What's Killing Your Cosmetic Practice Profits?

If you haven't watched this video, do it now and learn what top performing cosmetic practices are doing that you're not.

Hint: It's your internal systems.

A few weeks ago we sent a survey to 472 physicians asking about efficiency and productivity in their clinic or practice. Here's just a little of what we found out:

  • Over 9/10 of physicians said that their clinic operated at less than 80% efficiency, and 4 out of 10 said that their clinic efficiency was below 60%!
  • Physicians reported this "productivity gap" costs their clinic between $5k and $40k in lost revenue every month.
  • When I asked them what doesn't work, the most common responses: "lack of systems" (44%), "wasted time and effort" (50%), and "micro-management" (40%).

There is a better way that can pull you out of the micro-managing, hair-on-fire, unproductive daily grind and put you in a position where you're working ON your business, not IN your business. Take a look at the Ultimate Clinic Operations Blueprint.

Storytelling Patient Testimonials That Sell


The key to success in any business is to have some understanding of psychology that allows you to match your products and services to a buyers emotional need.

Human behavior, at it's roots, is driven by pain avoidance and the desire to increase pleasure. It's the basic trigger upon which all other actions are based. And what is the #1 way to most clearly communicate the pain/pleasure journey and outcome?


Humans "buy" stories, because, as you probably already know, people make their buying decisions with EMOTION. Stories put people inside of the experience in a relatable way. They work much better than simple data or list of features. Feature lists are how you sell commoditized products and if you're doing that, you're only competing on price which is eroding your margins and profits. 

Gerard Zaltman, the author of How Customers Think: Essential Insights into the Mind of the Market found that 95% of cognition happens outside of our conscious brain and inside our subconscious, emotional brain.

Telling stories activates parts of the brain associated with sight, sound, taste, and movement. They make us feel an experience without directly experiencing it. They literally transport us into the world of the story and light up our emotional brains, which is where we make our decision whether to buy or not. 

Then question then is: whose story do you tell?

There are any number of options here.

First off, you can tell your story, and by your story I mean you as a clinician... there are big benefits with this in that almost any story engenders the knowing, liking, and trusting that leads to patients feeling comfortable buying from you.

Second, you can tell the patient's story.  Here, you could talk directly to the patient going through a common experience, with just the right combination of specific details and vagueness so they can fill in the details for themselves. 

Third, you can tell the future patient's story.  By this, I mean the story they’ll be telling after they’ve benefited from your service.  This is called “future pacing” and the trick with it is to make it feel as real as anything that’s already happened or is currently happening to them.

But all of these stories come with a price. You've got to produce them all, or have others produce them for you. THAT is the beauty of patient testimonials and reviews, you're enlisting your happy patients to help sell these short stories to others in the form of "reviews".

Benefits of Patient Testimonials for a Medical Practice

As John D. Rockefeller said, "I'd rather earn 1% off 100 men's effort than 100% of my own efforts". Organizing and promoting your patients reviews can add significant growth and traction for your clinic. Your existing patient's 'reach and network' dwarfs your own. That's why it's critical to get your patients working for you. It's the "word of mouth" Holy Grail, but it doesn't build itself, you're doing to have to facilitate it.

It's all about social proof.

Professor of psychology and bestselling author of Influence: The Psychology of persuasion, Robert Cialdini says “If you can get people who are similar to the person you’re trying to persuade to speak on your behalf, it’s a lot easier for you than if you have to try to hammer your message one more time into a reticent mind.”

Human beings are social creatures. We look to others to determine what actions we should take.

If you're ready to follow Rockefeller and organize your patients to help grow your clinic, you're going to want to help them tell stories and add recommendations and reviews. You can either push that boulder up the hill yourself, or you can use tools that make it easy.

Our suggestion is that you take a look at the special offer from Podium, and then you get to work helping your patients tell stories that grow your clinic's new patient bookings.

#MeToo - Stories Of Sexual Harassment In Cosmetic Medicine


#MeToo - Is sexual harassment more common in cosmetic medical clinics than other areas? Do you have a story?

In speaking out about sexual harassment, clinicians and estheticians are growing a social movement outing those in power who have engaged in what amounts to criminal sexual behaviors.

In reading a story from the Washington Post on sexual harassment in medicine I began thinking of a number of incidents that I witnessed that, depending upon your point of view, could have been seen as sexual harassment.

From the article:

"A Kaiser Health News review of dozens of legal cases involving health-care workers across the United States shows patterns similar to those found in harassment cases that have cropped up in other fields: The alleged harassers are typically male, and they typically supervise or outrank the workers lodging the complaints. There are slaps on the butt, lewd comments and requests for sex. When superiors are confronted with reports of bad behavior, the complainants, mostly women, are disbelieved, demoted or fired."

Medical spas and cosmetic clinics are almost linear in their conformity to sexual harassment cliches. They are often owned an operated by males, often physicians, and staffed by (generally) younger women who have almost zero power inside of the clinic. Where a nurse in a hospital may have outside resources like a union or an HR department that may at least provide an option to make a complaint or provide a curb on behaviors, most staff in a medspa or cosmetic practice have no recourse other than to quit or file a lawsuit.

There seems to be something of a societal shift taking place that may recalibrate what is appropriate and clamp down on unwanted sexual behaviors.

I've witnessed a number of encounters that made me uncomfortable; a physician having a foot-rub from an employee, a couple of comments about looks, the occasional double entendre. But these were just observations of how physicians and others behaved in their own clinics.

I've also observed any number of actions that - in any other work situation - would be clearly outside of the bounds of permissible behavior; before and after photos of staff members being used to show vaginal rejuvenation or breast augmentation being just one of many examples.

As with most human interactions there are often two sides to the story.

If you have been subjected to unwanted sexual actions in a practice, or if you've been accused of misconduct that didn't happen, please click on the button below and tell your story. (We will not use your name or any identifiable information if your story is published.)

How To Write (Or Fix) A Killer About Page For Your Medical Spa


What's the most important and useful page on your medical spas website? It's your about page. Your "about page" is where new patients learn why they should choose you, stick with you, and what's in it for them.

After your homepage - which is where you're trying to drive all of your traffic too and so the number are skewed - your "About" page is going to be the most visited page on your site.

People want to know who you are, what you look like, why they should trust you over your competitors, and if they should trust you with their face and body. 

Crafting Your About Page

Crafting a grade A About Page requires more than just a location, your office hours and a paragraph on how you're great. While it's not easy writing about yourself, I'm going to walk you through, step-by-step, how to squeeze the most benefit from this critical page.

1. What Value Do You Give Your Patients

This one is a biggie, which is why we're starting with it. Your About Page should be ALL about the value you provide to your patients - NOT all about how great you are. Don't squander the chance to answer the questions that your perspective patients are looking for. Yes, patients want to learn about you and your team and we'll get in to that, but the most important thing they're looking for is how YOU are going to help THEM. That's what they're going to make their buying decisions on and that's why you have a website in the first place.

2. Who Is Your Clinic For? Who Is Your Target Patient?

Who is your most profitable patient? What is your most profitable treatment? Which treatment attracts the most new patients? These are the questions you'll want to start with. Don't fall in to the trap of trying to be everything to everyone. (The cliche holds true in cosmetic medicine as it does elsewhere.) Find a a patient who is right in your sweet spot and write directly to her. Why should this patient choose you?

On the Medical Spa MD page you'll see that right up front we're speaking to clinicians who are looking for info on the business of nonsurgical cosmetic medicine. Those 3 items; nonsurgical, cosmetic, and medical providers are how we filter and segment who we're talking to. It doesn't matter where you are in the world or if you're a MD, DO, PA, NP, RN, if you're a clinician we can help you. We don't cover lotions and potions, we don't talk to patients, and we don't tuck in to invasive surgical techniques.

It's all intentional. Why? Because when the right people visit your About Page you want them to immediately recognize themselves. You want them  to know that the site was created for THEM. Anything that detracts from that central point should be included only with great hesitancy. You're looking to connect to the right people, not all of the people.

3. How You're Going To Benefit Them

Ok, you've written a few sentences geared towards your ideal audience. Now what? Most sites you'll see will begin by talking all about themselves; what medical school they graduated from, how committed to patient care they are... There is a place for a little of that but it's not the main course (it's more like the mint at the end of the meal.)

Key takeaway coming here: Patients want to know about you because of how it may relate to them!

Some ways to think about your About Page.

  1. Tell a story: When you have a great story about how your clinic or medspa was built to change lives (even if they're your own), share it. Good stories humanize you and provide context and meaning to your services. Even better, good stories are 'sticky', meaning that your patients are more likely to remember them and pass them on as part of their story about your brand.
  2. Be human: Most medical spas, plastic surgeons and dermatologists have pages that scream stuffy and formal. Physicians were taught to control the situation after all and formality and hierarchy provide easy to see guard rails that keep everyone in their place. I'm the expert. you're the patient. You're lucky to be seen and treated by someone as magnificent as I. Patients hate that. My advice is to step off your pedestal and use your About Page to tell the human story of you, whatever that is. Don't be afraid to pull out a misstep or mistake (as long as it's not a negative treatment outcome) like switching majors in college or making a difficult life choice. People want to be treated by other humans, not gods.
  3. Skip the medical babble: Please don't use medical jargon. You may think it makes you sound super-smart to use "neuromodulators", but it really just makes your patients think you're talking down to them. People want and appreciate straight talk and clarity. Just be authentic.
  4. Be unique and visually interesting: Instead of following the classic script of writing a few paragraphs about your 'mission', try something that makes it more interesting and compelling. Everyone has some photos of their blank waiting and treatment rooms. Make something interesting that demands attention and that people will remark on. Boring = death. Don't do what everyone else is doing.

Here are some example About Pages that I've included for you to take a look at. I've purposefully excluded any medical spas or clinics since much more can be learned by looking at the best About Pages rather than just those from existing practices.

Great Example About Page Examples

If you have any other suggestions from sites that I have missed please leave a comment and let me know. Even more importantly, if you don’t like one of these pages I would love to hear why not. Oh, and these are in no particular order. I just couldn’t do it.

TUMBLR - A great about page that has credibility oozing out all over the place in an interesting package. It's clever and communicates very clearly with human copy



Bentley Motors - Bentley's About Us page does an excellent job of creating that magical and illustrious vibe. They use rich professional photographs and enticing copy. The whole point of this About Us page is to get you to feel part of the experience. To draw you in to their way of thinking and acting which is, in fact, their marketing plan and branding.


Eight Hour Day - Here'a creative studio with an awesomely human about page that tells the story of the people behind the brand. They use some straightforward copy and photos that make you feel like these are people who know what they're doing and that you'd really like to work with. Hey... that's the point.


Harry's - Yep, the razor guys. They don't even call this the about page. It's "Our Story". It's clean, there's plenty of white space, it has purpose and it's well designed.


Hello Alfred - A services platform for residential buildings, Hello Alfred's about page puts the founding story front and center and tells the "why" of their business, not just the 'what'.


The Saddleback Story - Leather travel bags hand made in Mexico. Another "here's how it happened" story about page that really checks all of the boxes. It's human, compelling and relates some really interesting stories that elevate their products from expensive leather bags to a complete lifestyle.


Ok, so there are some great About Pages out there to learn from.

Take a look at your existing About Page - if you have one - and just start making it better. Change out the photo. Write some better copy. Add some white space. Your About Page is going to be the most visited page on your site. Make it great.

If you'd like us to take a look at your site's about page and provide some feedback, just contact us.

New Dermal Fillers For Your Medical Spa.


The new Revanesse Versa and Teosyal RH fillers add to the growing list of available injectables.

There are a couple of new dermal fillers currently making their way into the cosmetic market in the US: Revanesse Versa, Teosyal RHA2, RHA3 and RHA4.

Revanesse has been in use since 2002 (Revanesse USA, 2018), while Teosyal has also been around for some time in Europe. They both (Revanesse Versa and Teosyal) now have FDA approval they've made their way into several clinics in the United States.

There are more than 30 dermal fillers allowed for use in the US, which makes for a crowded space. In many cases the differences between fillers in a specific product line or across competitors really boils down to user preference around viscosity, ease of use, name recognition in your patient population or any number of things. But... competition is good and just because you're comfortable using your Restylane or Juvederm line doesn't mean that you may not like something just a little better, even if it's only to allow you to reduce the price for your patients. Revanesse and Teosyal's addition to that line should give you some more tools.


Revanesse claims that it causes unwanted swelling less often that other HA formulations on their website.

"In a recent study another popular (HA) dermal filler was shown to produce swelling 24% more often than VersaTM. Our lower rate of swelling means many patients are able to get back to their lives almost immediately after the treatment."

In the clinical trial of Revanesse Versa 163 people participated in the study. Most injection-site adverse effects were either mild or moderate. The comparator group showed more reported filler adverse events, with an accumulated incidents of 553 events, while Revanesse had only 378.  Post-injection, 114 subjects experienced adverse effects, while 137 participants experienced effects with the comparator dermal filler. Swelling was considered a serious side effect, however, patients who have been injected with Revanesse also complained of swelling. (The feedback was from a patient review site.)

Researchers also conducted a retreatment addendum. Those who received retreatment experienced only mild to moderate adverse effects including hematoma, pain, and swelling. More patients experienced those effects seven to thirty days post injection.

Findings: Reported Frequently Injection-site TEAEs (for the first study):

  • Erythema = 35/163 = 22%
  • Hematoma = 82/163 = 50%
  • Pain = 62/163 = 38%
  • Swelling = 77/163 = 47%


Teosyal has a number of different fillers in its product line in the EU but it's only the RHA series that is currently approved in the US. Teoxane fillers have been examined in several studies, however there is so far one study about the RHA line showing efficacy - the filler line lasted for 6 months for the study participants (Rzany, 2018).

The Teosyal website doesn't make much in the way of claims of differentiation from other fillers but it's hard to say if it's just because they're a 'me-too' product or they don't have the data to them.


Aside from these two dermal fillers entering the US Market, it was announced that Allergan will acquire Elastagen’s product for $95m as part of their new injectable line, and that may change things even more. Elastagen uses Tropoelastin which has been studied in wound healing and skin repair. The potential for aesthetic use is right alongside and Allergan has probably done a lot of due diligence on Elastagen's efficacy and patient results. 



New Medspa Opening? What should I do?


Here's an email that we received a while back that is typical of where physicians new to the cosmetic space start - buying a cosmetic laser or IPL and then trying to figure out how to pay for it.

I am a newer reader and now subscriber to MedicalSpa MD. By the way great content!!

My wife's (Ob/Gyn) practice has recently purchased Syneron Emax and VelaSmooth equipment to begin their aesthetic practice within their Ob practice.

So now that the $$$ has been spent we are working on getting our Marketing, brochures, website etc together to begin to establish an image, look etc. and begin to take customers.

While you name several MedSpa www sites that have problems, do you know of any MedSpa sites that you really like?  We would rather not reinvent the wheel and if you might provide a few good www sites we might reference as starting points it would be much appreciated.

Also, I realize you are very busy, however, I think a "Top 10 list of things to avoid" in the MedSpa business or the "Top 10 things to do before you buy your aesthetic equipment" would be very helpful.  We just kinda jumped into this market and well as they say... now here we are.

I'm not going far out on a limb here to suggest that this probably sounds really familiar to a lot of clinicians who are just starting out, and to existing cosmetic practices who see competitors popping up around them.

So, we're going to break this down by parts and see if we can't provide some feedback that can help. In fact, we're going to make this part of a series of posts that pulls apart the hopes and false assumptions and injects both some hard realities and some tactical advice that you can put to work ASAP.

NOTE: If you have some questions like this, use the contact form and ask them. We'll do our best to answer your questions since there are others that also have them. (You will not be identified in any way so don't worry that your name or clinic will appear in a post.)

The Accidental Medical Spa

It's obvious from the first sentence in the email above that the spouse has been assigned the task of doing some 'market research' after the fact. It's not uncommon to have a spouse, office manager, or even a trusted friend take on the role of 'startup consultant' and try to bring some clarity to the chaos of trying to start a cosmetic practice inside or alongside your existing clinic. In a lot of cases the physician just wants someone else to do it and tie it up in a bow. After all, they're already working full-time in the practice that is paying the bills.

While I think there are better ways to approach a new business there are also some actual benefits to doing it this way. (Note that I'm not recommending this.) At least it causes you to focus in a way that gets you involved and problem-solving. After all, you now have laser payments to make and if you don't figure out things toute suite, you're in for a big loss. It has the effect of forcing you to pay attention and make some decisions. In the best cases you learn things quickly and make some smart decisions. In the worst cases you lose your shirt and sell your new lasers with a 60% loss which is a really painful lesson. In either case you're getting an education and you're paying for it.

More from the email: "So now that the $$$ has been spent we are working on getting our Marketing, brochures, website etc together to begin to establish an image, look etc. and begin to take customers..."


That's the sentence that really stands out more than the others. It's clear that - since the physician is an OB-GYN - the cosmetic portion of the practice is going to target the existing patient population, but once you start buying lasers you're on the hook for those payments one way or the other. It would be really nice if you knew that the demand was there before those payments start, and there are ways to do that. 

So what would I suggest?

If you're a physician who's thinking that you could bring in some additional revenue doing Botox and filler injections and getting a laser or IPL and selling those services to your current patient base.. well, you're right. IF you're smart.

First - and this is critical - sell the treatments before you have to deliver them.

It's not hard to do and you'll learn a lot.

The very toughest sales for everything you will ever do are the first ones. If you can make the sales you'll lower the risk and sleep easier at night knowing that you're going to be able to make your payments. Most physicians ask their current patients IF they would pay for something like Botox or stretch mark reduction or whatever... the real trick is to "presell" the treatments. The only real responses that you can trust are when a patient actually buys from you. That's the ONLY real test.

Here's how you do it:

  1. Announce to your current patient population that you're going to launch a new service; Filler injections or whatever. Don't position this as "I'm thinking of this, what do you think?". Just proceed as though you're doing it with a specific date or timeline.
  2. Attempt to presell the treatments or service to your existing patients. If you can't do it with your existing patients you'll find it even harder with new patients that don't already know, like, and trust you. Give them a discount for "pre-ordering" the treatment, something like 10 or 15%. (Don't make the percentage too high since you're trying to find out if you can sell it at full price.)
  3. Collect the money. The ONLY think that counts here is real sales. Do not count any "I'll buy it once you do it" stuff. Patients will always tell you that it's a great idea to offer more services but you need to know how many patients will buy it and what they will pay. (NOTE: Depending upon what the treatment is the cost may vary widely. If it's really expensive you don't need to sell as many as if it's something cheaper.)
  4. IF you're absolutely sure that this is a windfall, then actually buy the laser or add the service. If it's not clear, be very careful. Remember that you have to support every service you and and there are opportunity costs to anything you do.
  5. IF it doesn't sell, refund the buyers you have with your appologies and a small free gift (something like a 20% discount on their next filler injection or a free facial) as a thank you.

See how that works? 

You want to start collecting money before you actually make the investment and doing it this way puts you in a position to ensure that you're going to be adding a profitable service and not an $80,000 towel rack.

As always, thoughtful comments or thoughts appreciated.

Dermal Fillers: How Often Will Patients Sue You?


Everyone is offering fillers. If you're practicing cosmetic medicine for any period of time, you're going to have an occasional unhappy patient or unwanted outcome. Since dermal fillers are so popular, we wanted to take a look at how often fillers are causing problems that result in lawsuits.

Restylane, Juvederm, HylaForm, Belotero... the fillers are all here and deeply ingrained in every practice. The safety and efficacy of fillers is pretty well known and you've probably got a lot of experience already since you're performing lip augmentation and facial wrinkle treatments every day. But it's exactly the fact that fillers are so common and performed so often that can put you at risk. The odds that any individual treatment will have an unwanted outcome is really low, but since the number of patients you're treating are quite high, it's still a possibility you need to take seriously.

Here are some interesting results from studies that have been conducted in the last few years. (Links to all of the studies are at the bottom.) 

A couple of things to note here is that sometimes we're not comparing straight apples to apples. While OB-GYNs are the most common specialty to be sued, surgeons are next. If you're a cosmetic or plastic surgeon there may be a bias that elevates your risk somewhat. (If anyone has a study showing this please link to in in the comments.)

  • Medscape study, surgeons are second to OB-GYNs for being sued by the public.
  • Vila-Nova da Silva et al., 2015, breast surgery was the most common procedure filed for a lawsuit.

You're undoubtedly disclosing the possible side effects and expectations when you're doing your consultations, but there's an interesting study that correlates an expectation of the clinician with an elevated risk of being sued. The study found that disclosing all possible risks and outcomes didn't scare the patients, but that those physicians who thought so were at increased risk of a suit which is interesting. (Boyll et al., 2017) 

One of the last articles JAMA Facial Plastic Surgery published in 2017 were litigation cases filed due to dermal fillers and there is some risk of unwanted outcomes or mid-term issues; Hyaluronic acid fillers typically cause swelling and infection, while CaHA causes infection and pain, and PLLA and PMMA both cause nodules. In the study, most of the swelling were found in the tear troughs, while only infection were found in the nasolabial folds. Additionally, intra-arterial injections especially without sequelae were found in the lip and nasolabial folds (Rayess et al., 2017).

Other than this study, Ezra et al. (2015) also examined litigation earlier, and may have encountered the similar cases as with Rayess et al. (2017) back then, only granulomas were found as an adverse effect that resulted in a filed suit. 

In the Ezra 2015 study,  the real cause of most of the problems becomes clear - non-physicians who are performing the injection and there can be additional disciplinary actions in addition to a patient filing suit.

From the study: (This is about disciplinary actions, not lawsuits)

A total of 24 legal documents were identified: 19 cases and 5 disciplinary actions. Of the 19 cases, physicians were named as defendants in 13. Six of the 7 cases that named a nonphysician as a defendant involved a substance being injected different than the reported filler. Overall, 50% of legal actions from soft-tissue fillers were related to a nonphysician performing the procedure. Of physician subspecialists, dermatologists and plastic surgeons had the highest proportion of litigation (17% each); this is likely due to these specialties performing a higher volume of the relevant procedures. The majority of disciplinary actions were reprimanding physicians for not being present while a nonphysician employee injected patients with soft-tissue fillers. In 3 of the 5 reprimands, physicians were functioning as medical directors of medical spas.

The chances that you'll be sued by a patient for a filler injection treatment is extremely small unless you're doing something stupid like allowing someone who is unqualified, unskilled, or unlicensed. Be sure that you're using clinic best practices and procedures and that your staff is trained. Almost all of these problems can be avoided if you avoid the trap of thinking that any procedure is routine.


  • https://jamanetwork.com/journals/jamafacialplasticsurgery/article-abstract/2665429?redirect=true
  • http://www.jaad.org/article/S0190-9622(15)01857-5/fulltext
  • https://academic.oup.com/asj/advance-article-abstract/doi/10.1093/asj/sjx182/4461847?redirectedFrom=fulltext

4 Reasons You Should Never Buy Paid Patient Reviews, And 1 Reason You Should.

 Patient Reviews for Cosmetic Medical Practices

You're getting emailed from companies promising to raise your profile in the search engines by pushing hundreds or thousands of positive reviews, Facebook likes and Instagram shares to your sites and profiles, driving inbound patient inquiries and filling your treatment rooms. Don't do it.

Reviews are seen as one of the most valuable decision-making credibility markers that patients use when deciding who they're going to trust with their face. In fact, 85% of your potential patients trust online reviews - if they find them credible - as much as personal recommendations from their friends and family.  There is, however, a caveat to that trust. Consumers will only trust those online reviews as long as they believe they are authentic.

Here are some survey highlights from the latest 2017 survey:

  • 97% of consumers read online reviews for local businesses in 2017, with 12% looking for a local business online every day
  • 85% of consumers trust online reviews as much as personal recommendations
  • Positive reviews make 73% of consumers trust a local business more
  • 49% of consumers need at least a four-star rating before they choose to use a business
  • Responding to reviews is more important than ever, with 30% naming this as key when judging local businesses
  • Consumers read an average of 7 reviews before trusting a business - up from 6 last year

Since the value of reviews is so high, some medical spas and cosmetic docs have taken to trying to buy positive reviews from bot-farms. Not a good idea. 

Here are just a few of the reasons why you shouldn't buy online reviews for your clinic.


The biggest reason businesses shouldn’t buy online reviews is it’s against the terms and services of many online review sites. Businesses that ultimately do buy reviews or post fake reviews on behalf of their customers could suffer legal action or face sanctions.

Yelp has been very active in trying to ensure its reviews are authentic. Its Consumer Alerts program was created to make sure its reviews are properly vetted and provide helpful, accurate information to consumers conducting online research. If a business on Yelp is found to be purchasing reviews, their profile will be tagged with a warning to consumers about the dishonest activity.

The same is true for Google and Bing. If they catch you doing this the penalty can be severe and they will bury your search engine rankings - exactly the thing you were trying to improve.


As we mentioned, online reviews are a valuable tool for both patients as well as clinics. Patients are leery of clinics either posting fake positive reviews on their sites or trying to sabotage their competition by posting fake negative reviews on their competitor’s sites. To ensure that trust is earned, your clinic should make every effort to be transparent in their collection of online reviews and run from shady practices. Patients can be merciless in spreading the fact that you're performing underhanded reviews if you're caught, and it's really easy to catch you. 

If your reviews are unerringly positive and weren't actually written by your patients - with shortcomings included - you're going to get hosed.


This one should be obvious but we'll outline it anyway. When you buy online reviews, you are lying to your patients and potential patients. Once they suss that our you're in for some through word-of-mouth backlash and deservedly so.

One thing to note here is that it's often your staff that will spill the beans. It only takes one tech or clinician to wink or drop that "those are all fake anyway" and - even if it wasn't the intent - your clinic's reputation will suffer.


When you buy online reviews, you're not getting feedback from your real patients. Reviews can help you identify problems that might exist in your business and gives you the tools needed to fix them. Clinics that are focused on the customer and care about the experience being delivered won’t need to buy online reviews or post fake ones because their customers will be motivated to post positive reviews on their own.

If you're thinking about buying fake reviews, don't do it, just punch yourself in the ear instead.


The title lied.

There isn't any reason that you should buy patient reviews, but you should figure out how to get and use real reviews from our patients. If you're looking to improve both your recommendations and your search engine results, take a look at the Podium Special Offer for Members. It's the best tool you'll find IMHO and it works extremely well if you use it. You'll also save yourself countless hours of headaches and something like $1500 if you take advantage of the Members offer. Do yourself a favor and check it out or ask for a demo.

Can't separate your clinic from every other medspa? Try This Simple Innovation Technique.


If you're not doing anything other than what every other plastic surgeon, dermatologist, and medical spa is doing you're stuck competing on only one thing; price.

And that's a straight shot to the bottom.

There can only be one lowest price in a market and the second-lowest price will always lose. Just ask Kay-Mart and Sears who lost long ago to Walmart. Worse, a patient who comes to you based on price will leave you just as fast for someone who's offering IPL, Botox or cosmetic injectables for less.

To get unstuck and find some area where you can distinguish yourself you'll first need to identify the orthodoxies and assumptions that you're already using. The most common assumptions revolve around what others are doing and especially the "we've always done it that way" lazy way of thinking.

Here's a way to tackle this. Start by actually writing down the assumptions that you have that - if they are true - would prevent you from achieving your goals. Your clinic is filled with assumptions: patients won't pay for ___, my staff can't sell, they're not motivated, I'm not good at business, everyone is doing it better than I am, I have to work 60 hours a week... you're looking to root out orthodoxies by identifying existing assumptions and overturning them to illuminate blind spots or limiting beliefs to look at your problem in a new way. By articulating these assumptions you can then attempt to test them - which is key - in order to make better decisions that actually improve  your business and lifestyle. Y

Example: Alan Robinson (co-author of Corporate Creativity) writes in his book how KC Fine Furniture trained their delivery drivers in basic interior decoration so that when they deliver furniture to the customer, they help arrange the room, and accessorize. As a result, their rejection rate dropped from 10% (the industry standard) to 1%. That simple change decreased their returns by an order of magnitude. Nice.

Assumption Reversal

Here's an example based on a process from the book Orchestrating Collaboration At Work.


  1. List all the assumptions you have about a particular topic, even the most obvious ones. Remember, not all assumptions are wrong. You just want to be explicit about them because they may hold the key to achieving a breakthrough idea. (Aim for 10-20 assumptions
  2. Write down the opposite or a modification of each assumption.
  3. Use each assumption as a trigger for new ideas, write each idea on a Post-it® Note, and place them on flip-chart paper for evaluation.

An example: Assume you are a dermatologist with a new medical spa and want to attract new patients. You might list the following assumptions:

  • My existing patients are going to competitors who are charging less for filler injections.
  • I should lower my filler injection prices to compete.
  • I will make up the loss on other treatments.

Next, reverse these assumptions as shown in the following examples:

  • My existing patients are not going to competitors who are charging less for filler injections.
  • I should not lower my filler injection prices to compete.
  • I will not make up the loss on other treatments.

Finally, use these reversals to suggest ideas:

  • Emphasize that that you're not the "Walmart" of filler injections.
  • Stress the high cost of my treatments and "you get what you pay for".
  • Give patients who recruit their friends an "insider friends and family" deal.

Source 101 Activities for Teaching Creativity and Problem Solving. (VanGundy 2005)

What assumptions do you need to question?

You're always going to see competitors as the person just down the road, but the truth is that you're competing with much more than that. The path to success is paved with broken assumptions and you need to question - and test - all of yours. If you're relying on the wrong assumptions about your market, your patient population and your business, you're driving with the breaks on at best.

Cosmetic Consultations: Patient and Physician Perspectives on Scar Appearance


There are always differences in how providers and patients see both outcomes and - when there's surgery involved - normal byproducts of the treatment like scaring. Yep, patients see scarring different than you do as a surgeon.

You're already explaining scaring and expected results, but patients commonly discount what they see as secondary effects to the primary benefits. So while the new results are something that patients quickly adapt to as the 'new normal', but the scars - even if they're minimal - stay. If they're visible they can detract from the primary benefits over time.

A new article raises patient and physician perception of how patients and physicians disagree over the appearance of scars and it could cause some differences. What causes the disagreement over the evaluation of scars? The researchers looked for studies where the Patient and Observer Scar Assessment Scale (POSAS) was present, and from there, researchers found most studies had expressed indifference towards the scars. Based on their findings, the common reason for disagreement towards a scar when patients have a favorable rating towards a scar, while physicians did not detect a difference on the scar.


  • Only 28% of the studies had disagreements toward scar appearance
  • Sixty seven percent of the patients preferred a “given surgical closure method” (Zhang et al., 2018 p. E8) than what was performed.

Additionally, there is a psychosocial effect in the appearance of scars and in the quality of life of patient afflicted with surgical scars, as Zhang et al. also briefly discussed. Many patients are unhappy with the scar that results from their surgery. Dissatisfaction and depression had been reported on patients who had facial trauma (Negenborn, 2017). It is also alarming to learn how those with facial scarring would prefer to die than live with the scar on their face (Zhang et al., 2018).

The researchers recommend that a pre-operative discussion is necessary to set expectations, and that an improved assessment scale would help in identifying and rating scars better.

Several studies have investigated in the prevention of emerging scars and eventually treating them as well. 

According to Monstrey et al., (2014), silicone sheets or gels are the most effective non-invasive remedy to treat scars post-surgery. Additionally, some physicians would recommend massaging the scar to treat it. Other known treatment options for scar treatments are fat grafting-- which proved effective for several patients (Negenborn et al., 2017; Riyal et al., 2017), laser treatments (Alberti et al., 2017; Perez and Rohrich, 2017), and even botulinum toxin (Ziade et al., 2014).

So what to do?

Make sure that you're up front about expectations post treatment, but also walk through a treatment plan to address or treat side effects like scarring long term. (Especially if the patient is prone to keloid scarring) Patients can be expected to follow very specific pathways on how they view their results and you can go a long way in elevating their perceived outcomes if you spend just a little time up front.

3 Local Marketing Hacks For Cosmetic Medical Practices To Leapfrog The Competition


Turning your local reputation into sales results is a complicated effort that every medical spa, laser clinic, plastic surgeon and dermatologist is continually trying to solve.

Many of the traditional ways no longer work. Yellow pages are dead. Newspapers have fewer readers. Tired 'discount local flyers' are less effective. Everything is turning to the mobile web. According to Pew Research, 72% of US adults use a smart phone, and the percentage of your patients are going to be higher than that. And they're using those little computers in their hand to research and find businesses on-demand - "best local lunch restaurants", "great roofing company near me", or "lowest Botox treatments near me".

Google refers to these times when people are asking for on-demand information related to purchases as "micro-moments" and they are quickly becoming the norm of many consumers. If you're not optimizing your online presence to take advantage of these moments and get yourself in front of potential patients you're missing all of those sales since you're not even in the game.

With the current tools available and the way people interact with them you should no longer be taking a spray-and-pray approach, trying to get in front of everyone. Instead, look at your metrics and see exactly where your sweet-spot is by age, types of treatments, and margins. Then examine they're buying patterns. It's probable that before you're selling the most expensive and profitable treatments that patients are exhibiting certain buying 'tendencies' that you can address. Uncover what those pathways are and then market those entry treatments to that narrow market segment. For example you may see that your most expensive laser treatments are sold to patients aged 40-45 who first came in initially for Restylane or Juvederm. Rather than market the laser first, you should really be targeting them with low cost lip augmentation or fillers.

What are marketing "Micro Moments"?

A post on Think With Google highlights some key opportunities for capturing customer mindshare during micro-moments, including:

  • Identify the top mobile searches in your area. As mentioned previously, mobile device usage is on the rise. More and more consumers are conducting searches on the go and those searches result in increased foot traffic and increased sales. In fact, 50 percent of mobile searches result in an in-store visit within 24 hours with 18 percent of those visits ending in a sale within a day. Knowing what those top mobile searches are can help ensure that your business is the one capturing those customers.
  • Know the frequently asked questions related to your business. If you know what consumers are asking about your business you can create content tailored specifically to answer those questions. For example, if you were a dentist you might want to optimize for questions like “how often should I floss?” or “do I need braces?” Helping to educate your community about issues important to them can help you build trust.
  • Know how customers find your business. Finally, it’s important to find out how customers are getting to your business. Map your customer journey and identify specific moments where customers might have questions. Doing so can help inform your local marketing strategy to ensure your messaging helps push them from consideration to purchase.

Now that you have a better understanding of how micro-moments affect your business, let’s touch on how you can use these moments to get new patients in your front door.

1. Hyper-Targeting

Look for opportunities to personalize your message when you're putting yourself in front of someone. It's now easy to collect mountains of information about customers and potential customers. You can use that info to personalize calls-to-action to make them more appealing. According to HubSpot, personalized CTAs converted 42 percent better than CTAs that aren’t personalized. The personalization need not be as targeted as someone's first and last name.... no. Social media platforms allow you to segment audience quite well, so you can address a message to 30-35 year old women to 'Soccer Mom', or 'Empty Nester" for those 50-55. Just use something clever that your target identifies will immediately.

2. Optimize Directories

One way to ensure that your business is there when your customers need you the most is optimizing your directories for local SEO. Doing so will give your business a better chance to show up in Google’s Map Pack and near the top of local search engine results pages. There are a number of simple things businesses can do to optimize for local search, but for whatever reason, they neglect to do so. They include:

  1. Claiming all relevant business directories
  2. Consistent contact info across all listings and on your site
  3. Upload high-res photos to increase attractiveness of your listing
  4. Use your blog to drive links back to your site
  5. Collect and manage online reviews

3. Build Out Extensive Online Patient Reviews

Online reviews are search engine gold. They build your search rankings, add to your credibility, and are trusted much more than what you say about yourself. A vast majority of consumers trust online reviews as much as personal recommendations from family and friends. Finally, they can help your business get chosen because online reviews have a strong influence on purchase decisions.

If online reviews are so valuable, why do many clinics ignore them? If you don’t have the right processes or tools in place, collecting online reviews can be difficult. In the past, the process was long and cumbersome, so many customers didn’t follow through with leaving a review even though they were willing to do so.

The key for a successful online review program is to make it as easy as possible. You can do this by focusing on which review sites customers already use and then delivering invites via your customers’ preferred communications channel. Doing those two things should result in a significant uptick in your invitation conversions.

Take a look at the Podium offer for Medical Spa MD Members to see how this should be working for your clinic. 

Note: There are a number of other competitor systems other than Podium that you might want to review, but Podium is the only one that is currently a Medical Spa MD Select Partner.

New Research Areas Around Minimizing Scars For Cosmetic Surgeries?


New technologies are promising to be able to reduce the most visible after-effects of surgical cosmetic procedures, scarring.

The ability to truly reduce or eliminate scarring after surgery would be a godsend for surgical procedures where scars are visible. The scars are always a negative for the patient and they can become a focus that lessens the results that the surgery actually delivered. The current crop of lotions and potions have some effect, but some form of aggressive wound healing that minimized or eliminated scars would be an optimal outcome for any procedure.

In the article by published last year in the Science magazine, a research team found that they were able to reprogram fat from myofibroblasts by signaling it with the Bone Morphogenic Protein (BMP), which promote growth. In their study, they were able to find a way in regenerating fat from myofibroblasts in adults. The researchers observed that growth of hair follicles was indicative of adipocyte regeneration, which is what most of their findings resulted.  They noticed that adipocytes grew around the area where hair follicles appeared. 

If it were easy to execute, it could definitely change how aesthetic surgeons can treat scarring in patients.

There is an abundance of research on wound healing in the plastic surgery field. Possibly getting some insight from Plikus et al.’s research, aesthetic physicians and surgeons can be guided into finding a way to signal the BMP receptor, they can benefit greatly in using the approach so they could minimize the risk of acquiring a scar after the surgery and turn it into fat instead. In this manner, the adipocytes might be easier to treat as compared to the scars.

Plastic surgeons employ different techniques to minimize the scarring on the areas in which the incision was made. Silicone sheeting is one of the most popular techniques in minimizing scarring in the area. Another technique is to use corticosteroids (Janis and Harrison, 2014).

There have been many cases that examined treating wounds through methods such as laser resurfacing and injections. These two alternatives do help in accelerating wound healing, with botulinum toxins even enhancing the appearance of scars. Dermal fillers also have been seen to have regenerative properties, which could help in the process of healing.

As of the moment, the research team responsible for converting myofibroblasts to fat cells have yet to test their findings out on humans, but they were able to relate it to what they saw on the mice. It would definitely be groundbreaking especially in the field of aesthetic medicine. For now, it is up to the aesthetic physician to educate the patient how to treat their scars.


  • https://insights.ovid.com/pubmed?pmid=24469191
  • http://science.sciencemag.org/content/355/6326/748.long

ExpedMed National Conference in Little Rock, AK, March 9-10, 2018

ExpedMed National Conference in Little Rock, AK, March 9-10, 2018


Attending an ExpedMed event is a refreshing alternative to the typical CME course. Our ExpedMed CME curriculum is based on the textbook entitled Expedition and Wilderness Medicine edited by Drs. Gregory Bledsoe, Michael Manyak, and David Townes. Drawing from a wide range of wilderness medicine and expedition medicine topics — with a particular emphasis on wilderness, tropical, and travel medicine — an ExpedMed CME course will provide you with the information you need on a variety of important topics, all in a concise and practical format.

Past faculty at our ExpedMed events include Dr. Luanne Freer, Dr. Michael VanRooyen, Dr. Tim Erickson, Dr. David Warrell, Dr. Howard Donner, Dr. Alan Magill, Dr. Rich Williams, Dr. Ken Kamler, Dr. Martin Nweeia, Dr. David Townes, Dr. Michael Callahan, Dr. Karen VanHoesen, Dr. Howard Backer, and many others.

Read More

Vibration Anesthesia + Insulin Syringes: Does it make a difference?

 Vibration Anesthesia 

Having some yahoo stick needles in your lips hurts. We try to mitigate that using everything from topical anesthetics (the most common), ice, and even nerve blocks, but should we be using vibration anesthesia and/or insulin syringes?

Vibration Anesthesia has been explored since 2004, but it hasn't reached mainstream adoption.

The study also applied topical anesthetic cream to lessen the incidence of pain as well.


  • 25 patients underwent the procedure
  • 92% of patients were comfortable with vibration anesthesia
  • The 8% of unsatisfied patients felt more pain and anxiety from the vibrations

Previous studies are also on the positive side of vibration anesthesia.

In conclusion, vibration anesthesia is deemed effective from some other studies. Smith et al. (2004) conducted one of the earlier studies of vibration anesthesia with regard to dermal fillers. The researchers recommended the use of vibration anesthesia for several procedures to help alleviate pain, but it is also suggested to use other methods in producing less pain to the patient.

Another study also explored vibration anesthesia, Mally et al. (2014) showed the efficacy of vibration anesthesia, with around 95% of their participants preferring vibration anesthesia.

What anesthesia works in your practice and for your patients?

In another article, an insulin syringe was used to inject dermal filler on the lips. More and more studies emerge in terms of injection techniques. What about what the needles used for injecting dermal fillers, do they matter as well? 

It is best to consider the consistency of the filler (Urdiales-Gálvez et al., 2017) before going through what needle or cannula to use. Many physicians made the switch from needles to cannulas, simply because of its ability to reduce pain and cause less discomfort to the patient. There is collagen stimulation when a cannula is administered (Brackenbury, 2015). On the other hand, needles are more precise, and a few injection sites would suffice. Bruising is the most common complaint when using needles.
Both modes have their pros and cons, but eventually the physician will need to discern, which is much better for dermal fillers.

In one journal article, the researchers found that an insulin syringe is also an effective way to deliver dermal filler injections. Kechichian et al. (2017) used an insulin syringe for lip augmentation. It is a novel method, but the idea is to give the patient more comfort as the injection is administered. Their findings leaned towards the preference of using insulin syringe due to its fine needle.

In the end, it all boils down to the administering of the injection and the comfort of the patient, and the experience of the provider.

Would patches really replace injectables and laser or light based devices?


Microneedle patches seem to have beneficial implications based on the current studies presented by researchers. It could then give another alternative for patients, for those who would need short term solutions or quick fixes maybe. Since the patches were made for the studies, it may be too early to say if it would be produced for the public. 

A few months ago, a microneedling patch to reduce fat was tested on mice, having good effects after the application of patches. In another study, a patch was also developed to brighten the skin, additionally there was another study which examined the use of hyaluronic acid on the microneedle patch. In this new study, a microneedle patch was used to reduce the appearance of wrinkles.

The question then is, would patches be the future of cosmetic medicine?

The latest study in microneedle patches was conducted by Hong and colleagues. The researchers divided the 84 participants into groups of 3, group 1 had the patch applied solely, group 2 had the wrinkle cream and patch, while group 3 had the wrinkle cream only.


  • The researchers examined skin conditions before patch application, and 4, 8, and 12 weeks after application, with group 2 having improvement by 8 weeks, whereas groups 1 and 3 had eventual improve by the 12th week.
  • There were no adverse effects reported in the study.
  • Microneedle patch coupled with wrinkled cream was more effective as standalone patch or cream.

Would these patches have better efficacy than the current treatment options?

Based on the studies presented by the researchers, it would be good to examine the long term effects of using the patch. In the current studies about microneedling patches, there are no signs of adverse effects or symptoms on the subjects. It may be difficult to say regarding the use of patches as the literature is scant regarding it as these are nascent in the field. It does have its benefits, but a long term solution and efficacy are of utmost importance regarding treatments. So far, patches do offer short term solutions according to the studies.

Many things remain unclear regarding the use of patches, such as the long-term efficacy rate, number of treatments done to alleviate wrinkles or brighten skin, but the future of cosmetic medicine holds many possibilities, and patches could help advance the field for many providers and patients to come, considering it holds promise in the field to understand medical aesthetic in microneedling.

Aesthetic & Medspa Predictions for 2018

If you're ever looking at trends you'll find that there are always the same old things that are trotted out year after year; men are getting more treatments, some kind of new lip augmentation, and a new suture or thread built into a facelift. 

In 2017, the predictions dealt more with dermal fillers and fat transfer. For 2018, according to different aesthetic medicine institutions, the three procedures seeing a rise are Platelet Rich Plasma Injections, Genital Surgery/Rejuvenation, and Periorbital Rejuvenation.

Fat Grafting or Rejuvenation Injections

Platelet Rich Plasma (PRP) continues to rise in use for cosmetic surgery. The procedure itself has been performed countless of times in different branches of medicine. It is known for its healing properties, but it has branched out to aesthetics for its properties.

Even with the abundance of literature of PRP, it seems there is a need to further examine its effects with regard to aesthetic medicine. Dermatology currently uses PRP to restore hair, and “vampire facelifts” have been one of the most popular procedures and PRP.

Many remain wary over Plasma Rich Platelet due to the lack of evidence of its efficacy  however, it is effective in dermatology with respect to hair restoration. Yet, PRP, while still unfounded to be effective for cosmetic purposes, is still used by many aesthetic physicians for facelifts and fat grafting.

Despite the wariness by some physicians over the effectiveness of PRP, several physicians have conducted their studies and investigated the efficacy of PRP injections… 

Youthful Genitals

Aside from PRP, we will see the rise of genital surgery as well. Genital surgery, whether invasive or minimally invasive have seen an upward slope lately. 

Genital surgery is considered due to the beauty standards and media influences and the demographics involving those undergoing it. So far, some of the most popular procedures for genital surgery are vaginal rejuvenation and tightening. Non-surgical alternatives have also been developed like lasers and RF options for patients. Dermal fillers can also be used on the vagina and labia, and there have also been reports of botulinum toxins on the scrotum.

Periorbital for the Millennial

Millennials are gearing up to be the next generation many physicians will be seeing in their medical spas. It seems they are flocking to medical spas more, 

Periorbital rejuvenation could also be seeing a spike especially with millennials. According to IAPAM, this procedure would be considered preventive for the generation. Millennials may want to remove the wrinkles and black circles under their eyes, additionally, the older target audience would like one to have a natural-looking appearance when it comes to their eyes.