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!

Medical Spa MD: Average 2011 Physician Income By Specialty

Average physician incomes by specialties for 2011

The Medical Spa Physician Report: Learn From Experienced Operators

The Medical Spa Physician Report is critical information compiled from the answers of experienced doctors in cosmetic medicine.

Each Medical Spa Physician Report includes a survey of cosmetic clinics around the worlds physician interviews and case studies. We reach out to not only our member base, but also other prominent doctors in cosmetic medicine to find out what doctors are really thinking about technology, marketing, staffing and clinic operations.

And this is an experienced group.

Look at this graph from the last Physician Report and you'll see that 58% of physicians indicating that they've been practicing full time cosmetic medicine for 6 years or more.

You can always find the latest Medical Spa Report (as wells as previous issues) free to download in the Medical Spa MD Free Deals for Members... and if you're not a Member yet, you can join the thousand of other physician members and access all of the free deals right now.

Arturo Muñoz Meza MD, A Plastic Surgeon In Tijuana

A short visit with Dr. Arturo Muñoz Meza, a Guatemallan plastic surgeon practicing in Tijuana, Mexico.

Name: Dr. Arturo Muñoz Meza
Location: Tijuana, Mexico
Website: haimastemcelltherapy.com/
Facebook: Dr. Munoz

That’s Interesting: Dr. Munoz is a plastic surgeon at HAIMA Stem Cell Therapy Clinic which is located in Tijuana’s financial district; just 5 minutes from the international border of San Diego, CA.

Yes. In Mexico Stem Cell Treatment is currently being practiced at a clinical level; it is mandatory to have a license from the Health Department COFEPRIS (FDA in Mexico) This license allows the use of stem cell types beyond those approved in some western countries such as the United States, and some parts of Europe

Several years of education and training is involved to become a leader on the field. Can you share on how you started your career?

I was trained as a general surgeon in the Social Security General Trauma Center in Guatemala during the civil war. There was a large demand for medical services that time. That was the beginning of the acquisition of my expertise in the surgical arena. When I went to Mexico to complete my plastic surgery training, I was asked to stay and teach in the Resident Program by my mentor, Dr. Jose Guerrerosantos who is an all time recognized master in modern plastic surgery.

I was chosen by Dr. Guerrerosantos as his own Post-graduate fellow in Aesthetic and Cosmetic Surgery. This was considered to be a privilege in the Guadalajara University’s “Instituto De Cirugia Plastica y Reconstructiva de Jalisco”—an honor to be the master’s right hand.

Consequentially, I was exposed to the best plastic surgeons around the world, most of them are esteemed members of the American Society of Plastic and Reconstructive Surgery and the American Society of Aesthetic Plastic Surgery.

Why did you choose to specialize in aesthetic cosmetic surgery?

From what I remember during my younger years in school, I had exceptional A+ grades in Arts-drawing, sculpture and music. From then on, I felt that I needed to fulfill something in my life. When I started medical school, I wanted to be a Gynecologist so that I can advocate women’s health. But then, things changed when I was in my fourth year of General Surgery training. During a rotation in the Emergency Room, a patient came in with a chief complaint of cardiac arrest due to a gunshot wound. There were no vital signs so I had to proceed with a direct cardiac massage. In two minutes, we were in the Operating Room and I have successfully completed the anterior thoracotomy to access the pericardium and I found the right ventricle’s rupture and it took me seconds to set the suture. To cut the story short, my patient survived this!

The following day, I was asked by the Department Chief to report in his office. I admit that I was scared by the tone of his voice. The patient I treated wasn’t an ordinary citizen—he is an authority of the Police Department. I was a hero to my mates. After that, I was chosen as a candidate for the Cardiovascular Surgery Program.

I saw my patient again after 30 days for the revision of his scar. He brought me a thank you gift. I felt blessed. Before he left, he asked me a question:

“Can you please tell me why you left an ugly mark on my chest? Didn’t you promise that this will be removed?”

We just both laughed. I concluded my residency program with that in mind.

For some people, to live and be good looking is the same.

That’s where I began to look into plastic surgery. It is truly an art of giving the human body anatomical modifications to restore and rehabilitate until it is aesthetically pleasing.

Your practice is located inside HAIMA Stem Cell Therapy Clinic which is located just over the US border in Tijuana, literally five minutes from San Diego. Can you tell us more?

Several of us are business partners. We have a CEO who manages administrative issues and we have 80 attending doctors whose specialty range from Orthopedics to Neurosurgery.

Because of the geographical situation of Tijuana City, we are the first alternative choice of the American population in California as medical providers because of the cost and quality of our services. Before the crisis, this city was considered to be “Tiny Houston City” for medical services.

In my office, we have 3 nurses, 2 front desk assistants and 3 patient coordinators to run the consultation services. Before hiring them full time, we check their performance with a trial period to make sure that the're a fit.

I have a high compromise with my personal quality standards and try to radiate a persona that I’ve learned during the Guatemallan Civil War. It is something that the “Kaibiles”, the elite forces of the army, shout: “The possible is already done, the impossible is going to happen now.” It reminds me to do the best I can even without the latest ideal technological support and resources.

We give bonus's to our staff depending on the number of referrals that come in and the number of patients that decide to undergo surgery. For example, if we have 1-5 patients, they will have 5% of the total cost of services and treatments done. If we have 5-10 patients, they get 10% and if we have more than 10 patients, they get 15% per week.

Extra bonuses are given to our staff when we hear good comments from patients. They also get discounts on their own plastic or cosmetic surgery.

What IPL or laser technologies are you using?

I have SmartLipo which is a Nd Pulse Yag Laser, 1064nm WL,18W. It is expensive but this one’s a very useful state of the art tool for liposuction. We use this on selected body areas with limited adipose tissue like on the neck and waist. We also use this for axillary hyperhidrosis, lipomas and pseudogynecomastia. We also have Vaser for patients who have previously undergone more than 2 liposuction procedures. We have used the Microair machine in the past but it takes twice as much time in the Operating Room. Results are basically the same (or none at all) and patients reportedly had swelling, pain and numbness after the procedure.

You clinic is unusual in that it's inside a much larger clinic. How is it marketed?

Thankfully, word of mouth has been the most valuable resource for us. We always educate our patients with the procedures. I will never compromise quality over quantity. I take a number of patients I know I can handle daily. If I am saturated, I refer my patients to my colleagues. As much as possible, we try to be organized for our patient’s satisfaction.

We used to advertise in the Yellow Pages but that didn't pay off.

Personally I feel that my work is good enough to compete with the best. Patients feel that my services are also affordable when they evaluate the whole surgical experience.

The hospital has it’s own marketing program and we have commitments and policies in taking part to make it successful.

What is the most popular and profitable treatment in your clinic?

Sometimes, before we sleep,  I jokingly tell my wife “I am going to pray that everyday is “Lipo Day” because this particular procedure is in demand and very good in terms of outcomes. Basically, expenses are based in the O.R. charges and hospital rooms. Rhinoplasty is also perfect. We just need Lidocaine with Epinephrine, a couple of sutures, saline solution, nasal packs, antiseptics, micropore and external ferula.

We have good quality equipment and replace 1 or 2 pieces every year when we attend symposiums, congresses or meetings.

I left hair transplantation because it takes a considerable time of consultation and it requires me to train and supervise technicians as well. Honestly I don’t love this procedure enough to give this a substantial time in my practice.

I am a member of the Board of Specialists in Stem Cell Therapy. I am excited to offer this soon in our office.

What are the lessons you learned as a plastic surgeon? Can you share memorable moments?

Plastic surgery has given me a lot of experiences whether it be challenging, interesting or successful. But above all, the most fulfilling experience is observing the patient’s reaction when they look at the mirror for the first time to see the result.

On May 1997, I attended the ASAPS meeting in New York. I had the honor to meet many of my favorite authors like Jack H. Sheen and George C. Peck and took the courses with them. It felt great when I went back to Guadalajara and performed a reduction and balance rhinoplasty on Karla, an 18 year old who asked for rhinoplasty because she had a problem known as nose kyphosis. This is my most unforgettable experience, as this was my first rhinoplasty. 

After 4 weeks, I finally removed the patch and told her that it’s done. For me, the result was okay, a little swollen than normal. But I didn’t know what she was thinking and so I instructed her to look at the mirror on the next room to check her self. I couldn’t see her for a while and then suddenly I heard her crying. Jesus Christ!! I’m dead! I waited patiently for her to come back.

She looked at me and exclaimed “This is beautiful! All I can say is thank you!”.

For me, that is truly a gratifying experience.

What advice would you give to other physicians?

I think the best advice I can give to everyone in the cosmetic industry is to never perform anything that you are not trained for. If you are not qualified and naturally skillful, you are not the best option available for the patient. What people expect from plastic, aesthetic and cosmetic surgeons are natural, longlasting results and safe procedures. There is no one surgeon who is good at every procedure. He doesn’t exist. In time, he may develop his specialty. The procedure you do often which have exceptional results are highly recommended to your patients. Always do your best when performing a procedure because patients want to achieve perfection.

Avoid disasters in the cosmetic industry by eliminating greedy thoughts. As for myself, I don’t feel good with calf or gluteal implants, neither with hair transplantation. I am knowledgeable of those procedures but I am not passionate of these. When a patient asks for those, I usually refer them to an expert in order to eliminate the potential risks and fake unnatural results. I want to be honest to the patient. In this way, we can increase our credibility and gain the public’s confidence.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers around the world. If you'd like to be interviewed, just contact us.

Richard D. Gentile, MD MBA, A Plastic Surgeon In Ohio

Our interview with Dr. Richard Gentile of Gentile Facial Plastic & Aesthetic Laser Center with three locations in Ohio.

Name:  Richard D. Gentile, M.D., M.B.A.
Location: Youngstown, Akron, and Cleveland, OH
Website: www.facialplastics.org

That’s interesting: Dr. Gentile is deemed as one of America’s Top Facial Plastic Surgeons by the Consumer’s Research Council of America. 

Profile: Graduate of Ohio State University, The University of Cincinnati College of Medicine and Baylor College of Medicine Residency Program. International lecturer and author of many publications including the 2011 Textbook “Neck Rejuvenation” published by Thieme. Dr. Gentile is a past member of the Executive Committee of the American Academy of Facial Plastic & Reconstructive Surgery and served as its Treasurer from 2004-2007.

How did you realize you were meant to practice cosmetic medicine?

As an undergraduate student I had the privilege of spending a week externship with a Plastic Surgeon in Columbus Ohio. It was really my first exposure to medicine and I was significantly influenced by the mentoring that occurred. During medical school I was equally influenced by head and neck cancer procedures and elected to pursue postgraduate residency studies encompassing both cosmetic head and neck and reconstructive surgery.

With three different locations in Ohio you must be busy. Can you describe how your clinics operate and how you staff them?

The Facial Plastic & Aesthetic Laser Center is a fully integrated aesthetic practice with a free standing state licensed and nationally accredited surgery center adjacent to it. There are satellite offices in Akron and Cleveland Ohio where consultation and minor surgery is offered. We are privileged to see patients from all regions of Ohio, Western New York, Western Pennsylvania and West Virginia. We also see patients from other states and foreign countries as well. A full service medical spa is located in the Boardman office and one of the largest private laser clinics with 20 different aesthetic lasers.

Our main office is not located in a large metropolitan area so staffing is sometimes a challenge. (Larger metro areas feature more cosmetic practices training staff who then have experience in medical spas or pastic surgery centers when they interview for new positions.)

Unless someone moves into our area we usually do not have the opportunity to hire experienced personnel so we have to train them on site. Another disadvantage is the smaller surgery centers need per diem or part time staffing patterns unless they operate five days a week and frequently it is difficult to find personnel who are interested in more limited schedules. Understanding these special needs allows us to zero in on those candidates who are interested in the employment opportunities we offer. We have several aestheticians, a cosmetic surgery coordinator who also assists our marketing efforts, two RN’s one exclusively dedicated to the surgery center and anesthesia staff who are retained from a national staffing firm. Our front office has a billing director and a receptionist.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

We have two Lumenis One platforms one in Boardman and one in Cleveland. They are equipped with IPL, Light Sheer laser hair removal diode laser and Nd:Yag. We also utilize three fractional lasers the Lumenis Ultra Pulse with deep FX , the Cynosure SmartSkin laser, and the Sciton Contour with ProFractional capabilities. We also utilize radiofreqency units for skin tightening with LumenisAluma and Pelleve. We frequently combine these modalities in multi-modality laser skin rejuvenation. The Cynosure Med Lite is one of our most frequently utilized lasers and is used for Tatoo removal, non ablative skin rejuvenation and dermal toning. A 532 nm diode laser is used for non-ablative treatment of vascular and pigmented lesions. Laser Lipolyis is a big part of our practice particularly in the head and neck and we developed many of the facial surgery protocols for laser assisted facelifting procedures or Smartlifting™ procedures.

Have your marketing efforts successfully increased the volume of patients coming in your clinic?

We use or have used virtually all media to market our practice and find particular success with internet based, social media, and seminars to educate the public about the procedures we offer. Being features on the websites of our technology partners also helps to let patients know about the services we offer.

Our favorite referral are those that come from a satisfied and happy patient sending their friends and family members to us and those make up about 50% of our new patients.

Are there particular treatments that have increased your profits dramatically?

Our services are divided about 50-50 between surgical services and the other office based non surgical services including neurotoxins (Botox), dermal fillers and laser procedures. Among our surgical procedures 90% are facial plastic & reconstructive in nature but primarily cosmetic and not as much reconstructive surgery as previously.

A small percentage of our practice revenue comes from skin care products and related sales.

What lessons have you learned in your practice that you can pass on to those who have just started their medical spa?

Listen to your patients. I think it is important that they are not always in your office so that you can give them the result you think they should have. They are there to hear about how you can best help them achieve the result they are interested in. The closer you come to achieving their goals the more satisfied and happy they will be. Learn from the unhappy patients so that it can help you to either modify your approach or better select patients so as to not try to please the difficult to please patients.

It has been a great privilege to practice Facial Plastic & Reconstructive surgery for nearly 25 years and the greatest development from early practice to later practice is the accumulation of wisdom from the early years of practice. When first starting in practice you sometimes carefully walk into the exam rooms of post op patients not quite sure what the result is going to be like or whether there will be complications. 25 years later you pretty much know what to expect and the kinds of results that will be achieved. We are always innovating and trying to add modifications to our techniques that will enhance our patients post- operative results. So while we are getting closer all the time our practice continually strives to obtain the best surgical and non surgical results available anywhere.

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.

Opportunity In Surgitels & Medical Travel?

By Arlen D. Meyers MD

Building a chain of Surgitels

Jackie G, a 23 y/o investment banker and avid tennis player, has arrived at the Meyers Palo Alto Surgitel following her arthroscopic shoulder surgery in a facility across the street from the hotel. Jackie lives in Denver, but came to Palo Alto because of the reputation of her surgeon, Dr. Meyers, who charged a lot less than her Denver based orthopedist. MedVoy has recommended she spend the first postoperative night at  the Meyers Surgitel Suite because of its reputation for catering to patients needing accommodations following discharge from a medical facility or needing a place to stay while getting outpatient treatment. Jackie is accompanied by her girl-friend, Sara, who will be watching over her.

Fortunately, everything went smoothly with Jackie’s operation and she was discharged from the Palo Alto Surgicenter at about 3Pm that afternoon. A hotel van takes Jackie and Sara from the Surgicenter to the Meyers Surgitel. They arrive via a private entrance with a wheelchair ramp and are met by a hotel greeter who wheels Jackie in her wheelchair to her room. Jackie and Sara have been preregistered. The room is on the ground floor with spectacular, soothing views , just right for a patient who needs rest and relaxation. The room looks like no room she has stayed in before…part hospital, part hotel. All the surfaces are antibacterial and the bedroom and bathroom have guard rails, walk-in tub and antibacterial soap to clean her wounds. The sink in the bathroom has fixtures that allow her to turn on the water with her elbows, an advantage for someone who arm is in a sling. Her friend, Sara, is staying next door and can enter through a common door. There is a small kitchen so Sara can make Jackie a bowl of oatmeal for breakfast.  The room service menu accommodates her special post op needs as does part of the menu in the hotel restaurant. An inconspicuous storage locker has medical supplies and wound dressings for medical professionals who might come to the room to visit her before she leaves for home. Her postoperative pain medicine has been delivered to her room, thanks to an arrangement made with a local pharmacy chain. She attaches her cooling shoulder apparatus.  A computer monitor allows her to communicate with her doctor and the doctor’s staff as well as her children back home. It also asks her to review a video of postop instructions before she leaves and confirms that she has done so.

During the night, Jackie is awakened with pain in her shoulder. She calls the medical concierge who has the contact information for the orthopedist taking call for Dr. Meyers. Within minutes, she gets a call and is reassured that this is a normal event following her surgery. Soothed by the presence of her Shetland sheepdog, Charlotte, sleeping next to her, she has an uneventful night.

After breakfast on the deck of her room, Jackie and Sara check out online, the bellhop takes their bags and they leave through a private exit to a waiting vehicle that will take both Sara and Jackie to her surgeon for a postop check (if she can’t come to her room) and then to a relaxing three day recuperation at a local spa arranged by MedVoy as part of her medical travel experience. They even allow pets. Much to her surprise, a few months after returning home, Jackie receives a check from her health insurance company as a reward for helping them keep down medical costs. Jackie bought a new tennis racket.

About: Arlen D. Meyers is a founder of Medvoy and blogs regularly at Freelance MD

Submit a guest post and be heard.

Cosmetic Surgeons enlist patients to fight the Botox Botax.

Cosmetic surgeons are asking for patient help to fight the Botox Botax. Here's what the ASDS (American Society for Dermatologic Surgery) is giving it's members to solicit the support of Botox consumers: Here's the form.

The U.S. Senate health care reform bill  (Patient Protection and Affordable Care Act) contains a proposed 5 percent tax on "elective cosmetic medical procedures."  While this may look like an attractive option to Senators looking for ways to pay for health care reform, we know that:

• Cosmetic medical procedures taxes are an unreliable and risky revenue source, which has proved to be a failure at the state level;
• A tax on cosmetic surgery discriminates against working women;
• The definition of cosmetic procedures is arbitrary and almost impossible to administer; and
• enforcement would necessitate review of patient medical records by tax collectors, a clear invasion of privacy.

Please enter your zip code below to be connected to an automatic email system which allows you to send a quick message to your Senator asking him/her to vote against this tax.

I've received an number of emails about this over the last 48 hours. Is anyone worried that this 'Botax' will hurt your medical spa, skin clinic or cosmetic practice?

Medical Spa MD: Burned out & depressed plastic surgeons more likely to commit medical errors?

Surgeons who are burned out or depressed are more likely to say they had recently committed a major error on the job, according to the largest study to date on physician burnout.

The new findings suggest that the mental well-being of the plastic surgeon is associated with a higher rate of self-reported medical errors, something that may undermine patient safety more than the fatigue that is often blamed for many of the medical mistakes.

Although surgeons do not appear more likely to make mistakes than physicians in other disciplines, surgery errors may have more severe consequences for patients due to the interventional nature of the work. Some estimate that as many as 10 percent of hospitalized patients are impacted by medical errors.

"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Charles M. Balch, M.D., a professor of surgery at the Johns Hopkins University School of Medicine and one of the study's leaders. "All of us need to take this into account to a greater degree than in the past. Frankly, burnout and depression hadn't been on everybody's radar screen."

Nine percent of the 7,905 surgeons who responded to a June 2008 survey commissioned by the American College of Surgeons for a study led by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic reported having made a major medical mistake in the previous three months. Overall, 40 percent of the surgeons who responded to the survey said they were burned out.

Researchers asked a variety of questions, including queries that rated three elements of burnout -- emotional exhaustion, depersonalization and personal accomplishment -- and others that screened for depression.

Each one-point increase on a scale that measured depersonalization -- a feeling of withdrawal or of treating patients as objects rather than as human beings -- was associated with an 11 percent increase in the likelihood of reporting an error. Each one-point increase on a scale measuring emotional exhaustion was associated with a 5 percent increase.

Mistakes also varied by specialty.  

Surgeons practicing obstetrics/gynecology and plastic surgery were much less likely to report errors than general surgeons.

Researchers acknowledged the limitations of self-reporting surveys, saying they couldn't tell from their research whether burnout and depression led to more medical errors or whether medical errors triggered burnout and depression among the surgeons who made the mistakes.

The results are being published online on November 23 in the Annals of Surgery and will be published in the printed journal in an upcoming issue.

Notably, the research shows that the number of nights on call per week and the number of hours worked were not associated with reported errors after controlling for other factors.

"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," says Julie A. Freischlag, M.D., chair of the Department of Surgery at the Johns Hopkins University School of Medicine and another of the study's authors.

via sciencedaily.com

Perhaps the most relevant items here are the decreased reporting of problems by plastic surgeons and the fact that 'depersonalization' has entered the discussion.

I'm really curious about what plastic surgeons think of this study.