Physician Lifestyle Design

Guest post by Greg Bledsoe MD, MPH

I've posted a couple of articles about taking responsibility for yourself and "building your own ship" , and we've also gone through a few common reasons why physicians aren't the best at career modification.

In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).

I'll begin with a personal story...

When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique.  My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent.  Simple, huh?

I spent months thinking about how to do this as a physician.  I searched websites and blogs.  I spoke with mentors and colleagues.  I read the literature, all to no avail.  There seemed to be no conversation about a career like this in medicine.  I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.  

What I found, though, was that while the medical community was silent about how to develop a very non-traditional and interesting career, the business world had already awakened to the idea.  Within the world of business, the idea of becoming a "free agent" and overhauling your career through "lifestyle design" was beginning to pick up steam. 

Around this time I picked up a copy of the book Free Agent Nation by Daniel Pink.  I'm not sure how I found this book, but it became a sort of manifesto for me.  In this book, Dan explains how more and more individuals were escaping their cubicles to become independent free-lancers and living their lives with increasing flexibility and empowerment.  It was a great read and it hit me at a very important time.  Through this book I realized that I was not alone in my desire for more autonomy, and that a lot of workers who had already yanked themselves off the grid were thriving.  I was hooked.

The second book I read was a book that has become a bit of a cult classic already, Timothy Ferriss' text, The 4-Hour Workweek .  This book is a basic introduction to how Tim built a stream of residual income and then used his extra time and money to explore his interests and live a more interesting life.  It was Tim's book that introduced me to the term "lifestyle design," and while the phrase might seem a bit hokey, it's a very powerful concept.  Basically, what Tim discusses in his book is the idea that it is possible to live an incredible life if you prioritize correctly, live frugally, and develop your entrepreneurial side.  Some have criticized the book recently, explaining that no productive person-- not even Tim Ferriss himself-- really only works four hours a week-- but I would argue that that's not really the point.  The catchy title sells books, but it's the mindset Tim describes that is the reason why the book is an important introduction for individuals who feel helplessly caught in a hamster wheel at work.  Tim's point is that you can-- through ingenuity and hard work-- leap off the hamster wheel and into something much better.

So how does all this apply to physicians?

Well, when you have a career discussion with most physicians, it often boils down to whether or not that individual wants to continue practicing clinical medicine or go into a nonclinical job.  There's nothing wrong with either, mind you, and I have friends who have great careers in each; however, for me and for many other physicians, I suspect, this approach is just too simplistic.

The fact is, I like clinical medicine.  I've spent a of of time getting good at what I do and I'd like to continue to be able to help people by providing good clinical care to patients who need it.  I also like many aspects of the nonclinical opportunities available to physicians-- things like consulting, writing, medical device development, and many other niches really appeal to me.

My main question is not whether I want to practice clinical medicine or jump into a nonclinical career, it's how do I design my life to be able to practice medicine, participate in the nonclinical activities I enjoy, and still have the flexibility to pursue life outside of medicine?  Discussions about clinical versus nonclinical are at their core too reductionistic for most modern physicians.  What most modern physicians really need to be having are overarching discussions about how to design a lifestyle that incorporates the multiple facets of their career interests and also does not overlook the ultimate (and most likely unspoken) goals they have for their lives. This is a much deeper conversation, but one that is desperately needed today in this time of significant upheaval in our healthcare system.

So where do you begin if you're a physician and you are interested in exploring this idea of "lifestyle design?"

Well, don't go to the career advice section of your specialty journal and certainly don't go to the HR person at your hospital or academic institution.  

In my opinion, you should begin by checking out the conversations going on in other fields.  There are some incredible websites built around some really creative and interesting people who are living fascinating lives and teaching others how to do the same.  Check out the following as a starting point:

• The Blog of Tim Ferriss: Experiments in Lifestyle Design
• The Art of Non-Conformity Blog
• Thrilling Heroics with Cody McKibben
• The Blog of Corbett Barr

Once you immerse yourself in this culture you begin to see possibilities that you never would have realized before.  What's more, as a physician there are even more possibilities available to you than for the typical person, if only you'll step out and take a little risk.

Over the last few years this idea of lifestyle design has been a focal point of my thinking when it comes to career moves and ultimate goals.  I've invested a lot of time, cash, and sweat into learning how to build a unique career, and my hope with ExpedMed is that we can use this website as a vehicle to help other physicians, just like you, succeed in designing a lifestyle and career they truly enjoy. 

The Newest In Dermal Fillers

Dermal fillers remain one of the most known methods of non-surgical rejuvenation, due to its popularity and effects, many patients have preferred dermal fillers. However, not everything ends well because of the possible adverse effects of dermal fillers. Thus there have been studies to ensure the safety of administering inejctables.

A couple of studies.

Double Injection Technique

Novel techniques are developed and presented to ensure the delivery and safety of the filler. Injecting requires skill and precision, thus it is crucial to learn safer techniques in injecting dermal fillers especially in the danger zones. One dermatologist mentioned that during a demo, the subject had become blind also.

Intravascular injection is something that all providers avoid due to disastrous side effects it causes on patients, and due to this delivery of injection, there have been cases of blindness and providers must always practice care and precision in administering the injection. 

The technique was double injection, as presented by the researchers, Huang and Lin, which could help prevent intravascular injection. Their method aims to thwart the possibility of intravascular injection, basically there would be an inner and outer needle in performing the procedure. In the event of drawn blood, the inner needle would move the blood out.

The researchers do admit limitations to their method and there could be more research that may be done in order to use this method.

Regeneration is the new Rejuvenation?

Dermal fillers could also demonstrate its efficacy in regeneration. Only two studies have examined dermal filler use for regeneration, it seems likely that in the near future, physicians could use dermal fillers for soft tissue regeneration. There are two studies regarding tissue regeneration and filler or fat injection, which have regenerative properties.

Fallacara et al. (2017) suggest that Urea could be cross-linked with HA considering its properties. According to the researchers, this could be the future of dermal fillers, and that could treat cosmetic issues other than its usual common dermatological concerns (e.g. psoriasis, calluses)

Additionally, there is another alternative to filler for tissue regeneration, which was discussed in detail by Dr. Cohen through Medscape that fat was also helpful in rejuvenating and regenerating  the reason he used fat was it made for a more natural look and that it lasted longer as compared to using fillers. Additionally, it adds more volume.

CaHA with Ascorbic Acid?

The study examined the efficacy of CaHA with Ascorbic acid to treat stretch marks. The researchers tested it on 35 patients, and on areas where stretch marks commonly appear such as: thighs, knees, buttocks, abdomen, and breasts. 

Findings:

• 63% of patients in the study were satisfied with the treatment; while only 1 was unsatisfied.
• Most patients were more satisfied in areas like abdomen, buttocks, and breasts.

Dermal fillers would have more potential uses in the future, and that it could have other uses in the future. For now, dermal fillers remain as one of the most popular treatment for cosmetic concerns, leaning towards rejuvenation.

A list of cosmetic dermal fillers here.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426873/
https://www.researchgate.net/publication/315818101_Hyaluronic_Acid_Fillers_in_Soft_Tissue_Regeneration
https://journals.lww.com/prsgo/Fulltext/2017/09000/Calcium_Hydroxylapatite_Combined_with.17.aspx

Here's Why Podium Should Be Your Reputation Management Software

Getting positive patient reviews that give an accurate representation of your medical spa's reputation used to be hard. Now it's easy.

Receiving negative patient reviews is a bummer, especially when one of your unhappy patients - perhaps with unrealistic expectations - looks to wreck your reputation online. And it's the angry, unhappy patients who can really damage your reputation because their voice or 'comment' is abnormally enlarged since your happy, satisfied patents are not the ones who most often leave you reviews.

It seems that patient reviews fall in to two camps; friends and family who you beg to give you reviews, and unhappy patients who seem bent on destroying your reputation.

No more.

Podium gives you a super simple way to to gather patient reviews from almost all of your patients and build your reputation on Google, Facebook and other review and reputation sites. (Watch the video above to see how easy it is to request a review.)

There are a myriad of benefits for a continual stream of reviews including:

1. Increasing your SEO rankings and visibility of your clinic for more patient traffic.
2. Increasing the number of inbound contacts you're front desk is fielding.
3. Outbound contacts to your existing patients via text message (a 99% open rate)
4. Control of your online reputation by gaining a massive influx of patient reviews that more accurately show your actual reputation and lessen the effect of a few unhappy patients.

Check out the Podium special offer for Medical Spa MD Members.

Facebook, Google, word-of-mouth all expand your reach - note that Podium handles this use case as well - but reviews can make or break your reputation and either lead to long term success, or abbreviate your opportunities.

You'll notice on this chart that online reputation is critical for  "Medical / Healthcare" businesses. The reviews that you now have are setting the tone for your new patients since a whopping 87% of consumers - including consumers of cosmetic medicine - now search for even local businesses before they contact them. 

It's often the case that successful clinics are competing in ways that the rank and file don't appreciate, or don't have access to (Asymmetrical Competition), using tools and spending smart money in areas that actually benefit them in the long term rather than just saying yest to the salespeople who walk through the door.

Take a look at the special offer and free setup that Podium is offering to Members.

Sentient Lasers Joins Medical Spa MD As A Certified Partner

Sentient Lasers is joining Medical Spa MD as a Certified Partner - providing Members access to the highest quality used aesthetic lasers and promising to keep our Certified Partner 7 Point Guarantee.

The highly prohibitive costs of new aesthetic lasers can make the profitability of your clinic or practice challenging. Fortunately, the advancements in medical laser technology over the last few years, as well as changes in the economy, now offer you the ability to buy medical lasers of almost any type at a significant savings – often up to 75% off of manufacturer prices.

Every cosmetic laser Sentient lists on Medical Spa MD is inspected, tested and refurbished to manufacturer’s specifications at our warehouse before it is ever available for resale. This ensures that our certified pre-owned lasers are the best on the secondary market.

"We're excited to join Medical Spa MD's Certified Partner Program", says Chris Cella, CEO of Sentient Lasers. "It's fits with our own Blue Dot Certification and gives Member of access to the very best quality lasers while providing the best, ethical service in the industry - and let's them save 70% off of buying a new aesthetic laser."

You can always see Sentient Laser's current offer to Members here.

(At the time of this posting it's a free upgrade from a standard 30 day warranty to a "Gold" 90 day warranty on any used aesthetic aser, IPL or RF device for free if you mention Medical Spa MD - a $2,500 value.)

To get this deal from any Certified Partner, just mention that you're a Medical Spa MD Member. No need to do anything else, just mention Medical Spa MD for ANY purchase and Sentient Lasers will take care of you.

Sentient is the third used aesthetic seller to join our Certified Partner Program and not the last. Our program gives our Members access to our 7 Point Guarantee and provides the largest single marketplace of used cosmetic lasers where you're guaranteed to get the lowest possible price and additional benefits.

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Learn more about Certified Partners

Remote Patient Monitoring Research

Remote Patient Monitoring via Smartphone

Telehealth is finally beginning to show real adoption with the move to outcome based care.

Any number of virtual care platforms have now thrown their hat in the ring to attempt to make patient communications as easy as regular calls. 

Smartphone monitoring seems like a good option for physicians and patients alike. The literature on smartphone monitoring is limited, but it shows potential for clinical use.

In a recent study by Dalla Pozza et al. (2017), the researchers explored patient monitoring after treatment, which asked their patients to take photos of post-op procedure as they were instructed by their surgeons. Patients were asked to send photos of the front and side views of their face to send to the surgeons.

Out of the original 57 in the sample, only fifty followed-up with post-operative photos.

The following procedures performed were:

• (32) Facelifts, platysmaplasty, submental lipectomy;
• (14) Upper and lower blerophaplasty;
• (11) Fat injections

After treatment, three patients experienced complications early on. The patient in the study still preferred the usual face to face consultation, but the researchers mention that most of their sample were older patients, and were not able to adapt to some applications used for the study.

A similar study also examined the use of patient monitoring via smartphone. Chee et al. (2016) focused more on laser resurfacing on the dermatological aspect of it. Their study provided insight on the patient’s use of smartphone monitoring. There were 123 patients in the study, and having done the procedure around 12% had adverse events after it. Due to the complications, the dermatologist treated them the day after. Numbers dwindled as only a few answered the follow-up survey leaving only a few to report the smartphone review had good effects on them.

According to the authors, 95% out of the 24 who completed their survey felt at ease with the teledermatology process.

There is the risk of violating HIPAA and HITECH. In the first study, the researchers mention that limitation as patients may not have a HIPAA-compliant smartphone to send images or details of their condition. In this case, physicians have the responsibility to make sure their images are secure. In the second study, patients were wary with sharing their photos as well.

To learn more you might take a look at the scores from the KLAS 2017 Virtual Care Platform Report in which a dozen or so telehealth platforms (TruClinic, American Wellness, InTouch, etc.) were scored across a number of criteria.

Medical Spa MD Certified Partners

Buy your next cosmetic laser or IPL from a Medical Spa MD Certified Partner with confidence that they will meet our 7 point guarantee.

When you buy your next laser or IPL from a Medical Spa MD Certified Partner, you know that you're dealing with an organization who has agreed to meet our high standards, and that their continued inclusion in our program relies on treating Members with transparency and honesty. All Medical Spa MD Certified Partners have agreed to our 7 point guarantee.

As a Member, If you purchase from a Medical Spa MD Certified Partner who does not meet our standards and our 7 Point Member Guarantee, you can contact us directly and we will intercede on your behalf. If we determine that a Member has been treated unfairly or that there has been a violation of our values, we will revoke that companies privileges and access to the program, and we will list publicly list that company as a business that we will no longer work with. 

If you are a Medical Spa MD Member who have purchased from a Certified Partner and want us to investigate an issue or complaint on your behalf, you may contact us here.

Our 7 Point Member Guarantee

Every Medical Spa MD Certified Partner has agreeded to:

1. Follow our Terms & Conditions and our Code Of Ethics
   You can read them here.
2. Transparent Listing Prices
   Any product listed on our site will be immediatly available at that price. There will never be any "bait and switch" tactics of listing of products that are not under the direct control of the listing company.
3. Lowest Price
   Certified Businesses agree that the price you see on Medical Spa MD is the lowest price for that item on their own site or anywhere else.
4. Awesome Service
   Certified Businesses agree that they will provide Medical Spa MD Members with their highest level of service at all times.
5. Public Reviews
   Certified Businesses agree that after every purchase they will use a verified Podium account to send you a request for a public review of their service.
6. Member Only Benefits
   

   Certified Partners agree to provide free, special benefits, upgrades, price reductions, and/or perks to every identified Medical Spa MD Member purchasing a laser or service.

   You must identify yourself as a Medical Spa MD Member before purchasing to recieve these benefits.

While this program can't guarantee that nothing bad will ever happen, it does go a long way to cleaning up the industry and gives you (if you're a current Member) much more serious remedies and security when you're buying a used laser or IPL. It also begins to clean up the marketplace since we will actively be looking to publicize and identify cosmetic laser resellers who are not ethical or have unhappy customers.

Here's a short FAQ about this new program for Members.

Which used laser companies are currently Certified Partners?

There are currently two used laser resellers in the program; Sentient Lasers and Rock Bottom Lasers. 

• Sentient Laser - Free upgrade from 30 day Silver to 90 day Gold warranty for Members.
  View Member offer from Sentient Lasers 
   
• Rock Bottom Laser - Free upgrade from 60  to 120 day warranty for Members
  View Member offer from Rock Bottom Lasers

Want to become a Certified Partner? Apply here: https://medicalspamd.com/partner

Why is this program needed?

If you've purchased a used aesthetic laser or IPL from an unethical reseller you already know why this is needed. If you haven't had a bad experience yet, we're here to make sure you don't. This program looks to hold laser sellers more accountable since we will actively be looking to publicize and identify cosmetic laser resellers who do not act ethically including.

We aim to make every purchase transparent and ethical for our Members.

Why do laser sellers want to be a Certified Partner?

They want the increased sales from our Members, and they're also concerned about the damage that unethical vendors do to their own reputations and the entire industry.

What types of businesses can be a Certified Partner?

Any business that sells cosmetic lasers, IPLs and medical devices to our target market - physicians practicing nonsurgical cosmetic medicine worldwide - can apply to be come a Certified Partner if they agree to abide by our terms, our 7 point guarantee, and what special benefits they will provide to Members. Applicants are then vetted by us to determine if they should be added as a Certified Partner and can display the Medical Spa MD Certified Partner Seal.

We will only work with vendors who have both the intent and the resources to provide high quality services to our Members. We're currently focused on the used aesthetic laser market but if this program is successful, we may extend it to other areas.

Note: Other businesses may apply to be a Select Partner but only cosmetic laser and IPL vendors may be "Certified" and list their inventory on our site. 

What should I do if I feel like a Certified Partner is treating me unfairly or violating the Certified Guarantee?

First, contact the vendor about the issue. All of our Select Partners are very aware of identifying Medical Spa MD Members and will usually bend over backwards to try and remedy the situation.

If you're still not satisfied, you can contact us directly using the form at the top of this page. We will collect your information and contact the vendor directly to investigate what happened. You may be contacted for additional information. If we determine that the vendor has acted dishonestly, unethically, or violated our Certified Partner Agreement we will take any number of actions up to and including publicly disclosing the issue and banning the vendor from the program and site.

What happens after I file an issue?

The first thing we'll do is collect some additional information from you by email or phone to try and determine the order of events and what happened. You may be asked to forward emails or detail phone conversations. We will then contact the Certified Partner on your behalf to tell them that we're involved and to get their side of the story. (Note: They should already be aware of the issue since you should have contacted them first.)

We will essentially conduct our own investigation to determine if there was a violation of our terms or 7 point guarantee, or if the vendor acted unethically. If we determine that the vendor is at fault we will work with all parties to attempt to resolve the issue to the Members satisfaction.

If we determine that the vendor acted intentionally to violate their agreement with us as a Certified Partner we will take additional actions that may include publicly disclosing the issue or incident, notifying our Members, and removing the vendor from our Certified Program. 

Do you guarantee that I'll be happy with the outcome?

No. You may be a jerk who will never be happy. However, if you're somewhat reasonable we will work hard to come to the best resolution we can for you.

Not a Member yet? You must be a Member to realize these benefits.

3 Types of Content for Your Own Medical Spa MD Academy Course

When we launched the Medical Spa MD Training Academy we intended it to fill the training needs that are not being addressed by typical training systems, and to do it at scale, making the latest training available to every clinician and clinic.

Most clinicians think of training in very specific methodologies, most often the terms "hand's-on" is applied. It's common for cosmetic physicians to fly around the country, or to other countries, to receive training in 'hot' or trending techniques that are in demand and which may bring in extra revenue.

But "hands-on" training has any number of drawbacks, most notably the fact of very limited scale. The reason that most technical courses demand that you be at a specific location is not because it's the most effective way to deliver training, it's that in the past there have been technical limitations that have prevented the easy dissemination of information.

But those limitations have been removed to a large extent. Now, there are college courses by MIT, Stanford, Harvard and others that educate thousands or tens of thousands of students at a time. The benefits are staggering and it's only old-school thinking that limits the application of these technologies in new spaces.

Here at Medical Spa MD, we help physicians set-up their own courses and want to give you the opportunity to reach other audiences.

Our goal is to provide quality training, not just clinical "how to", but other training as well. Operations, social media, leadership, software, and everything else that goes in to building a successful clinic.

We also look to help clinicians who have valuable skills and training to find an audience, which is the single largest issue that stops the sharing of information; is it worth it?

Courses do not need to be long or involved. I've taken plenty of courses that are free or took 20 minutes. There are no real restrictions about what you can do as long as it makes sense. How do I close a sale? How do I schedule a team better? How can I manage my money? Which technology should I buy? How to negotiate? How do I run a Facebook campaign? What can you use to start your own course?

All information is already know, but the value of a course is that it's curated and provided as a guide, not just a jumble of information.

Re-purpose a presentation as a course.

You may have given a presentation or talked at a conference. Most of these types of presentations are easily re-workable to create a short (or long) course and get in front of a much bigger audience. It's actually quite easy and we're happy to help.

Share a Technique

 It does not have necessarily to be your own copyrighted technique. There are plenty of clinicians around the world who have never been exposed to what you take for granted.

Use Your Existing Course

Even if you have this course posted over another site, you may not be reaching the audience you are expecting. Our community encompasses thousands of physician members on the site, and we assure you there are physicians still willing to train more.

Aside from reaching a wider audience, we have tools for you that could help you easily set-up your new course. Have questions? Contact us here and tell us about your new course.

Microneedle Patch May Replace Lasers & Injections for Fat Removal

Researchers created a skin patch to deliver a drug that can convert white fat to calorie-burning brown fat.

Liposuction is still one of the top procedures performed by surgeons worldwide. It is consistently in the top five in the ISAPS Global Statistics, and it may continue to rise.

On the other hand, fat freezing, lasers, radio-frequency, and ultrasound technology are the common treatment modes of treatment for fat removal. These devices have different effects on each individual, some may work, some may not.

What if patients do not need to go to a clinic and could eventually stick a patch on themselves to remove the fat?

A patch is currently being developed to burn the fat in your “love handles”, and it is being tested in mice. A study by Zhang et al. (2017) They use brown fat by using nanoparticles and Rosiglitazone on the patch. The researchers used brown fat because of its properties. They used the in vivo method in their study. Their patch seemed effective on the mice and it could serve as therapeutic use for patients with obesity. In their study, the researchers found an increase in the following factors: energy, oxidation, and body weight control (Zhang et al., 2017, p. E).

Zhang et al., ACS Nano

The research team designed a skin patch with 121 cone-shaped polymer needles that can be filled with a drug encapsulated by nanoparticles. The tiny needles penetrate the skin and the ends collapse. The nanoparticles then slowly release the browning drug into the fat cells. By delivering the drug directly to fat cells, the drug’s side effects in other parts of the body might be prevented or minimized.

The researchers tested the skin patch, which was a little larger than a pencil eraser, on the abdominal fat pads of three groups of normal mice. The first group received a skin patch without any drug; the second group received a patch containing rosiglitazone (a diabetes drug that’s also known as Rosi or by its trade name Avandia); and the third group received a patch containing a compound called CL 316243. In mice treated with either drug, the white fat cells shrunk and beige fat cells appeared. A genetic analysis and other tests confirmed that both drugs induced fat browning and improved metabolism in the mice.

The research team then treated obese mice with skin patches for 4 weeks. The drugs increased browning, as evidenced by smaller fat cells and increased expression of brown fat cell genes. They also reduced the size of the fat pad and improved metabolic signs.

It's possible, even likely, that patches may eventually replace surgical and non-surgical means of losing fat in the love handles? For now, patients would still need to undergo either a surgical or non-surgical procedure.

How poor systems are killing your clinics long term growth, profitability and value.

Stop micro-managing. Stop flailing. Stop losing patients. And stop losing revenue.

A few days ago, I sent a survey to 472 physicians asking about efficiency and productivity in their clinic or practice. Perhaps you're not surprised by some of the results. You might even recognize your own clinic here.

• Over 9/10 of physicians said that their clinic operated at less than 80% efficiency, and 4 out of 10 said that their clinic efficiency was below 60%!
• Physicians reported this "productivity gap" costs their clinic between $5k and $40k in lost revenue every month.
• When I asked them what doesn't work, the most common responses: "lack of systems" (44%), "wasted time and effort" (50%), and "micro-management" (40%).

There is a better way that can pull you out of the micro-managing, hair-on-fire, unproductive daily grind and put you in a position where you're working ON your business, not IN your business. Take a look at the Ultimate Clinic Operations Blueprint.

The Simple Secret To Getting Awesome Patient Reviews.

Review marketing is the easy way to get your patients to market your clinic for you.

One of the challenges that every medspa or cosmetic clinic has is in trying to get patients to share their thoughts about your practice to their friends. Yep. Word of mouth.

Fortunately, a number of the barriers getting in the way of that have been overcome by software, and others are simply a matter of implementing the right systems.

To start with, you're going to need to get comfortable with the simple practice of asking for a review. Yeah, that's essentially the simple secret; ask. But you have to do it the right way. A recent survey found that 7 out of 10 patients said they would be willing to leave a review if asked. If it's that easy, why do we fail so badly to secure our patients help.

For most people, it comes down to the idea that it's potentially placing a burden on the patient by asking for a favor, or, that if they say no it will be embarrassing in some way. But both of those thoughts are wrongheaded.

When most people, including our patients, are asked for a "favor" they don't see it as a burden. Their perception when you ask them is that you value them and the relationship. Think about it. When someone asks you for a favor your reaction, especially if it's small, is to say yes. Additionally, the mere act of asking can strengthen the perception of the relationship and improve the patient's perception of their relationship with you.

Benjamin Franklin was a master of this.

Throughout his life Ben Franklin built a deep network of friends. However, not everyone was a fan. In his autobiography, Franklin mentions a man who vehemently opposed his candidacy for Clerk of the General Assembly of the Pennsylvania House. No matter how much ‘servile respect’ (a.k.a., kindness in today’s terms) that Franklin showed, this individual’s opinions on Franklin could not be changed. Interestingly, Franklin tried the exact opposite method, and it worked:

Having heard that he had in his library a certain very scarce and curious book, I wrote a note to him expressing my desire of perusing that book and requesting he would do me the favour of lending it to me for a few days.

“He sent it immediately – and I returned it in about a week with another note expressing strongly my sense of the favour. When we next met in the House, he spoke to me (which he had never done before), and with great civility. And he ever afterward manifested a readiness to serve me on all occasions, so that we became great friends, and our friendship continued to his death.

”This is another instance of the truth of an old maxim I had learned, which says, ‘He that has once done you a kindness will be more ready to do you another than he whom you yourself have obliged.’”

It's a simple emotional reflex. When you do a favor for someone you become tied to their success and happiness in asmall but important way. The act of helping them just a little makes you want to help them more.

One of the hardest parts of asking for a review is not only knowing when, but how to ask for a review.

When is the best time to ask for a patient review?

Many clinics will post something on their Facebook page or just ask in an email. 

Completely useless. You may get an occasional thumbs-up on a facebook post but it does almost nothing to benefit you or your clinic.

The perfect time to get a glowing review of your clinic is just at check out, when the patient is interacting with the front desk and they're inside your clinic. It's the point in time when they're focused on the outcome, or, if it was a consultation, are looking forward to it. It's also the point where you have maximum control of both the way that you ask and what you're asking for.

The best success rate and reviews are generated using a simple system at check out that uses text messaging that you send directly to the phone in their hand.

Here's how it works.

After the treatment or consultation the clinician or technician mentions that the patient will be asked during check out if they would be willing to leave a review. It's explained that patient reviews are incredibly important to the clinic and that they're taken seriously. If the patient would be willing to leave a review, the clinician or technician will take that as a favor.

Then, during check out, the front desk asks if they can text the patient a review request. They can simply click the link, select a 'star rating' and leave a few thoughts. It happens right now, in the clinic, and will take less than 60 seconds.

Patients say yes because it's immediate, it's fast, and it's simple. 

You'll never have success just asking patients to go log in to their online social media accounts and say wonderful things about you. That doesn't work. 

The patients that are willing to go do that are the one's that are not saying nice things about you. They're the handful of patients that are angry. Those patients are really motivated.

So, in looking at how this should work we brought on Podium as a Select Partner and they've agreed to give Medical Spa MD Members both special pricing for their software, and special training for your staff on how to manage your patient review marketing.

Take just a second and see how Podium can help you drive new patients and protect your reputation.

And, if you're smart, you'll try out Podium's special offer for Members. It's a month-to-month service so there's no risk, and when you do it right (note the training you'll have access to) it's a no-brainer.

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A special offer for Medical Spa MD Members from Podium.

Non-Surgical Nipple Reconstruction or Correction Using Dermal Fillers

Using filler injections to treat the areola nipple complex (NAC) after surgery.

Most hyaluronic acid filler studies focused on dermal fillers are about injection techniques and areas of injection in the face, and sometimes the hands, but hyaluronic acid fillers’ other function can also be used in reconstruction. There are only a few cases in using dermal fillers to correct or reconstruct any physical surgical complications.

One case of using dermal fillers was to reconstruct the nipple areola complex, which for some patients, they lose the Nipple Areola Complex (NAC) projection after surgery (Belman et al., 2017).  The article’s case focused on a 49-year-old woman who has undergone a mastectomy, and the researchers observe that sometimes after surgery the NAC suffers from atrophy. As such, the physicians of the study sought to correct the surgery using dermal fillers. A bilateral injection was made on each nipple, and the procedure was a success adding projection after injection.

Key Findings:

• Increase of 1.5-1.6mm on both breasts
• Nipple projection for both breasts are 3.3mm after injection

A similar study was conducted back in 2010 where the researchers used Artecoll to augment the nipple (McCarthy, 2010). It also focused on creating better nipple projection. Twenty-three patients underwent the procedure in the study, and with the use of Artecoll, the mean post-injection was higher than pre-injection.

There was a case wherein a patient had multiple cleft lip and palate surgeries (Stolic et al., 2015). The injection was carried out after biphasic therapy. The researchers mentioned the importance of injection technique when correcting the surgical complications.

Another case involved injectables to reconstruct soft tissue on the ear. In that case, the study’s investigators used Macrolane. The study’s investigators conducted multiple injection sessions to expand the ear needing reconstruction and expansion. There were no reported complications after the treatment sessions.

Despite the studies’ outcomes, adverse effects may arise with the patient, and it could be necessary to follow-up with the patient after a few weeks or months. Bottomline is, dermal fillers help patients give a natural look, if the physician knows what they’re doing. It is important to know injection techniques as well to avoid any complications.