The New Medical Spa MD Marketplace

We've just launched the new Medical Spa MD Marketplace where you can get special offers and deals from companies.

We've just launched a new, updated marketplace to let Members take advantage of offers and deals from our Select Partners and outside companies who to provide special offers to our Members.

In addition to the publicly available offers which are visible and available to everyone, our Members will also receive additional offers and discounts that are not available publicly. (Yet another great reason to join us.)

You can already find some incredible offers like discounted software, upgraded warranties, and group buy wholesale pricing on fillers and injectables.

And we have a Certified Partner Program to protect all of our Members.

Need a waiting room video to increase your up-sells and educate your patients about your other services? Need a designer to create a kick-ass Facebook page graphic? Want to know that when you buy a used laser that you've got someone who can intervene on your behalf?

Done.

Have a product or service that could benefit our Members? Become a Select Partner.

A Free Embezzlement & Employee Theft Scams Course For Members

There are only two types of cosmetic clinics; Those who have have been stolen from, and those that don't know that they've been stolen from yet.

Every cosmetic clinic has this problem.

Every. Single. One.

And it's not hard to see why. Most people aren't bad, but there's always temptation, especially when it's easy or there are outside pressures or gripes that make it easy to justify taking just a little here and there. That little voice that says, "I'm the one doing the work. The patients love me. Everyone else is getting rich. I'm owed more...".

We're doing our part to help protect your clinic by taking our popular embezzlement guide and turning it in to a free course with video explanations and added it to the new Medical Spa MD Training Academy. You'll learn how how these scams work, and how you can protect your clinic from them.

This course is entirely free, and may just save your clinic.

In this course you'll uncover all kinds of creative, never-thought-of-that scams:

  • A physician employee connecting his personal account to the credit card terminal.
  • A PA injecting patients with saline and stealing Botox to run a side business.
  • Laser technicians "up-selling" treatments and pocketing thousands in cash every week.
  • A simple accounting scheme that drove a clinic into bankruptcy.
  • A manager treating patients on weekends.
  • Front desk staff using a simple credit card scam and skimming 3% of sales.
  • And (unfortunately) many, many more...

These physicians and clinic owners weren't stupid. They weren't lax or taking their eye off of the ball. They were just victims of the myriad creative ways that these scams work, and they hadn't taken this course yet.

This course gives you the inside cheats, tricks and scams that people use every day, and the simple ways that you can prevent the vast majority from ever getting started in the first place. This course is for every physician, clinic owner, manager and employee working in cosmetic medicine.

How To Use Your Patients To Grow Your Medical Practice

The best marketing for your clinic is when your patients do it for you.

Word of mouth takes many forms, but it's increasingly being handled online through social networks and search engines. Patients are now researching you online before they call. They look at your reviews. They run searches with your name and "complaints", "malpractice", "lawsuits", "reviews". If you're going to compete, you have to be in the game.

To do that, you're going to need the right tools, which I'm going to show you, but you have to be convinced that they're important to buy and use or you'll just stay with what you know, so I'm going to dive in to why you need them first.

You've got a marketing problem that you didn't have before.

It wasn't long ago when you just needed to be found, and ranking high in searches drove traffic and filled your treatment rooms.

No longer.

Consumers of all types have subtly changed their decision behaviors online and are weighing buying cues much differently than just two years ago. Reviews are seen by prospects as increasingly important in their buying decisions.

That changes the playing field. (Don't believe me? Just keep reading.)

When asked, 90% of people read reviews before visiting a local business. 85% of those people relate that they trust those online reviews as much as they would a family member or trusted friend.

But it goes beyond simply making the first call to your front desk. Consumers spend 31% more money with businesses that have higher reviews than their competitors. It has nothing to do with price, the quality of service, or other metrics. It's the perception in the consumers mind that higher rated businesses are more trustworthy than those with few or negative reviews. There's a simple reason for that I'm sure you're aware of; a review is how the consumer 'felt' about the business after everything else was taken in to consideration; price, value, responsiveness... The star matrix is really a metric of satisfaction at the end result.

Just today I was looking to arrange three business lunches in the coming week. In every case it was the number of reviews and the star totals that made the decision for me.

Here was my thinking:

  • Few reviews? It's too risky; there are safer choices.
  • Lower star rating? Patrons weren't satisfied. Who want's to eat there?
  • Negative reviews by themselves? Tricky... some people are jerks so an occasional bad review is unavoidable, but it's too risky. I'll go somewhere else.
  • Negative reviews with responses? A few negatives is okay. I can trust the positive reviews more and - especially if the business has responded to the reviews - I think they take their reputation seriously. It makes me more confident that they don't want negative reviews and they work harder than others to avoid them.
  • Lot's of reviews (even a few negatives) and a 4+ star rating? That's the place.

And the above is especially true for your clinic.

Think about what you would do if you were deciding between two clinics – both with 4 stars – where one clinic has 5 reviews and the other has 25.

You'll choose the one with 25 every time, and that's costing you patients if you're the clinic with only 5.
 

Do reviews really drive new patients?

Here are the results of a survey we sent out to members showing the importance and value of enlisting patients in your growth strategy. The recipients were selected from a cross-section of members to try and hit all types of clinics; dermatologists, plastic surgeons, medical spas and cosmetic clinics.

Question: What is your most effective marketing?

effective-marketing-patients-medspa-md.png

Yep. Number 1 and 2 - word of mouth referrals and internet searches - both fit squarely around your online patient reviews. Everything else is a very distant third.

Reviews are a primary traffic driver and trust builder:

  • Reviews are free. Advertising that is completely free of cost is a rare commodity. Reviews let your patients build links to your site and drive new traffic.
  • They're authentic: New prospects want to know what your existing patients think of you. Reviews let them communicate that in an authentic voice that prospects relate to.
  • They build trust: 92% of Americans trust word-of-mouth more than any other form of marketing – even if they don't personally know the person... and online reviews are more trustworthy than testimonials on your site that you have complete control over.
  • Improves your search rankings: Google ranks websites according to their perceived authority and their ability to provide valuable content. Customer reviews can help tell search engines that your brand is established, and when more people online are discussing your firm, Google will rank your site higher in search engine results. It also helps to add links to customer reviews on your site, because Google rewards sites that contain links to other authoritative websites.
  • Lowers your bounce rate: Customer reviews help your business stand out and make visitors to your website more interested in your product or service because of the value others have had. The impact on your site’s bounce rate can be meaningful and can help to trigger higher rankings as bounce rate is arguably one of the ranking factors involved in search results.
  • Previews your star ranking: Many sites that feature star rating systems will show a preview when someone does a search for your brand. This means that a person will not need to click on their page to see that your company was rated favorably, as the star level and the first few sentences will show up on the search results page. Google will sort search engine results based on the number of reviews received, giving you an advantage and an SEO boost. Your good reputation will then precede you, increasing the likelihood that a person will click through and choose you above your competitors.

Reviews are interesting in another way as well; they tell you what's important to your patients and they identify weak spots in your systems that you can address.
 

Do reviews really increase your revenue?

From the same survey, we also asked clinics how much revenue  each new patient added in just the first month. The lifetime value of each patient is dependent upon the clinic type (nonsurgical / surgical) but can be expected to be a multiple of this number.

Question: How much is a new patient worth to your clinic in the first month?

patients-worth-first-month.png

It's interesting that there's a gap here in the middle, but once I thought about it it made a lot of sense; the clinics we surveyed were fairly well divided between "medical" and "spas"... So if you're a cosmetic medical practice you're far more likely to be on the right of this graph with each new patient spending North of $2000 the first month.

Question: How many new patients does your typical client refer each year?

patient-referrals-medspa-md.png

Okay, this is were we start to see some hope of shifting the results here to the right if you're getting on board with patient reviews and those reviews are working for you. If you're able to shift that 3 patients a year to just 4, that would equate with roughly a 20% greater delta in your yearly growth and a corresponding increase in revenue and profits. Just a small increase in the coefficient can have a dramatic effect in the end result over time.

That's what we're looking to try and do.
 

What should I do?

The short answer to "what should I do?" is - Do something. Anything. But don't do nothing.

How much less is your clinic worth to someone who wants to buy it if your reviews are negative? How much harder is it to recruit staff? How many patients are you losing that you don't know about.? Simply put, your online reviews are your brand, and an indication of patient trust and satisfaction. Reviews are what people are saying about you to others (which is what your brand is), and you can't just ignore your brand and reputation if you want to have a successful clinic or valuable asset. 

You have 3 options; you can ignore it, you can do it manually, or you can do it automatically.
 

Option 1 - Ignore my online reviews

You can't ignore it... Well, actually I guess you can. After all this is what most clinics do. They bitch and moan about someone leaving a negative review since they know it hurts their reputation, but they take no proactive actions to increase or control those reviews.)They simply float along with the status quo and hope nothing happens.

Here's what ignoring it means:

  • Your competition may not ignore it, which means that they're either taking your existing market share, or they're putting you further behind while you're not even showing up to compete.
  • You're reputation is uninsured: Something really damaging can happen which you won't be able to respond to.
  • You're missing out on every new patient that might have been brought in. You're missing sales, word of mouth, and compounding growth. This is really where you're killing yourself long term.

Pros & Cons: The only pro to this is that it's free, but the cons are legion. If you're ignoring your reputation and new business you're damaging your clinic. Go stub your toe in penance.
 

Option 2 - Do it manaully

Yes, you can do this manually but don't be fooled that it's not a lot of work. It is, but up until now this was the best way that you could address this need and what most clinics have tried to do in some form.

Here's a simple framework of what you should be doing right now at your front desk.

  • Implement operational systems at your front desk check out procedure that is followed for every single patient. (See the Ultimate Clinic Operations Blueprint)
  • Every happy patient should be asked to please leave a testimonial or review on their Facebook page or on your Google Business Listing. You should ask if they would be willing to use their phone to do it right now. (You may want to add a small discount or free product gift if they're willing to do this.)
  • You should contact Tea & Muffins Design to have some postcards made where patients can fill out a testimonial right there that you can use.
  • You should send an email or postcard reminder soon after each appointment. (You'll want to keep track of who has already left reviews or you'll irritate your happy patients with redundant emails.)
  • You should set up a number of Google Alerts to try and monitor when reviews go up so that you can respond to them.

Pros & Cons: We'll, at least you're doing something but this is time intensive and a real pain in the ass to try and manage after the first week. The opportunity cost is huge in the time invested and the "just-one-more-thing-to-try-and-manage" costs.

And there's another problem with this. Even if you're proactive and constantly ask your patients to leave reviews, they don't. 

Have you ever left a review? You have to be really motivated and it's much easier just to do nothing once you're out of the clinic.

But where there's a problem there's also an opportunity.
 

Option 2 - Do it automatically

To be an automated solution you need to have software that is both drop-dead simple to use, and gives you complete control on both Facebook and Google.

It also needs to be easy to incorporate it in to your operations, and use easy workflows; texting review requests, reputation management, notifications, tracking, permissions, and even additional patient interactions.

Here's what this software should do:

  • Needs to be really simple to use: No more than entering a name and phone number. Needs to be used during check-out when patients are most willing to leave you a positive review AND any time thereafter.
  • Needs to be simple for the patient. Needs to work via simple text message, not an app or download.
  • Needs automatic monitoring of my reviews: I want to be notified of every review and be able to respond  in one place, not login to every review site.
  • Needs accounts for each team member: I want track everyone inside the system, and their reviews.
  • Send external texts: I want to be able to send text messages to my patients as followup, reminders, or just to inform them about an offer we have coming up.
  • Let's patients and prospects text me: I want prospects to be able to text me directly from my Google review page or Facebook.
  • Simple... Did I say that already?

Since we're aware that this is a growing need for our Members we took a look at the front-runners in this space. Here are 3 of the top business review software providers to take a look at with their user satisfaction ratings supplied by G2 Crowd.
 

Highest Rated Reputation & Review Management Software

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Highest Rated Ease Of Use Reputation & Review Management Software

Ratings from G2 Crowd

Ratings from G2 Crowd


As shown above, Podium is the clear winner among business review management software providers both in total user satisfaction and usability - which is critical.

so we contacted Podium and asked them to help us provide their software at a discount for our Members (you).

They agreed.

So, Podium partnered with Medical Spa MD to provide a special offer exclusively to our members which includes both a full Podium account, discounted fees, and special training for your staff in our Training Academy.

Here's a quick video I made to show you how simple it is to send a review request to your patient while they're checking out!

This is exactly how your front desk staff would use Podium when a patient is checking out, or your staff would use it from their cell phone right in the treatment room.

"Hey, would you mind me texting you a review request to give us some feedback?"

Damn that is nice!
 

Here's Podium explaining more about their software.


And about their messaging feature which allows patients who see you online to text you questions, a much easier action to take than calling and talking to someone.

Because reviews are increasingly critical for every business there are startups that are building solutions to fill the need - including using patient reviews to fill your appointment calendar, increase patient satisfaction and compound your patient referrals and word of mouth marketing.  


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Get this special offer from Podium 

Medical Spa MD Members receive a special, full service Podium account that includes: no setup fee (save $300), a 10% discount forever (save $330/year) and on-demand patient review marketing training for your entire staff ($597 value). 

This offer is not available anywhere else

The 10X Consultation Playbook will be our next course. Here's why.

The 10X Consultation Playbook - The ultimate guide to mastering patient consultations that sell. See it here >

A little while back I wrote a post about the 5 areas that I've found most closely correlated with success in the 17 years that I've been building top performing clinics.

Here's the post: 5 Lessons From 22,362 Clinics About Building A Successful Cosmetic Practice

If you leave any 1 of these 5 areas out you're hamstringing your business and and stunting your growth. If you're good at at least 3 and you'll be competitive, and if you're good at all 5 you'll own your local market... the world is your oyster. 

  1. Mastering patient consultations (sales)
  2. Replacing yourself with systems (operations)
  3. Delivering the remarkable (patient experience)
  4. Aligning your staff's perceived best-interests (leadership)
  5. Waging asymmetrical warfare against the competition (strategy)

You'll notice, and I discuss this in the post, that there's nothing on treatment results (patient outcomes), what IPL or device you're using (technology), or price (money). That's because these three areas, the areas that most clinic owners - especially those starting out - obsess over have no correlation with the success of the clinic. (Now' don't blow a gasket. I'm not saying that they're not important, especially around patient outcomes, but only that they do not contribute to how successful you are going to be in relationship to other clinics. Failure in these areas can destroy you, but success in these areas will not make you successful.)

That post obviously hit a nerve, especially around the top two areas on the list; mastering patient consultations and using systems to automate your clinic operations. And that's understandable. The consultation room is where the money is made, and clinic operations is where the money is lost. 

In fact, we received so many questions and inquires around improving consultations - more than 8 times what we normally receive - that we changed up the training course roadmap.

Our roadmap had been to systematically build a set of comprehensive trainings to teach you (#1) how to implement systems in your clinic (The Ultimate Clinic Operations Blueprint) so that you could make your clinic run more efficiently, then to launch a course (#2) on marketing that taught you how to bring in hundreds or thousands of new patients a year, and then to launch a course (#3) teaching you systems for consultations that convert (selling).

But in seeing the questions coming in we're switching that up a little.

The next Training Academy course we're launching will not be The Ultimate Clinic Marketing Plan, it will be The 10X Consultation Playbook.

Here's why: The single most important determining your sales success is how well you do one thing; consultations

Poor consultations destroy your reputation and waste every dollar you spend on bringing new patients in to your clinic. And they're not uncommon. It's simple math; 49% of clinicians are performing consults that are below average. Poor consultations will put you right on the edge of going out of business, and will force you to try to compete on price. If you're having thoughts around pricing, or if you're using terminology like "loss leader", or if you're just at the lower end of the pricing wars in your local market, it's likely - more than that, it's probable - that your consultations are below average.

Average consultations generate some sales and leave you bumping along and quasi-satisfied with your business - where you can't quite figure out what's missing. You know that you're leaving money on the table but don't exactly know why.

Heads up: The maddening thing about average consultations is that you won't see them as being average. You'll see them as way above average, just like every other person when asked to compare themselves to others. It's called illusory superiority and there are almost endless examples:

  • In Kruger and Dunning's experiments participants were given specific tasks (such as solving logic problems, analyzing grammar questions, and determining whether jokes were funny), and were asked to evaluate their performance on these tasks relative to the rest of the group, enabling a direct comparison of their actual and perceived performance.

    Results were divided into four groups depending on actual performance and it was found that all four groups evaluated their performance as above average, meaning that the lowest-scoring group (the bottom 25%) showed a very large illusory superiority bias. The researchers attributed this to the fact that the individuals who were worst at performing the tasks were also worst at recognizing skill in those tasks. This was supported by the fact that, given training, the worst subjects improved their estimate of their rank as well as getting better at the tasks. The paper, titled "Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments", won a Nobel Prize in 2000.
     
  • In a survey of faculty at the University of Nebraska–Lincoln, 68% of professors rated themselves in the top 25% for teaching ability, and more than 90% rated themselves as above average.
     
  • In a similar survey, 87% of Master of Business Administration students at Stanford University rated their academic performance as above the median.

Don't think that's you? 

Everyone describes themselves in positive terms compared to other people, and this includes thinking that they're less susceptible to bias than other people. This effect is called the "bias blind spot" and has been demonstrated independently.

We sent a survey to cosmetic clinicians (some of our Members) and asked them to score their consultations against their competitors on a scale of 1 to 10.

The results of that survey fit right in with every other study on how humans perceive themselves. Almost every clinician rated their consultative skills between 5 and 9. So, if you think that you'd rank your consultations as a 7 or 8, you're right at the top of the bell curve of average.

Consultation Survey Results

Consultation Survey Results

(One interesting note; In speaking with two different clinicians who had rated themselves as a 7 and an 8 in this survey I brought up the fact that their self-rating put them in the 'average' column. Both of them immediately re-calibrated and added another point or two to their rating in order to remain above average.) 

You may have a competitor that is not using technology as good as yours, is not as technical skilled, does not deliver outcomes that are as good as yours, who is charging more (or less) than you do, but is still taking patients away from you. It's maddening, but there's a reason. They're delivering great consults. They're building empathy and trust with their patients. They're guiding along the journey that patient is asking for. There's no way you can compete with that based on having a newer IPL and - if you're going to be competitive - you're going to have to get better at consultations.

But there is good news. Mastering patient consultations is a skill set you can learn.
 

The money is made in the consultation room.

Great consultations are the secret of incredibly profitable clinics. They almost print money. Great consultations fill your schedule and treatment rooms and create fanatically loyal patients and they boost your revenue faster and easier than any other thing you can do as an individual. And great consultations come in all sorts of flavors.

It doesn't matter what your 'shtick' is. You may be rolling old school as a luminary plastic surgeon with a hundred degrees on your wall and a staff of 40, or you may be a family practice doc who's just learning Botox, or you might be setting up a new clinic and going through some sleepless nights wondering how you're going to pay for everything. Your consultations are something that you can improve that makes an immediate difference.

I've seen a lot of clinicians who are fantastic in the consultation room.

  • A plastic surgeon from Brazil who was all air kisses and theatricality. He looked and acted every bit of the Hollywood cliche plastic surgeon from his slicked back hair to his designer suits, but when he walked into the consultation room he stepped off his pedestal and patients knew they could trust him.
  • A Ukrainian physician who was working in the US as an esthetician with movie-star looks and fashion sense who literally sold three times as much as the physician in the clinic.
  • A goof-ball dermatologist who could barely dress himself and looked half the age of his patients open a brand new clinic and destroy the entrenched local competitors by being a boy-next-door.
  • An internist who was completely new to aesthetics pull a clinic out of foreclosure and make it insanely profitable by sitting down with patients and talking girlfriend-to-girlfriend.

All of these clinicians were different, but they all killed it in the consultation room, not because they were consultation savants, but because they understood that consultations are critical to success and they worked hard to improve. Their tactics and personalities varied dramatically and the way they presented to the patient were completely different, but the formula they followed was the same every time.

That structure, that system, that repeatable formula is what the 10x Consultation Playbook delivers.
 

Hope is not a strategy.

It's not going to happen by itself. You weren't trained in sales. In fact, some of the things you were taught are actively hampering you. You're not going to suddenly understand everything you need to know and do to improve your sales and neither is your team.

I can not tell you the number of times when I've asked clinicians how they start a consultation and it's some form of "tell me what you'd like done", or they hand the patient a mirror with something along the lines of "tell me what you see that you don't like". Worse still are the clinicians who actually just launch in to a litany of all the things they can see that they could "fix", oblivious to the frozen smile on the patient sitting their horrified and embarrassed to find out that they're such a wreck. 

The fact is that great businesses aren't built on luck or chance. The're built on repeatable rules and proven processes and reliable frameworks.

It may not sound too exciting, but I'm okay with that.

Because you know what is exciting? Implementing your new systems and finding that your conversion rates, and revenue spike. That is sexy. The best parts of business always are - without fail - the measurable parts. Everything else is just guesswork. And you can't build a business that wins by just relying on your guesses.

Systems help you pre-decide what’s important to you — ONCE — and then force you to stay focused. Instead of your clinic staff wondering what they should do… or making it up on the fly… you’ll have a clear system to follow that is both structured, and flexible, so you’re not working with so many variables that you have no clear idea what's working and what's not.

Once you integrate these systems into your clinic, you’ll feel the freedom of being able to make decisions and see their effects rather than just hoping that you're headed in the right direction.

Think of a simple system you already use — where you put your keys. Maybe it’s by the door, or in the kitchen. Yet it’s become a habit and you never think about it. You don’t have to “try harder” to put the keys where they should be… it just works. It’s mindless. And it does what it needs to do.

Now think about your consultations and the way they work.

You already have a 'system' that you're using. You're beginning the same way, you ask the same questions, and you give the same answers to the same questions each time. That's something of a system, but is it the best you could do? Couldn't it be improved if you actually had a structured system and formula that ensured that every consult was perfect?

That's why we're moving the Playbook up to be the next course we publish; because the money really is made in the consultation room and improving your consultations is the single easiest thing you can do with your existing clientele to bring in more revenue.

You don't have to spend money on advertising, or buy a new fractional laser. You just have to spend some time starting with the basics and building on your existing skill set. you don't have to get a new license or insurance rider.  You don't have to travel or take on inventory. You just have to learn and use some new skills that you can put to use immediately.

That's why I know that when you improve your consultations, you're going to see results.

Small differences in your [system] performance can lead to large differences in your results
— Brian Tracy

 Top performers know how to sell. Average performers don't.

The Playbook is not being built around hard selling or gimmicks or unethical practices. It's not about talking people in to treatments they don't need or being pushy. It's not about pressure. In fact, it's probably not at all what you think of as "sales training".

It's about guiding your patients along the journey they want to take.

The 10X Consultation Playbook is a  system that will take you past the guesswork. You'll get the frameworks, strategy, tactics and repeatable techniques to systematically improve your consultations and conversion rates. You'll learn exactly what to do and how and when to do it, but just as importantly you'll learn WHY you're doing it. In short, 10X Consultation Playbook is a method, a system, and a proven FORMULA... that clinicians have applied successfully over and over to produce high converting consultations, increased patient loyalty, and greater revenue.

It will also come with a 30 day money back guarantee and integrates perfectly with the Ultimate Clinic Operations Blueprint.

And it's not just for you. Every member of your staff will learn these systems too.

So if increasing your conversion rates, sales and income is of interest to you, please take just a second and sign up on our early bird list to be notified when the Playbook launches. Once you're on the email list we'll be sending some early snippets  and lessons and requesting feedback. And you'll also get a one-time special discount for being on the list when we go live.

 

Questions? Please leave a comment or contact us directly.

5 Lessons We've Learned About Building A Successful Cosmetic Practice

Patient Experience

John D. Rockefeller's quote of "I would rather earn 1% of 100 people's efforts than 100% of my own" is exactly right. So how do you get your patients to help you out just 1% and turn your dribble of patient referrals into a torrent?

The smartest clinic owners know that getting your patients to work for you just that 1% is the path to easy, repeated sales, makes life difficult for your competitors, and isn't forcing you to work 80 hours a week to keep your head above water. Savvy clinicians intuitively work towards each of these goals, but they often don't think of them as part of a whole. In this series of posts we're going to pull these topics apart and detail why and how they all fit together to build a machine that perpetuates and grows your clinic's income. 

I'm going to break down 5 critical areas that you need to spend effort on improving if you're going to move past the average medical practice income and reputation and get into the VIP section of top performers. Leave any one of these out and you're hamstringing your business. 

  1. Mastering patient consultations
  2. Replacing yourself with systems
  3. Delivering the remarkable
  4. Aligning your staff's perceived best-interests
  5. Waging asymmetrical warfare against the competition

Note what's NOT on the list - anything about patient outcomes. (We'll take it for granted that you're not burning patients with your IPL or they're getting ptosis from your Botox.) Outcomes are really what patients "perceive", not the actual clinical result. Improving these 5 areas will readily increase patients perception of the value you're delivering, and their outcomes. What else is not on the list? Price. (More about this below.)

Here's why these 5 areas are of critical importance to your clinic, and what you can do to start improving them.

Mastering Patient Consultations 

Top performers know how to sell. Average performers hope you'll buy.

On a scale of 1 to 10, where would you rank your consultations? How good do you think you are? It's probably that you think that your consults are somewhere above average.  After all, you're getting patients and you're busy so what's the problem? Isn't being busy the goal?

Actually, no. Everyone is busy. That part's easy. Being successful and profitable is the goal. (Having a work/life balance and a 36 hour work week may be part of that too.) and if you're not delivering perfect consultations you're stepping on your own success. 

It's most likely that your consultations - like most - are completely average.

94% of college professors believe that their teaching skills are above average, a statistical impossibility, but there's nothing special in this regard about academics, clinicians also think they're above average in every self-assessment of skills.

We sent a survey to thousands of clinicians and asked them to rank their consults on a scale of 1 to 10. The results of that survey fit right in line with the college professors, every response rated their consultative skills between 5 and 9. So, if you answered the question above and ranked your consultations as a 7 or 8, you're right at the top of the bell curve and you can bet that your consultations are solidly average. Sorry.

Why is that important?

Poor consultations destroy your reputation and waste every dollar you spend on bringing new patients in to your clinic. Poor consults will put you out of business.

Average consultations generate some sales and leave you almost (but not quite) satisfied with your business - where you can't quite figure out what's missing and your clinic is just grinding along. 

Great consultations are the secret of incredibly profitable clinics. They almost print money. Great consultations fill your schedule and treatment rooms and create fanatically loyal patients and they boost your revenue faster and easier than anything else.  Best of all, mastering patient consultations is a skill set you can learn.

What to do: You need to improve your consultations. To that end, we're about to launch the 10X Consultation Playbook in the Training Academy in order to teach you and your entire staff how to master consultations. This masterclass teaches you everything you need to know to put your consultations at the very top of the heap. Oh, and it's 100% satisfaction guaranteed.


Replacing Yourself With Systems

Top performers use systems. Average performers don't.

 Stop working IN your clinic, and start working ON your clinic.

Systems are what every clinic uses in order to stop micro-managing, stop flailing, stop losing patients, and stop losing revenue. They're a way of replacing yourself. Systems help you pre-decide what’s important to you — ONCE — and then force you to stay focused. Instead of your clinic staff wondering what they should do… or making it up on the fly… you’ll have a clear system to follow that is both structured, and flexible, so you’re not constantly “trying harder” to “catch up.”

Once you integrate real systems into your clinic, you’ll feel the freedom of not being crushed by the necessity to be involved in everything (I'm talking to you, micro-manager) because you know that everything is getting done, and it's getting done right.

Think of the simplest system you use — where you put your keys. Maybe it’s by the door, or in the kitchen. Yet it’s become a habit and you never think about it. You don’t have to “try harder” to put the keys where they should be… it just works. It’s mindless. And it does what it needs to do.

You may be thinking that you already have systems. You have a manual, you have some "policies", everyone knows pretty much what to do and when.

Eh... I'm skeptical.

A few weeks ago, I sent a survey to 472 physicians asking about their clinic's efficiency and productivity. Perhaps you're not surprised by some of the results. You might even recognize your own clinic.

  • Over 9/10 of physicians said that their clinic operated at less than 80% efficiency
  • 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's 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.

You're smart. You're tired of sloppy training, loose accountability, and variable patient care and you want some control of your business and your lifestyle. You're tired of putting out fires, answer the same questions, micro-managing everything, and running legal, clinical, and business risks.

Get real systems and put them to work for you.


Being Remarkable

Top performers are remarkable. Average performers are nondescript.

Please don't be beige.

Hard I know, but beige sucks. Beige is mediocre. Beige is completely forgettable. Unfortunately, most clinics aspire to beige... do what everyone else does. It's safe. They're thinking, "I should be able to make go of it... I can do what others are doing...  at least I won't make any costly mistakes that cost me."

Not so.

Working to be average is among the most costly mistakes clinics make, and the most common. Playing it safe leaves stillborn everything you might do that could cause a patient to 'remark' about your clinic. It leaves your patients in limbo and forces you to carry all the water yourself. 

To get your patients to tell others you need to do two things; first, you need to be worthy of being remarked upon and second, you need to make it easy.

Example of being remarkable: One of my clinics was located near a big U.S. Air Force base with about 20,000 military personnel and staff. When operation Iraqi Freedom was launched in 2002 many of those military members were about to be deployed to Turkey for a year. Just before this deployment were some politics going on in the UN and France vetoed a resolution which was unpopular at the base.

I took the opportunity to launch a tongue-in-cheek PR campaign to "Veto French Armpits" and we gave away free underarm laser hair removal treatments to every female military member as well as any wives or girlfriends of military personnel. It was open-ended and completely free series of 7 treatments, a complete package. We didn't tie it to other offers, and yes, we did get some patients who took advantage of it completely but that was what elevated it and made it remarkable. 

The result? We donated more than $40,000 in treatments which made us a lot of friends and brought in a massive surge of new patients, we got national media attention and a deluge of local coverage, and we took a massive chunk of the market that continues to this day. That investment in being remarkable produced about a million dollars in revenue over the years, dwarfing our investment.

If you're open to seizing opportunity, you can do remarkable work with just about any situation. We secured a massive patient population not by doing something that was simple, but by doing something that was remarkable.

Do something, anything, that makes you worth talking about.

Second; you need to make it easy for your patients to help you. If you don't,  you're missing out on all of the goodwill and positive thoughts you're generating.

How many times have you asked patients to share a Like on your Facebook page, or leave a review on Google, or just hoped that they would see how incredible you are and tell everyone?

Hope is not a strategy.

You need to make it easy for them, and that means facilitating the action you're asking them to take - Keep a stack of postcards at the front desk and give them $10 off if they'll write a friends address and a short note when they check out. Give a free package for local business owners or their spouse. Start a corporate program. 

The key is that you want to build these out as part of your standard processes and make it drop-dead easy.

Take a look at the special offer from Podium, the leader in patient review marketing. It's a paid application that allows you to capture reviews from you happy patients right at your front desk when your patients are most likely to take the time to help you out.


Aligning Your Staff's Best-Interests With Your Clinic's Needs

Top performers are leaders. Average performers just pay.

If you think that anyone works for you, well, news flash -  they don't. They all work for themselves, just like you do.

Your job, as a business owner, is to align what they perceive to be in their own best interest with your business goals. This will always include money, but there are other areas where you can have a drastic impact. Workload, environment, professional and personal satisfaction, advancement and training, reputation... your goal is to make your staff believe that making your clinic excel is the most closely aligned with their desired path forward. Do this, and you're going to have a motivated team.

If you can't do this, you're going to have constant turnover and you'll lose income. Your staff may comply with your demands, but they're working for a paycheck, and it only takes a single arched eyebrow or eye-roll to cost you a $4,500 package sale or destroy a reputation with a patient. Multiply that by every patient interaction and you'll see a significant problem.

What's the difference?

Leaders understand that everyone works for themselves. They understand that leadership is given by those willing to follow from the bottom up. Leaders have to live up to very high standards to be worthy of being followed, and they work at it constantly.

Average performers think that their staff works for them. They have 'authority' that flows from the top down, but they're not leaders because they're not worth following. People work simply for a paycheck and will leave as soon as something better comes along. 

What can you do?

  • Work hard to be be someone that others are willing to follow. It's not easy and there are challenges. You'll occasionally be taken advantage of but much less so if you just take the authority route. 
  • Implement systems in your clinic that get your head above the ground and allow you to focus on bigger picture goals.
  • Constantly talk to all of your staff members. Be aware of changing attitudes that may signal a problem. Ask them how aligned they think they are with the clinic. Most people will be very open if they sense that you're interest is genuine.
  • Empower them to make decisions, and use policies to make sure that everyone knows which types of decisions they can make.
  • Get better at interviewing people and asking the right questions.
  • Fire faster. Firing is difficult and most people wait until there's real damage being done.
  • Make sure you understand common embezzlement and employee scams. Forewarned is forearmed

When you've aligned your team you'll feel like you're running downhill. Everything is just easier.


Destroying Competitors With Asymmetrical Competition

Top performers make it happen. Average performers hope, and hope is not a strategy.

Like it or not, cosmetic medicine is a business, and that means that it's going to be increasingly competitive as treatments and services become commoditized and prices drop leading to increased competition.

Asymmetrical Competition is finding and exploiting game-changing opportunities that your competitors can't easily match or compete against. 

When we began opening clinics in new locations we devastated the existing clinics run by clinicians who were taking their patient populations for granted. These physicians (mostly plastic surgeons and dermatologists at the time) expected that they would simply inherit all new cosmetic treatments as part of their current fiefdom of "aesthetics". 

They couldn't respond or adapt to the playing field we created.

Rather than position ourselves as competitors to existing practices we redefined the market and positioned ourselves as the experts in nonsurgical cosmetic technologies. We positioned the existing plastics and derm clinics as experts in surgery and dermatology, and we took everything else. The competition didn't have an easy answer since what we were doing was a fundamental change that they couldn't respond to or reproduce.

We focused with absolute madness on keeping appointments on time, on incredible patient services, and on giving power to our patients. We built systems that put our clinics on autopilot and allowed us to easily scale. We empowered our staff to make any decision, as long as they could explain that it was in the best interests of the clinic. We initiated corporate programs, free educational seminars and consults, incredible comfort and atmosphere, and we took all design and marketing seriously. We trained our staff to perform consultations based on sales and service that crushed our goals while turning our patients into raving zealots. We embraced social media and email. We answered questions and posted our pricing right on our website. In short, we did everything that they couldn't do. 

Of course they adapted and started trying to copy us, but they couldn't actually compete. They didn't have the systems, or the desire.

Asymmetrical Competition is available to you as well. You just need to look at what your capabilities are and match those to the market's need. Most clinics don't have the ability to change. They're essentially locked in place and that always presents you with opportunities to exploit areas that they can't adapt to.

As a Medical Spa MD Member you have assess to a wealth of information and know-how about building your clinic. Special offers from partners when you're buying your next laser or IPL, group-buy wholesale pricing on fillers and injectables, software deals, design & marketing services

Be smart and take advantage of it all.


Note What's Not On This List

The cosmetic medical market has matured in the last 15 years, but 5 areas above are not entirely tied to medicine, they're really business strategies. You won't find "improving patient outcomes" here because those are simply table stakes. 

Patient Outcomes - You can't build a business marketing better patient outcomes.

Outcomes are what the patient says they are. You can have a perfect outcome but if the patient expectations are unrealistic, the 'outcome' from the patients point of view can still be negative. Trying to build your clinic and reputation only through your technical prowess is essentially a dead end because it's beyond your control.

(Now I'm not saying that this is not a priority and shouldn't be your focus, but I am telling you that trying to convince your patient population that you're 'better' than the competition makes you seem small and petty and is only a part of what a successful strategy looks like.)

Technology - Not a determining factor in your success

There are successful clinics using every platform.

Choosing the right technology is important, and can save you money, but the lasers and IPLs that you put in your clinic are all producing the same light waves. There are differences; customer service, cost, consumables, and usability, but none of those will either put your clinic out of business, or make you more money on their own. It's reasonable to let laser companies help pay for some of your marketing, but don't make the mistake that they're going to really help you much. patients don't buy based on which IPL you're using, they buy from someone they know, like, and trust.

If you're looking to save money and find a reputable vendor of used devices, contact anyone in our used cosmetic lasers classifieds who is a member of our Certified Partners program and you'll get a great deal. (And if you have a complaint you can contact us directly as a Member and we'll intercede on your behalf.)

Price - The death spiral of lowest-pricing.

Do not hitch your wagon to being the low-cost provider unless you love being on the verge of bankruptcy at all times. There can only be one lowest price in any market, and everyone who will come to you because of price will leave you just as fast. If you can't justify higher pricing then put the work in to build a clinic that does. 


Conclusion

In future posts we're going to dive into these areas in detail and help you take actions to improve them.

Have some thoughts on this or anything to add? Leave a comment. I read them all.


References For This Post:

  1. Svenson, O. Acta Psychologica 47, 143–148 (1981).
  2. Kruger, J. & Dunning, D. Journal of Personality and Social Psychology 77, 1121–34 (1999).
  3. Gabriel, M. T., Critelli, J. W. & Ee, J. S. J. Pers. 62, 143–155 (1994).
  4. Hoorens, V. & Harris, P. Psychology and Health 13, 451–466 (1998).
  5. Alicke, M. D. & Govorun, O. in The Self in Social Judgment (eds Alicke, M. D., Dunning, D. A. & Krueger, J. I.) 85–106 (Psychology, 2005).
  6. Cross, P. New Directions for Higher Education 17, 1–15 (1977).
  7. Taylor, S. E. & Brown, J. D. Psychological Bulletin 103, 193S210 (1988).
  8. Shedler, J. et al. American Psychologist 48, 1117–1131 (1993).
  9. Colvin, C. R. & Block, J. Psychol. Bull. 116, 3–20 (1994).
  10. Sharot, T. The Optimism Bias: A Tour of the Irrationally Positive Brain, New York: Pantheon Books (2011).
  11. Johnson, D. D. P. & Fowler, J. H. Nature 477, 317–320 (2011).
  12. Trivers, R. Deceit and SelfDDeception: Fooling Yourself the Better to Fool Others. (Allen Lane, London, 2011).
  13. Barber, B. M. & Odean T. Quarterly Journal of Economics 116, 261–292 (2001)
  14. Johnson, D.D.P. 2004. Overconfidence and War: The Havoc and Glory of Positive Illusions. Cambridge: Harvard University Press (2004).
  15. Enquist, M. & Leimar, O. J theor Biol 127, 187S205 (1987)

Waiting Room Marketing That Sells Automatically

Your waiting room lets you market directly to your patients when they're most receptive, and video triggers the greatest emotional response and patient inquiries into your services and products.

Marketing to your patients in your waiting room should be like shooting fish in a barrel. After all, they're already inside your clinic and they're sitting there waiting for you. If you're smart, you should be using that time to educate your patients about your services and explaining all of the treatments and programs you're providing.

Don't put out damn magazines and don't install free WiFi!! Why the hell are you wasting this golden opportunity?

Here's a list of the most effective marketing strategies and how you might implement them.

Waiting Room Marketing Videos

The very best waiting room marketing is a customized looped video that goes through your service offering; lasers, fillers, Botox, payment plans, financing, packages and whatever else you're offering. They're emotional, they're aspirational,  If you do this correctly it's incredibly powerful and you can count on a slew of new questions, up-sells and cross-sells.

Take a second and view some examples of Frontdesk Custom Marketing Videos >

Note: While the videos all come with music, you'll want to have them looping on mute with just the images or you'll drive yourself crazy listening to the same songs over and over.

Customized Educations Materials

Don't put out general magazines. Instead, build booklets or binders with customized educations materials about your services. You can use the vendors advertising materials to begin but as soon as you can you should look to produce your own materials that explain - from your point of view - the services and treatments from an educational point of view. Patients want this information and it sets the stage for the consultation or treatment room conversations by priming the patient with questions that they can ask. How much do you pay for Restylane? How painful are fillers? What skin type am I? What treatments are synergistic?

Product Displays

Show off the products you are selling in your medical spa.Your products should not be stored in a shelf somewhere. You could probably have patients try out Testers for several products. Make sure the products are visible and accessible by your patients. Not only showing off your products a marketing strategy, it would definitely help your revenue. Make sure they're not expired.

Waiting rooms can be a bore or anxiety inducing, so try out these strategies to put life in your waiting room and see how it works out.

How To Reuse Your Clinic's Patient Reviews As Content

 Focus on how to be social, not how to do social.

“A brand is no longer what we tell the consumer it is – it is what consumers tell each other it is.” – Scott Cook, Founder, Intuit

You've spent a lot of time investing in getting your patients to leave some sort of review or comment. So, the question is, could you repurpose those reviews?

Read More

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

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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?

Stories.

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

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#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.)

New Dermal Fillers For Your Medical Spa.

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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

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

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.

Elastagen

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. 

References:

https://revanesseusa.com
teoxane.com
http://revanesseversadfu.com/wp-content/uploads/2017/10/Versa-Physician-DFU.pdf
https://www.elsevier.ca/ca/product.jsp?isbn=9780323480086

Dermal Fillers: How Often Will Patients Sue You?

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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.

References:

  • 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

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

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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.

Procedure

  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

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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.

Findings:

  • 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.

New Research Areas Around Minimizing Scars For Cosmetic Surgeries?

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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.

References:

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