From a start in internal medicine, Dr. Alex Denes has moved to an entirely cosmetic medical spa and practice.
Dr. Denes worked as an assistant surgeon for 30 years before entering the cosmetic field in 2000. We sat down with Dr. Denes to find out what he's learned, and what lessons he has to pass on.
Name: Dr. Alex Denes
Location: Hemet, CA
That's interesting: Dr. Denes is qualified as an expert witness for the US Department of Justice and the California Medical Board. He's appeared as an expert witness for the defense in hundreds of medical malpractice cases.
He is Medical Director and VP of Medical Affairs of Hemet Community Medical Group, a multispecialty group consisting of 155 physicians, and Corporate Medical Director for KM Strategic Management Group.
How did you transition from Internal Medicine to Cosmetic Medicine?
After several years of practicing Internal Medicine, I developed an interest in cosmetic procedures. About 10 years ago, I attended a workshop on Botox, and became certified to use it. Next came fillers (it was collagen at the time) and I took a similar training course and began injecting fillers. It sort of grew from there. I joined the AACS (American Academy of Cosmetic Surgery) and they have been an enormous asset in my training. I attended a large number of seminars, workshops and live surgery demonstrations on all of the procedures I now perform. I studied with leading cosmetic surgeons, working under their supervision and direction, until they felt I was competent to do the procedure on my own. I have done this for liposculpture, breast augmentation, breast lift, rhytidectomy (face lift), blepharoplasty and abdominoplasty, among others.
What's your clinic like? How is it organized? What treatments are available?
Our primary office is a cosmetic surgery office where we do all consultations, treatments and surgeries. We have a front office staff of 2 people – a receptionist and a care coordinator. In the back office, 2 RN’S and an MA. One of my RN’s, April Turner, is a highly trained Medical Aesthetic Specialist. She performs all the non-invasive procedures (fillers, Botox, chemical peels and lasers.) I perform all surgical procedures and CO2 laser resurfacing. We have our own, in office, JCAHO-certified surgery center where we perform all of our procedures. April and I recently opened a free-standing MedSpa in a nearby community (Canyon Lake,) where she performs the same non-invasive procedures that we do in the primary office. We recently added a Light Sheer in the medical spa as well. In addition, she does galvanic current and other facial procedures there.
How do you supervise your staff? Are you using commissions?
We believe in a stable and comfortable environment for our staff. Certainly, in a small office, there will be some conflicts . But everyone is very respectful about the rights of others, and small squabbles get settled pretty quickly. We do not pay commission, because we don’t want our staff to “oversell.” A satisfied patient is our greatest asset, and we never want to pressure anyone, or to over-promise on outcomes. We are fairly generous with our compensation plans because we expect top performance from all of our staff, and it is only fair to compensate them to commensurate to their efforts. All of our staff members have been with us for 7 to 15 years.
What IPL/lase technologies do you like and dislike? Do you recommend purchasing these devices?
We use an IPL and Diode laser and are very happy with the outcomes. We have a Clarion unit with 5 different heads for various applications (skin tightening, vascular lesions, pigmented lesions, acne and hair removal.) We purchased the unit new, on a lease program. We also have a Light-Sheer pulse diode laser, which we use for hair removal, as well as a 512/1024mm Nd-YAG laser that we had used for tattoo removal and pigmented lesions. We are happy with all the technologies, except our Nd-YAG, which is underpowered to provide a timely and cost effective tattoo removal treatment series. Lastly, we have an Erbium/CO2 laser which we use for facial resurfacing.
Due to the large costs associated with light therapies, we leased all of our lasers (and by now have most of them paid off.) We don’t buy service contracts for cosmetic lasers, because they are obscenely expensive. We have an excellent certified laser technician who services and maintains our equipment on site, which we found to be a much more affordable solution.
Where do you spend money on advertising? How successful are you marketing efforts?
I utilize a marketing consultant who helps me design all marketing programs. We do limited print advertising (full page ad in the Shopping Guide which is published 8 times yearly.) We do quarterly live seminars and are active on social media (Facebook, Twitter and LinkedIn.) We also publish a monthly newsletter (email-distributed) and maintain an active website. We have found our greatest marketing strategy is to provide excellent patient care. Approximately 50% of our new patients are by referral. At our Canyon Lake office we offer $100.00 toward any treatment for every four friends referred to and treated by us.
We have done poorly on radio and TV, and do not pursue those avenues any more.
What treatment modalities create the most sales for you? Have you dropped any treatments? Are you looking to add anything new?
On the non-invasive side, Botox and fillers are our biggest sellers. In the surgical office, Liposculpture is our #1 procedure and has the highest profit margin, because the disposable costs are fairly limited. Erbium/CO2 laser is next, then breast augmentation. We are dropping tattoo removal because our laser is underpowered and we don’t want to invest in a new one. New equipment, especially lasers, is very expensive and we don’t have plans to purchase anything new. We are quite satisfied with our current “menu” of services, and are not anticipating any major changes. We may add an IPL to our MedSpa location.
Can you share an interesting story that happened in your clinic? What lesson have you learned?
I had a patient come in for liposculpture. She wore a size 14 dress and wanted me to make her a size 4. That, of course, would be impossible, and I clearly told her so. She laughed and said she was just kidding, but she was very outcome-oriented. After a very long consultation, I told her I really didn’t think we should operate on her. Her expectations were just too unreasonable, and regardless of how many times I stressed the limitations of the procedure, she kept coming back with the “size 4” comment. I felt good about turning her down. BUT, she called a month later and asked for another visit. She was very humble, and very anxious for me to do her lipo; she pleaded and begged. I resisted, but she wanted it done so badly, I gave in. I spent an enormous amount of time explaining that I could not guarantee dress size, inches lost or weight lost. All I could guarantee was that I would do my best to give her a good result. I think you can guess the outcome. Right after surgery, as she was waking up from the IV sedation, her first words were: “So now I’m a size 4, right?” I gnashed my teeth, and still do so every time she comes in to complain about her disappointment. We got what I think is a great outcome: she lost several inches from her waist, hips and buttocks. But she was no size 4! This is the type of patient, who has unrealistic expectations, will never be happy (and even if you could, by some miracle, make her a size 4, she would complain that she is not a size 2 !!) Moral of the story: choose your clients (whether surgical or non-invasive) very carefully. It’s imperative that you thoroughly document your patient education; And If you have any doubts, DON’T WORK ON THEM.
What insights can you share to those who want to start their own medspa?
I would say “Start Small.” We’re in a down economy, and many people don’t have a lot of disposable income. We all want a fancy, upscale facility with lots of staff and gadgets, but that is expensive, and you’ll be struggling to recoup the costs. Rent a small space in a nice shopping center or mall with good foot traffic. Furnish it tastefully but stay on a budget. Cross-marketing is a tremendous advantage: it is cheap (or free) and benefits both sides. A friendly and responsive staff is your best advertising, and I would go to great lengths to hire someone who KNOWS and CARES about your Med Spa. He/she needs to be very knowledgeable about your products, procedures and prices. Make sure your staff is excited about this field and eager to learn and excel in this field. Take careful and detailed before and after pictures, (of EVERY patient and EVERY procedure) and show them off! (if they are recognizable in the photo, you must get a signed Model Release form from them.) Patients LOVE to see before and after pictures of patients you have worked on. The more the better. Facebook, websites and photo-albums can be a tremendous asset. Most importantly, remember you are selling a service more than a product. What will set you apart from everyone else is your customer service and attentiveness (and, of course, the quality of work that you do.) Take plenty of time and care with your consultations, be honest and do not overpromise. If you get a bad vibe about a potential client, go with your instincts! I’ve never been sorry for turning someone away with whom I didn’t feel comfortable. On the other hand, I’ve been sorry several times for taking on a client that just didn’t “click.”
About: Did my undergraduate work at UCLA. Then attended Creighton University School of Medicine, received my MD degree in 1973. Internship and Internal Medicine residency at St Mary Medical Center/UCLA. Board Certified in Internal Medicine.
This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.