Doctors' offices in Columbia and across the nation increasingly are becoming one-stop shops for both medical and cosmetic services, offering procedures generally done by plastic surgery specialists.

Doctors say they offer cosmetic services so they can better meet the needs of their patients. But plastic surgeons find the trend disturbing. They understand the motivation, though: As doctors face reduced reimbursement rates from insurance companies, they look for ways to bring in extra money.

Whatever the doctors' reasons, patients say they like the familiarity, convenience and discreetness of going to their own doctors for cosmetic services. And more and more people are asking for them.

In 2005, close to 11.5 million surgical and nonsurgical aesthetic procedures were done in the United States, according to the American Society of Aesthetic Plastic Surgery.

But that figure is conservative; it is based on a survey of only plastic surgeons, dermatologists and ear, nose and throat specialists. Those specialties represent just a fraction of physicians who now offer cosmetic services. More than 80 percent of cosmetic procedures in 2005 were nonsurgical, and almost half were done in an office facility.

Dr. Stephen Izard, who runs First Care family practice on Decker Boulevard, said he started offering cosmetic procedures after several patients approached him.

So did Columbia gynecologist Lilly Filler, who thought about cosmetic services after treating a young woman who had excessive hair growth on her face and body.

"I began to see that the care of the skin and the care of women overlapped a lot with what we were doing in our office," said Filler, who 15 years ago founded Women Physicians Associates.

Miriam Harrison, a patient of Izard's for 21 years, turned to her doctor for treatment for wrinkles, enlarged pores and things "sagging a bit here and there."

Robert Austin, a Columbia businessman and seven-year patient of Izard's, also felt comfortable having brown spots removed from his face at his doctor's office.

"It made it very convenient. They were right there where I go for my medical needs," Austin said. "And it was discreet. No one knows what you're there for."

New Jersey gynecologist Marco Pelosi II, founder of the International Society of Cosmetogynecology, said, "The gynecologist is probably in the most ideal position to provide cosmetic service."

Gynecologists treat women through their various life stages and have surgical skills transferable to procedures such as those aimed at making scars inconspicuous, said Pelosi, who seven years ago started offering liposuction in his office. He also offers mesotherapy for "body-sculpting," as well as cosmetic fillers such as Restylane, and Botox injections for smoothing the skin.

Cosmetic services bring new patients and more money into doctors' offices. Americans spent $12.4 billion on cosmetic procedures last year, says the American Society for Plastic Surgery.

Insurance companies don't cover cosmetic services, so clients pay the full cost. Prices can range from $100 to more than $4,000, depending on the service. The cash flow helps keep doctors' bottom lines in good shape.

"I think as long as physicians have to work as long and as hard as they do," said Columbia plastic surgeon John D. Newkirk II, "the tendency is to do those things that give maximum revenue with minimal work."

The procedures being offered in doctors' offices are relatively quick and easy. In fact, many offices advertise them as "lunchtime" services, since people are well enough to go right back to work afterward.

"It's when something goes wrong, or something has to be modified, when the training comes into play," said Pelosi, who offers training courses for doctors, one of which Filler attended.

"I'm not sure the public is well-served by going to anybody whose residency does not include training in those areas," Newkirk said. "A weekend course in liposuction is inadequate training and experience to allow any physician to carry out that procedure in his or her office."

"It's all politics, and its all about money. It has nothing to do with the practice of medicine," Pelosi said. "The American Medical Association ... states that education, training and experience are the qualifications needed to be able to practice any procedure, whether it's brain surgery or taking a hangnail out."

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