Dr. Brian Howard runs his solo-practice in Roswell, just outside of Atlanta, Georgia.

Dr. Brian Howard is boarded in both plastic surgery and otolaryngology. In this interview we got together to find out what he thinks of his practice, cosmetic technologies and staff compensation.

Name: Brian Howard, MD, FACS
Location: Roswell, GA
Website: drbrianhoward.com

That's interesting: Dr. Howard is a recipient of the Outstanding Research Award given by the American Academy of Facial Plastic and Reconstructive Surgery and was recognized by the Consumer Research Council of America as a Top Physician.

You started out to be an ENT surgeon. Why did you make the switch to plastic surgery?

Life as a surgeon began for me in my first residency in Ear, Nose, and Throat Surgery at the University of Texas-Southwestern in Dallas, TX. My initial plans were to specialize in Head and Neck cancer. It became clear during the course of my ENT training that what I enjoyed the most were the cosmetic and reconstructive surgeries that are performed by typical Otolaryngologists. After some serious soul searching, I decided to pursue a full residency training in plastic and reconstructive surgery. Though this prolonged my lengthy education even further, it was a wise decision as I continue to enjoy the daily challenges in the variety of surgical cases I perform. Early in my private practice career, I focused heavily on reconstructive surgeries. As I gained experience and my reputation and referral patterns matured, my practice slowly morphed into a primarily cosmetic practice.

You have a solo practice. How have you organized it?

Yep. I have a solo private practice in Roswell, GA, which is just north of Atlanta. As a solo practice, I go to great lengths to maintain a boutique experience for my patients and my staff. While this means that at times there can be a small wait to get into my office for a consultation, we do our best to accommodate patients and make their experience a very positive one from the get-go. My office is run with tight coordination between my Practice Manager and me. I have a back-office position that helps a great deal with all procedures and patient management, a receptionist who also helps with patient scheduling and as an assistant to my Practice Manager, and an Esthetician. My staff works with great precision and care, and always has the patient as their main concern and focus. We work extremely well as a team, which is a rarity in any field. My average patient is female, in the age range of 22-60, although I also have a large male population.

We offer a full smorgasbord of cosmetic procedures for our patients, both surgical and non-surgical. A large part of my practice stems from a huge demand for SmartLipo liposuction. I also remain active in skin cancer reconstruction.

Can you give us some insight on how you hire your staff? Are you using commissions?

Hiring the right staff is as much luck as it is a science! I spend a great deal of time and effort with every hire, and yet have not always wound up with high quality personnel in the past, regardless of the pay scale or benefits offered. At the end of the day, you have to go with your gut feeling, make sure you do your due diligence in making the hire, and spend the appropriate amount of time training the staff. Establishing good lines of rapport and communication are crucial to a tight team operation. My current team is the best I have ever had. I have not found commission to be an overly useful or positive aspect of staff performance and have stopped using it completely. I find that fair pay, respectful treatment, and good office synergy coaxes the best performance out of my employees and creates a healthy and energetic environment for everyone. Patients are quick to notice this and it makes them all the more comfortable in becoming and/or remaining a loyal patient.

What IPL or cosmetic laser technologies are you using? Are you looking at anything in this area?

I have never been a big “gadget guy,” and have gone out of my way to avoid buying every new cosmetic toy as it is released. Having said that, I have made a couple of purchases to fill void in the services I have to offer my patient population. SmartLipo liposuction has been my biggest revenue driver for the past four years straight, and the demand remains high. Our backlog for SmartLipo speaks for itself.

I also have a Fraxel laser for various skin condition treatments. Nearly every day my office received a call or a drop-by visit by a rep detailing the newest, greatest thing. Experienced plastic surgeons know that Shangri-La technologies are diamonds in the rough and rarely bite into these sales pitches. I wait for experience and science to support or dismiss any new technology before considering jumping on the bandwagon. I won’t allow my office to become the land of misfit toys of useless devices.

As a whole, SmartLipo has been in the most demand and has kept us extremely busy since I purchased the machine in 2008. The demand is dizzying at times. Luckily, it is also the most profitable procedure I do. I also have a large patient population wanting non-surgical rhinoplasty, which has a nice margin as well.

Where do you spend money on advertising?

I have slowly eliminated nearly every form of advertising in my practice over the years. I am fortunate to now have a strong word-of-mouth and colleague referral base that provides me enough business to remain busy. Certainly, this took time to establish and become confident with. But now we have a web site that we actively maintain with our SEO provider. We also have a presence on Facebook and Twitter.

How do your patients express their gratitude and appreciation?

The best memories in a cosmetic practice are simply when patients do or say unexpectedly nice things to either my staff for me. Seeing a good result in a patient I operated on is certainly satisfying (very satisfying!) and something I attempt to achieve a 100% success rate. But once in a while a patient will go way out of their way to make sure you know how pleased and thankful they are. These are the things that turn a good day into a great day. We receive written testimonials nearly every day from our patients and try to post some of these on our website for prospective patients to read.

In your years of practice, what's the most valuable thing that you have learned?

When I stop to think about it, all of the pearls and wisdom I have received from my years in private practice are simply extensions of things learned from my wonderful faculty during my residency training years. I think we all pass down these bits of wisdom and adapt them to our own practice. I won’t be so narcissistic so as not to give due thanks and recognition to the surgeons who taught me during my residency training years.

What's the best advice you got as a physician?

“Never let them see you sweat.” You can’t afford to panic and lose control when you are in the driver’s seat of running your own surgery practice.

What's the worst decision you've ever made when you started out?

Purchasing a device instead of leasing the piece of technology. I did this with my first big office purchase. Although the device has turned out to be a wonderful extension of my practice, the technology changes so rapidly that I would urge any younger plastic surgeon to strongly consider a lease instead of buying the equipment outright.

About: Dr. Howard started his six-year residency in Otolaryngology-Head and Neck Surgery in Dallas, Texas. and continued to full residency in Plastic and Reconstructive Surgery. He has certification in both plastic surgery and otolaryngology. and has been an active member of ASPS, ASAPS, FACS. He was the past Chairman of Surgery North Fulton Regional Hospital and past Chief of Plastic Surgery Division North Fulton Regional Hospital

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.