Interview with Dr. Enrique Exteberria, founder of Clínica Etxeberria.
Dr. Entique Etxeberria is a member of the Board of SECPRE (Spanish Society of Plastic, Reconstructive and Aesthetic Surgery), as Member of Private Healthcare. He is also It is also a founding member of the European Association of Plastic Surgery Aesthetic (EASAPS), a Fellow of Stanford University and a Fellow of the International College of Surgeons (FICS). His Clínica Etxeberria opened in 2009 and is located in Bilbao, Spain.
We interviewed Dr. Etxeberria for the Medical Spa MD Physician Report.
Medical Spa MD: Can you tell us a little bit about you and how you got started in cosmetic medicine?
A: I do not know why, but from a very young age I was extremely attracted to surgery. When I was 14 years old, I wanted to become a plastic surgeon with a focus on aesthetics. I started early at 16 years old, I was able to assist as a volunteer attending to the Pathology Department of Hospital Basurto (Bilbao, Spain). Then, at 17, I started helping a team of experimental cardiovascular surgeons at the University of the Basque Country-UPV (Bilbao, Spain) and when I was 18 years old, I published my first scientific paper. Shortly after, I started my medical education. After finishing my university education and after a required step as lieutenant in the Spanish Army as Medical Doctor, I performed the studies for the title of Specialist in Plastic, Reconstructive and Aesthetic Surgery at the Hospital Aranzazu in San Sebastian (Basque Country University-UPV), in the Basque Country, Spain.
I was always attracted to Surgery and Aesthetic Medicine and Private Practice. This led me to be a visiting doctor and to complete rotations in hospitals and institutions renowned throughout the world as:
- SPAIN: HOSPITAL DE BASURTO, Bilbao; HOSPITAL DE CRUCES, Bilbao;
- England: KINGS OAK HOSPITAL, London
- FRANCE: INSTITUTO NECKER, Paris
- MEXICO: HOSPITAL GEA GONZALEZ
- USA: STANFORD UNIVERSITY HOSPITAL
Finally, in 1998, I fulfilled my dream of opening my own Private Clinic of Plastic and Aesthetic Surgery in Bilbao, Spain, my hometown, where I’m currently practicing.
Medical Spa MD: Can you tell us about your clinic?
A: Clinica Etxeberria currently employs 11 people (2 plastic surgeons, a cosmetic doctor, a team of 6 nurses and 2 aestheticians) plus 4 people in charge of administrative matters (management, administration, computers and advertising).
Our company is focused on the aesthetics of Cosmetic Surgery (50%). Aesthetic Medicine (30%) and Laser (20%). We are a reference center for facial and breast surgery, although minimally invasive treatments (Fillers, Toxins, Suspension Sutures, Laser, RF and Cavitation) play an important part of our business.
Our clinic is located in Bilbao, a cosmopolitan city with an area of 1 million inhabitants. The socioeconomic environment is medium to high and is the main city in northern Spain. Basque society has a high-purchasing power with the highest GDP of the Spanish state.
Medical Spa MD: Since you’re in Spain and most of our readers are not, can you explain how the Spanish view cosmetic medicine and how the market has developed?
A: Aesthetic Plastic Surgery in Spain has among the highest acceptance and consumption rates in the world. Good evidence for this is that despite the global economic crisis of the last few years, the number of cosmetic surgery consultations and surgical procedures in Spain has continued to rise. The same can be said for aesthetic treatments and laser medicine in general. Breast augmentation, liposuction and rhinoplasty, surgical treatments, and Botox, facial fillers and laser treatments, all continue to rise in popularity.
In absolute numbers, Spain occupies 4th place worldwide in total number of treatments. If we compare this figure with the number of inhabitants, Spain is the 2nd country in the world (behind only USA) in plastic surgery and aesthetics. Consequently, Spain is the European leader in these types of medical/surgical treatments.
Despite the sector’s growth, the presence of 900 board certified plastic surgeons, along with almost 4,000 physicians involved in cosmetic treatments, makes business and expansion opportunities difficult with so many players. They have created a “virtual ceiling”, when it come to the expansion of Plastic Surgery and Aesthetic Medicine in Spain.
Medical Spa MD: What IPL or laser technologies are you using?
A: In Spain, legislation on the use of laser platform is too loosely regulated in my opinion. Any Medical Graduate (General Practitioner) can make use of them. The increasing number of laser centers in recent years has been exponential due to this leniency in Spanish laws. However, in our center we offer highly specialized laser treatments. For years we have been relying on Cynosure laser equipment, which we find to be reliable and very effective for our patients. The have also provided superior customer and technical service. We use the following in our practice:
- The SmartLipo MPX-for cellulitis, lipodystrophy and flaccidity
- Non-ablative photorejuvenation (Acclaim, Cynergy PL and Elite MPX)
- Ablative (CO2 Performa) and hair (Elite, Apogee) and pigmented lesions treatment (Affinity QS, Accolade)
Despite being a sector that has expanded greatly in the last 10 years, in Clinica Etxeberria, we think it has reached its “ceiling”. Because IPL treatments in Spain are used mainly by dermatologists and aestheticians, a limited number of cases reach to centers such like ours.
Medical Spa MD: How do you manage your staff?
A: We strongly believe that staff working in our center must be very professional and competent. It costs a lot to find, train and coach the ideal person. We make our people feel strongly involved in the success of our business by offering them profit sharing of the company and commission for specific treatments.
Also I think that coaching and continuing education are essential. In fact, our full-time staff receives an extra 5% pay per month, with the express obligation to invest that amount in continuing education. We also attend seminars and events as a group.
We have very little turnover because our staff feels a kind of “ownership” and tell us that they feel very appreciated and empowered. I believe that other clinics may treat their staff as low-level and as a result, their team members don’t feel any responsibility for the success of the company and the satisfaction of the patients. By not hiring the right people and treating them with respect, you are costing yourself nothing but time and money. Do it right the first time.
Medical Spa MD: How do you market your clinic?
A: I really think that marketing is the aspect that has changed the most in our business. The advertising we were doing 10 years ago has been almost completely forgotten.
We think that Internet presence is fundamental. Not just a website well positioned and appropriately updated, but a set of answers and information online that are very professional and relevant. In fact there is a person in our office who is dedicated exclusively to maintaining our online presence.
As a result of this conviction, we are increasing our presence and advertising on social networks (Facebook, LinkedIn, Twitter, Branch Out), and collaborations in specialized blogs and websites. We are also promoting advertisements only in medical webs.
Today, our advertising on paper (phone books, newspapers, magazines) we have restricted to the minimum required (10% of what we did 10 years ago). We have also removed the radio and TV advertising, which we found to be ineffective without huge budgets available for us.
Medical Spa MD: What treatments or services are most profitable for you?
A: Our top profit makers for surgical treatments and procedures are breast surgery, liposuction and blepharoplasty.
For our non-surgical treatments, botulinum toxin (Botox, Vistabel, Azzalure, Bocouture), the Fillers (Juvederm, Restylane), vectorization with Sculptra and volumetrization (Voluma, Sub Q) take the lead. I would also emphasize revitalizing facial and cervical treatments using multivitamin complex (Filorga NTCF).
Finally, within the laser treatment, the facial rejuvenation laser (ablative and non ablative) is most profitable.
Medical Spa MD: What advice would you give to other physicians based upon your experiences?
A: The bottom line, provide a high-quality service at a fair and competitive price. Stay away from a strategy of quick profits and discounts such as those made in large areas. The whole concept of patient loyalty is the goal.
Give a very scientific “image” of the products and services than you sell and provide. Educating your patients is worth more to them than a diploma hanging on the wall. We have an obligation to convey to the patient very technical evidence and reasoning so they can make an educated decision that they are comfortable with. Added information diagnosis systems like Canfield’s Vectra or eStetix (Crisalix) are valuable. Together with Nikon ViewNX and Allergan Biodynamic, we have had a conversion rate of queries at nearly 90%. Also, information in pdf format to hand out to patients is great, but we have taken it to the next level at our clinic. We have iPad’s in the waiting room for the patient to interact with and learn about our procedures. Similarly, when on the phone, we ask for our clients’ email, so we can do marketing campaigns, personalized and individualized.
Secondly, I consider important to have a 360 º scope when we communicate with our patients. As a plastic surgeon, I was taught and educated to offer a surgical solution in 90% of cases. I believe that the wider is our therapeutic offer, with emphasis on minimally invasive therapies, the greater the acceptance of our patients. This will lead to our clients to “where they want to go” and not “where we want them to go”. This truly shows the respect we have for our patients.
Finally, high-professional standards are critical. Daily and small details give a great image. Design, consistency, reliability, punctuality, respect and professionalism, are the weapons that can lead a patient to choose us over our competitors.
About: Dr. Entique Etxeberria is a member of the Board of SECPRE (Spanish Society of Plastic, Reconstructive and Aesthetic Surgery), as Member of Private Healthcare. He is also It is also a founding member of the European Association of Plastic Surgery Aesthetic (EASAPS), a Fellow of Stanford University and a Fellow of the International College of Surgeons (FICS). His Clínica Etxeberria opened in 2009 and is located in Bilbao, Spain. Read Dr. Etxeberria’s bio here.