Interview: Dr. Edward M. Zimmerman, A Cosmetic Surgeon In Las Vegas

Edward Zimmerman MD is a cosmetic surgeon and owner of Las Vegas Laser & Liposuction.

Name: Edward M Zimmerman, MD
Location: Las Vegas, NV
Website: lasvegaslaserandliposuction.com,  zimmermanmd.com

That's interesting: Dr. Zimmerman is currently serving as the President of the American Board of Laser Surgery.

What inspired you to enter the realm of cosmetic medicine?

I grew up in DC, the son of a professional artist who allowed me to build, dismantle and tinker with just about everything mechanical and biologic. I brought the first CO2 laser into an outpatient office in Western PA as part of our faculty practice in the early 1990’s. One day a patient asked me to take off a benign mole, which is my first cash paying procedure. The rest is history.

Can you tell us more about your clinic and how it's organized? 

I designed it and I am the Medical Director of Las Vegas Laser & Lipo, an 8000sf, state licensed, state of the art facility. I supervise and perform aesthetic procedures including Botox and filler injections; ablative resurfacing, lipo-sculpting, laser assisted blepharoplasty and facelifts using monitored tumescent anesthesia and conscious sedation. Our goal is to educate and help design programs and treatments that help patients regain and keep their own natural, youthful appearance and vitality. We welcome new cosmetic laser technologies. We have medical students and MA’s rotate through the office and and physicians to observe and train. 

My wife Marilyn in the practice manager for 15 years.  My RN and most of my staff have been with me for years as well. Our patients are 80+% women-mainly 30 to 65 years old, from a mixture of backgrounds, economies and ancestry. The office is conveniently located just off the SW bend of the I-215, a short drive from the airport and the Strip, in the first floor of a newer professional building. It is close to 2 of the newest hospitals in Las Vegas.  Patients come and go with privacy and security in one of Las Vegas’s newest professional centers, featuring plentiful, well lite parking and attractive landscaping.

Creating a successful medspa can depend on the staff. Have you developed a set of hiring practices? 

We have little staff turnover... usually when spouses relocate etc.  We are a small, tight knit group who have to help each other.  Base salaries with communal compensation and bonuses seem to encourage that better than straight salary or 1099 employment.  

We recently had a front office staff move to Zappos after I lent her their CEO’s book on “Delivering WOW and Creating Happiness....through Service..” In interviewing dozens of candidates, and trying a number on for a day to a week before we settled on one person to bring in to training and probation, we developed better job descriptions and training policies with measurable guidelines and endpoints. Having written policy and procedure has helped us evolve from a “mom and pop” clinic to an organization that is run like a business.

What IPL or laser technologies are you using? What are your considerations before buying a new equipment?

We utilize cosmetic lasers, light, IPL, CoolSculpting, laser/water/power assisted liposculpting and fat grafting with and without PRP at this point.  We are on the verge of bringing in focused US. With limited funds and minimally cooperative banks, it’s important to analyze every purchase with the most pessimistic but realistic ROI, shop for the best lease and lending rates and know when to back off and cut your losses if things don’t work out.

The laser companies “sell” me by putting me in touch with like-minded docs who have made their tech work in similar practices and have excellent reputations with others - like Medical Spa MD - and being flexible with letting us try the equipment to see if it’s a “fit” for the practice. Companies that offer extended warranties, help with marketing, training and negotiate the cost of disposables and have good delivery and service reputations get more attention from me.  

What are your core strategies for marketing your clinic?

We use the FotoFinder Suite to take digital pictures of just about everything-for patient education and to remind patients of how far they’ve improved, plot their continuing procedures and maintenance and  to analyze the success of our treatments.  It is a tool that has paid for itself many times over.  

We also use Patient Pads for information intake and consents and Touch MD for our consultations-all high tech devices that let us show lots of before and after pictures, educate patients on realistic results and confirm that the patient-practice relationship is solid from the start and stays that way.  We screen all procedure patients for Body Dismorphic Disorder with a standardized set of questions and discuss the results frankly with patients.  We don’t take short-cuts that compromise patient safety or results and we’re not afraid to refer patients elsewhere if we don’t seem to be on the same page.  I have lots of my own before and after pictures and the practice mission and philosophy on our new website, which I built with my daughter.

I employ social media to maintain our Facebook, Linked-In and Twitter accounts. We run monthly internet “specials” on different fillers, procedures and toxins and have regular “Evenings of Beauty” where we cater a Power Point presentation at the office and offer free consultations, drawings and special pricing. We are not shy about asking patients to post positive reviews about their experiences and send them personalized thank you notes with coupons good for discounts on future procedures when the send friends who actually do new procedures.

We have a billboard a couple of exits up from our office and a 4 x 26 foot, backlit sign “Las Vegas Laser & Lipo” across the top of the building that is easily visible to the hundreds of commuters on the I-215 each day-one of the reasons we choose this location for our new office.

We also have uniform scrubs with the practice logo, water bottles, pens, day-timers, chap sticks and business cards and brochures that all brand the practice and purvey the passion and professionalism of our special practice.  

You and your staff should be enthusiastic, walking examples of the procedures you offer. Talk the talk and walk the walk! Have a list of patients who will rave about your work and your office to perspective patients who want to talk to someone who had a similar procedure already.

What are the most sought after treatments and how do you select cosmetic treatments that will most likely fit to your patient's needs?

I simply don’t offer treatments that I don’t have passion for and skill at delivering optimal results, which is to say, I don’t offer every procedure because I choose NOT to.  I refer patients out to physicians I would send my family to who would benefit from more invasive procedures or ones that I feel are beyond my training, experience or enthusiasm.

That said, do your homework and invest time and money in technologies that “fit” in your practice. Market the coming of a new tech/procedure well in advance of it’s arrival, have a waiting list of patients to schedule after your training and offer special pricing during it’s initial use so that you get plenty of your own Before and After pictures as soon as possible. 

In Las Vegas, most patients want easily visible, even dramatic, but natural results. Non-ablative technologies have not been a good fit in my practice. Minimally invasive surgeries utilizing proven technologies are money makers in my practice along with fillers-especially Radiesse and Artefill. Toxins, laser hair removal, IPL and superficial peels are all good, solid procedures, but more “loss leaders” which allow us to educate patients about what else we offer.  We are always looking at new cosmetic technologies and teaming up with other physicians and technology companies to joint venture and share risk as well as profit. Technologies that consistently perform stay and those that don’t are replaced.

Patients appreciate that we are both innovative, honest and always searching for the next brick in the fountain of youth.

Any lessons learned from practicing cosmetic medicine? 

I’m lucky to have a job that I have passion for and actually get paid to do and teach to others. I’ve surrounded myself with upbeat, supportive and talented staff and peers. I try to stay open to suggestion and criticism. We continually evolve and re-invent ourselves and the practice to perform our mission. That requires continual surveillance, honest evaluation and directed education-output of time, money and effort. I think the most successful practices operate as a business, have a reasonable sense of humor and demonstrate their care and respect for their patients by being honest and respectful--especially when what the patient asks for is unsafe or too much.

I have no qualms about charging a reasonable amount for our expertise and what we’ve built and most patients respect that and feel they are getting more than their money’s worth.  We routinely create happiness by delivering safe, sage, science-based WOW.

Want some stories?...we’re actually keeping track...you can’t make this stuff up, but you can buy the book when it comes out!

Finally, never allow a patient to cajole, compliment, beg or embarrass you in to performing a procedure you are not comfortable doing.  Don’t be afraid to share your passion and excitement about what you do.  It’s contagious and you’ll attract patients who will really appreciate and enjoy your services.

About: Edward M. Zimmerman, MD has a passion for office-based cosmetic procedures. He has degrees from Johns Hopkins and Georgetown University and The George Washington University School of Medicine. He is a Fellow of the American Society of Laser Medicine and Surgery since 1994; member of the American Society of Cosmetic Laser Surgery; member of both the American and European Academies of Cosmetic Surgery and the American College of Phlebology. He has received the prestigious Award for Academic Excellence in Cosmetic Surgery Education from the American Academy of Cosmetic Surgery. Dr. Z is a Diplomate of, and currently serving as, the President of the American Board of Laser Surgery. He received the “Best of Las Vegas” award for Cosmetic Surgery for 2009, was selected as one of America’s Top Surgeons-2010 by the Consumer’s Research Council of America, was elected a Lifetime member of the Cambridge Who’s Who Registry. He has been a PSP “Top Doc” in 2010 and 2011. His office has been acclaimed for Excellent Customer Care by CMUS Talk of the Town - 2010, 2011, 2012. He has held multiple faculty appointments, lectured nationally and internationally and is a sought after consultant in the aesthetic industry. 

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.

Medical Spa MD Report: How Many Years Have You Been Practicing Cosmetic Medicine?

How many years have you been practicing cosmetic medicine full time?

From Medical Spa MD Physician Report Volume 1

The majority of physicians responding to the survey have more than 7 years of experience practicing cosmetic medicine.

For purposes of our survey, it is positive to see that just over 60% of our respondents have been practicing cosmetic medicine for more than 7 years.

This skew towards more experienced physicians may be due to concerns by younger, newer, or more inexperienced physicians that they may be helping a competitor in some way. We expect that this result will flatten as more physicians take part in the survey.

Become a Member to receive the Medical Spa MD Physician Report. You can find the report and more freebies here.

Want to contribute to the next report? Learn more >

Have thoughts on this graph? Leave a comment and let's hug it out.

Medical Spa MD Report: What Is The Total Income Of Your Clinic?

What is the total income of your laser clinic or medical spa per month?

From the Medical Spa MD Physician Report Volume 1According to the respondents to the first Medical Spa MD Physician Report, the largest number of medical spas is making somewhere between $25k and $100k per month.

Another positive note regarding our sample population; there is a nice variety of business sizes, again offering a wide range of perspectives with the highest percentage of the group falling between $10,000 and $100,000 in revenues per month. This, along with the clinic size (next question) appears to indicate that most of the clinics surveyed are operating with a single physician.

What's also interesting is that we have some very large clinics responding with 6% indicating that they're grossing more than half a million dollars a month. These clinics are probably the same ones that have a staff size of 20+.

Become a Member to receive the Medical Spa MD Physician Report. You can find the report and more freebies here.

Want to contribute to the next report? Learn more >

Have thoughts on this graph? Leave a comment and let's hug it out.

Are Groupon Deals Killing Your Medical Spa?

There's a deluge of Groupon offers from Medical Spas who are using cheap laser hair removal treatments to gain new patients... Is it working?

This Groupon tactic is used by skin clinics who are desperately trying to get new clients and don't know how to market effectively or drive perceived value.

Let's take a look at some of these offers and run some numbers on how effective, or ineffective, this will be for your medical spa or laser clinic.

Here's the first of the offers for laser hair removal that I've received from a local laser clinic in the last two weeks. (I think I've received five or six.)

This Groupon offer is from Enlighten Laser Cosmetics of Bountiful, UT.

Okay, so let's take a look. Enlighten is offering an 84% discount on laser hair removal from a starting price of $617 for a savings of $518.

The starting price seems about right for what the average cost of most 6 series laser hair removal treatments are in the area so that appears about right. Since they've sold 700 treatments the can't be unhappy about that since it appears that they're getting swarmed with new clients. Let's dig a little deeper.

The selling price is $99. Groupon takes 50% so Enlighten is taking $49.50 for each sale. They may have sold many more than 700 but let's go with that number. So, with 700 sales at $49.50, Enlighten is bringing in a respectable $34,650 from Groupon...

So let's break down that number and see what we find.

With 700 sales at an average of 6 treatments we see that that gross number of $34,650 comes in at a mere $8.25 per treatment. ($34,650 / 700 = $99 / 6 treatments = $8.25 per treatment)

Not so good.

That's $8.25 before any labor, rent, treatment tips, appointment scheduling or anything else. It also ties up around 4,000 or treatment room time that this laser clinic won't be able to use for other treatments. They'll also have to deal with all of the support issues; phone calls, appointment setting, consultations, equipment depreciation and the inevitable complaints and patient issues that arise any time you're treating a patient population of 700 individuals.

If you've ever sold gift certificates you know what I mean. You sell a boat-load in December for the holidays and then starve in January and February as your rooms are booked delivering the services and no money's coming in.

So, what is the most likely scenario?

Enlighten laser clinic is going to skimp on treatment time.

Instead of performing a complete treatment, the staff is going to be under a lot of pressure to get these patients in and out. One likely scenario? They'll cut a 45 minute treatment to 30minutes. They'll perform skip treatments where they're not covering the entire area but treating every other one. They'll have a waiting room stacked six high or schedule patients only on off hours... All of these can lead to exactly the opposite result that Enlighten is looking for, happy repeat clients.

I'll also note that as I've spoken at length about before, the people buying these Groupon deals are coming for price, and they'll leave it just as quickly... Not the patients you're looking for.

Here's another laser hair removal offer from Lisse Laser & Aesthetics Medical Spa in SLC, UT.

This offer arrived in my inbox early this morning so it just started. They have 101 sold deals now but it doesn't end for 24 hours so they'll probably sell many more. (Note: While I wrote this post their sales have climbed to 371 in about 40 minutes.)

Lisse Laser & Aesthetics Medical Spa is taking a much sneakier approach. They're listing their value at $2000 in value.

Here's Lisse's Groupon offer:

...for $145, you get six laser hair-removal treatments on the lower or upper legs (a $1,000 value for women, $1,400 value for men), lower or upper arms (a $700 value), or Brazilian bikini area (a $1,000 value for women, $2,000 value for men)

So again, six treatments but at least they're making an extra $23 per patient. Let's do the math again.

$145 per sale / 6 treatments = $24.16 per treatment.

Lisse is going to have all of the same issues and problems with scheduling, service, appointment setting and the rest as well.

(I'd be interested to hear how those medspas that are using commission (which I personally hate) to pay their staff feel that this kind of discount effects both the level of service and the commission structure. If you have a thought on this please comment.)

And there's another problem.

Selling your services at this type of discount positions you in the marketplace as the cheap player in town. You'll never be able to control your pricing. You'll never be able to create steady, repeat buyers that pay a premium for your services. You'll never be able to bring in the bigger treatments and you'll always have cash flow issues.

• Read: Your Medical Spa Pricing, Cognitive Dissonance, & How To Charge More

Instead, you'll always be scraping along at the bottom of the barrel... if you can survive this type of cut throat slash-and-burn price war.

I can see that Groupon is doing a great job of selling their deal to laser clinics just by the endless stream of deals.

For Groupon this is great. They just made $34,650 from Enlighten by sending out an email... but Enlighten is the one who's stuck delivering all of the services, making all of the appointments, dealing with the customers, and putting their reputation and business on the line, including the potential of any issues that hit their malpractice insurance or medical licensure. (I'm not saying this will happen, just that the risk is entirely on Enlighten and the physician, not Groupon.)

Undoubtedly, there are some occasional successes and I've heard from clinics that claim that they love Groupon, but I've never heard from a physician who was paying the bills that this worked well. It's often the staff that like this since the clinic is now busy, but the physician owner is the one that's not making any money and still paying out.

Here's a quote from a business that ran a Groupon offer.

After three months of Groupons coming through the door, I started to see the results really hurting us financially. There came a time when we literally could not make payroll because at that point in time we had lost nearly $8,000 with our Groupon campaign. We literally had to take $8,000 out of our personal savings to cover payroll and rent that month. It was sickening, especially after our sales had been rising. So the experience jaded me, and the interactions with the few bad Groupon customers we had jaded our staff. After all of this, I find myself not even willing to buy Groupons because I know how it could hurt a business...

This business owner goes on to tell of her experience that the Groupon clients also lambasted her business on Yelp and other review sites with negative reviews.

If you have an opinion on this or experience with Groupon, please leave a comment.

Additional posts on Groupon:

• Medical Spas & Groupon Group Buys
• Your Medical Spa + Groupon
• Groupon & Fee Splitting
• Groupon post on Techcrunch

Niche Yourself & Your Medical Spa

If you're not comfortable with creating or finding a niche that your medical spa can dominate... get familiar with it.

Guy Kawasaki is a well known speaker on technology, venture capital and startups. I've seen him give this presentation a number of times and this is dead-on accurate for any business, including your laser clinic or medspa.

If you're just copying everyone and trying to feed on the edges of the marketplace, your medical spa's just an also ran and you'll never experience the ability to control your prices or your income and you'll always be playing second fiddle to those clinics and physicians who understand these principals.

Own A Niche. Any Niche. (Medical Spa Blueprint)

"If you can, be first. If you can't be first, create a new category in which you can be first."  - Al Ries & Jack Trout, The 22 Immutable Laws of Marketing

There's something innately attractive about uniqueness.

To be unique you need to dominate a niche. I don't care what niche it is, but you need to dominate it.  If you can't dominate the niche where you are, you need to create a new one.

How can you tell if you're considered to be unique? Pretty simply. There's a single two word phrase that people use to describe someone who's dominating a niche. You'll hear it used all of the time as a recommendation: "The best".

It doesn't matter what you're the best at, only that you're the best at it.

Now all uniqueness is not created equal. If you're 'the best orthopedic surgeon in the country', you're going to be sitting pretty. If you're 'the best orthopedic surgeon in Evanston, Wyoming', it's less of a talking point.

Perhaps you're in cosmetic medicine like a lot of the docs that I know. It's probable that there are  dozens of plastic surgeons, dermatologists, and medical spas that are in your target area and trying to get to your target clients.  How are you going to set yourself above the noise as the single choice? How are you going to get those patient referrals?

How are you going to position yourself as 'unique' in order to compete?

You're going to find something that you can be the best at.

You may be in family practice or internal medicine. Fine. You're clinical practice is general in nature, but that doesn't mean that there's no uniqueness to be had. You always start where you are.

Sure you have patients that already love you. So what. So does everyone else.

Like everyone in cosmetic medicine, already know that you’re ‘target’ is generally going to be women. You’re right of course, more than 95% of your clients will be female, but what else do you KNOW about the women that want YOU to be their cosmetic medical provider. If you’re like the average medspa, even those that have been doing this for years, not that much. You’ll also be able to deduce pretty easily that women looking for Botox. or fillers, or cosmetic surgery are generally over 30 and less than 55 or so. Right again. That’s a ‘second qualifier’. In fact, those two items put you on par with 99% of what cosmetic clinics know about their Botox and filler patients… but that’s not the end.

If this sounds like you, then you’ve joined the 99% of other providers who think they should target EVERYONE instead of a small, focused niche. In the best case, these clinics limit their success, in the worst, they set themselves up to fail miserably.

You need to learn how to target your perfect client with laser-like focus. With the right niche targeting, you’ll be able to tailor and optimize not only your services, but also your medspas pricing. And when you learn to target your services SPECIFICALLY to this person – making it truly personalized – they will pay virtually anything, and they’ll thank you for it.

Of course targeting this way isn’t easy. It takes a little work so it’s generally ignored by the lazy.

Let’s go through a quick example to set the stage. Imagine that you’re hired by a medical spa or laser clinic and you’re told, “Help us get more patients.”

The first question you ask should probably be, “Who are you trying to reach?”

If the response is, “Well, everybody. We just want a lot of them.” Turn in your notice. You’re doomed.

What’s wrong with this approach?

Think about it this; when was the last time you went out of your way to purchase a product that was just right for you, but it was also “just right” for your retired father and your 18-year-old neighbors kid? If you found such a product would you buy it? Would you pay a premium price for it? Of course not.

You’re looking for something that speaks directly to you. That serves YOUR needs – not your needs and everyone else. That’s why a woman will spend $600 on a Kate Spade handbag instead of the Target knock-off, men buy ‘men’s razors’ when cheaper women’s razors work just fine, and why your perfect target patient will pay you a premium and beg you to treat them.

Take note of this point because it’s important: If you’re targeting to EVERYBODY then you’re selling to NOBODY.

It may sound counter-intuitive but it’s true: The more you niche yourself, the more money you can make.

An excellent example of this is Johnson & Johnson Baby Shampoo. It’s been around forever and you probably already know the ‘No more tears’ slogan. Know who their market is? It’s not babies. Babies don’t by shampoo. In fact, it’s used by adults far more than it’s use on babies. Why, because it’s ‘niched’. It says right on the label who it’s for… even though they know that more adults use it.

You’re not offering exercise videos… you’re P90x who’s blowing the doors of of sales by targeting the hardest workout for the hardest bodies.

You’re not selling cooking lessons…  you’re selling cooking lessons for new brides.

And you’re not just selling Botox and fillers.

See the difference?

STORY

Dr. Greg Bledsoe wanted to teach wilderness medicine. He's edited a book on Wilderness Medicine, had tremendous domain expertise and vast experience. The problem was, there was already someone there. The Wilderness Medical Society had a hold on that niche as the biggest player in the market and liked it that way. There was no room to join that organization and then work up. The committees running medical organizations rarely change. So Greg created his own niche. He called on all of the A-list physicians he knew in wilderness medicine and put together his own conference. He focused on physicians who were entrepreneurial and wanted adventure. He ignored compaines and organizations and targeted the 'small fry'.

Now, ExpedMed hosts wilderness medicine conferences that include exotic travel locations, CME accreditation, and incredible teachers. Not only did Greg created his own niche and made a profitable business, he's put himself at the center of a network that have generated three new businesses.

This is an iterative process after all. You're not going to decide that you're the best

STORY

When I first started writing Medical Spa MD I was running a number of cosmetic medical clinics. It was 2002 and the 'medical spa' craze made is seem that there was a physician squirting Botox on every corner and a 'medspa franchise' in every strip mall. I needed a way to recruit physicians easily and quickly as we opened up new locations around the US.

I attracted physicians to Medical Spa MD by offering unique content that they couldn't get anywhere else.

If you're a physician running a cosmetic medical practice, almost all of your information comes from marketing and sales materials. Trade magazines, conferences, and the rest of the information pipeline are all sponsored by the manufactures and service companies. No advertising supported trade publication is going to come out and name the winners and losers or tell you which technology is best. They couldn't, but I could.

I created Medical Spa MD as site that was for physicians who wanted real information. Since I didn't need to make money from sponsors or advertising, I could offer the 'secret' information that physicians were looking for.

We give honest opinions and reviews. We connect physicians in cosmetic medicine in a way that no one else can. We turn down 99% of businesses that want to partner with us.

The result? Medical Spa MD has 5,000 physician members worldwide and is the primary community for physicians around non-surgical cosmetic medicine.

As a generalist, you have to make sure that you are one of the best in the industry, have unique service offerings, and you are considered accomplished in a few other fields. 

If you do it persistently enough, you will OWN that niche. People will not be able to imagine that niche without you.

The secret to commanding premium rates is in identifying a very specific niche that buyers demand, and focusing on that niche while excluding everything else.

There's no really good short cut around this. If you don't already have any unique skill set, you're going to have to develop one. You can't hoodwink everyone into buyers by just saying that you're better. Decide on a single special attribute or 'specialty' and make it your own. Actually BE better at it in some way.

Oh, by the way, you can only pick one niche.

Listen to this as a claim; I'm the worlds leading proctologist and neurosurgeon. Or how about this; I'm the city's leading Botox provider and the best at liposuction.

You can not be 'the best' at more than one specialty. I know that you want to be the best at more than one thing. I know that you think you are and you might actually be, but the marketplace won't believe you, and belief determines 'what someone will pay'.

Here's a perfect display of niching: Alexander Rivkin MD at Westside Medical Spa came up with a niche; the non-surgical nose job in which he uses Restylane or Juvederm. Nice. Look at the press he's getting.

Now Dr. Rivkin is offering all sorts of treatments and most of his revenue comes through other services but his 'brand' and positioning starts with the niche that he built. It set him apart and let's him dominate a niche.

Have the confidence to find your niche, define who you are, then declare it again and again and again and again.  If you target your martket smartly, over time you will own that niche.