DX / Differentials / DERMATOLOGY GROUPS

D-01 — PATIENT ACQUISITION COST · DERMATOLOGY GROUPS

Cost per new patient is climbing — dermatology

Cost per consult is climbing — and cost per encounter was never measured

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

1. 01

   [COS] The spend is measured against leads, and the leak is between a lead and a shown consult

   A consult is the unit of demand in the cosmetic line, and a consult that does not happen is a cost, not a soft loss. Where the practice counts inquiries rather than shown consults, every stage of decay between them shows up as "rising cost" with no visible cause.

   In the only published aesthetics funnel that exists, the top-performer benchmark runs: inbound leads 100% → booked consult 42% → consult closes 58% → end-to-end lead to paying patient 24%. Median time to first lead contact among those top performers is roughly 2.1 hours. CorralData is explicit that these are top-performer numbers, "not the cohort average… read these as what GOOD looks like, aim for this, not as how everybody's doing" — so a typical practice converts worse than 24% end to end.

   CorralData Research, Q1 2026 Aesthetics Industry Benchmark (100+ aesthetics brands on the CorralData analytics platform). Two caveats stated by CorralData itself: these are top-performer figures, and "plastic surgery and dermatology centers are EXCLUDED from the cohort." This is a medspa funnel used as the nearest available proxy. No dermatology consult-to-treatment conversion rate is published anywhere.

   NOT THIS IF — You already measure cost per shown consult and it has been stable while cost per lead rose. Then the increase is auction-side media price, and the funnel is not your problem.

2. 02

   [COS] The manufacturer, not the practice, is setting the effective price on your largest cosmetic line

   Injectables are the biggest single cosmetic revenue line, and realized revenue per treatment is being moved by loyalty-program economics rather than by list price. A practice can hold price, hold volume, and still see revenue per treatment fall — which reads on the marketing report as rising cost per acquired patient.

   AbbVie's FY2025 10-K attributes an 11% decline in US Botox Cosmetic net revenues to "unfavorable pricing due to customer loyalty program changes, lower market share and decreased consumer demand." US Juvederm fell from $519M (2023) to $385M (2025) — 26% in two years. The loyalty programs are large enough to move practice economics: Allē reports 8 million members across 30,000 US practices; Evolus Rewards is approaching 1.5 million members with over 255,000 redemptions in Q1 2026 and an approximately 70% repeat treatment rate.

   AbbVie Form 10-K FY2025 (filed 2026-02-20) and MD&A; Allergan Aesthetics press release 2026-04-30; Evolus Q1 2026 earnings release (8-K Ex-99.1). Manufacturer revenue is not units — no unit or syringe volume is published by any manufacturer. Allē's "30,000 practices" carries no methodology footnote and "practice" is undefined.

   NOT THIS IF — Your cosmetic mix is weighted to energy, laser and skin health rather than injectables. Published cosmetic mix puts neurotoxin at 22.9% and filler at 9.6% of revenue; a practice materially below that is less exposed to this mechanism.

3. 03

   Reputation and social are making the decision before your media gets credit for it

   In cosmetic dermatology the purchase decision is made against reviews and a provider's visible work, then a branded search closes it on the cosmetic consult page. Where reviews are stale and that page answers none of the four stated barriers, paid media has to buy a decision it used to only have to capture — and the price of that is exactly what shows up as rising cost per consult.

   94% of consumers say rate-and-review websites impact their decision. 74% follow, or would follow, their provider's social media, and nearly half say a provider's social presence impacts scheduling. The stated barriers are addressable on a page: cost 24%, side effects and safety 16%, pain 14%, concern about results 11%. And the credential is worth something — dermatologists are the physician of choice in 12 procedure categories, with 95%+ satisfaction in 8 of 15 treatments.

   ASDS, 2025 Consumer Survey on Cosmetic Dermatologic Procedures, n > 3,500 consumers, read at the society's own release. Measures consumer intent and stated behavior, not transactions.

   NOT THIS IF — Your review recency and volume already lead your catchment and your before-and-after library is current. Then the cost increase is media-side, not reputation-side.

4. 04

   [MED] The medical line has no acquisition cost because it has no acquisition — and its demand engine is degrading unmeasured

   Medical dermatology demand is referral, recall and surveillance. None of that generates a media invoice, so none of it gets a cost per encounter, so its decay is invisible until the schedule thins. Meanwhile the cosmetic media budget absorbs the blame for a whole-practice number.

   The median dermatologist carries 496 Medicare beneficiaries — the closest thing to a published panel figure this specialty has, and it is Medicare-only. There is no published dermatology cost per encounter and no dermatology marketing-spend ratio; the only spend ratio that publishes is paid media at approximately 5% of revenue (median account ratio 5.3%, split roughly 59% Meta / 41% Google), and that is a medspa cohort with dermatology excluded.

   CMS PUF by Provider, CY2024; CorralData Q1 2026 Aesthetics Industry Benchmark. We state this plainly on /sources/ and /benchmarks/: no dermatology-specific acquisition-cost benchmark exists. Any vendor quoting one — the "$441 cost per acquisition" figure in circulation is a vendor illustration, not data — is quoting an illustration.

   NOT THIS IF — You already run a measured surveillance-recall cadence with a tracked show rate and a counted referring-physician list. Then the medical line is instrumented and the rise is genuinely in the cosmetic line.

5. 05

   You are bidding against a channel dermatology has already ceded

   The cosmetic auction is crowded by med spa operators with lower clinical overhead and no medical line to protect. The practice best qualified to own the category is the smallest owner of it, so it competes on media price against businesses whose entire cost structure is the media.

   Of physician-owned US medical spas, dermatologists account for only 4% — and only 37% of medspas are physician-owned at all, so roughly 1.5% of US medspas are dermatologist-owned. 74% of medical directors come from non-core specialties (core being plastic surgery, facial plastic, oculoplastic and dermatology), up from 69%; nurse-practitioner ownership of single-owner medspas doubled from 11% to 23%. There are more than 11,000 US medspas and 18% of them opened in a single year. Two manufacturers document the same drift in SEC filings — Cutera's Chapter 11 first-day materials: "Over half of installed systems were located at medical spas which typically do not treat acne."

   AmSpa 2022 Medical Spa State of the Industry Report, quoted verbatim in Eichinger J, Casale J, Daniels P, Rice A, "Trends in Medical Spa Statistics and Patient Safety," Dermatologic Surgery Feb 2024;50(2):216-217; AmSpa 2024 edition (data year 2023, self-selecting survey blended with modeled market data) for the director and ownership figures; Cutera 8-K Ex-99.1, Chapter 11 first-day materials, filed 2025-03-05.

   NOT THIS IF — Your catchment has low medspa density. Count it before assuming it — the national figure is not your market.

HOW TO TELL THEM APART

How to tell these apart in your own numbers

Each of these is a measurement you can run yourself, without us.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

[COS] The spend is measured against leads, and the leak is between a lead and a shown consult	Rx 03 · patient conversion →	Speed to first contact and a booked-and-shown definition of a consult. What does not work: raising the budget against a booking step that loses more than half of what it receives — that multiplies the leak and prices it as growth.
[COS] The manufacturer, not the practice, is setting the effective price on your largest cosmetic line	Rx 04 · marketing attribution →	Three separately-counted stages, monthly, split medical and cosmetic. Cost per lead is not a number worth reporting in this vertical.
Reputation and social are making the decision before your media gets credit for it	Rx 04 · marketing attribution →	We would surface the realized-net trend and hand the decision back. Loyalty enrollment and product-line strategy are procurement and clinical decisions, not marketing decisions, and we would say so rather than sell around it.
[MED] The medical line has no acquisition cost because it has no acquisition — and its demand engine is degrading unmeasured	Rx 02 · medical practice websites →	Reviews, recency, and a page that answers the four stated barriers — cost, safety, pain, results — before the form. This is the cheapest line item on the page and it is usually the largest one.
You are bidding against a channel dermatology has already ceded	Rx 04 · marketing attribution →	Frank version first: for most medical lines the answer is a recall list and a phone, not media. If the overdue-surveillance population is large, that is the cheapest demand in the building and it does not need us.

• Rx 02 · medical practice websites — The differentiator is the credential and the medical adjacency — the thing 98.5% of the medspa channel cannot claim. If the site does not say it, the media is buying an undifferentiated click.

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	One budget, one funnel, and the whole test fits in a spreadsheet. The single-site failure mode is charging medical and cosmetic to one line and then reasoning about a blended number that describes neither business.
Group	Cost per shown consult diverges by site long before anyone notices, because the group reports a blended figure — the standing failure mode in multi-site dermatology marketing, where one number is asked to describe eleven funnels. The first useful group-level artifact is the same three-stage funnel run per location — the spread is usually larger than the trend everyone is arguing about.
Platform	At platform scale the media buy is centralized and the intake is not, so the platform optimizes the half it controls. The number that matters is cost per shown consult by site, not blended cost per lead — and a platform that cannot produce it will not survive a diligence question about it.

OTHER PRESENTATIONS — DERMATOLOGY GROUPS

• The schedule is full and the number stopped moving
• The demand is already in the building
• Same brand, same fee schedule, four-fold spread
• How much of this survives the surgeon leaving the room?