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Editorial Spotlight | May 2017

Founding FIRM: An Aesthetics Clinic

Middle-aged patients who present seeking refractive surgery are interested in regaining a lost aspect of their youth. They want to get rid of their reading glasses and reclaim the crystal-clear vision they had in their younger years. Often, these patients think and feel younger than they are biologically. They maintain active lifestyles and busy professional and personal lives, and they want their physical age to mirror their mental age.


• The desire to reverse the effects of aging is addressed by both the ophthalmic and aesthetic specialties.

• Patients today maintain active lifestyles and busy professional and personal lives, and they want their physical age to mirror their mental age.

• Ophthalmologists looking to enter the aesthetics space should start with the eyelids.

This desire to reverse the effects of aging is addressed by both the ophthalmic and aesthetic specialties. In my practice, I observed that my refractive surgery patients were not interested solely in getting rid of their readers but also in addressing the cosmetic issues involving their eyes. Patients would inquire about minor aesthetic solutions, such as treatments for their crow’s feet. These concerns were not reserved only to women but were expressed by men as well.

For a long time, I could offer these patients only blepharoplasty, a standard surgery to repair the appearance of the eyelids. That was the only aesthetics procedure we provided at Medipolis—that is, until we started a partnership with FIRM.


Prior to opening FIRM, I conducted a market survey to evaluate the drivers behind the aesthetic market and interest in aesthetics by people in my region. I found an overwhelmingly positive response to aesthetic treatments in general, validating my belief that an aesthetics clinic would flourish in Antwerp.


We had previously incorporated beauty services into Medipolis with the Beauty Clinic By Medipolis, focusing on skin care and massage. When we added an aesthetics component in December 2016, we moved both branches—beauty and aesthetics—under one roof in a new clinic called FIRM (Figures 1–3). FIRM collaborates with a dermatologist, an aesthetician, and a plastic surgeon, and it offers an array of services as follows:

Figure 1. The FIRM logo.

Figure 2. FIRM reception area.

Figure 3. FIRM examination and treatment room.

FIRM beauty. The offerings provided at FIRM include microdermabrasion, laser hair removal, oxygen treatment (Figure 4), permanent makeup application, eyebrow services, massages, and a universal contour wrap.

Figure 4. A patient undergoing an oxygen treatment (Intraceuticals) at FIRM.

FIRM aesthetics. FIRM also offers chemical peeling, wrinkle and perspiration treatment, solutions for rosacea and pigmentation irregularities, and skin tightening. We also offer Tixel (Novoxel), a thermal fractional skin resurfacing system based on thermomechanical ablation technology, and Ultherapy (Ulthera), which uses ultrasound to treat the subdermal structures and stimulate collagen production.

FIRM also offers CoolSculpting (Zeltiq Aesthetics; acquired in April by Allergan). We chose to implement this procedure, also known as cryolipolysis, because of its excellent safety profile. There are many devices on the market with no safety data available, but multiple studies documenting the efficacy and safety of cryolipolysis have been published.1-4 The CoolSculpting handpiece contains thermal sensors that continuously monitor the temperature of the skin so that, if the skin goes below a certain temperature, the machine stops. Other companies do not have that built-in safety feature, and there are reports of both frozen and burnt skin. The built-in safety is important.

Liposuction causes pain and postoperative bruising, and it requires an at-home recovery time of around 2 weeks. By contrast, with CoolSculpting, patients can resume their daily activities and return to work the next day. The procedure requires no anesthesia, cutting, or stitching, which is appealing to patients.

The other nonsurgical options we offer at FIRM, such as Botox (onabotulinumtoxinA; Allergan) injections and skin rejuvenation, cost a couple of hundred euros and may seem more approachable to patients and thus appealing on a wider scale. It is also easy to get touchups with these treatments.


For ophthalmologists looking to enter the aesthetics space, I advise starting with the eyelids. Ophthalmologists are already familiar with this area and well trained to advise patients. The clinician can then progress to tightening and rejuvenation of the eyelid skin or getting rid of crow’s feet. Other aesthetic surgeons may not be so fond of treating the skin very close to the eye, and they may be afraid to go near this skin. This territory is therefore reserved, in a way, for the ophthalmologist. From there, adding other aesthetic treatments might require adding a plastic or aesthetic surgeon or dermatologist to your staff.


Great synergy exists between ophthalmology and aesthetics. We refractive surgeons are familiar with patients’ desires to regain the physical abilities they had in their youth, and this objective extends to their physical appearance as well. In both specialties, delivering superior care using safe and effective treatments and providing the most pleasant patient experience possible will help guarantee that patients continue to seek your services for their various needs.

1. Avram MM, Harry RS. Cryolipolysis for subcutaneous fat layer reduction. Lasers Surg Med. 2009;41(10):703-708.

2. Klein K, Zelickson B, Riopelle JG, et al. Non-invasive cryolipolysis for subcutaneous fat reduction does not affect serum lipid levels or liver function tests. Lasers Surg Med. 2009;41(10):785-790.

3. Nelson AA, Wasserman D, Avram MM. Cryolipolysis for reduction of excess adipose tissue. Semin Cutan Med Surg. 2009;28(4):244-249.

4. Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic Plast Surg. 2009;33(4):482-488.

Erik L. Mertens, MD, FEBOphth
Erik L. Mertens, MD, FEBOphth
  • Medical Director, Medipolis, Antwerp, Belgium
  • Chief Medical Editor, CRST Europe
  • e.mertens@medipolis.be
  • Financial disclosure: None acknowledged