to make money for the hospital is by increasing volume. If the demand is high, there will be more surgeries. The more surgeries, the more money.”I don’t think plastic surgery is quite the cash cow people think it is,” Ressler said last month. “It’s no different from other elective surgeries. What makes it a viable option is that the demand for plastic surgery is high right now.”At the center of AVH’s planning is Dr. Dennis Cirillo, who opened The Aspen Institute for Plastic and Reconstructive Surgery 12 years ago and has seen his business grow steadily since. Cirillo, the only plastic surgeon in Aspen, offers a more optimistic prognosis than Ressler. He said that along with increasing volume, elective plastic surgery is inherently more profitable than other elective surgeries because it cuts out the middle man – the insurance carrier.”Most plastic surgeries are not covered by insurance, so patients pay upfront,” he said. “This increases the hospital’s cash on hand and prevents the many months it often takes to collect an insurance payment.”One of the reasons Cirillo claims AVH can become a destination clinic is because his own practice has become precisely that. While as much as 30 percent of Cirillo’s work is noncosmetic – post-cancer breast reconstructions, post-accident facial reconstructions and burn treatments – the vast majority of his business is elective procedures. And 75 percent of those elective procedures are performed on second-home owners and visitors to Aspen.

“Second-home owners are a huge opportunity for this community,” Cirillo said. “Aspen is an ideal place to come have plastic surgery in relative anonymity. My patients already do that all the time. The destination model is one that can work. I’ve shown that with my own practice.”Ressler and Cirillo agree increasing elective cosmetic surgeries at the hospital will benefit all community members in the long run – the extra revenue will be put back into the hospital, helping support essential services such as the pediatrics and obstetrics departments. But it’s a tough sell.”Sometimes I feel like it’s me against the world,” Cirillo said. “Too many full-time members of the community don’t see the potential of second-home owners as patients. I believe they are vital to the survival of community institutions such as the hospital.”What local doctors are doingWhile Cirillo and Ressler focus on how plastic surgery can bolster revenues at Aspen’s public hospital, a handful of local physicians are banking that cosmetic procedures also can help on a smaller scale.Although Cirillo is the only Aspen doctor licensed to perform plastic surgery, any doctor can become certified to administer lesser procedures such as Botox injections and laser hair removal (Cirillo said too easily, but the fact remains).Dr. Tim Kruse is in the process of moving his Glenwood Springs practice to Basalt. A family practitioner by training, Kruse went to a five-day conference a few years ago to learn how to give Botox injections and laser treatments. He said these procedures are popular among a host of patients.”I got into this because I saw an increase in the demand of patients,” he said. “It’s not just the high-end people who see a blemish in the mirror and want to take care of it.”

Kruse said income from cosmetic procedures has only bumped up his revenue about 10 percent. But direct income is only one of the benefits. “Botox lasts around four months, so there’s a good chance a patient will return for more treatments,” he said. “Also, my practice has definitely grown on the whole. A patient may come in for a cosmetic procedure, like what I have to offer across the board, and then use me as their primary-care physician.”Kruse is not the only doctor who is wise to the benefits of cosmetics. Dr. Ron Razzore recently stopped seeing patients at Aspen Medical Care to open the Aspen Center for Cosmetic Medicine. He now offers Botox, threadlifts and other nonsurgical procedures. Although Razzore could not be reached for comment, a former patient of Razzore’s, who also happens to be an Aspen Times reporter, said that one day, out of the blue, he was transferred to another doctor and told Razzore was no longer seeing general medical patients.Everyone involved in plastic surgery, from Ressler to Cirillo to Kruse, agrees the stigma once surrounding the field is starting to lift. With both the local hospital and local doctors trying to cash in on a hot trend, cosmetic surgery will likely continue to change the face of the Roaring Fork Valley.”It’s not necessarily a bad thing to want to look a little better,” Kruse said. “Aspen is a beautiful place inhabited and visited by beautiful people who want to stay that way.”Eben Harrell’s e-mail address is

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