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!

SIMON Says: “Run Forrest Run!”

Saying ‘No’ to Prospective Cosmetic Medical Patients

Certainly, everyone is entitled and should have access to cosmetic medical and surgical services. However, depending on your particular risk tolerance, there are certain times when you might want to just 'pass' on treating a patient.  Knowing which patients to sidestep is a gray art and is frequently based on hunches and ‘gut’ feelings.  This subtle impression, as described in Malcolm Gladwell’s book 'Blink: The Power of Thinking Without Thinking', is correct more often than not.  However, there are more objective guidelines available to help decide whether or not to dance with a particular patient. Several of these tips have been developed and expounded upon in numerous papers by Dr. Mark Gorney and in the book 'The Patient and the Plastic Surgeon' by Dr. Robert Goldwyn.  Consider running for the hills if:

• The patient is a SIMON – single,immature, male, overly expectant, and narcissistic.  Even worse if they answer to SIMON-SLAP (SIMON + still lives at parents). 
• You don’t click with the patient – or just plain dislike them
• The patient is critical of previous physicians but thinks you hung the moon.
• The patient is rude to your staff.
• The patient demands a guarantee.
• You are asked to do something you can’t deliver.
• Anyone in a hurry to have surgery – gotta do it now!
• The surgiholic patient.
• Patients wanting procedures because they are prodded by friends or family members.
• The out-of-town patient who has to bolt before you are comfortable with them leaving.
• The patient who is vague, indecisive and leaves the driving to you.

Unfortunately, patients don’t walk into your office with a label on their shirt saying ‘I’m going to be a real problem’.  Listen to the voices in your head and apply the above principles.  Cosmetic medicine is supposed to be fun – don’t let a rogue patient slip through the cracks and haunt you.  It just isn’t worth it!

Patients with High Expectations (Dreams versus Reality)

It is true that we all have dreams and we all, in some way, want to believe in magic.  But when it comes to cosmetic work and people's appearance, it's best to be realistic. I know we all have patients with unrealistic expectations. These patients are the ones we should be more careful with and we should spend more time educating them.  Patients with high expectations are usually well informed and they know about all the new technologies but they also, many times, are expecting unrealistic results. I have developed a good eye for these patients and what I have learned is that it is best to create low expectations, show them before and after photos that don't show fabulous results and always offer the possibility to go and get a second opinion. If they decide to stay and pursue their treatments, they know what to expect.  Taking before and after photos with these patients is very important or if you have a computerized image system (Visia), it is also helpful. At the end, the patient will be satisfied and feel that they got good results but realistic ones and you will save yourself from a potential headache.   

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.

The Value Of Board Certification In Cosmetic Medicine?

Is it better and safer to get Botox injected by a family physician who has been injecting patients for 15 years or a newly graduated plastic surgeon who just finished his residency last week?

In Cosmetic Surgery, the term "Board Certified" is the most highly used term for marketing purposes today. Thirty years ago, many doctors were "Board Eligible" or non boarded and their value came from their training and their experience and their expertise, not just a label. Today, doctors are expected to be board certified in something. That something is the topic of heated battles and debates and many of our colleagues are just as confused about it as are our patients and the public and the media. Insurance companies and third party payor and even hospitals require board certification and may use it for determining reimbursement. 

The American Board of Plastic Surgery (ABPS) and The American Board of Facial Plastic Surgery (ABFPRS) have had many decades of heated nasty all out warfare. For the most part, on the surface at least, the war is over but small battles and skirmishes are still waged amongst these two specialties here and there around the country. But cosmetic surgery is no longer being offered purely by Plastic Surgeons or Facial Plastic Surgeons, Oculoplastic surgeons, Oral surgeons, otolaryngologists, & dermatologists are a significant part of the cosmetic surgery providers. More over, family physicians, ER doctors, Radiologists, OBGYNs, and other doctors whose specialty is not traditionally associated with cosmetic surgery are now the fastest growing population of cosmetic surgery providers with Botox and fillers and lasers as their entry to the more involved mini facelifts and blepharoplasties and liposuction. The American Board of Cosmetic Surgery and the American Board of Laser Surgery has given this large heterogonous group of non-cosmetic surgeons an umbrella to gather under and a label to use for marketing and validation.  

The American Board of Plastic Surgery and The American Board of Facial Plastic Surgery have now joined forces in order to "protect the public" and inform the media and public about the lack of proper residency or fellowship training by many of these new non traditional providers.  Protecting the public is a noble endeavour and a great cause but I ask who is going to protect the public from less inept members of the American Board of Plastic Surgery and the American Board of Facial Plastic Surgery?  There is no doubt that the vast majority of poor cosmetic surgery with bad outcomes are being performed by Board Certified doctors, most of which are actually certified by these two esteemed Boards (ABPS and ABFPRS). 

Then what is the true value of "board certification" and how will the public be protected? We must police and control our own profession as a whole before we are controlled by outside forces. In Ontario Canada, a deal between the society of Plastic Surgeons and the Department of health posed a new regulation where no one other than a plastic surgeon could use the term "plastic surgery" in their advertising! So, is it better and safer to get Botox injected by a family physician who has been injecting patients for 15 years or a newly graduated plastic surgeon who just finished his residency last week or even from a nurse who works at a plastic surgeons office? This is a tough question that needs to be answered by us doctors before it gets settled for us by external forces.