Keeping Your Aesthetic Patients Happy Is Good Business

Keeping patients happy makes sense, both to avoid problems and build your reputation and referral base.

Not all patients that state they had a poor experience from another provider are signaling the proverbial red flag. Most of these patients HAVE had an experience of poor treatment outcome.

And to add salt to their wound,the previous treating provider could care less!

We must keep in mind that for most of our patients, coming in for Medical Aesthetic treatments is an exciting and much anticipated experience.

The number one reason patients state they no longer go to their previous provider is, "He was a jerk!" Oddly enough, the number one complaint I hear regarding a female provider is "I had to wait too long." This is not to say there are no female jerks or that patients don’t have to wait too long to see a male provider. These statements are simply the most common that I hear from (from) my patients.

No one is perfect. I don’t care how good you are at fillers, Botox, lasers, and surgery. We’re human, and we have bad days too. Bottom line: If you did achieve a less than desirable outcome, fix it for heaven's sake! With a smile on your face. If you're running more than 15 minutes behind, be prepared to apologize profusely and don't let it happen again. At both our clinics over 50% of our new patients are by referral. The most common reason for these referrals: “They're so nice!” Patients in general have a sense of helplessness when it comes to being treated by a provider. Do not tell a patient what they have to do. This is not life or death nor a dictatorship. Our patients know that we truly love what we do and we care. You don’t have to be all hugs and kisses, but, you'd better have a smile and a few jokes up your sleeve. You must keep in mind that this is the grown up version of a trip to Disneyland. It’s an E ticket ride with a high price tag. This is not an area of medicine of need.

This is completely a "WANT" this treatment situation. We encourage our patients to tell us what they are looking to have done and then offer safe, sane treatment options for them. This gives the patient a greater sense of control, and a decreased sense of possibly being pressured. If they can't afford all of the treatments at one time, what ever you do, never pressure a patient! If they like the one treatment you do and you personally, they’ll be back. And that’s how you keep your patients.

Painless Neurotoxin Injection Method? Join the Discussion!

What injection methods are most useful and reliable for neurotoxin injections: Botox & Dysport.

I have been in clinical private practice going on 14 years now and enjoy a busy and healthy cosmetic surgery practice.  Injectables, both fillers and neurotoxins, remain an integral part of my practice and I suppose that the loyalty my patients show by continuing to return to me as their injection provider is testament that my skills must be competitive with the many other local physicians who offer the same procedures.  I definitely do not price cut to keep the volume or attract new patients, and I believe I price fairly taking into consideration both my training and experience with typical pricing in my area by "mainstream" cosmetic providers.

I continue to strive to offer the least painful experience for my patients and have tried multiple different methods to decrease the degree of injection discomfort for my patients.  From topical anesthetics, icing, slow injection delivery, and currently vibration-distraction techniques, I have yet to find the WOW approach. I do use lidocaine-treated fillers and believe that these have advanced our patients' injection experience to an appreciable degree.

My intent for this entry is to stimulate a healthy community discussion on what methods the readers have found useful and reliable for neurotoxin injections (to keep this discussion focused I am not encouraging discourse on filler injections but perhaps this can be a future topic of discussion), in addition to disregarding any approach that they have found particularly not beneficial.  We all want to make our injections as easy as possible for our patients, so I am hopeful that this topic can generate healthy dialogue!

Botox & The "Spock" Look

Botox + fillers that make your patients look like Vulcans?

The clinical and cosmetic uses of neurotoxins continue to grow. Botox, perhaps after aesthetician visits, are often the first procedure consumers consider. It is very common for patients to tell me that they have been considering Botox treatments for 3 to 5 years. We frequently see these patients pleased with there Botox treatments and then very interested in fillers, non-invasive body contouring, and often surgical procedures. However, what quickly interrupts this transition to other services is a result from neurotoxins that looks unnatural.

In our practice, we have increased patient retention and satisfaction after their initial Botox treatment by reviewing with them possible outcomes. Patients will often complain about a quizzical or "Spock" look after glabellar and sometimes forehead injections. I am still surprised that patients are not told of this and that there is a simple remedy. As most practioners know, 2-4 units additional neurotoxin at or just above the over arched area will soften the arch of the eyebrow.  A follow-up call/visit or just good instructions to the patient can turn a dissatisfied patient into a lifelong member and proponent of your practice.

Add Allergan's Brilliant Distinctions Program To Your Website's Social Media Buttons

What is the Allergan Brilliant Distinctions Program?

Brilliant Distinctions (BD) is a frequent user program by Allergan for their products of Botox, Juvederm, Latisse and their skin care line. This program gives the patients coupons and rebates. Many practices in the US who inject Botox have the opportunity to join this program. Your Botox/Allergan representative would have more information. In my location, Brilliant Distinctions is well utilized.

New Patients look for Brilliant Distinctions

I have also found that when experienced Botox and Juvederm patients move to my area, they sometimes come armed with Brilliant Distinction discounts which they would like to use. They have called my office asking whether we take Brilliant Distinctions  These patients usually come from different states, and the transition process is painless. We just need their name, zip code, and birthdate. With that information, the patients can use their points and earn new ones at our practice. With any patients who have somehow created multiple accounts, a quick call to the toll free hotline provided by Brilliant Distinctions usually solves the problem.

Creation of the Brilliant Distinctions Button 

I thought it would be useful to create a button that goes along with some of our social media buttons. I presented the idea to Allergan, and they actually helped me create some of their logos that matched the size of frequently used social media "buttons." By buttons, I mean those icon or logos that represent Facebook, Twitter, YouTube, etc. I have had links from my website before to Brilliant Distinctions, but they were big clunky pictures, and I've never matched it up on the page with the Facebook or Twitter logos. I asked Allergan about the idea and they sent me basic BD logos to work with. I spent some time trying to make these logos match, and I've shown them to Allergan.  Allergan has a section on their website for physicians which has logos to use on their websites, but when I contacted them, they didn't have ones of this design. I thought I'd share these logos with you so you can put them on your websites yourself or have your trusty webmaster do it if you like the idea.

Please feel free to copy the Brilliant Distinctions Buttons (ie. Right click/save-as). 

I've seen many beautiful websites out there with beautiful social media buttons. Now you can also add a matching BD logo to the collection.

I made a website displaying the logos that Allergan and I tweaked to match most common social media buttons which are already used on many plastic surgery, dermatology, and aesthetic websites.

Increased Botox Longevity With A Zinc Supplement

Botox & Zinc? Does Zinc make Botox last longer?

An American Academy of Cosmetic Surgery news brief has reported that a Houston oculoplastic surgeon, Dr. Charles Soparkar, has come up with a way to make Botox (and presumably all botulinum toxin neuromodulators) more effective and last longer. In a modified double blind, randomized, placebo-controlled, crossover pilot study and a subsequently completed formal study, the duration of effect was increased by 30% in over 90% of the patients studied. The study included both cosmetic and medical indications (blepharospasm, hemifacial spasm).

The theory goes like this: Botulinim toxin is very dependent upon zinc for effectiveness. Unfortunately, 50% of the US population is zinc deficient. Apparently, dietary zinc can be poorly absorbed due to binding elements found in many foods called phytates. Dr. Soparkar’s group posited that adding zinc to the diet of patients having a weak response or short duration of effect to botulinum toxin may be beneficial. Additionally, a phytate munching phytase enzyme was added to increase zinc bioavailability.

The result is a prescription medication called Zytaze. Each capsule contains 25mg of highly bioavailable zinc citrate and 1500 mg of Phytase. Patients take 2 caps daily for four days prior to AND on the day of injection. The drug is supplied in a 10 cap pack and cost $60 - $80. The result has been less frequent and decreased amounts of toxin needed and potential patient savings. (However, does the cost of the drug nullify these advantages?) This is great news for patients and a potential niche offering in the commoditized botulinum marketplace. Maybe not so great for practices depending on a high turnover of renewable products and services. 

Who else has experience with Zytaze?  

I Want To Be A Fibroblast!

What criteria is most important when choosing a treatment or technology to stimulate fibroblasts for skin rejuvenation?

Being a dermatologist focused on aesthetic treatment options for improving skin's condition  it's quality and overall appearance – I clinically and scientifically overlook tons of different approaches.

Basically, and I think we can agree on this, many treatments try to target the fibroblast. Its about the stimulation of this branched tissue cell who's function is to maintain the structural integrity of connective tissues by continously secreting precursors of the extracellular matrix such as ground substance, a variety of fibers notably the reticular and elastic ones and cytokines.

The goal in many skin rejuvenation treatments is to activate and stimulate the fibroblasts... and there are countless strategies to do this: You might choose chemical peels, energy based devices such as non-fractionated or fractionated resurfacing lasers, intense pulsed light (IPL), infrared light or radiofrequency. One might think of dermal filler substances such as hyaluronic acid or – better – calciumhydroxylapatite (there are even publications on a stimulating effect botulinum toxin type a...). Further one might consider microneedling, dermabrasion, etc..

Or think about "newer" technologies such as platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid). And last but not least cosmeceuticals (this list is not exhaustive!!).

Which strategy to choose? It's actually very difficult to find way through this jungle!

I would like to encourage and activate the discussion here and ask for your opinion: What are the most important criteria for you when you do your choice? Is it about mangeability, about downtime, about scientific proof, about safety, about treatment protocols (such as e.g. multiple treatments), about clinical experience of other physicians, about availability, about the learning curve, about the deligability, about the costs?

What's your decision maker here?

Embezzlement & Employee Theft Can, And Probably Will, Happen To You.

Employee embezzlement and thefts are the most common crimes in any cosmetic practice... in fact, it's pervasive.

Believe me it can and it did happen to us. It’s still hard to believe that I saw the evidence and ignored it because I just could not believe what my eyes were seeing. Instead of going with my gut instinct I listened to a mountain full of lies from my Physician Assistant so the first lesson learned is trust what your eyes are seeing and rely less on distracting noise.

When all was said and done, our P.A. had stolen over the course of just 14 months, more than $200,000 in Botox, Fillers and Laser Treatments. 

How was she able to accomplish this?  The theft occurred in three primary ways.

1. With Botox/Dysport she would mix the proper dilution of 2.5 and then draw out a full syringe of properly diluted Botox and re-inject another syringe of saline. She would then take the syringe of Botox and put into her mini-cooler posing as a lunch box which she brought every day to keep it cold and then treat patients out of her house. The evidence of this was apparent with patients complaining of poor results. She would cover herself with some inventive lies such as; Botox out too long and I did not want to waste it, the refrigerator was not cooling to proper levels, she put the Botox in the freezer and the solution crystalized and weekend the Botox, I may have accidently put in too much saline and I used Dysport and it does not work as well as Botox.  Looking back I can clearly see the evidence but listened to her lies and excuses.
2. On fillers her number one excuse was that the product “leaked” while injecting and she was forced to use another syringe. Other excuses were the patient had a bad result so to keep them happy she offered a free syringe, a reaction that forced her to remove and re-inject later and I threw in some free syringes because she bought a package of Fractional Laser Treatments.  Most of the time, she was simply pocketing the syringes to again inject patients of our practice at her house.
3. Watch you consults and close ratios. We have been in a bad economy so this was hard to gage.  She would “feel” out the patient during the consultation and those who she believed would be players she would offer discounts for Fractional Laser, IPL’s, Matrix etc. if they paid her directly in the room in cash. I was tipped off by this from a competitor who called me and told her one of their patients told them about this. After firing my P.A. within weeks we had identified 36 patients who paid cash in the room.  She told those patients she was the co-owner so it was ok to pay in the room… To add insult to injury we had to complete their treatments as well.

The Medical Spa Embezzlement & Scams Report

Download the new Medical Spa Embezzlement & Employee Theft Scams Report 

Submit your own story about medical clinic embezzlement or theft here

After having gone through this we put in some practices that I wish we had done all along.  We now perform a Botox and filler audit every Friday. Every unit of Botox is logged onto a log sheet by patient and same for fillers. If we are off by more than 5% I will meet with my NP to go over the discrepancy.  On lasers shot counts are logged for every patient. As an example if Mary comes in for a Fractional Laser Treatment and the beginning shot count was 45,000 and ending shot count was 45,400 then the next patient for the same treatment should begin at 45.401. We also now provide to each patient our policy of ONLY paying for services at the front desk during check out.

I was also amazed to find out that every staff member suspected what was going on but was afraid to say anything because they did not want to cause any problems if they were wrong. Lastly review your insurance policy for theft coverage. I was mortified to find that ours only covered $10,000 which left us loses of about $200,000.00. We were able to absorb the losses but many others might have been forced to lay off staff or worse go out of business. As a non-physician owner I trusted far too much that a professional medical practitioner would not steel. I now understand all too well that the white coat which commands respect could also have hidden prison stripes and to use my eyes and cover my ears…

Update on 2012-07-25 18:41 by Medical Spa MD

Update: We're going to compile a report on embezzlement and employee theft in medical clinics.

If you have a story about an employee of fellow staf member who was stealing or embezzling, please help us all by submitting that story here: Submit your story about medical clinic embezzlement or theft:

Personally identifyable information so you can submit this story anonymously.