For physicians who have decided to incorporate cosmetic services into their established dermatology practice, the early planning stages are like a honeymoon. Managers and physicians engage in lively discussion about creating a medical spa or aesthetic center. New skincare lines are road tested by staff. Lasers are contemplated. And “coming soon” is the excited response for all cosmetic inquiries. During this phase it’s easy to look at the move toward cosmetic services through idealistic, rose-colored glasses.