Alison Werner (00:10)
Hello and welcome to the Plastic Surgery Practice Podcast. I’m your host, Alison Werner. We’re going to be doing a special multi-part series with medical aesthetics industry consultant, Terry Ross, to discuss the opportunities, challenges, and growth pathways in the medical aesthetics industry. Over the next several episodes, we’ll explore practical insights and actionable strategies that can help practices thrive in today’s dynamic and competitive market. In this first episode, we set the stage by examining the current state of the industry and discussing some of the key obstacles

practices face from market shifts to business training gaps.

Terri is a globally recognized practice management expert and CEO of Terri Ross Consulting. With nearly two decades of experience, she specializes in helping medical aesthetic practices achieve sustainable growth through strategic business development, team training, and data-driven solutions, empowering providers to maximize efficiency, profitability, and patient outcomes.

In this episode, we’re going to talk about how practices can identify their growth opportunities, the importance of business fundamentals, and why training for both doctors and their teams is crucial for unlocking potential. Whether you’re a provider, practice manager, or team member, this series is designed to give you the tools and knowledge to move your practice forward. So let’s jump right in and see what insights Terry has to share.

Alison Werner (01:27)
Terri, thank you for joining me today. It’s really great to see you again.

Terri Ross (01:28)
Yeah. You are so welcome. Lovely to be here, Allison. Thank you so much for having me.

Alison Werner (01:34)
Well, as I said in my introduction, we’re going to set the scene and talk about the state of the medical aesthetics industry. So what are you seeing with your clients?

Terri Ross (01:44)
Yeah, such a great question. And obviously, with an election year, I think the industry is struggling. I think the industry as a whole, not I think, I know, the industry as a whole is down around 17%. But there is a lot of tremendous growth opportunities. I think that the biggest challenge practices face right now is there is a lot of private equity coming in and roll up in consolidation. I think there’s also a lot of struggle with practices understanding

Alison Werner (02:01)
Mm

Terri Ross (02:14)
where their growth opportunities are. And that’s simply because of a lack of training or a lack of understanding the knowledge of what the benchmarks need or should be.

Alison Werner (02:24)
Okay, so you mentioned there that, you know, those are some of the things contributing to this decline. What about, what are doctors doing that is preventing them from turning around and finding a way forward with growth?

Terri Ross (02:44)
It’s such a loaded question. Yeah, I mean, I think it’s very easy for, you know, physicians, medical providers as a whole in the aesthetic space to just, you know, show up for work, do surgery, treat patients. And a lot of what I teach all over the world and at every society is that this this still is a business, right? There’s a business of plastic surgery, and we have to treat it as such and give it the same level of

credence that we do our clinical experience and giving patients this journey and results. That’s only one piece of it. If we want a sustainable, profitable practice, we don’t have a choice but to say, maybe perhaps the same way someone’s been doing it isn’t good enough anymore. And I will have to say that from all my experience in almost 20 years in the space and lecturing all over the world and

what I do for a living is really help practices identify those areas of opportunity. And a lot of it comes down to, again, not understanding gross profit of procedures, not understanding efficiencies of time, not understanding the right compensation models, not understanding how to build a treatment plan that can combine both surgical and non -surgical, which ultimately

That is the quickest way to get better patient outcomes and increase revenue. But all of that comes down to a fundamental problem and one problem only, and it’s a training issue.

Alison Werner (04:21)
Okay, so talk to me some more about the training. What do you think is missing?

Terri Ross (04:31)
The industry, the industry lacks fundamental business training. And, and I think, you know, Dr. Renato Sulz is a key opinion leader, plastic surgeon in Park City, past president of many societies. Myself, Dr. Sulz and Isaac Musely, my co -CEO, my ex co -CEO and business partner with Apex, started our own business conference called the 4S Summit.

And we started it in 2023 to fill the gap. While people can go to all these ASAPs and ASAPs and everywhere, there is a practice management track, but it’s 15, 20 minutes of talks and not enough for someone to actually go back with a blueprint of what to do and how to educate. So that’s the problem. We’re in these roles and no one’s held to KPIs.

No one’s holding anybody accountable. No one’s inspecting what they expect. And then the ones that are, you know, how do we coach to change? Because at the end of the day, is just, it’s change behavior. Change management is what we have to do if we want something different.

Alison Werner (05:38)
Okay, so this might be a lot, but what are some tips for just getting started with that? Like you mentioned, you have the summit, which is a great educational opportunity. But for a practice that’s just sitting down, maybe what’s the best way to assess? What do I need to do to change the culture within my practice?

Terri Ross (06:00)
Yeah, I love it. Thank you. Such a great question. I mean, look, this is maybe a little self -serving, but I think that if, I, you know, there are experts in businesses, right? For a reason, we would hire a coach, an athlete, a tutor. We hire experts in other areas of our life. And I very much pride myself on.

that when we work with practices and they retain us is that every practice needs to go through like a practice assessment, some sort of business valuation, not evaluation financially, like evaluation. Like what is the health of your business? That is the diagnostic tool, right? It’s the history and physical. We have to start there in order to understand what’s wrong, what’s right, where are the areas of opportunity? More importantly, how do I course correct it to make money? That’s where people have to start.

Alison Werner (06:34)
Mm

Mm -hmm.

Terri Ross (06:54)
whether they retain me, work with an expert or try to do it on their own, you know, is another thing. If they work with us, that’s where we start. And then we are on that journey with them to execute change. If, you know, they wanted to just look at two metrics that I would advise people to look at right now. And you have to look at where is your gross profit of procedures and whether that’s in surgery or non -surgical. And most plastic surgery practices have both.

Alison Werner (07:01)
Mm

Mm

Terri Ross (07:22)
and know what that baseline is because if you don’t know what that is, you know, then we’re paying time and labor and probably losing money. So I can affect that change by again, looking at efficiency of time and or increasing the cost and or perhaps not doing it at all because maybe it’s not making money and it’s bringing revenue down. And then looking at revenue per hour and surgeons have a baseline revenue per hour. Non -surgical rooms have a baseline revenue per hour. And that’s looking at the revenue generated by divided by the hours.

Alison Werner (07:33)
Okay.

Mm -hmm. Right.

Terri Ross (07:52)
a provider worked, that’s the baseline. Those two metrics in of itself, if no one did anything, can be changed immediately to have an exponential change to the bottom line.

Alison Werner (07:59)
Mm

Okay. So and I know part of what we’re to be talking about in this series is pathways to growth. So opportunities. So if you take those metrics and you realize I’m struggling, how do I grow? Can you talk a little bit about kind of what you think about what what’s on your radar in terms of growth? We’re going to get into specifics with each episode, but just kind of talk about what pathways give an overview of the pathways you see at this point.

Terri Ross (08:35)
You know, it’s quite simple, honestly, if somebody were actually to just take a moment to digest their business and what has to happen.

Practices, I mean, look, if we really are honest about the industry, it’s becoming a commodity, right? I mean, there’s, I’m in Los Angeles and one of the most competitive markets in the country. And it’s competitive and it’s a commodity. What’s not is not anymore how, you know, are they board certified and how many years of experience and how many case studies? Yes, that’s true. And yes, that is a value proposition.

But if some doctor is up against other people in a three mile radius where there’s hundreds of people doing something similar, how is a consumer going to choose? And we have to be clear on that value proposition. And then that comes down to, again, I’m going to beat a dead horse. It comes down to training. If practices are spending money to acquire a patient, right? So one, what is your marketing spend? I’ll give the number. It really should be around 8 to 10 % of total revenue.

And if it’s, so then you’re, so then look at your CAC. What does it costing you to get a patient? Then if they call the practice, this is, this, this is directly related to your question, the areas of opportunity, those patients better be converted. Those conversion metrics need to be at 70%. Most people don’t track them. Most people don’t even know. If you know that, then you’re like, okay, now I can back into, am I getting the right patient in the door or is my team just not trained to convert them?

Alison Werner (10:04)
Okay.

Mm

Terri Ross (10:12)
Now they can fix the problem. So that’s one area of opportunity. Are we getting the right person and then are they being converted? Second is looking at those two KPIs I just said. What services am I doing? Surgeries am I doing? What is my narrative to the world? Do they yield the highest return on investment? Two, because that’s what we’re going to be marketing for. Three is when patients come in for the consultation,

Alison Werner (10:16)
Okay.

Okay.

Mm

Terri Ross (10:39)
you know, is the philosophy of your business transactional or transformational? So if I just acquired a patient and, you know, Allison comes in for a consultation, am I going to talk to Allison about her facelift or Tommy Tucker boob job only, or am I going to give Allison a comprehensive treatment plan that encompasses a, you know, a whole host of modalities that will get you the best outcome and then in turn,

Alison Werner (10:55)
Mm

Terri Ross (11:09)
increase your revenue and help with lifetime value and retention. And if we can master those three simple things, they sound simple, but it’s a lot of work to master those things and then hold people accountable to the metrics. But if we can, I mean, this is where magic happens. This is really where exponential growth happens and where practices will outperform someone else.

Alison Werner (11:20)
Mm

Well, and I, yeah.

Well, and I like that you said that, you know, it’s the doctor, it’s also training the staff and it’s recognizing that it’s the team has to be on the same page to make a change.

Terri Ross (11:38)
100%.

Yes, unfortunately not a lot of

I don’t say a lot. mean, obviously, think there have been, you know, people are recognizing now that they they don’t have a choice. And if they don’t know how to do it, they should work with experts to help them learn how to do it. Because it is the team. The team can make or break the business. It’s not just good enough anymore that I’m a great surgeon in the O .R. But what is the rest of my team doing?

Alison Werner (12:09)
Mm -hmm. Yeah. And I know some of the pathways we’re going to discuss in the future episodes are very specific to services that can be offered and how to maximize the value of those services, the value per patient. But overall, this is about creating that larger connection between doctor and team to make something of these programs. So if you’re going to offer a service, make the most of it.

Terri Ross (12:17)
Yeah.

100%. I mean, absolutely. And understand, you know, when we analyze financials for our practice, you know, sometimes just the total revenue is all clumped into one area. And so where’s the breakdown of the revenue? What percent of the time are you doing ex -surgery, ex -non -surgical? Like, where is it really coming from? And is that the driving force? And then how many people come in for just one thing versus multiple things?

And if we just are able to recognize that data can be scary for a lot of people, but it’s very sexy when you understand what to look at, because it’s the power of intention of how to make the right changes. Otherwise, we’re uninformed. We think we’re busy all day. Busy doesn’t mean being profitable. And then we’re looking at our books and we see money in the bank. Well, that may not be your not profit. Like, let’s really take a look at this and how to end.

Let’s bring it back to the culture. It’s going to improve culture and reduce turnover.

Alison Werner (13:37)
-huh.

Absolutely. Yeah, no, exactly. Exactly. So there is a people element to this as well. But I like what you said there of, you know, don’t be afraid of the data because I know I, you know, I talked to so many doctors in this specialty and others and the business training isn’t there. You go there to be you go to school, become an expert in your clinical field. And maybe now some of the medical schools are catching up and offering a business.

Terri Ross (13:44)
as a whole other series, right?

100%.

Alison Werner (14:09)
you know, course or two, because they recognize that you’re also probably going to be a small business owner if you’re not working in a hospital. And so you also have to accept that that you are a business owner and that is a completely different skill set. And it comes with some data and it’s not scary.

Terri Ross (14:17)
right.

Yeah. Yes, it is. And let’s talk about this because it is a retail medicine. It comes with saying, you know, I have to be a salesperson. You know, people don’t like that word and I have an entire training program, but they have to really embrace that you’re not selling anything, but you are educating these clients on what’s possible for them to achieve an outcome that they want.

Alison Werner (14:37)
Yeah. Yeah.

Terri Ross (14:53)
And that does require a skill set that’s very hard for many providers to do.

Alison Werner (14:58)
Yeah, yeah, absolutely. And then, and that makes it important to have staff members as well who can also excel at their sales skills, which might not be what you’re looking for when you’re hiring. So, yeah, yeah. Well, Terry, I’m looking forward to talking with you over the next couple of episodes as we explore some of these growth paths. So I ask our audience to please check back for the next episode. And I hope you enjoy it. Thanks, Terry.

Terri Ross (15:07)
Right. 100. Yeah, absolutely. Absolutely.

Thanks so much, Alison. Thanks, everyone. Talk soon.

Alison Werner (15:29)
Thank you for checking out this episode of the Plastic Surgery Practice podcast. Be sure to check out PlasticSurgeryPractice.com to keep up with the latest industry news. Until next time, take care.

Alison Werner (00:11)
Hello and welcome to the Plastic Surgery Practice Podcast. I’m your host, Alison Werner. We’re back with part two of our multi-part series with medical aesthetics industry consultant, Terry Ross. We’re exploring key growth pathways and business strategies for medical aesthetic practices. In our first episode, we took a deep dive into the state of the industry, the importance of business fundamentals and the role of training in driving sustainable success. Today, we’re continuing that conversation by exploring one of the most talked about trends in medical aesthetics, the ozempic weight loss craze.

This category is booming, but the key to maximizing its potential lies in integrating it as a vertical into your practice that fosters long-term patient relationships, not just quick transactions. Terri is a globally recognized practice management expert and CEO of Terri Ross Consulting. With nearly two decades of experience, she specializes in helping medical aesthetic practices achieve sustainable growth through strategic business development, team training, and data-driven solutions.

empowering providers to maximize efficiency, profitability, and patient outcomes. Here, she breaks down how practices can offer weight loss services the right way with strategic planning, team alignment, and a holistic approach to patient care. Let’s dive in.

Alison Werner (01:23)
Okay, so Terry, the Ozempic weight loss craze is here to stay. And so now it’s the question of how can you make it a vertical you offer that creates a continuing relationship with your patients and isn’t just a one and done. and this category does offer growth potential. So, but you have to do it right to maximize the profit per patient. So what are you seeing first with this category of services?

Terri (01:40)
Hmm.

Yeah, it’s a hot topic, right? It’s a hot topic. It’s growing rapidly. Certainly, I think there’s controversy about it amongst, you know, surgeons and providers as a whole. Like, should I, shouldn’t I, long -term effects. I think, you know, obviously I’m not a clinical provider, but what I see from a business side is that there’s a lot of benefits to it. But if we’re just thinking about

Alison Werner (01:51)
Mm -hmm.

Terri (02:19)
just wait in America as a whole. You roughly two thirds of Americans are overweight or obese. And we have to really recognize that, you know, it’s a, it’s a problem. And the amount of money that is being spent in advertising and marketing this year alone is $882 million. Just in

Alison Werner (02:22)
Mm

Mm

Yeah.

Wow.

Terri (02:48)
marketing for weight loss drugs. That is massive. And there are, I think, you know, over 50 products in clinical trials. So what does that tell us? That we either can embrace it. And when we’re thinking about our practice, and if surgeons don’t have a med spa, they should. And if they if they’re looking for other verticals, this should be one because

Alison Werner (02:49)
Okay. Yeah.

Hmm.

Mm

Okay.

Terri (03:14)
you know, what is that going to do? Obviously bring a new subset of patients in your door that weren’t otherwise there that if converted or be given a treatment plan, that is massive opportunities for growth and lifetime value of one person.

Alison Werner (03:19)
Mm

Mm -hmm.

Yeah.

Okay, so what does that treatment plan look like to keep that relationship ongoing?

Terri (03:38)
Well, think about it, right? You have different groups of patients, right? You have your young patients, right? You have middle -aged, you have older older population, and everybody has unique sort of things going on, right? They have laxity, skin tone, fine lines, wrinkles, weight loss. mean, when they’re on these medications for the right reason, now they’re also going to be experiencing all these other things.

Alison Werner (03:51)
Mm

Mm

Mm

Terri (04:07)
which means they’re going to need some kind of tightening. They’re going to need some kind of fillers. They’re going to need some kind of retail and facials. They’re going to need perhaps surgery. And so think about that. Just if we’re thinking about all of the treatments any practice can offer, know, whatever they’re, I would say there’s riches in the niches. We don’t need to be everything to everybody, but if we are building a treatment plan that can combine these therapies together.

Alison Werner (04:25)
Mm

Right.

Terri (04:36)
and educate the consumer on what’s possible along the journey. This isn’t just like losing weight and, you know, we’re all done here now. No, it’s not. It’s how do you make a person look and feel their best, which is going to require multiple, you know, multiple things. And I think that is a very big difference between, again, running a, you know, high volume practice and being transactional.

Alison Werner (04:45)
Yeah.

Mm -hmm.

Terri (05:06)
versus being intentional and transformational to the patient. And that’s a choice the practice has to make.

Alison Werner (05:10)
Okay. Okay. And then in terms of integrating this type of vertical weight loss related services, in terms of integrating that vertical, what’s your advice to the doctor? And then how should they approach talking to their staff? What is it from that implementation side that they should be doing?

Terri (05:33)
Look, it’s not as easy as I think people think. There are many doctors, and some are my clients, that are making millions of dollars a month and who have developed a program. I mean, you have to look, there’s issues with compounding pharmacies, whatever manufacturer you’re gonna get it from. There’s the educational side on the provider side. Then there’s a whole host of labs and genetic testing and genomes. There’s so many things happening that…

It really is to say, let’s sit down and identify, you know, do we have the right staff in place? Does everybody have a desire to do it or learn how? Is it going to be a program, not a product? It’s not, I’m just selling a product. Is it, it is a weight loss program. Okay. At our 4S summit, let me just say this, if anyone’s listening and very interested in this,

Alison Werner (06:19)
Mm -hmm. Mm.

Yeah.

Terri (06:30)
Dr. Johnny Franco is a plastic surgeon in Park City and he’s literally running in December an entire weight loss program that is tied to our 4S Summit. And he’s been very successful and he’s in Austin. And so I think it’s really saying, is this something that we want to do? Do we have the patience to do it or do we need to grow and get new patients? But the program needs to be tight and well thought out, not, hey, let’s just get some product and start doing it.

Alison Werner (06:36)
okay.

Mm.

Terri (06:59)
Because when you start to look at the data and the success rate, it’s usually not very successful.

Alison Werner (07:04)
Okay. What metrics would you advise practices that are implementing a new program like this? Because as you said, it’s not just offering a service one thing and you might look at, okay, what’s the bottom line of me offering? What was my profit? What was my expense? This is a program as you’re describing it. What should they be looking at or tracking to know that this is effective? This is a good use of our time and resources.

Terri (07:30)
Yeah, mean, again, I’ll always kind of go down to profitability of offering it. What are the margins? What is the, how much time is it taking you to do this, to see one patient? And then more importantly, that revenue per hour, if they’re coming in for this, but the philosophy of your practice is such that they have to get a consultation, right? A true consultation, not just for the product, right? They have to get this holistic.

Alison Werner (07:58)
Mmm.

Terri (07:59)
consultation. And if that’s the philosophy, then that in of itself, you’re going to know if it’s successful, because I might start off on Ozempic or whatever I’m getting, I might start off on that. But in two or three months when I’m losing weight, now I’m scheduled for fillers and Botox and lasers. It’s a plan. That’s how you know it’s working. Or are the people just coming in just to get their monthly refill? That’s to me not successful.

Alison Werner (08:01)
Okay.

Mm -hmm. Mm -hmm.

Okay. Can I ask with the practices that you’ve seen doing this, are they, they’re not marketing it saying we offer Ozempic They’re saying something along the lines of we offer a weight loss program or weight loss service. How are they marketing it?

Terri (08:47)
That is an entirely different, my God, beast. mean, look, if you think about, no, and that’s what, you know, I did a webinar recently again with Dr. Franco, but, you know, we have to look at, we really have to look at this whole TikTokification and social media. I mean, we do, we have to just be smart. You know, how many people are seeing your message? If we think about marketing, it has to be consistency, conviction, and then what’s the level of content?

Alison Werner (08:50)
Ha ha ha!

Yeah

Terri (09:16)
that we’re putting out on a regular basis that is affecting some. And we have to look at keywords, crazy stuff’s happening, ozempic face. mean, we have to really start to investigate what is resonating. And then all of these AI tools, and it’s just becoming madness, but it’s not something that we can ignore.

Alison Werner (09:24)
Yeah.

Mm -hmm.

Yeah, yeah, but it also doesn’t have to be overwhelming that shouldn’t put you off of it.

Terri (09:43)
No, no. mean, look, I think every post is an opportunity to educate the clients on, again, what you do, what your practice is about, your value proposition versus, again, I just need some weight loss meds and I’m going to go down the street to this like, Joe Schmo place versus write some legitimate place to get this big plan.

Alison Werner (09:54)
Mm -hmm. Mm -hmm.

Well, and this is really an opportunity to really differentiate yourself from those. Hey, I offer Ozempic. You know, you can talk about how I’m offering, you know, I’m going help you on this whole journey because like I know just in my area, I’m also in LA and I see signs for Ozempic everywhere. Yeah, exactly. And it’s always like come in for Ozempic, but it’s never I don’t think I have personally seen where it’s part of some larger

Terri (10:14)
100%. Yeah.

Yes, yes, exactly.

Yeah, right. Right. We are right. are in the Mecca

Alison Werner (10:37)
program or some larger practice and focusing on like, what does this mean for me? Because then you always hear about like, ozempic face. Well, then you got to go see the plastic surgeon instead of, okay, if I work with a plastic surgeon in advance before I get there, maybe I can avoid some of these things. If I’m

Terri (10:37)
program.

Yes, yeah.

Yeah.

But think about what you just said and along the dialect of this conversation. And thank you so much for having me to talk about this and be on this series with you Business is down. Everyone’s wondering what we’re going to do in 2025. look, recognizing that you and I are in such a hot commodity state. And yet we’re both saying there’s many people just marketing Ozempic or

Alison Werner (11:03)
-hmm. Mm -hmm. Mm -hmm.

Mm -hmm.

Yeah. Yeah. Yeah.

Terri (11:21)
know, mounjaro whatever the hell it is. And that’s just not good enough. So I think it’s an opportunity for every practice to say, a minute, what is my message? What’s my value prop? What is my narrative? What kind of people do I want coming in my door? Because now that comes right down to cost per acquisition. I might come in your door, but I’m only going to get one thing. That’s a very symptomatic approach.

Alison Werner (11:34)
Mm

Terri (11:47)
again, versus looking at somebody or wanting them to be a long -term patient.

Alison Werner (11:51)
Mm hmm. Yeah. Well, I think it’s also recognizing that, you know, if patients are going out there to go to Ozempic like I said, there potentially is a relationship with a plastic surgeon or an aesthetic practice built in because your body is going to change and you’re going to want to deal with aesthetics as you go on that journey. So just get in there to begin with basically. Right. Exactly. Just get it from the it from the get go. Maybe you save a little money on surgery.

Terri (12:05)
Yeah. Yeah?

embrace it now, right? Right? Get on the bus now. Yeah, everybody will be happier. Business will succeed. Patience will be happier. Everybody wins and makes more money. It’s just, it’s a beautiful thing when we look at it from that perspective versus I’m scared to do it or that’s not what they came in for or I don’t want to be pushy. We have to embrace that. Again, this is an opportunity to educate.

Alison Werner (12:28)
Yeah. Yeah.

Well, and it’s keeping in mind that this is one of many verticals you can offer, but it’s about making sure it’s not just a one and done service. It is part of a program that incorporates your other service and offerings. Well, Terry, thank you so much for having this conversation with me and we will be I know and we will probably hit it again because I have a feeling this one is going to be here to stay for a while and is only going to.

Terri (12:47)
Yeah.

Yes, 100%.

Thank you, love this topic.

Yep.

I agree.

Alison Werner (13:04)
grow in so many ways. but we will be back in our next episode to talk about another growth pathway for your practice. So stay tuned. Thank you. Okay, bye.

Terri (13:11)
phenomenal. Thanks, Allison. Stay tuned. Appreciate it.

Alison Werner (13:17)
Thank you for checking out this episode of the Plastic Surgery Practice podcast. Be sure to check out PlasticSurgeryPractice.com to keep up with the latest industry news. Until next time, take care.

Alison Werner (00:12)
Hello and welcome to the Plastic Surgery Practice podcast. I’m your host, Alison Werner. We’re back with part three of our series on growth pathways and business strategies for medical aesthetic practices. In our first episode, we explored the current state of the industry and the importance of business fundamentals and training. In the second episode, we tackled the ozempic weight loss trend and discussed how to integrate it into your practice as a long-term patient relationship opportunity rather than a one-off service.

In this episode, we’re diving into another powerful avenue for growth, wellness. As patients increasingly seek holistic approaches to their health and appearance, the concept of wellness is reshaping the landscape of aesthetic medicine. But what does wellness really mean for plastic surgery practices traditionally focused on surgical solutions? And how can practices incorporate these services in a way that enhances patient loyalty, retention, and profitability?

Once again, I’m joined by Terry Ross, a leading practice management expert to help us understand how wellness offerings can complement your surgical practice, meet patient demand, and drive sustainable growth.

Now, Terri is the CEO of Terri Ross Consulting. With nearly two decades of experience, she specializes in helping medical aesthetic practices achieve sustainable growth through strategic business development, team training, and data-driven solutions, empowering providers to maximize efficiency, profitability, and patient outcomes. With that, let’s jump in and explore this new growth pathway.

Alison Werner (01:38)
So Terry, I know in talking to you, all the rage right now in the aesthetics industry is this idea of wellness. But my question is, what does that mean, especially for a plastic surgery practice that is typically focused on surgical approaches for their patients? Because the fact is, patients are looking for alternatives to surgery now. So how do practices meet them where they are? So I guess maybe to start, let’s talk about what does wellness even mean in this industry today?

Terri (02:07)
I know that’s such a great question, Alison. Thank you so much. You know, I think if we look at the evolution of plastic surgery and aesthetic medicine as a whole, you know, functional, integrative medicine and wellness, it’s just becoming such a relevant topic in the field and it’s gaining so much more traction because patients and surgeons, you know, frankly, have to recognize that the clients want a overall, like, holistic approach.

to wellbeing, which in turn again is going to generate better patient outcomes. And if you think about the industry, everyone is striving for retention. And it’s hard to manage. It’s hard to track with traditional software. But if you look at like other big industries, consulting industries like McKinsey, what we’re showing is that the wellness industry is growing.

exponentially. mean, my God, I think I have some stats here that, you know, it’s about a $4 .4 trillion and it’s growing 10 to 15 % annually. Patients are more likely to return 60 % more likely to return when we’re engaging in these other types of services. Those are pretty astounding numbers that we have to pay attention to if we want patients to be loyal to us.

Alison Werner (03:19)
Wow.

Okay. Yeah.

Okay, so what type of services are under this umbrella?

Terri (03:39)
You know, I think when we think about the types of treatments, I mean, we talked a little bit last time about weight loss. We’re looking at stem cell therapy. We’re looking at, you know, IV therapy. We’re looking at hormone therapy. I mean, there’s so many things that can fall under this category. And it’s really a matter of

Alison Werner (03:59)
Okay.

Terri (04:01)
we know where practices want to go and what they want to offer.

Alison Werner (04:05)
Okay, so when you’ve worked with practices, what have you seen that has worked for a plastic surgeon? Because what you listed there, that’s a whole host of services. And it sounds like maybe that might involve bringing in other practitioners to offer some of that. So what’s a good approach to doing this?

Terri (04:24)
Yeah, I think that one, you have to really define and I could pick this apart. Obviously there’s things for lymphatic drainage and oxygen therapy and cry. There’s so many things I. And it’s easy to get confused. It’s easy to get caught up in the hype at conferences when people are selling these things. I think it’s very important to really go back to the basics.

Alison Werner (04:30)
Mm -hmm. Mm.

Terri (04:51)
And what I mean by that is what type of a practice do you currently have and do you want?

and put real meaning behind that. Because we are changing mindsets. It’s not just about doing good medicine and doing good surgery. It’s not that that is paramount, but it still is a business that we have to run, sustainability and profitability. We have to, and efficiently. And in order to do that, again, it requires a lot of money to gain new patients. So what does our current patient base look like? How many people return?

Alison Werner (05:04)
Mm

Yeah.

Right.

Terri (05:30)
What are they coming in for? What’s the average spend? And then the philosophy of the company. So when you make it a philosophy, then these other services don’t become optional, if that makes sense. So obviously I’m very passionate and I’m on faculty. I’m so honored to be on faculty at all of these surgical societies and in the non -surgical space too. And what we really need to pay attention to is

Alison Werner (05:37)
Mm

Yeah.

Yeah.

Terri (05:58)
How can I build this comprehensive holistic treatment plan to get the patient the best outcome that will require many of these modalities that augment the outcome? So that’s the priority. They’re going to augment the outcome because you believe it’s the right thing to do. And when you believe it’s the right thing to do, this isn’t salesy, and patients are now exposed to other added value treatments that are impactful.

Alison Werner (06:07)
Mm -hmm. Yeah.

Mm

Terri (06:28)
can now bring them coming back in when they already had the facelift or the tummy tuck or the breast dog, but now I’m coming back in for these other things that are beneficial on a holistic level.

Alison Werner (06:32)
Right? Yeah.

Okay, so talk to me about some of the things or some of the services that you’re seeing that are really creating that relationship with the patient that you think are good options. Because if somebody’s looking, if a doctor is looking or a practice center is looking to start this and they don’t know where to start, what are some things that you think are good place to start?

Terri (07:06)
Again, that is such a loaded question because it’s really going to be dependent on the respective practice. If you’re a body guy, then a girl or woman, you’re going to want to focus, in my opinion, I always say there’s riches in the niches. So if you’re a body surgeon, you’re going to want to focus on things like Shape Scale is a new product on the market backed by significant investors.

Alison Werner (07:08)
Mm.

Mm.

Mm -hmm.

Terri (07:34)
And it’s taking over sort of the in -body device where it can measure body mass, water, weight, circumference, in addition to look at inflammation internally. I mean, it’s incredible. And why would something like this be valuable? If I’m a body surgeon and I’m looking, right, and we’re doing all these surgical treatments, what else can keep people coming in the door? And so something like that is beneficial. Lymphatic.

lymphatic, not even just lymphatic manual massage, but there’s a lot of modalities out there that offer a lymphatic. These are all combination therapy. Again, certainly IV therapy. Now I don’t promote IV therapy. It’s not necessarily a moneymaker, but it can be a valuable add -on. Oxygen therapy. But again, it’s really dependent on the practice. Now if you’re facial plastic, you might offer something else.

Alison Werner (08:10)
Yeah.

Mm

Yeah. Right. Well, I appreciate that you said that because if they can just approach it as, okay, if I am someone who focuses on facial aesthetics, then this is the group of services I’m going to offer. If I’m looking at more looking at the body, then you know what? I’m maybe not going to look at the facial stuff right now. I’m going to start in on this journey looking at what are the body services I can offer that can complement the surgical procedures I’m doing. So at least that gives them an idea of where to start.

Terri (08:39)
Yes. Yes.

Yes. Yes.

100 % I think again back to it again it’s easy to get swept up in these new and new shiny fancy toys that doesn’t mean they’re going to be beneficial for your practice it doesn’t mean your clients want them it doesn’t mean your team can sell them and then they end up sitting there so let’s be smart we have to be strategic and we have to be smart and there’s easy ways to do that right do a survey monkey to your patients ask them what they’re looking for

Alison Werner (09:06)
Mm -hmm. Right, exactly. Right.

Mm

Terri (09:23)
Start to look at the data. Again, do people come back? Why or why not? If you have a med spot or offer nonsurgical things, and I would imagine 90 % or more of surgeons do, how much of the revenue is coming from where? Because when we start to look at our business in that lens, we can make informed decisions versus, my god, I love this thing and it’s amazing. Well, maybe it is, but is it right for you?

Alison Werner (09:49)
Right. Right. So how do you as a how what do you recommend to practices that are looking to do this? And as a doctor and as a staff, you have to talk to patients about it. What do you how do you recommend they take that approach to start to talk to patients about that holistic approach?

Terri (10:00)
Mm

Yeah, I think it goes back. I will always, again, be very bullish and bold with conviction and passion is that it really has to go back to the training, the training of your entire team. Again, it’s very simple to hire people and put them in a role. But what is their why behind their job? What is their role? What KPIs are they tied to? And we have to go back to say, well, what is my process? I think the industry lacks a process.

Alison Werner (10:20)
Mm.

Mm.

Hmm.

Terri (10:36)
Meaning, if Alison came in and then Mary was at the front desk and then Larry was there the next, like, is it a systematic, right? What does the company have SOPs? And that conversation begins with using the right tools, such as a cosmetic interest questionnaire. Then it becomes an easier conversation to open up a door.

Alison Werner (10:44)
All right.

Yeah.

Terri (11:01)
when you’re introducing something on a piece of paper because you think it’s the right thing to do to expose clients to all of these other things. Statistics show 60 % of patients said they did not know practices offered certain things. Why? Because we don’t educate them. We treat it transactionally. They come in for the consult. We talk about the one thing or the two things, and then they go. And then that’s it. Then there’s no follow -up.

Alison Werner (11:18)
Mm.

Yeah.

Terri (11:28)
45 % of people are never followed up with it all. So if we can just go back to the basics, say, what is the philosophy of my practice? How well is my team trained? Are we using the right tools in the consultation? How valid and how good is the consultation? And are we building a treatment plan? And that needs to be not optional. If you’re surgeon, if you’re a provider, you have to believe that that’s just the right thing to do.

Alison Werner (11:31)
Hmm.

Mm.

Terri (11:55)
And that is the only way, that is truly the only way to build loyalty, to build retention, to have better outcomes and to make money, which is what everyone wants.

Alison Werner (12:04)
Yeah. Yeah. Well, especially as you said in a previous episode, you know, the fact is the market is down. So you’ve got to find a way to offset some of those numbers. So what metrics should practices be looking at as they’re undertaking this and as they’re gauging whether these things are working?

Terri (12:11)
Mm

Yeah, think we have to look at, one, really let’s pay attention to how much revenue are you bringing in, and then in what areas. What percent is surgery? What percent is non -surgery? What percent is wellness? Looking at your profit margins. We have to have a significant, right, gross profit. Looking at the potential devices or modalities you might bring in.

Alison Werner (12:41)
Mm

Terri (12:55)
and the gross profit on those, which in the non -surgical world, right, need to be over 60 % and much higher up at surgery. But it needs to be high. needs to make sense because we’re not paying labor. We’re not discounting. Let’s look at our patient conversion rates. Cost per acquisition to get a client in the door. I think those are a couple of significant things to look at where it doesn’t become overwhelming and then we can make a decision. And then what is the cost of that thing and how quickly can I either pay it off?

Alison Werner (13:03)
Yeah.

Yeah.

Mm

Terri (13:24)
or get adoption from your clients.

Alison Werner (13:26)
Mm

you know, the fact is that eventually some of the service has probably become a little stagnant. So how often or what should be what should practice owners be looking at when it’s like, maybe I need to look at adding something new or maybe this is getting tired. How would you tell them to approach that?

Terri (13:53)
That’s a good question.

I’d like to believe that decisions are made based on facts and not feelings. when a practice chooses to buy anything, does it complement the surgery, number one? And is it something that your patients want? If that’s the case, then hopefully the utilization of those pieces of equipment, devices, products, whatever it is, are being used.

Alison Werner (13:59)
Mm

Mm -hmm.

Terri (14:22)
when a practice is operating at a 70 % capacity, that’s when from a provider perspective, that’s when really, at least on the nonsurgical side, that’s really when we can say, okay, maybe it’s time to expand and or offer something else. And or if you want to increase revenue streams, and there’s something innovative on the market that complements your business, that’s when. You know, I think if things are just sitting there stagnant, we really have to just start to question why.

Alison Werner (14:45)
Mm

Terri (14:52)
Do people not want it? Does it not work? Why is it not selling?

Alison Werner (14:55)
Mm

Or is it just the passing fad or trend or whatever it is?

Terri (15:02)
Maybe, they’re right. Maybe depending on whatever, whatever it is. I think, I think in our, in our world, there’s not a lot of hype, trendy stuff. mean, there can be, but hopefully we’re not, we’re not buying that just because of, you know, because we, we, you know, we saw it at a conference. Like, does it actually make sense in your business model?

Alison Werner (15:06)
Yeah.

Mm -hmm. Mm -hmm.

Mm hmm. Yeah. How do you talk to doctors about who are trying to figure out how to vet a new offering a new technology to know that it’s right for them?

Terri (15:40)
I think obviously first and foremost, right, is there enough scientific data to back the support, the results? Talking to other key opinion leaders in the industry, not just talking to the company, like getting real facts, like how are other practices using it? Do patients love it? How is it being used? Was it worth the investment? Just, I think just do some research and really not just take it from the company.

Alison Werner (16:09)
Okay.

Terri (16:09)
And really making sure there’s adequate training and then marketing support from the company around helping the practices to execute something.

Alison Werner (16:19)
Okay. And then in terms of marketing to patients about the services you’re offering, is there any advice, especially if they’re trying to capture those patients who have already just done their one and done and don’t maybe realize that the practice offers more, but they’re kind of on the books, they’re there. How do you suggest that practices market to those patients, but also to the larger community?

Terri (16:45)
Yeah, I think a couple of things. think, again, back to what we talked about a few minutes ago, really making sure that you have the tools. If you have a cosmetic interest questionnaire, everyone fills that out. Prior to them coming in, everyone must fill that out. It’s just a protocol. That’s one. You’re going to get facts. You’re going to see how many people fill out that they’re interested in something, whether it’s a problem or a product or a treatment. That’s one. The second thing is when we think about marketing, it’s reach and frequency. It costs, you know, it takes

Alison Werner (16:57)
Okay.

Terri (17:14)
eight to 10 touch points, sometimes up to 30 touch points for a client to make a decision. So how often are you writing newsletters or blogs that are written for SEO, by the way, not just somebody in the practice who’s not even a real good writer, write something, but how often are we putting out valuable educational material on our website to increase ranking on our social media platform?

Alison Werner (17:31)
Mm

Terri (17:41)
about something and that is a way, know, everybody is seeking information and we need to be seeking it from the right source. So I think, you know, forget looking at SEO and your website and PPC and ads and all this stuff. It’s, let’s get out, let’s provide valuable information to our patients that will eventually resonate and they’ll want to come.

Alison Werner (17:49)
Mm -hmm.

So what’s your final takeaway message for practices that I really want to focus in on offering a holistic approach if they haven’t already started?

Terri (18:17)
Yeah, I think the final message is…

And people might not want to hear this answer because not everybody has strength in running the business, but we really just do have to go back. Again, it’s easy for surgeons to be in the OR and be really busy, and that’s amazing. But busy doesn’t mean being profitable as a whole. So let’s really, I invite you, and I encourage everyone listening to really say, OK, what is my business today? Am I happy with it?

What’s working? What’s not? Where can we improve? How well is the team trained? Are my benchmarks and my KPIs being met? It’s either yes or no. There’s no gray. And if they aren’t, it’s an opportunity. It’s not a bad thing. It’s an opportunity to improve and to grow and to make the right decisions that can have a positive impact. So that’s what I would say. Don’t be reactive. Don’t make irrational decisions.

Alison Werner (19:01)
Yeah.

Terri (19:22)
financially make sense for the business? the team going to embrace it and sell it? Do your patients want it? Can your business afford to do it? And what are your expectations if you bring it in? And that’s it. And I think when we can just embrace this business side of it, everyone will be in a much better place, both financially and from a patient safety and outcome perspective.

Alison Werner (19:51)
Yeah. One more question. If a doctor is feeling or a business owner is feeling overwhelmed by taking on this and moving beyond the surgical and looking at the whole business, where should they go to either get help to figure out how to do this or to just educate themselves? That works. Well, no, I think it’s

Terri (20:08)
Call me. Call me. No, I mean, look at now this is bit self -serving, but thank you for asking. No, I think. Yeah, no.

Alison Werner (20:18)
question because you just talked about how, you know, they’re making a big transition and they’ve got to look at a lot of things and it can be overwhelming.

Terri (20:23)
Yeah, no. Yes, and thank you for asking. I’m super proud. I don’t know if everyone knows, but Dr. Renato Sulz, Isaac and myself, Isaac Musely, my ex -co -CEO, we sold the company. But we started the 4S Summit. And the 4S Summit is a sales and business mastery summit that we started to fill the gap in the aesthetic market. And it’s really a two and a half day.

down and dirty deep dive. It’s a conference around business. And I’m sharing that because the ASAPs, so excited, recently sent out a press release that they have adopted the 4S Summit as their sole practice management provider. And why? If the societies are recognizing, a minute, surgeons are seeking help and advice. I’m gonna say, if you’re stuck and struggling, please don’t try to do it on your own. You’re gonna waste time and money, perhaps make costly mistakes.

Alison Werner (21:05)
great. Yeah.

Yeah, absolutely. Yep.

Terri (21:22)
we’re here to really do sort of an initial business evaluation and we write a very deep dive formal business report to help practices understand where the opportunities are and how do we coach them to fix it. So that’s what I would say. I invite you to call me.

Alison Werner (21:36)
Yeah. Excellent. Well, Terry, thank you again, as always. It’s been a pleasure. All right. Thanks.

Terri (21:43)
Thank you, Allison. Take care. Thanks for listening.

Alison Werner (21:47)
Thank you for checking out this episode of the Plastic Surgery Practice Podcast. Be sure to check out PlasticSurgeryPractice.com to keep up with the latest industry news. Until next time, take care.

Alison Werner (00:10)
Hello and welcome to the Plastic Surgery Practice Podcast. I’m your host, Alison Werner. Today we’re back with part four in our podcast series on growth strategies for medical aesthetic practices. So far we’ve explored both the critical elements of thriving in a down market and opportunities for growth, such as understanding the business fundamentals, integrating weight loss services to build long-term patient relationships, and expanding into wellness offerings to meet the growing demand for holistic care.

Today, we’re shifting gears to discuss a topic that’s reshaping not just aesthetics, but healthcare as a whole, artificial intelligence. AI is rapidly making its mark in patient diagnostics, practice management, and personalized care, offering practices new ways to boost efficiency, precision, and profitability. But how do you integrate AI in a way that benefits both your patients and your business? And where do you even begin if AI feels like an overwhelming leap?

To help us navigate this, Terri Ross is back to break down the opportunities AI presents for plastic surgery and aesthetic practices, along with practical steps to get started.

Terri is the CEO of Terri Ross Consulting. With nearly two decades of experience, she specializes in helping medical aesthetic practices achieve sustainable growth through strategic business development, team training, and data-driven solutions, empowering providers to maximize efficiency, profitability, and patient outcomes.

Let’s explore how AI can become a game-changing tool in your practice.

Alison Werner (01:42)
So as I said in my intro, I wanted to talk to you about artificial intelligence in the plastic surgery space or even the aesthetic space as a whole, because it is a hot topic. Health care is trying to figure out how to integrate it and where it makes sense. And there’s really a lot of areas. It’s there’s a diagnostic front, you know, that area. Then there’s practice management. And then there’s also like how do you integrate it with the patient? There’s all these options now. So basically, let’s get started with

How big of an impact is artificial intelligence or AI having on the industry at this point?

Terri (02:16)
It is so crazy. It’s just, and even for us, right? Even for me, getting our arms around it, it’s a lot, but when you can learn it and adopt it, it’s so impactful in terms of reducing time. So I would say if you look at 2023 report in the allied market, AI healthcare as a whole, it’s projected from about 15 .4 billion in 2022 to almost 103 billion

Alison Werner (02:18)
Yeah, I know.

Hmm.

Terri (02:45)
billion by 2030. So if we think about aesthetic medicine, that is a hot topic of emerging markets. And to your point, looking at it from the patient’s perspective, the practice management perspective, and then enhancing the patient journey. So there’s so many things. And if you think about some of the companies, a report by Modface, which is a L ‘Oreal company, found that patients who used AI -based skin analysis tools. And there’s some great things on the market.

Alison Werner (02:46)
Hmm.

Mm

Terri (03:13)
they were 32 % more likely to proceed with recommended treatments due to the technology. And there’s so many phenomenal, again, pieces of AI technology out there to look at the face, analyze the face, whether it’s the scan, whether you need lasers or you need fillers, it’s amazing.

Alison Werner (03:21)
Hmm.

Yeah.

Well, and I think one of the things that in my discussions with people about AI is it’s this idea of creating a custom offering for you. AI is looking at you and giving you what you need. So talk to me about how the market is looking at AI.

Terri (03:51)
It’s interesting because there are some people just like any doctors and providers that are early adopters and are the ones that are like a little bit reserved and perhaps still could be on paper charts, right? But when we’re thinking about it, it really can, when it’s being embraced, help providers and patients get accustomed to look at specific data.

And that data can help create more accurate treatment plans that are tailored specifically to that patient. I think that’s one of the biggest areas of opportunity is that we’re not just making a diagnosis or selling something when people don’t like to sell based on because we want to versus using this technology to say, God, this is just the right thing to do. And it’s being adopted more because you have something to back it up with.

Alison Werner (04:36)
Yeah.

Yeah. So let’s talk about the three areas that we can kind of categorize AI’s integration. Let’s start with patient care and kind of that diagnostic treatment planning. Where is AI coming in there?

Terri (04:49)
Thanks.

Yeah, so as it relates to the patients, I think AI can be very impactful.

whether it’s a consultation in person or virtual, really, again, recognizing doing some of those skin analysis visualizations on the face and or the body, which are helping with these treatment plans and assessments. And then we’re able to monitor progress specific apps and usage, which is fantastic.

Alison Werner (05:28)
What about in terms of kind of the practice management side then? Where is AI integrating then or can be integrated then?

Terri (05:37)
Yes. Look, we all know that running a practice is hard, right? It’s hard. There’s 60 over over 60 practice management software is on the market today. And I get that’s probably a question I get asked every day. Which software should I use? And frankly, I have to say, you know, they’re all great. I mean, they all have pluses and minuses. But I think AI can really help automate some administrative tasks, scheduling, follow ups, patient appointments, retention.

And some of the daunting things that candidly, I don’t think a lot of practices or teams are doing, but I think it can help with the overall patient experience and retention, which is gonna alleviate time in the practice that can be more focused on patient care.

Alison Werner (06:24)
And then what about in terms of, more on the doctor’s end, what are you seeing in terms of the diagnostic diagnostics?

Terri (06:35)
I think kind of back to what we had talked about, there’s very few ways. mean, yes, there’s a bunch of body scans and phenomenal photography software that practices can use, but I think we can look at it now at a more…

at a level I think that can be embraced because there are so many apps that patients can now take home and measure and monitor back to, again, skin types and body composition and helping to use these tools to build that customized treatment.

Alison Werner (07:06)
Okay. Is there any, you know, I think when I talk to people, they sometimes worry that AI is going to replace them in some way. Is AI going to replace providers? I’m sure that’s a fear out there.

Terri (07:16)
my God. It’s so funny, Da Vinci, I’m sure surgeons, one of my first, I didn’t take the job, but there’s the Da Vinci robot, right? that right? And so, listen, I certainly don’t, I don’t know about what’s gonna happen 10, 20 years from now, but I think AI really should be looked at, that it is a tool to help augment human skills and human behavior, not to replace.

Alison Werner (07:23)
Mm

Yeah. Yeah, I’ve heard of that.

Terri (07:43)
And it is really designed to give us more time back and improve with precision, but not replace patient.

Alison Werner (07:51)
Yeah. Well, and I think that’s the thing to look at it is you look at it as a tool that can simplify some tasks that otherwise might be a little burdensome. So do you think what’s the role of AI in like a smaller practice that might be like, you know, I don’t need to take this on. It’s too complex. You know, I’m fine just chugging along.

Terri (08:01)
Yeah.

There, think that regardless of a practice size, because there are so many people getting into the space, is really irrelevant. I think that the tools are becoming affordable, they’re becoming more accessible, they’re becoming SaaS models. And I think when applied and selecting the right thing can be extremely advantageous in helping with efficiencies.

especially in a smaller practice. think 64 % of practices that have implemented AI reported reducing operational costs within their first year. And that is huge because there’s not enough manpower to add to payroll. So why not adopt some of these tools that can help us with greater efficiencies.

Alison Werner (08:57)
Yeah. Do you think, well, in terms of a business from, let’s go from the practice management side. Are there any tools that, you know, you’ve seen practices using or not even a specific tool, but just something that these tools can do, whether it be helping them with their marketing or helping them, you know, with communications that you have found beneficial.

Terri (09:23)
I would say…

The main tools are a lot of the AI analysis tools, and that’s more on the patient side, on the administrative side. Yeah, I would say it’s more kind of what we talked about, whether there are open API integrations with their current practice management software, but we have to, there are so many tools to use, whether it’s a practice management, a CRM, right? There’s marketing, there’s, we have to be able to bring these tools together all in one to assess what’s working, but as it relates to where people get stuck,

Alison Werner (09:29)
Okay, that’s fine.

Terri (09:53)
If 45 % of people are never followed up with retentions low, we can use these AI tools for reach and frequency and touch points to connect with the patient that they candidly are more apt to adopt to, which is on your phone or an app of some sort.

Alison Werner (10:11)
And I think the fact is that, you know, lot of the practice management software is there. Patient communication software have kind of already integrated a lot of this AI. So it’s just accepting that it’s there, but also realizing there are other tools out there that you can make a choice to integrate. And there’s stuff that’s out there in the general market. It’s not necessarily doesn’t all have to be specific to a health care setting. There are AI business apps that you can integrate into a place.

for the practice management side or even some of the patient communication. Okay. Do you think AI will make patient care less personal? Because I know I’ve heard that as a question.

Terri (10:41)
Absolutely. Yes, absolutely.

I think so. I think it goes back to the philosophy. We’re in this cash -based retail business. I think maybe it’s on the contrary. mean, maybe it’s going to make it more personal because we have these amazing tools now. Right now, I think people are so into texting. There’s little human. There’s less of the human interaction. So think if we look at these tools, like I said,

to help us at a deeper level to enhance something, that’s the benefit of it versus taking less care away.

Alison Werner (11:32)
What’s your kind of overall take or what’s your recommendation to practices that are like, okay, I need to start embracing AI on some level or I at least want to dip my toe. Where would you say to start? Would it be the patient interaction side? Would it be the diagnostic side? Would it be the practice management side? Where do you think it’s easiest to just dip your toes in so you feel comfortable?

Terri (11:55)
I think that, again, instead of practices guessing or wanting out of a desire, what is needed? I encourage every practice when I work with them, we have to be clear. Take a minute. Take a minute to do a SWOT analysis. Strengths, weaknesses, opportunities, and threats. What’s working well? What’s not? The two top are internal things we can control. The weaknesses and the threats we can’t.

But we have to identify what those things are first. So if you are suffering with administrative things and patients aren’t coming back and there’s no shows and retention is low and conversions are bad, then focus AI there to help improve that. If your revenue is down and patients are being transactional or symptomatic and only getting one thing and not coming back, maybe there are added beneficial AI tools.

that will enhance the patient experience. So identify first what you need and then start there and then master it before you move on. Otherwise it will become overwhelming and nobody will do anything or use it in the right way.

Alison Werner (13:01)
Right. Well, and I was going to my next question was going to be how does this tie into kind of our larger series, which is about, you know, growth opportunities for your practice in a down market. So you kind of just set it there. Find the areas where you’re struggling, where you’re down and find a tool that maybe can help you get out of that hole.

Terri (13:15)
Yeah.

Yes, yes. And then do one or two things well. It can be overwhelming. I’m so blessed that we have so many clients working with us. it really is, let’s just be smart and be open minded to that if we’re not learning, we’re not growing. And shame on us if that’s the case. Let’s just be vulnerable and be honest about.

what you do well and as a surgeon or a provider and an owner of a practice, you’re still an entrepreneur and a business person, which means we have to still invest the same level of time and money and care in your team, in your business. It’s your baby. It’s your legacy. The same way you practice your craft to improve the surgical techniques, we have to give our business the same thing. And if you’re not doing that, then you should. And when you do, it’s just so rewarding.

what can happen.

Alison Werner (14:13)
Well, I love that you said that because I think that’s the overall message we’re going for with this whole series. It’s you are an entrepreneur. You do surgery great. You’ve got that. You were trained for that. You weren’t necessarily trained to be an entrepreneur or a business owner. So figure out what you can do and take the time to learn where you don’t know how to do something. It doesn’t have to be a mountain you can’t climb. can. There are tools and there are tools to get you there and people to help you along the way. Yeah.

Terri (14:27)
Yeah.

100%. 100%. I love this segment. Thank you, Alice.

Alison Werner (14:43)
Yeah. Yeah. Well, thank you so much, Terri. I really appreciate it. All right. Thanks.

Terri (14:48)
Okay, thank you honey. Talk to you soon.

Alison Werner (14:53)
Thank you for checking out this epiosde of the Plastic Surgery Practice podcast. Be sure to check out PlasticSurgeryPractice.com to keep up with the latest industry news. Until next time, take care.

Alison Werner (00:10)
Welcome back to the Plastic Surgery Practice podcast. I’m your host, Alison Werner And today we’re wrapping up our series on growth strategies for plastic surgery practices with consultant Terry Ross. Over the past few episodes, Terry has provided insights into the state of the market, the key metrics practice owners should be tracking, expanding into wellness and non-surgical offerings, and the impact of technology like AI on patient engagement and practice efficiency. Now it’s time to bring it all together with a focus on accountability.

Growth and expansion offer incredible potential, but they come with the responsibility to hold yourself accountable as business owners and to hold your teams accountable for their roles. Today’s conversation is about making intentional choices, deciding if you want to build a thriving business or remain focused on clinical work, setting clear expectations and creating a plan that aligns your business with the life you envision for yourself now and in the future.

Alison Werner (00:58)
Again, Terri is the CEO of Terry Ross Consulting. With nearly two decades of experience, she specializes in helping medical aesthetic practices achieve sustainable growth through strategic business development, team training, and data-driven solutions, empowering providers to maximize efficiency, profitability, and patient outcomes.

Alison Werner (01:16)
Terry, thank you so much for joining me for this episode.

Terri (01:18)
Thank you, Allison. I’m really excited to be here as always and kind of pull all this together.

Alison Werner (01:23)
Yeah, okay, so over the course of this series, you’ve shared some really valuable strategies for growth, growth and success all come down to accountability. For practice owners, what are the first steps to holding themselves accountable to both their clinical and their business goals?

Terri (01:38)
Well, before I answer that, if you don’t mind, I’d love to share and shed a little light when we’re thinking about accountability. And there were some recent statistics I think that would be empowering to share. 60 % of aesthetic practices in 2023 said that they had inconsistent staff performance in implementing KPIs, looking at efficiencies. And when we’re thinking about

Alison Werner (01:40)
Mm-hmm.

Mm.

Terri (02:05)
practice owners and spa actually said 68%. So taking a combination of medical spas, which most plastic surgeons have 68 % of practice owners reported struggling again to balance their roles as doctors and as business owners. And so this does prevent the challenge. But teams perform literally and profits increase almost 30%.

Alison Werner (02:13)
Mm-hmm. Yeah.

Terri (02:31)
and retention improves around 41 % when we hold people accountable. So I think the first thing to your question that business owners need to do is one, put on the entrepreneur hat, right? As a surgeon, you still have to be an entrepreneur and an owner and a leader. And the other is to really take a good, hard evaluation to say,

What are the traits, not even the skill sets, right? You can teach skills. I cannot teach somebody to be motivated and hungry and driven, right? We can’t teach those traits. So what are the roles within the practice? We all know what they are, right? You’re front desk, you’re PCC’s, you’re providers, you’re surgical staff, right? We’re managers. And what truly are the traits that you’re looking for for that role to be successful? And then the next would be

Alison Werner (03:08)
Mm-hmm.

Mm-hmm.

Hmm.

Terri (03:27)
And I don’t want to use a job description loosely, backing into what a job description is intended to do. It’s not a piece of paper, someone signs that I’m just going to do these tasks. But what are you going to hold them accountable to? For example, a front desk should be held accountable to conversions.

Alison Werner (03:36)
Mm hmm. Yeah.

Mm-hmm.

Terri (03:46)
Right. And PCC should be held also accountable to conversions and surgical, right. Getting more surgeries on the books. Managers accountable to profits. Those are just a few things. So I think that’s where we need to start.

Alison Werner (03:53)
Mm-hmm.

How should practice owners then approach setting and reinforcing clear expectations then for their staff?

Terri (04:07)
I love the question. Look, data doesn’t lie. It’s not emotional. It’s not about feelings. I think a lot of people struggle with understanding the data. Well, in order to answer your question, you have to look at the data, right? How many new patients came in? How many were converted? What is the average spend per patient? What is the retention rates? I mean, what is our retail? And then we can say,

You know, think management should have morning huddles or morning team kickoffs, right? To get everybody setting the tone for the day. What are the expectations? What are the goals? Are we up or are we down? How are we going to hit it? One, something motivating. Two, are we having monthly meetings as a company?

Alison Werner (04:45)
Thank

Terri (04:51)
Right to talk about what’s working, what’s not go around the room. Have everybody be responsible, not talk at your team. Have everybody in their respective departments go around the room and talk about their what they’re held accountable for. And then I think performance reviews are critical and a lot of practices just don’t do them. And you know where you have your team rate themselves, you can really get a lot of information on how they feel they’re doing. You read it and then you rate them and then have a conversation.

Alison Werner (04:54)
Mm-hmm.

Terri (05:21)
And I think any good leader is there to, again, coach people up or coach them out. But we have to give them an opportunity to do that.

Alison Werner (05:30)
Okay, so that’s how to hold the team accountable. How does the doctor hold themselves accountable?

Terri (05:38)
Yeah, think that, yeah, yeah, I love it. look, and I say this from a humble place, but from a place of working with a world renowned plastic surgeon, Renato Saltz, which everyone knows, we started our own conference to fill this exact gap because you’re a surgeon, you’re amazing at your craft.

Alison Werner (05:41)
or the business owner hold themselves accountable.

Terri (06:02)
But there is no you’re not taught the business side of medicine. So it’s hard because you can be super busy right and have a thriving practice money in the bank. But yet there’s like a lack of leadership and culture and and that’s to no fault. It’s just that that’s what comes out in every survey. So I would say. Reflect on reflect on why you started your practice in the first place.

You know, it’s one thing to say, want to write, I want to provide good patient outcomes and good results and be a caretaker. That is great. But that if you chose to not work in a hospital and own a business, there is a side of you that really has to kind of be vulnerable a bit.

to say, OK, well, what kind of leader am I? Am I motivating? Am I encouraging? Am I lead by example? Or am I dictatorial? We teach this in the 4S Conference. So who are you as a person? Why do people want to work for you? Why are they loyal to you? And if you struggle in that area, I think then, look, many people have life coaches, business coaches, mentorships.

and or, you know, our conference out. So I think there’s ways to improve it. And that is really the only way you’re going to build that culture of unity and leadership that you want.

Alison Werner (07:18)
Mm-hmm.

Yeah. You know, a lot of doctors, if they decide to become a business owner, it’s because they want to have a certain lifestyle or they want to have a certain future once they leave their practice. When looking at the lifestyle they want both now and when they retire, how can a practice owners ensure that their business goals align with those personal aspirations?

Terri (07:50)
Such a great question. I’m always, and if you guys know me now, I’m always gonna tie it back to data because there’s only so many hours in a day, so many hours in a month, right, to do surgery or to see patients.

So in my opinion, and my strong belief is really understanding what kind of practice do you have and how much revenue can you maximize out of the place. I think that’s really important to right? To know what that potential could be. And then it’s about saying, okay, well, right, what is my family, my personal lifestyle? Are my kids in school? Are they in sports? My wife? And making sure you can set goals that are achievable to hit.

Or not, maybe we’re operating at 70 % capacity, whatever that might be, right? Or revenue, whatever that might be that you’re comfortable with, but that you also have a quality of life. And when you know those two things, there’s no rat race. We’re not chasing money or wondering why one month was great and then one month wasn’t great, or why some team stays, why do they quit? Like why some thrive, some don’t? Well, what have we, what training have we provided them? And then what-

Alison Werner (08:39)
Mm-hmm.

Terri (09:04)
What are you as an owner, your expectations? And then when we can draw those together, it’s just facts and not emotional.

Alison Werner (09:11)
Yeah. If practice centers feel overwhelmed by that balance between clinical and business growth or clinical work and business growth, what support systems or resources can help them stay kind of committed to both?

Terri (09:26)
I believe and I speak for myself. I’m just a lifelong learner. I constantly am involved in coaches I’ve had, still have, mentorship again that I belong to. When you’re surrounded by a team of people, a tribe, a Materious Tribe, a community, you thrive together. And I think there’s this space is evolving so rapidly that I would encourage everyone again, if they’re not suffering, please, you know.

Alison Werner (09:30)
Mm-hmm.

Mm-hmm.

Terri (09:55)
look up our 4S Summit or seek out someone with expertise that you don’t have.

Alison Werner (10:02)
Okay, so my final question for practices that have listened to the business owners that have listened to the previous episodes and they’re thinking about taking on one of these expansion opportunities. What’s your final message for them in terms of doing so successfully?

Terri (10:17)
Yeah, I love it.

Make sure that the decisions make sense for the business and that your team is bought into it. You know, have transparent conversations about why. I’m always going to go back to the why. Like, what is the purpose? How is it going to affect your business? Who is going to be involved? Right? Who’s responsible? Who, what, when, where, why? I think those things really matter at the time. Does your, does your market demand it? Does your market demand it? Do the patients, are they going to come for it? Have you surveyed them?

Alison Werner (10:43)
Yeah.

Terri (10:51)
And then is it going to be profitable for you, whatever that expansion services are? Is that the right thing for your service mix? The last thing anyone wants is to buy a piece of equipment or bring on a new treatment and it sits there or it flops. So just get everyone involved, get everyone bought in, identify who’s responsible for what, seek information from your patients and.

make sure it makes money and that the execution of anything is such that you can track progress.

Alison Werner (11:25)
Great. Well, Terry, if anybody wants to get in touch with you, to work with you, or to learn more about the services you offer, what’s the best way to do that?

Terri (11:32)
Thank you so much. Yeah, please visit terryrossconsulting.com is my website. My Instagram is also Terry Ross Consulting. And then the conference that we have is the 4S Summit. Thank you, Allison. I’ve been so honored to be part of this amazing podcast that you’re doing. So kudos to you and the team for really giving back to the industry and putting out such great information.

Alison Werner (11:55)
Great. Well, thank you again, Terry, for all your time and for your expertise on all these issues. thank you. All right. Perfect.

Terri (11:58)
Yeah. Thank you, Allison. soon.

Alison Werner (12:03)
Thank you for checking out this episode of Plastic Surgery Practice podcast. Be sure to check out PlasticSurgeryPractice.com to keep up with the latest industry news. Until next time, take care.

Alison Werner 0:04
Hello and welcome to the plastic surgery practice podcast. I’m your host. Alison Werner, for this episode, I talked to Dr Babak Azizzadeh about plastic surgery and aesthetic procedures with younger patients. Dr Azizzadeh is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, Head and Neck Surgery. He is the director of the Facial Paralysis Institute in Los Angeles, and an associate clinical professor at the David Geffen School of Medicine at UCLA. Here’s our conversation. Dr Azizzadeh, thank you for joining me today.

Dr Babak Azizzadeh 0:35
Thank you so much for having me. Alison, I’m really excited.

Alison Werner 0:39
So, we’re going to now talk about plastic surgery and younger patients, but we’re also going to talk about aesthetic procedures. So to get started, we were going to talk about rhinoplasty. Can you talk to me about that younger population? What ages are we dealing with here?

Dr Babak Azizzadeh 0:56
So rhinoplasty, obviously, are commonly known as nose job, and the lay public is is a procedure that’s really probably one of the most popular, if not the most common, procedure that’s done from an aesthetic perspective, and a large portion of the patients who do undergo rhinoplasty are teenagers and young adults, typically speaking, between the ages of 16 to 24 I would say that’s the largest portion of patients, at least in my practice. And obviously, when we’re dealing with individuals who are minors, we really need to be considering a lot of different factors, because we have to take into consideration their physical ability to undergo surgery, and then the social factors that go into undergoing surgery. So on the physical side, you know, boys and girls age differently, their bone structure is different. They undergo puberty at different times, and because of that, there is some variation in terms of the timing of when you want to do rhinoplasty from a physical perspective. In young girls, typically, we want to look at when they had their first period and wait at least a year or two after that. That typically falls anywhere between 15 and 16, and we want to make sure that they’re finished with their growth. A lot of times, one of the questions we ask is, have they changed their height? Have they had any changes other than the typical standard physical changes, and that gives you a guidance of when physically they are ready. With boys, it’s a little bit later, because boys tend to undergo puberty a little bit later they can and they continue to grow. So I know this is long winded, but the reason, physically, we don’t want to do it earlier is because the septum, which is this kind of the internal cartilage inside the nose, that’s often addressed, in addition to the external aspect, is the growth center of the cheeks and the mid face. So touching the septum can impact the actual facial growth, and the mid face facial growth is really important to our attractiveness and beauty, so we don’t want to stunt that. We don’t want to impact that. So that’s kind of a summary of the physical aspects of undergoing rhinoplasty.

Alison Werner 3:40
Okay, so what about the social aspects you mentioned?

Dr Babak Azizzadeh 3:43
So the social aspects are much more complicated, because most of the time, obviously all the time, minors come in with their parents. The parents are involved, generally speaking, in the decision making process. So you want to make sure you have really two stakeholders, the patients and the parents in this process. So number one, we don’t want it, we want to make sure that the patients really want to have this. We want to make sure that they physically need to have it before jumping into needing it. And we want to make sure that the communication between the patients and their parents is really, really solid. They need to be mature. The discussions need to be mature. There can’t be bickering. You can’t have the parents forcing their kids to have rhinoplasty and vice versa. Some kids are driving their parents in and making them pay for this procedure. So it needs to be, all of this needs to be really all happening together at the same time. There can’t be any question marks. If there are question marks, I always suggest waiting an additional year or two and revisiting. The procedure. The other factor that goes into it that’s not talked about almost ever, which I’ve published on, is nose and nasal deformities can have a tremendous amount of social impact on kids. Major nasal deformities, very large noses, very no just like kids who have like loppy or kids can get teased, kids can really have a significant psychosocial impact in school. So sometimes we wait, actually, too long to address issues related to major nasal deformities. So I’ve published on this extensively. I think we need to think about a nasal deformity, kind of like what we do with ears and other factors, and address those a little bit earlier than later.

Alison Werner 5:51
When you have a patient come in, a younger patient come in, how many appointments are you doing to kind of feel out them and the parents and figure out some of these social issues.

Dr Babak Azizzadeh 6:02
Yeah, so plastic surgeons are really good at psychology. So it’s, it’s a lot of what we do involves psychology, analysis, sociology and so forth. So typically, our first discussion is a pretty lengthy one. It’s between 30 minutes to an hour, closer to an hour we, you know, have, you know, obviously, listen to our patients and the parents what their goals are. Make sure those goals are realistic. Make sure they’re valid. If they’re coming in for a little thing, you know, don’t do anything. You’re going to wait. But if it’s like kind of a, more of a, I would say, major issue, or moderate to major issue. You then continue the discussion. We go through an educational process of what you know, the anatomy is, what the before and afters can look like, and that, you know, really give them a view of like this isn’t going to change your life for the most part. There are certain cases that it does change our life, but for the most part. And then lastly, we do a morphing, three dimensional morphing. Throughout this hour, I am listening for cues. I am hearing body language. I’m looking at the body language and the interaction between the parents and the kids to make sure that there isn’t any red flags. If the kids are mature, their issues are valid, the parents are supportive, and vice versa. They’re a good candidate. If any red flags and these factors come in, I generally tell them to wait an additional year. Let’s revisit. So that’s really our first evaluation, and then if they decide to proceed with surgery, and I agree with it, we have a second evaluation closer to the surgery date. I have canceled many patients during that time because if I see any red flags popping up, any of the issues that I’ve outlined. So that second preoperative consultation is another touch point where we want to make sure that everyone’s on board, everyone’s really looking at this in the correct way.

Alison Werner 8:15
So then once you’ve gotten to that point of it’s right for this patient, what are we talking next in terms of procedure and timing?

Dr Babak Azizzadeh 8:24
Yeah, so that’s a good question. I generally like, from a procedure perspective, to do these in the summer, early in the summer, so that the kids have plenty of time for recovery. Rhinoplasty, unlike many other surgeries, healing process a little bit takes a little bit longer. You know, the recuperation is very fast, but the healing process of the nose, the final results are a little bit slower than other plastic surgery procedures. So I don’t want to rush the patients in terms of that recovery. When I was training, it was a very, very, very and still today, like it was like spring break, Christmas break, a lot of people, but it was like one or two weeks, very, very quick. So now I try to kind of put everyone in the May, June area time period, so that they have plenty of time during the summer to recover. And you know, preoperatively and postoperatively, obviously, the parents are very involved in the post operative process with the kids. We’re very involved in the post operative process with the kids. Kids do really well. I mean, the and to be honest with you, probably they are the happiest plastic surgery patients we have, if you choose correctly, because it really it’s important to them. It’s really important, and it’s something that, for the most part, when they come in, they’ve really thought about it, and they’re well researched, because now they have, you know, the internet, they have social media. Sometimes some unrealistic expectations exist, but we can kind of manage that.

Alison Werner 9:58
Okay, so I want to switch gears just a little bit to talk about lip fillers, because that is another procedure, non surgical, that you’re seeing in your practice with younger patients. So what age range are we talking here?

Dr Babak Azizzadeh 10:13
Yeah, I mean lip filler, lips are tremendous, tremendous area of interest in in young adults, 20 and up, and older adults too. But really, I would say age 20 and up, you just see, you know, over the last five to 10 years, because of social media influencers, there has been a tremendous increase in interest in utilizing lip fillers. So it’s a common procedure that I would say we see in all age groups, especially in young adults, in, you know, in the age range above 20. And it’s a satisfying procedure, if it’s done correctly, judiciously and safely, because sometimes you get almost like lip dysphoria, where you don’t know, the patient doesn’t know how much to augment and what looks natural and what doesn’t. So you just have to, as the practitioner, you just have to take it one step at a time and really, really go slowly, go conservatively, so you get an authentic, you know, kind of, you know, a result that people don’t know. That individual has had lip fillers. And over the past year, I would say, I’ve seen more people come back to erase the lip fillers than ever built before because they were overdone. They got duck lips, they got these weird look, and people are no longer looking at their eyes, and that’s the focus, right? When we do no surgery, when we do face surgery, when we do lip augmentation, we don’t want that area to be the area that the casual observer is looking at, right? We want them to look into their eyes. And so when the lips is the only thing that when you’re out on a date or you’re socializing, people are looking at that’s not a great look. So lip fillers just need to be done very, very judiciously.

Alison Werner 12:27
Is there a difference between a lip filler candidate or a patient at 20 versus 35, 40?

Dr Babak Azizzadeh 12:37
Yeah, I think the results, believe it or not, are better in a 20 year old because their lip volume, the elasticity of the lips, the mass of the lips, the muscles of the lips are firmer and have less looseness to it. So a little bit of filler can go a long way, whereas let’s kind of like really separate it out to someone who’s 60, right? They have a lot of atrophy. The elasticity is really poor. The lip have really kind of, you know, involuted. So the difference between a 20 and a 60 year old is tremendous and definitely more satisfying in a 20 year old than a 60 year old, because it’s really hard to get in a 60 year old, we have to go more towards lip lifts rather than surgical Yeah, so that we can kind of shorten the upper lip, naturally avert the lip so and there are some younger patients that we like doing lip lifts for as well. And some people don’t need lip fillers. They need lip lifts. But for the most part, the more with fillers in general, the better the tissue elasticity, the better the results, because the filler has a place where it can kind of expand itself, so you don’t need as much filler, and you could get a more natural result.

Alison Werner 14:02
What do you consider kind of best practice when it comes to lip fillers in a younger patient?

Dr Babak Azizzadeh 14:07
Yeah, I mean, start slow. Start very slow. Hyaluronic acids, obviously, I think that’s, you know, and everyone has their preference, you know, in terms of what hyaluronic acid gel to use, but go very, slow. And, you know, it’s hard to do that, right? Because people are busy, the patients are busy. You’re busy. You don’t want to put, like, point two CC’s a filler and have them come back in a week or two and use another syringe and so forth, so. But that is the best practice. The best practice is slow, steady, have them come back in a month or two, do more at that time, and that, I feel, is the best practice of getting the best results.

Alison Werner 14:50
When you have younger patients coming into your practice, what are some of the concerns or just issues that you think about with them compared to your older or middle aged patients?

Dr Babak Azizzadeh 15:00
Yeah. I mean, for the most part, younger patients just sticking to maybe fillers and other aesthetic enhancements, or even rhino they’re looking to do plastic surgery to look better. It’s more about the attractiveness factor. Whereas someone who’s in their 50s, they want to look more youthful. It’s two very different factors that you’re looking at. Of course, the 50 year old wants to look better too. Youthfulness and attractiveness go hand in hand and so forth. But the younger adult who is coming in, they’re looking to address flaws, address factors that hopefully they think are going to make them look more attractive. So it’s a little bit different, and it’s actually more difficult, right? Because attractiveness is so individualized, right? It’s in the eye of the beholder, and that’s why I’m, like, very trustworthy with younger adults, to kind of listen to them and tell, you know, like hear them out, because they kind of have their own esthetic eye that you have to work with sometimes. Obviously, you don’t want anyone to look unnatural, but I think you do have to listen. I mean, you listen to everybody but younger patients, they have their own like what they’re looking for, and sometimes you will be guided a little bit more by by the patient.

Alison Werner 16:32
Do you feel like social media has changed the way younger patients talk to you now?

Dr Babak Azizzadeh 16:38
1,000%. 10,000% Yeah. 1,000,000% Yeah, of course. I mean, look, social media has completely turned everything upside down in terms of, comparatively to 20 years ago. 20 years ago, young adults, younger patients, really didn’t know about any of these things other than, you know, rhinoplasty or something, you know, ear clipping or something like that. Now, I think, you know, plastic surgery is just people are bombarded by their, you know, by plastic surgery transformations, by social media influencers, by doctors. I think there’s a lot more information out there. Some good, some not so good. Sometimes overload, information overload, sometimes misinformation. So there is, the interest is tremendous. It’s like on a whole different level compared to 20 years ago. But young adults, they’re great consumers, because they actually just like, you know, 45 year old soccer mom, yeah, they’re great consumers. They’re coming in they they know kind of what they want, but just like anyone else, you gotta educate them, you know, educate them on what’s real, what’s not, you know, kind of more of a fad and so forth.

Alison Werner 18:02
Yeah, I would think that managing expectations are what is real, what’s right for them is a bigger conversation.

Dr Babak Azizzadeh 18:09
Yeah, but they’re very open minded. I think, I think they’re, you know, for the most part. I think when, when you explain why you want to do something or not to do something, I think they’re very open minded. They’re not going to be like, you don’t know, I’m going to go to someone else. I mean, for the most part.

Alison Werner 18:26
Well, what’s your overall kind of take on young girl, younger patients and plastic surgery?

Dr Babak Azizzadeh 18:33
Yeah. I mean, I think sometimes some plastic surgeons and aesthetic practitioners look at young adults or even teenagers as like, okay, maybe they’re not as they don’t understand what’s going on as much they don’t give them. But I think it’s a very, very educated consumer group, and I think they kind of know what they want. They will ask questions, they will do research. And overall, I think there, they have probably the highest rate of satisfaction out of almost any age group with procedures, as long as the procedures are done correctly and conservatively. So I love the age group. I think they’re phenomenal, phenomenal patients. And it’s actually really fun, because they get so excited they have a lot of interest in it. And it’s, it’s, it’s changed a lot over the past 10, 15 years.

Alison Werner 19:34
Well, Dr azizadeh, thank you so much for talking me today.

Dr Babak Azizzadeh 19:37
Thank you, Alison, and I appreciate your invitation again.

Alison Werner 19:40
as always. Thank you for joining us. Be sure to subscribe to the Plastic Surgery Practice podcast to keep up with the latest episodes, and be sure to check out plasticsurgerypractice.com to keep up with the latest industry news. Until next time, take care you.

Transcribed by https://otter.ai

– Hello and welcome back to the Plastic Surgery Practice Podcast. I’m Alison Werner.

– And I’m Keri Stephens, and we’re your hosts. Today we’re joined by Stuart Mohr, Vice President of Marketing and Clinical at Jan Marini Skin Research to talk about how to grow your practices, procedure, results, and ROI, by offering clinically-backed skincare. Stuart has been in the aesthetics industry for over 20 years, joining Jan Marini in 2010. Stuart, thanks for joining us today. Can you please just tell- Yeah, can you just give us a little bit about your background? 

– I’d be happy to. So, as you mentioned, I’ve been in the aesthetics industry for coming on 25 years now. I’ve been at Jan Marini Skin Research for about 15 of that prior. My background, while I’m VP of Marketing and Clinical now, my background is biomedical and electrical engineering. I designed lasers in ophthalmology and dermatology for about a decade before getting my MBA and moving to the marketing side, where I then worked for a laser company as well within marketing and came to Jan Marini Skin Research about 15 years ago. So, you know, the fun thing in that background is as a, I’ll call it an atypical background for marketing, is it’s given me a wide view of many of the services and procedures that are offered in the aesthetics industry. The aesthetics industry from a professional services side to the home care that you take home and use, to that the patient takes home and uses, to how those really fit together and what you should expect from the services that you perform, from the home care you perform, and how each fits into the business operations of a healthy practice.

– Okay, well great. So let’s get started. Med spas and aesthetic practices have grown significantly over the past couple years and are projected to continue to grow, offering services like laser procedures, peels, microneedling and more. So, where does professional skincare fit into these services in these locations?

– That’s a great question, and it’s one that has unfortunately a much more varied implementation in practice than it should have by what the patient is looking for. And what I mean by that, a lot of times in practices, I mean, let’s be frank, why does somebody come to a practice? They go for a service, that’s why you go see someone, right? You go to have injections, you go to have a laser procedure, you go to have a PLE. So they’re going for a service. But a critical part of the results that the office is delivering, piece of it is what you do in that service. How effectively you use it, what devices you’re using. The other part of it is what is the person doing every day at home and are they using things that you know and you’ve proven to deliver the results that you’re attempting to achieve? A lot of times offices don’t necessarily put that together. They say, I’m going to do this laser procedure, and, you know, you often hear the, if you wanna maintain these results, you could use this skincare. Well that doesn’t say get the results, that says maintain the results. Or they say, what are you using? If you want to use something I have, that also isn’t it. If you look at what the patient wants, and New Beauty Magazine actually did a survey of patients. They surveyed about 1500 patients. I forget the number exactly, but they surveyed them coming out of aesthetic services. Over 80% of them wanted to have product recommended to the patient to achieve the results that they’re looking for. Every patient who goes in and has an aesthetic service now is already using skincare. The question is, is that skincare delivering results for the concern that they have? The answer is probably not, or they wouldn’t be coming in specifically for that service. When those patients were serving, they said, how likely would you be to purchase product recommended by the office? 80% of them were likely to purchase the product recommended by the office. And they considered a recommendation by the office to be the number one influencer on whether they purchased something or not. Not their friends, not social media, not anything else. It was the office. But the reason they wanted it was for results. So when you’re looking at the, you know, the dichotomy that is this practice, they come for you for services, you should do the service, the services that are right for their procedure, of course. But you also should recommend the home care that they’re using every single day between those services to achieve superior results. And that’s the part that we’ve done multiple studies, and I can talk about those in a minute, but using effective product doesn’t just maintain the results. It doesn’t just have a revenue component. And it does, and we can talk about that too. But first and foremost, it delivers better results faster for faster patient set for greater patient satisfaction, faster results, and an immediate tie to your office, which is also recommendations and everything down the line. So when you don’t, if you don’t recommend product to a patient, you are missing part of what they’re looking for. It would be like going to your dentist and having your teeth cleaned and having the person say, oh, do you brush your teeth at home? Do you use a fluoride containing toothpaste? Oh, okay, well if you wanna maintain the results of what we clean today, you could use this thing. Of course, nobody would say that. What you do at home is part A, what you do in the office is part B. You cannot do in the office every day at home. You cannot do every day at home the service that you do in the office. But, you know, call it peanut butter and jelly, peanut butter sandwich alone, I admit, I like it. A jelly sandwich alone also good. But peanut butter and jelly is better and it’s more than either one of the two alone were. So when you’re looking at putting these together, one plus one equals three. One and one are great, but that combined is better, and that’s where an office has that ability to be the expert that selects the product that really delivers results, that’s proven to deliver results, and then integrates it into the service in pre-treatment, in immediate post-recovery, and in post-treatment, which is now into the infinite future to keep it into the infinite future, I almost had past, into the infinite future to maintain engagement with that patient over the entire lifetime value of that patient for their ultimate results with your practice over the years.

– Great, so what should plastic surgeons be looking at when they’re deciding on skincare lines to incorporate into their practices?

– That’s a great question. One of the things that I’ve heard from Jan, and Jan is the founder of our company, but, a comment that she said that rang amazingly true to me is nobody says, hey, I’ve got the fifth best solution out there. You know, I’m mediocre, but you should do business. Nobody says that. So of course an office is bombarded by everybody being the best, and everybody has the most amazing new ingredient that was, you know, grown in tropical jungles under a full moon. And it create like-

– Yeah.

– What’s the science that shows if something works? This is where my biomedical engineering background is where I look at something. Does it deliver results? So if we’re looking at our products for Jan Marini Skin Research, we have a hyperpigmentation product. That hyperpigmentation product is a non-hydroquinone product. It has a kitchen sink of solutions to solve hyperpigmentation or to address hyperpigmentation. But more important than that is hydroquinone works. People know that. So when we were looking at this product and we said we have a non-hydroquinone product that we wanna bring to market, the question is, does it perform at least as well as hydroquinone? Because if not, why should an office use it? So we have a published clinical study of a split phase study using our product on one side, using a 4% hydroquinone on the other side. And it outperformed the hydroquinone at all points in times in the study and was statistically equivalent, if not superior, to the hydroquinone. Now that’s why you should use a product. It’s because there’s true data, not a story of what a petri dish would do, not an in vitro study on an ingredient. Those are interesting, that’s why they put it in a product. But does it work with another ingredient? Does it negate the effects of another ingredient? Do they work? What is the final formulation, in final packaging, in final use on final patients? Does that deliver results? Now that’s a first hurdle, and I can share my screen and share studies that we have, but also you all can look at the studies that we have. The second part that you have to consider as a practice is what are you treating? I would love it. The world would love it if you could have one product, one technology that solves everything. Not only does it decrease hyperpigmentation and improve fine lines and wrinkles, and cure acne, and reduce rosacea, it also helps you lose 30 pounds. You keep your hair, every piece of, I mean, wouldn’t that be amazing? But that’s not reality.

– Yeah

– Reality is there are ingredients, there are ingredients that are compatible in formulation. There are ingredients that are incompatible in formulation but can independently be used on the face, they just can’t be formulated together, ’cause one breaks down the other. So what is the formulation and what are the ingredients in each of the individual products to address the concerns that your patients have? Now a company can have a solution for one. Okay, great, you have an anti-aging solution. What am I gonna do for my hyperpigmentation customers? What am I gonna do for my adult acne patients? What am I gonna do for my teen acne patients? And again, it’s acne, but what’s the market that they’re looking for? An adult acne patient probably wants acne and some fine lines and wrinkles and maybe some hyperpigmentation. What am I doing for rosacea or redness? What am I doing if the person just says, you know, I just have dry skin, I’d like something that’s more moisturizing. What are you doing as your sunscreens? What are you doing? So you have to look at a more complete picture of what is it you would like to address with the skin. And in reality in a typical practice, hyperpigmentation, acne, fine lines and wrinkles and rosacea are the big four, volume and laxity filling into that kind of the fine lines and wrinkles, but volume and laxity. And then skin types, there are oilier skins, there are drier skins. So do you have a couple of solutions that can address drier or oilier skin with technologies that were designed for that concern? So question we often get from offices, oh, what’s your story? What’s your ingredient? Oh my god, wouldn’t that be wonderful? Back to that miracle ingredient that does everything. I’d be skeptical of anything that claims that it does everything. If we are formulating a solution for acne and we have published study, we have studies for acne, it’s an acne solution and we’re looking at what addresses acne. If it’s hyperpigmentation, we’re looking at something for tyrosine inhibitors, for myogenesis, stimulating hormone, antagonists, all of that. If we’re looking for fine lines and wrinkles, it’s collagen elastin, do they cross over in places? Sure. But are you formulating for the end result that you want? If we’re looking at post-treatment, was it an ablative procedure or a non-ablative procedure? How compromised is the epidermis? How much transepidermal water loss do you have in that recovery period? Do you need a more occlusive solution? Do you need a more just generally hydrating solution? Because you don’t want a heavy, thick occlusive solution on a moderately compromising, say mid-level, fractional non-ablative procedure. But that solution for a fractional ablative procedure that’s more aggressive wouldn’t be remotely sufficient. So again, what are you looking at, and does a company have the ability to offer more of that breadth of solution for you so that you are not trying to pick 15 different companies with 15 different products? Putting on my business hat for a second, there is also a value in what you look and have in a practice. In marketing, there are studies at grocery stores where there’s everything under the sun. And they’ve done studies on jellies in an aisle, flavors of jelly. As more and more jellies and flavors were added, you got differential increases for a couple, at which point it started dropping off into less net sales even though there were more flavors. And what that does is it’s because the consumer doesn’t know anymore. If you have everything, you stand for nothing. If you have nothing, you have none of the results that you can deliver. So do you have solutions that have vetted solutions to them that have proven results, not just stories? And finally, a consumer, consumers are looking for brands they trust, from people they trust. The practice is the people they trust, then it’s from brands they trust. And so what you offer in your practice, if you have a Coca-Cola like beverage that’s not Coca-Cola, that is a dark brown beverage called a cola that you put a different name on, are people gonna be as interested in that or is it Coca-Cola? And if the brown beverage that you have is not Coca-Cola and somebody else has a different brown beverage, do you start getting tainted by the opinions of the other one that you didn’t like even though you don’t know this one. The brand, Coca-Cola, in this case, it’s the same quality everywhere, every time because their brand is also on the line. So there is a value in brand, but that brand you are recommending. So you are the expert as the business, as the practice, as the physician, as the esthetician in the office, as the nurse, you are the expert recommending a proven solution that you have vetted that is designed to solve the concern that the person has. So that’s how they, the three fit together from how do you practice and select.

– I was gonna ask you about profitability next, but before we go there, can you go back to, you talked about, you know, you have some of this clinical results and you have some photos, and I know that our listeners won’t be able to see them, but if you could kind of just talk through what they show and then we’ll also include a link to them in our show notes so they can find them there. But would you mind just kind of diving in a little bit into that?

– Yeah, I’d be happy to. Let me share my screen here and I can share a couple and then I’ll actually, I’ll also share a little bit about how they go together with services, because how they tie into your procedure is also an interesting one. So if we just look at, let me just share my entire screen.

– And just so our listeners know, if you wanna see the video of this podcast, it will be available on the Plastic Surgery Practice website. And also you’ll be able to find it on YouTube so you can see what Stuart’s about to show us. But he’ll talk through it as much as possible.

– Yeah, absolutely. So let me just jump to quickly, I’ll share, and do you all have my screen now?

– Yeah, yeah.

– Okay, so this is actually just our website. But if we’re looking at acne, what we’re talking about for home care results alone is before use, six months after use. So you’re looking, this is topical only. This is not any antibiotics or oral, anything else. Skin types, anything from darker skin to lighter skin. Similarly, if we’re looking at hyperpigmentation, we’ll give it one second to load, there we go. This is an example of topical only. This is no chemical peels, no laser procedures. This is just topical in two months. If we look down these for any number now, you add peel. This is the before, this is the after, this is chemical peels that we have in combination with home care for hyperpigmentation. Again, after, before. And this is just three months with a series of peels and products. But when we talk about, and so these are the results. To the studies, when you’re looking at studies, does a company have the studies that prove the data and the results of what you’re looking for? This is the split versus hyperpigmentation. This is actually product using 4% hydroquinone and product using ours. In the after, both sides are definitely better, but you could argue this side of the face is a little worse than this side, which makes sense. This is the driver’s side of the face in this particular patient. But in the after, if anything, this side is maybe the better of the two when you say what’s the degree of improvement? But again, this is the proof points, not just the before and after. And one thing I want to point out on before and afters, these aren’t a tiny little crop in on a tiny little piece of the face that is showing that, hey, this wrinkle right here or this wrinkle right around the eye got less ’cause I zoomed way in. You can look and tell that the face is in exactly the same position. It is exactly as relaxed. We show the entire full face and view to see that the person isn’t scrunching, isn’t doing. But we have the data that supports behind it. And this is across a whole host of different concerns and solutions, from acne, to wrinkles, to vitamin C in a split face versus a leading vitamin C, to redness, to hyperpigmentation, to anti-aging products, hand products, neck solutions and published studies. So when we’re looking at these, what are the studies that prove the efficacy to get that result? But let me jump over and and say here, if we are looking at results with devices, if somebody has rosacea, they come into your practice for a laser treatment, laser or broadband light IPL works as well. But in this one we looked at a study and we said, what if one arm of the study gets three laser treatments? And the reason for three laser treatments is most rosacea treatments, redness treatments are three to five treatments as you’re running through it. So we said what if arm one of the study gets three laser treatments, arm two of the study only gets two laser treatments. So the laser plus product arm of the study has to achieve equal results to three laser treatments, but it only gets two, but it gets home care. Well the interesting thing is normalized results in the two arms of the study. At baseline, this is where everybody started, right? This is the normalized baseline for everyone. After one laser treatment, the group that was receiving skincare at home in conjunction with their laser treatment outperformed the laser only arm. What’s interesting though is not only did they outperform it, the results after one laser treatment and skincare for that month was equal to the results of two laser treatments. But two laser treatments followed, this is measured at eight weeks. So laser treatment one, month post laser treatment, laser treatment two, one month post. One month post two laser treatments, the arm with home care was statistically significantly superior to the laser only arm that also received two treatments. Now at this point in the study, the laser only arm got a third laser treatment and they continued to improve. The laser plus skincare arm did not get a third treatment. They could have had a third treatment theoretically moving down like this. They didn’t get a third treatment, they just continued using the home care products and they continued to improve. Not at the same pace that they were when they were getting product and laser, ’cause of course, remember, peanut butter and jelly. But they continue to improve such that it was not statistically significantly superior to have two laser treatments and product versus three laser treatments, but it sure wasn’t inferior. So when you’re looking at this in the practice, what does that mean? It means that if you get the product that you’re doing your laser treatments and the person is using their home care, they’re getting better results faster in the services that you’re providing while simultaneously getting secondary benefits from those products on other things that they were also concerned with. ‘Cause what if rosacea was their number one but also fine lines and wrinkles, also texture, also pore size or some hyperpigmentation. You can help addressing that at home. And this is an example of somebody baseline to post in the arm beginning two treatments and home care. Now this one, I showed this picture before. We just completed a study and I have some of the preliminary data here, it will be published year, looking at IPL. Broadband light, in this case, BBL, used in conjunction with home care. The home care was used as a pre-treatment. So think about somebody coming into your practice, they come in for a consultation on day one. You say, you know what, yes we’re going to do, we’re gonna schedule you for a series of of IPL treatments. The first appointment we have available is in three and a half weeks, is in four weeks. It’s on this date. Person says, I’m not free that date, whatever. You lock in a date. This person at baseline is harder to treat with IPL, there’s more actinic bronzing, there’s more epidermal damage visible. You have to be a little lighter on your IPL ’cause you don’t want patterns where you miss areas, et cetera. At two months here, this is way easier to treat. Do you treat more aggressively to get these higher contrast lentigines? Absolutely. But what the topical product gets is everything uniformly and the superficial things the easiest, which is often lighter contrast. The higher contrast ones that are deeper, those devices do those best. What if you had hit this with a device, hit this with a device. So when you combine the two of those, this is looking at somebody, our product, Jan Marini Skin Research, JMSR, plus the BBL, versus the BBL alone. So at baseline the person started skincare. They didn’t get an IPL treatment, they didn’t get anything. They came in at one month. So they had their baseline, and here was their result pre their BBL treatment. It gets, it occurs on this date. The group that got skincare, here’s the patient perceived improvement in texture. They were measured at both times. This group’s already significantly improved. This group hasn’t had anything yet. Who’s talking about their doctor? This group. Now after a BBL procedure, still better after two, still better. If we look at discoloration, better, better and better. And actually statistically significantly better at all points along this. This is by physician assessment in discoloration. If we’re looking at improvement in wrinkles, better. At overall improvement with pre-treatment, this is physician assessment looking at wrinkles, at texture, at discoloration, better. So at all points the person had better results. And this is a study we did with Dr. Ibrahim. This is an example of a patient baseline to post with the product. Another baseline to post with the product. So when we’re talking about how the products go together, and how the results do, and how do you select a company that delivers results that has the proven results to do it, and then talks about how do those tie into the implementation in your practice, that’s how you put it together. The last thing in that, and then I would like to talk about the business side of it, ’cause I think that’s one that’s often missed.

– Actually, I wanna segue kind of into that, but yeah, go ahead.

– Yeah, let me share one final piece in, how does a company help you? How do you work with a company? Do you know exactly which product to recommend every time? Does your staff know exactly which product to recommend every time? How do you pick which that product is? How do you pick what goes together? The company can help you with that as well. And so if I, again, show this, this is an example that we have, where this is a book that our customers have access to simple questions, and you can offer the patient a good, a better or a best solution. Let’s say hyperpigmentation was their number one concern, then this is the product we recommend is good. There’s a vitamin C and a sunscreen that ties with this for better or best. And here’s an example of a before and after and a before and after. If hyperpigmentation was their concern, here’s what we recommend, here’s better, here’s best and a solution. If acne was their concern, here’s your recommendation. If volume and laxity was your concern, here’s your recommendation. If redness was your concern. So the idea is you can make it really simple to direct the office quickly to solutions that are for them, that anyone in the office, your front desk staff, the esthetician in the room can do more of an assessment. The nurse who was doing injections can easily have an assessment. The services that you offer in your practice can tie in immediately and easily with tools and assets that the company can help you with as well.

– Well, okay, so now that we’ve covered the difference that home care with professional skincare can make in, you know, prepping the skin, results, and then recovery and maintaining, you started to talk there a little bit about the benefits in terms of profitability for the practice. Can you elaborate on that?

– Yes. So again, let me share screen here because easier to show this one on a slide. So if we think of an example, and this the BBL example that I showed from our study. If you’re thinking about an office, and please understand every single person who is looking at this, your numbers are gonna be your own numbers. These are broad, but the concept is what I’d like you to walk away with and think about your own practice’s numbers. But in general, you have something that you charge for that procedure. And let’s say you charge four to $500 for a service. Within that service, you’re going to have costs because you’ve got a 45 minute room booking with staff doing that, so you’ve the staff, you may have device payments, you have overhead on the office space, everything that’s in there, let’s just say that’s around 250 to 350 of the cost of your service, and this is 400 to 500. So you’re going to have somewhere around $200 of profit that comes from that service that goes to the business that you then turn back into everything else you need in your business. But that’s the direct line that drops out. And so in three to five treatments, say an average of four, it’s about $800 of the 2K that was revenue. When you add skincare in, if you add skincare that was recommended, right, in that same study, it’s $400 retail. The cost to you wholesale is half of that. So your cost is 200, which means there’s 200 in revenue. But remember, this was with this service, this is what we recommend. There’s no added room time, there’s no added staff time, there’s no added overhead time when you are adding it to the treatment that you’re doing. And understand, this could be any number of treatments. This isn’t just for a pulse light, this is your fractional non-ablative, this is your fractional ablative. This is chemical peels, this is facials you may be doing, this is injectables. Everything that you’re doing in your practice, if it’s cosmetic and it’s tied to one of these concerns, in just minutes, you can make the recommendation for what skincare ties to that. Well that means that’s 200 to profit, and the person buys four to five times per year. Which if you said four and a half, that’s $900 of profit. You just doubled the profitability per hour of your practice. So adding JMSR to your office services, you increase the results. So you saw that. Increasing the results increases patient satisfaction. They are looking for results. That’s what they’re coming to you for. They’re not coming to you to save money, they’re not coming to you to waste money. They’re coming to you for results. So if you increase their results with a solution that delivers, that’s a satisfied patient. And again, all sorts of data is out there that shows that patients who are using services and home care and getting better results are your stickier patients, stay with you longer. They make more recommendations. It extends their results. They’re continuing to use it over time. So it enhances them and extends them. You can double your profitability per hour in cases. Now if this was a fractional ablative, your service procedure costs, prices are significantly higher, but you’re still adding a thousand dollars annual of revenue, of profit, sorry, not revenue, of profit. Double that for revenue. With every patient with zero added minutes and they’re getting better results tied in. So you can significantly enhance, and in this example, double your profit per room hour in your practice with greater satisfaction and greater results, which is greater referrals, which is new patients like the patients that you just treated. And everybody wants patients like their best patients. Your patients’ friends are your best patients. And these are the recommendations that they’re going to make because they’re getting the results while your office is enhancing the revenue that you are making per hour by doing something that delivers superior results and satisfaction to the patient. So you’re doing what they want for them, and the practice benefits from it as well.

– So I wanna get more into the patient relationship side. I like that. So how does integrating professional skincare into recommendations affect the longevity of patient’s relationship with the plastic surgery practice?

– Yeah, that’s a great question, and one that I think is sometimes thought about, sometimes not. If we’re talking about a plastic surgery practice, and let’s just say two services, and I know there are many of them, but let’s talk about two services, injectables and surgery. Your injectable patient comes back maybe once a year, plus or minus. About once a year they’re coming in for their injection. What are they doing for all of the other things that they might do for services in the course of the year? Are they going to you and thinking about you if they’re getting a facial, if they’re getting, if they’re going to the store and looking for something for hyperpigmentation, did they even know that you had a laser device to do that hyperpigmentation treatment, or did they just know you for the injectable that they did? So when you tie them into delivering more results for their concerns, you open up the door to a ton of what your office is now offering. And this is a data piece I received from a partner that we work with that has video in office for practices. But they were saying the data show that the predominance of patients are unaware of 80% of the services you offer in your practice.

– Wow.

– Think about that. All of these things that you offer, most of your patients don’t know, even though you told them. And I know you tell them, but did it sink in at the time they were concerned? The more things you engage them with, they’ve now done their injectable and their home care for their wrinkles, which helped them with their hyperpigmentation. And they did remember, they were saying they wanted to address their wrinkles, but also this hyperpigmentation, and you recommended this product, but that you also had this other service. Well now they come back in three months later ’cause they decided to do that service. But they’ve been engaging with you and they came back in to get the next round of product as well, or to follow up and talk with the person about optimizing something that they wanted. If you jump to the surgery example, they don’t come in every year. They come in far less frequently than that because it’s a phenomenal procedure. But you don’t have that every year. What if your home care is tied into that and is the thing that engages them with your office? Even if they buy it through your website, if they buy it and we have an e-commerce solution that helps the patient buy it from our website while giving you the profit. But even if they buy it from our website, knowing that you are the one that connected them to it, there’s a reminder of you and things that you were recommending, and outreaches that you may have tie that much more in. So you’re engaging, the more you engage a patient with solutions that you have that deliver results, the more tied to your practice and more valuable your practice becomes to the patient, and the larger the customer lifetime value is that you receive per patient. And when you look at it from a business perspective, there is a cost of acquisition of every new patient. You don’t wanna be constantly finding new patients. What you wanna do is maximize and optimize the value of every person that you engage with so that you maximize the customer lifetime value, both to them in what you offer and from them in what your practice gains.

– Okay, so I get that someone can purchase these skincare products in office, but what happens when they run out? How does Jan Marini Skin Research help plastic surgery practices continue to engage with their customers?

– Yes, so people buy product four to five times a year. That’s about the number of purchases per year. And use myself as an example, I have a full-time job. I have three kids, I coach multiple soccer teams. I’m not driving across town to go get something in the middle of the day, right? I’m lucky to get lunch in the middle of the day. So what do they do when they run out of product? Sometimes they do have time, that goes across town, that comes to you. Sometimes they go for that other service that they booked and they set aside and they planned it. But people have busy schedules. They run out of product tonight. Oh, that was the last one. Oh my god, I’ve been meaning to, I knew I was running dry. I just scraped the last remnants out of this.

– Yeah.

– How do I get it? If you have an e-commerce solution of your own, on your own website, on your own thing, great. More power to you, it’s a lot of work. You have to keep your website, keep it up to date. You’re shipping things in and out. How are you doing your inventory fulfillment, all of that. That works for a lot, for some practices. It doesn’t work for some practices. We work with you either way. So if you have your own business, and your own e-commerce with your own sales for the person to deliver it and get it delivered to their house in two days. By the way, today’s consumer, Amazon has wonderfully spoiled all of us. If I could have a show of hands from people in the audience, I know I just have the two of you, but if I ask every one of you who may have watched this now or into the future, if you say will come to you in a week or seven to 10 days, you’re like, hmm.

– No, one day, two days, max.

– Right, two days. You want something now. That’s what the consumer today expects. So if you’re delivering that, great. Alternately, every single customer of ours has a unique ID that we give you a link that if you put on your website, if you put on an email, if you put on your social posts, when a consumer clicks on that link and comes to our website, we know they came from you. We ask them to create an account so that you get credit for every purchase of theirs. As soon as that patient creates an account, your record is permanently tied to their account. So from that point forward, if they visit you and follow your link and come to us, great. If they just straight come to us, great. No matter how they end up buying from us, we know that they’re your patient and you get the profit from the sale as the practice. So that gets funneled right back into your business, less a shipping cost, that we directly inventory, we fulfill, we ship, and the patient receives it typically in two days from order for most of the country. Three days for a random, you know, far outside place. But the patient receives the product in one to three days from order, which is precisely what they expect with e-commerce that you don’t have to maintain and run, but every patient automatically gets that. And if we market to them because we have a new product launch, because this product goes well with that product, you get the profit on it. So we end up becoming an accessory to your business to help market to those patients to drive profit to your practice.

– Well, we have to end there. Stuart, thank you for taking the time to break down the impact that skincare products could have on the practice, both in terms of procedure results, patient engagement, and profitability. And thanks for talking about how doctors should evaluate skincare brands and what they should be looking for. Thank you again, take care.

– Thank you very much.

Alison Werner 0:10
Hello and welcome to the plastic surgery practice podcast. I’m your host Alison Werner. In our continuing series looking at retail skincare products you can incorporate into your plastic surgery practice. My co host Keri Stephens and I look at Defenage a beauty brand that offers a range of anti aging skincare products that incorporate defensins a patent pending technology that is exclusive to the company’s products. And joining us to learn more about this product in this episode is Dr. Gregory Keller, a Board Certified facial plastic surgeon who has offices in Beverly Hills in Santa Barbara, California. Dr. Keller is a full clinical professor at UCLA, where he is also the co director of the facial plastic surgery fellowship and on the medical staff. Here’s our conversation. Dr. Keller, thank you for joining us.

Dr Gregory Keller 0:50
It’s my pleasure. Thank you for inviting me.

Alison Werner 0:53
Great. Well, to get started, can you tell us about your focus in facial plastic surgery and about your work at UCLA?

Dr Gregory Keller 0:59
Yes, my primary facial plastic surgery practice is in facial rejuvenation. And I have been doing this exclusively for some years. As you mentioned, essentially, I’m a clinical professor there on on staff still and run the facial plastic surgery fellowship at UCLA. My work has been primarily in working with stem cell technologies. For one thing, we used to have labs at UCLA to do this and also in developing Facial Plastic procedures. We were one of the early people in endoscopic facial plastic surgery.

Alison Werner 1:37
So as I mentioned, you’re in private practice as well. But what are the key trends or demographics you’re seeing amongst your patients?

Dr Gregory Keller 1:45
Well, it’s very interesting. I’m seeing in addition to the usual facial plastic surgery, rejuvenation, practice, I’m seeing older and younger people as well. And all of these people want to change, they want to change in their skin. They want to restoration, some things and the younger people want to prevent problems that they see occurring to people older than them.

Keri Stephens 2:09
When it comes to talking to patients about their skincare routines. What does that conversation look like?

Dr Gregory Keller 2:15
Well, basically, they want to know that they’ve gotten more technical, because the web is out there and they’ve researched a lot of things. So they want to want to know what we’re doing and how we’re doing it. And what’s unique about products that that do this particular work. We’ve had retinols for many years that stimulate the basal cell, which is a stem cell that grows older with you, and undergoes maturation, and mutations can form skin cancer. So they’re looking at other things, what’s out there that can really make a difference for them reliably without too much inflammation or problems.

Alison Werner 2:51
You offer Defenage products in your practice and your practice centers, what role does retail skincare play in your business,

Dr Gregory Keller 2:59
it has a lot of role in my practice, actually, one of the things that we’ve wanted to do is retain patients and to do that, we have to give them a service that really makes sense to them. And that they come back for over several times. So we do offer medi spa type of services. And in addition to those skincare products are really natural, and also things that help healing and things that we can do preoperatively to them to help healing and postoperatively to them to encourage healing to occur. It’s unique, not too complicated, and also doesn’t involve a lot of what we call SKU numbers, we don’t want to sell a lot of different products for very little profit, what we’d like to do is give someone an overall skincare type of solution that will help them preoperatively, postoperatively, pre laser work, pre non-invasive work and just help them alone with a high incidence of satisfaction. So we have a significant skincare sales that keeps multiplying. The thing about skincare is if someone’s really happy with their skincare, and keep reordering that it’s a geometric increase. Because if they tell somebody and we get a new patient, we still retain the old patient ordering things. So it’s a geometric effect on our practice.

Alison Werner 4:25
Building out on what you just said, How long have you been? How long has retail been in your practice? And have you seen a shift in recent years? Because there’s a lot of talk about how people are spending a lot more on skincare after the pandemic. Have you seen a shift in your practice in the last few years.

Dr Gregory Keller 4:40
We’ve been doing retail for some time. And what we’re finding is that people since the pandemic really picked it up because now they’re looking at themselves in zoom such as we’re looking at ourselves while doing this podcast and picking ourselves apart. So definitely skincare sales have gone up. We’ve also wanted to simplify that because people get all over the place. We’d like to have a product that people keep ordering two thirds of the time.

Alison Werner 5:09
So that kind of ties into my next question, which is kind of what is your decision making process when deciding on what products to offer in your office? And you said there, you’re looking for those products that people are going to repeat buy? But is there anything else that goes into your decision making? When you’re What are you looking at in terms of the products? Then what are you looking at in terms of like company support or that relationship?

Dr Gregory Keller 5:28
Well, that’s a good question. You know, one of the things that we’re looking to do is simplify. Most plastic and facial plastic surgeons don’t want to sell 50 products for $5 profit apiece, what we’d like to do is find something that reliably reliably works for people and that they can simply use and that we’re sure will work in a unique type of way. So that’s why I choose to use primarily Defenage, we do have another sunscreen type of product that we use. But Defenage really can answer most of the questions because it has some unique scientific technology that specifically influences the skin, the pores, the pigmentation, the skin tension, wrinkles, and most of all, healing. Defenage is your natural way of healing, when we can use that pre-, post-op. And for skincare maintenance, we have one set of products not too complex that we can sell as a unit. And for the practice, it’s great, because we’re not selling a million different products for $5. We’re selling one product that just that the profit on which justifies the staffs time and explaining everything.

Keri Stephens 6:44
Right. So as a clinical professor, can you explain with the defensins molecules are and how they work?

Dr Gregory Keller 6:51
Yeah, defensins are actually a peptide that has a unique type of use. Defensins stimulate our what’s called our LGR6 stem cell which is at the top of the hair bones, so we can get it to penetrate the skin deeply enough to stimulate that. If you have a burn, most products stimulate the basal cell, and that’s between the epidermis and dermis. So that those cells grow old with us, they mature, they can mutate and form skin cancers. So we want we want to establish cells that can regenerate our skin, start new keratinocytes forming, and the way that naturally happens is that when we cut ourselves or injure ourselves, burn ourselves for instance, then what happens is that defensives are secreted by neutrophils, and these defenses stimulate the LTR6 stem cell, which is a stem cell that’s gone into hibernation after it forms all of our skin, when it goes into hibernation. It stays young, essentially. So when it’s brought out and stimulated by the defensins, since it forms new basal cells that can form new young skin. So really what we’re doing is youthening the skin in a natural healing matter. It’s a unique peptide that has a single use. So we’re not worried about cancer formation or other bad side effects. It also does it without inflammation. So your skin isn’t getting red and irritated like it can with other products. If there’s any irritation, it’s just your new skin turning over quick enough very quickly.

Alison Werner 8:31
So there have been a number of clinical studies looking at Defenage products, and they’re defensins. What findings stand out to you?

Dr Gregory Keller 8:40
Well, I think the one that was most interesting, and it was the first one ever to do a double blind, randomized clinical trial, and look at everything, pore size, skin tension in an objective 3d manner with a quantified care setup, so that you can actually see the difference. And it’s a very impressive type of article that clearly showed all of the benefits of defensins that really don’t occur with anything else. So I think that article is the single most impressive one. There are other articles that I also find interesting, such as the ones that show micro needling, putting Defenage on right afterwards and seeing the incredible results that you get with just plain micro needling and defensins, which testifies to the healing properties that it has. There are other studies but those two I find most impressive.

Alison Werner 9:34
You’ve talked about what defensins do now when you put them in incorporate them into the skincare product formulations for Defenage, what can users expect or what even you know, what do plastic surgeons need to know about what those formulations can do?

Dr Gregory Keller 9:49
Well basically what defensins The other thing I like about defensins is patients can see a result very quickly if they use the first thing that I usually put people on the first thing they’re usually interested in is the product of the face and I’m a facial plastic surgeon. So that’s what I see even though there are uses for the body and the hands and the eyes and everything else my most and hair, I also do hair, but usually we start people on products for the face. And when we do that, what we use is a scrub that has a sugar scrub in it, that makes a difference in sets the skin up, and then there’s a serum that helps actually there’s a cream that we use next, which actually helps the serum which has a higher amount of defensins than a cream and usually what we see is that within a week, people start to see a difference. And by six weeks, they see a real difference in their skin that pigmentation gets better, the pores get better, the skin gets more tension. And for physicians, Defenage has a different pro-line that actually is more effective than the regular defensins are. So most people will switch onto that even after buying Defenage maybe online or something like that, they’ll start to ask their physician and he can tell them that they have a pro-line, that works better. And with the pro-line, we really five or six weeks they really have a definite change to the skin particularly. I’m in California and so we have a lot of sun damage people you know of all ethnic backgrounds, we’re very diverse. And it causes that without any inflammation which is very important for people because we don’t want to do we don’t want people to get reactive hyperpigmentation and such. And the defensins actually diminish that pigmentation, those age spots the sunspots, wrinkles, pores and such.

Keri Stephens 11:45
So when we talk about anti aging products, what are some of the user concerns Defenage products can tackle?

Dr Gregory Keller 11:52
Well, basically again, I think the most common thing in my practice is sun damage and just plain aging wrinkles, brown spots, you know coarse skin, they’re not retaining water and it’s drying out transepidermal water loss moisturization so what we want to do is turn over the skin and the epidermis quickly and thicken it so that their skin looks better and younger people with poor skin often look tired to add and that type of thing. So definitely just really can make a difference.

Keri Stephens 12:23
So I want to get into get into the Defenage pro-line. What are your go to products that you typically recommend to patients

Dr Gregory Keller 12:29
Basically, the trio kit is what I start out with particularly preoperatively. I want their skin to heal wall and react. Well. defensins oddly enough are used for for burns in Europe. An interesting point, if you have a sunburn and put the serum on, your sunburn will go away very quickly. So that’s sort of fascinating if you’re in Hawaii or somewhere like that, Florida. So those are the go to products is the trio kit. A lot of women like the neck cream, because necks often sag. And that’s definitely a favorite. The eye cream really can moisturize and make the eyes look good and it feels good as well. Again, I’m a facial plastic surgeon, body cream is great. I have people who almost bathe their bodies. But I’d say that for me as the facial plastic surgeon, the trio would be the go to.

Alison Werner 13:19
And that’s the that’s the pro-line correct was that the consumer line?

Dr Gregory Keller 13:22
The pro-line, yes. Most of the often the consumer line is great. And there’s a lot of publicity out about that and in a way that drives people into the office to ask their doctors this stuff any good. And interestingly, on the consumer line, they found that there’s a 66% reorder rate which is amazing for skincare products in that the normal reorder rates 14 or 15%. So the pro-line has a higher and higher concentration of defensins in it. And that that really helps it to work work a little bit better. And most of my patients have switched over to the pro-line

Keri Stephens 13:59
Defenage has recently released its 150k hair follicles serum, which also incorporates these age repair defensins and also a skincare line for men. Can you talk about these products bring to the table.

Dr Gregory Keller 14:13
It’s interesting, and that’s based on a 2013 study that studied burns basically. And they did a double blind study where they applied off defensins to people with burns and did used so you know, a sulfa cream for the other ones, the standard treatment. And they found that not only did the skin get better, and grow better with the defensins, but hair also grew back on the people that were used in defensins. And they assumed that that was a WNT1 pathway that did that. And they did some RNA messenger RNA work, which was fascinating. But the very fact that the hair grew back was quite interesting. So that was sort of the basis for getting involved with the hair, hair work. And people that followed with a study by an independent lab, it’s entirely independent to look at, because hair goes through several cycles, anagen and telogen. And as as we get older if we’ve had thyroid problems, if we’ve reached menopause, if we just have the genetic tendency, we start to get thinning women particularly get thinning first, down the part line Ludwigs, one, two, and three are well known. So they did studies with hair pulls and biopsies. And you can tell if a hair is in the telogen stage, which is the resting stage, or the anagen stage, which is the active growth stage, people who have hair that stays in the anagen phase longer, the hair gets longer as time goes on. And it’s growing. So people with hair down to their knees have what’s called an angora disorder, like an angora sheep, it just stays an anagen. But if your hair is in telogen, like many women around menopause, then you know, your hair will fall out before it can really get long and thick. It’ll stay a sapling rather than a tree type of thing. So what they found was that Defenage reversed that tendency. And rather than 80% of the hairs in sort of a telogen, makeup, and 20%, anagen that reversed to 80% and anagen and 20% telogen. So that was good news. So people have done done very well with it, there are a couple ongoing studies with it that so far, so good. Most of the patients that I treat, are happy with it.

Alison Werner 16:45
Keri also asked about the product line for men, how how much of a proportion of men are in your practice. And you know, what do you think about that line?

Dr Gregory Keller 16:56
Well, I also do hair, so probably 30% of my practices men, they’ve been very happy with the product line, the ones that aren’t candidates for hair transplantation or don’t want to do it but still experiencing thinning hair will use that often needling and platelet rich plasma. And they seem as happy with the product is with the platelet rich plasma. But we’re still doing both to try and encourage hair growth both in men and women. And so it’s sort of a program that we do that with where we use of course all all of the usual things red light, propecia, if people will take it, the hard thing is getting guys to take them propecia you know in the many other medical kinds of treatments. But you know, the PRP has a lot of articles for it. And we’re finding just about as good a result with the hair product, which seems to be more the problem with a PRP as it takes painful injections, or painful micro needling. So people are much more accepting it first of the Defenage treatment.

Alison Werner 17:58
And then Defenage released a skincare line for men. Do you find that that’s resonating with some of your clients?

Dr Gregory Keller 18:08
I do. And as a matter of fact, my wife uses the women’s and doesn’t like the men and I like the men’s cream and don’t like the women’s. The men’s cream is a little thicker, and is more geared for male skin penetrates in a different manner. So it’s so that that may be testimony to it. So usually, if a man wants it will give him the men’s cream and the women. Likewise, the ladies cream.

Alison Werner 18:36
So we talked a little bit before about how consumer spending for skincare has definitely increased in recent years, especially with the pandemic. What does it mean to you as a business owner to capture some of that market and how patients buy their products through your practice?

Dr Gregory Keller 18:48
Well, again, if it’s just keeping contact with your patient and fulfilling their needs, and that’s the principle, essentially, we’re small businesses and sometimes even large businesses. But basically what you want to do is, is to have contact with that patient. And if you can do some good for them with their skin. Often, they’ll ask you about other things about your laser or your micro needling with radiofrequency or your micro needling or your facials. So it’s part of the overall picture that keeps that patient attached to you. And it does that without being too complicated when SKU numbers are numbers of products that you have to keep track of and all of that for my you know I’m in solo practice for me that’s really a pain in the tail. So it’s a simple method, we know we make a good profit for each set of products that we sell, we don’t have to sell 50 little SKU numbers, and the patients are happy as I say two thirds reorder almost. So that patient is coming in and out to either visit our practice or contact us about purchase. And when they do that out, they often ask other questions about other procedures and products and even surgery for that matter.

Keri Stephens 20:05
As a final question, we want to know, what excites you most for the future of facial plastic surgery?

Dr Gregory Keller 20:14
You know, a, there’s so much I need to say there is one thing unique about Defenage in that they do have a pro-line, that’s unique. So unlike some of the products, you can’t go online and order it, buy it first and then order it somewhere else. So it does keep patients within your practice. What excites me, a lot excites me. And you know, a lot of it, there are things in surgery that aren’t discovered and looked at even some of the anatomy parts that are only recently been looked at, we published one on a fascia that hadn’t been identified, you know, in conjunction with an international group, based in Italy, Cara Armadale, a plastic surgeon, in fact, and so there, there are lots of little things, even in our own field that are sitting right in front of us, you know, is for ptosis and Mueller rectomy better or a direct approach, because a lot of this has been each person’s experience. And I’ve really looked at studying, what really excites me are the advances in stem cell work. Exosomes, as you know, are one thing out there. There also have been very negative effects from them, and result in FDA black box ruling. So if you’re prescribing exosomes, and you tell your your malpractice insurance company about it, that your insurance will go up 10 times, almost guaranteed because it’s absolutely forbidden by the FDA. And a lot of places say that the exosomes are okay, and they don’t need FDA certification. That’s not true. The FDA has got definite statements about that. So, so I’m excited about all of the products, you know, and what what stem cells can do. I’ve been I’ve had stem cell labs for 22 years, started at UCLA, where we worked with fibroblasts and a few other simple things, and then graduated made liver cells and everything else. But you know, it’s just not there yet. The the Russian experience was pretty bad, and that stem cells injected into the vein, actually cause almost an 18 increase incidence of glioblastoma. So we have to know where we’re going with that and how to turn the switches on and off. And that really isn’t defined yet. So, but the prospect of it really excites me. CRISPR excites me a lot of those things that may happen in Japan or somewhere like that first, but those things excite me a lot. So that gamut goes from the day to day stuff that we do to what’s out there in the future.

Keri Stephens 22:54
As always, thank you for joining us and be sure to subscribe the plastic surgery practice podcast to keep up with the latest episodes. And also please check out plasticsurgerypractice.com for the latest industry news. Until next time, take care.

Alison Werner 0:10
Hello, this is the plastic surgery practice podcast. I’m your host Alison Werner. For this episode we have with us Dr. Sal Pacella, a Board Certified Plastic Surgeon and private practice in the La Jolla and San Diego area. He’s here to talk about Fresh Start surgical gifts, a San Diego based national nonprofit that delivers reconstructive and plastic surgery to disadvantaged pediatric patients with physical and cosmetic deformities at no cost to patients or their families. Dr. Pacella. Thanks for joining me today.

Dr Sal Pacella 0:35
My pleasure. Thanks for having me.

Alison Werner 0:36
So before we dive in to talk about fresh start, can you tell our listeners about you and kind of where you are in your practice? Sure, absolutely.

Dr Sal Pacella 0:43
So I’m originally from New York State and I trained. I did my plastic surgery residency at the University of Michigan. And shortly after that I did a couple of fellowships one in cosmetic breast surgery in Los Angeles and another one in Atlanta. I moved to San Diego in 2008. I’m now the division head of Plastic Surgery at Scripps hospitals, one of the biggest health systems in Southern California and my practice is a large amount of facial surgery, probably about half reconstructive and half cosmetic surgery. So the nice thing about kind of where we are in, in San Diego, it’s very centrally located. We take care of a lot of patients from all over the southwest, Las Vegas, Los Angeles, etc. And we take care of international patients from Mexico as well. So it’s kind of a unique place to be from the standpoint of how we do our philanthropy.

Alison Werner 1:42
Now we’re here to talk about freshstart surgical gifts and as I said, they’re organised a nonprofit that delivers reconstructive and plastic surgeons, disadvantaged pediatric patients. Now recently, they collaborated with University Health San Antonio for its inaugural surgery weekend, which saw world renowned surgeons donate their time and expertise to provide medical care to for children. Can you talk about what fresh start is exactly, and what your role with the organization is?

Dr Sal Pacella 2:10
So I think it’s helpful to understand a little bit about the history of fresh start and how it started. So it’s actually a grassroots charity that started in Encinitas, California, just one of the coastal towns here in San Diego, was started by a cranial facial surgeon, pediatric plastic surgeon named Dr. Dennis Nigro. And he used to go across the border in Tijuana and donate his services in his time for children. And then I think he, he slowly realized that he could bring a lot to to the country by operating on kids in country, but could do a tremendous amount more if he sponsored those children to come to the US and do their surgery and recover here while they have access to world class care. So the organization grew from just a surgery organization that was done in the office operating room to one that’s now done in a major pediatric hospital in the southwest Rady Children’s Hospital and through a large clinic. So we had been operating fresh star for many, many years, just solely out of San Diego. And we quick quickly realized that the model of this organization is really transferable to too many cities. So San Antonio is actually our third location. We have a satellite location in Chicago on the south side of Chicago that treats patients internationally that that may have deformities that are not covered. And we also treat children that are that are domestic children that may be underinsured for things like ear surgery or lip surgery or things that have congenital deformities that may be insurance may not cover. San Antonio is a similar model, obviously with volunteer surgeons that donate their time and the operating rooms donate their time and resources, and it’s really got a global influence across across the world.

Alison Werner 4:07
Well, you’re a member of the volunteer surgical team. Can you talk about what that involvement looks like?

Dr Sal Pacella 4:13
Sure, sure. So in San Diego, there’s probably a core group of six to seven surgeons all have different sub specialties that assist with what we call surgery weekend. So I am a plastic surgeon by training I have a special interest in ocular plastic surgery or eyelid reconstruction. So I tend to do a lot of the surgeries that involve reconstruction in and around the eyelid orbit. I work with a pediatric ophthalmologist Dr. Greg Ostrow who’s one of our directors as well. And we may collaborate with cases for children there is we have a sub specialist who concentrates on ears we have another sub specialist who may concentrate on breast surgery. So among all of our specialists, we’re really able to offer the entire gamut of plastic surgery from a reconstructive standpoint. So getting back to the surgery weekend, so the way the organization is structured, so we have one of the surgery weekends every six to eight weeks or so. And what that entails is, prior to the weekend, several weeks before, we have a meeting called the MediCal program committee meeting where all of our surgeons get together. And we talk about potential prospective patients. So we have a big outreach community program, where patients from all over the world comply, their applications are translated for our group in English, they’ll send in photographs will send in images, they’ll send in any radiology and medical program committee will decide whether or not they’re appropriate candidate for surgery. So from there, if they’re accepted into the program, there’ll be sponsored, to travel to the US there’ll be sponsored with transportation and, and have their surgery here and recovery here. And when it’s safe to head back to their home country or home city, they do so without any risk.

Alison Werner 6:03
What types of cases have you worked on that have really stood out to you personally,

Dr Sal Pacella 6:07
so quite a few throughout the year. So I mean, the the stories and the difficulties of some of these children really kind of, kind of stand out at you. So early on in my career with fresh start, I took care of a young girl from Ukraine who was born with a congenital eyelid deformity where her eyelids did not close all the way. And you can imagine, you know, the ridicule and the ostracization that would occur for somebody like that through their teenage years. So we helped put her eyelids back together to raise lid positions, so that, you know, there’s a level of normality for her to get back into life. And she had her surgery here and went back. One of our star patients in the Fresh Start surgical groups. Fresh Start surgical gifts program is, is a gentleman by the name of Beloved. He’s a gentleman from Africa, who, unfortunately, as a young child, picked up a landmine. And this exploded in his face just a tragic, horrific accident. He was originally cared for in country and then basically transferred to the US for his acute care. Several years after this, he approached our organization when he was about I think, 13 years old, to undergo the the end stages of reconstructive jaw surgery, dental implants, etc. So he’s, he’s a gentleman I’ve personally operated on probably about 10 times throughout the years. And he’s a shining example of, of just what hard work and, and dedication will do. So he has since moved to the United States, he has gotten a college degree, he’s actively pursuing his citizenship to the United States. And he married a young gal and has a baby on the way. So really fantastic story.

Alison Werner 7:57
For those who are interested in getting involved. What are you guys looking for in terms of volunteers? And what does it take to get started on getting involved?

Dr Sal Pacella 8:06
Great question. And I would say that our volunteer group is not limited to just doctors, nurses, and medical personnel. So if you’re a medical personnel, we’re always in need of volunteer surgeons, volunteer nurses to not only work the operating rooms, but work the clinics, if you’re a surgical tech or medical assistant, there’s a huge need for that as well to get the rooms prepped and the instruments handled, etc. But if you’re a non medical personnel, we have just as unique of a need. We’re always in need of clerical support for patients to coordinate their trips back and forth. We’re always in need of folks to support the surgery weekend, our volunteers, you know, we’d like to feed them and treat them well. So they come back and stay with the organization. So we’re always in need of folks kind of running point and transferring people back and forth and bringing food etc. So really, it’s just a matter of applying to the organization for for volunteerism.

Alison Werner 9:05
And then if it’s a plastic surgeon, what would you say as a as a peer? How does the time commitment here and just the resource commitment look for you.

Dr Sal Pacella 9:15
So you know, the thing I love about Fresh Start is it, it is an opportunity as a surgeon, to work with colleagues in the community that I may not ever see in my private practice. So for example, we approach this as a very team oriented case. So we may have two or three surgeons operating at the time, and we do the surgeries on a weekend. So it’s very non disruptive to your family life if you have young kids, etc. Just a few hours on a Saturday or whenever the case can be completed. We’ll then see the patients again on Sunday morning and perhaps see some patients in the office on Sunday morning for an evaluation. You know many times when we do mission work that’s out of country, you know, you’re you’re traveling a large distance and being out of town for a week. And that can be, you know, disruptive to your practice and disruptive to your family life. So this is a unique way to really give back to the community, the global community, and really haven’t integrate into your life. The final thing I’ll say about that is you know, we we live in a world in medicine that is overrun by technology, and medical records and insurance companies, and there’s frustrations with billing and, and the entirety of medicine. The wonderful thing about Fresh Start is all that goes on the wayside. And we are uniquely and continuously reminded that the most important aspects of what we do as surgeons is the doctor patient relationship. And Fresh Start is a purity of the doctor patient relationship. And that’s what I really admire about working with the organization.

Alison Werner 10:58
We talked about doctors getting involved, but what if a hospital or surgical center is interested in bringing partnering with fresh start?

Dr Sal Pacella 11:07
So right now, you know, our our mission is to really work with the the high end, Rady Children’s Hospital, and the beauty of that is where patients are exposed to pediatric specialists, pediatric anesthesiologist, et cetera. Now years ago, we used to do our surgeries out of a out of an office surgery center. And although that was that was great for what we did at the time, we sort of outgrew the outpatient setting, and now we have a very unique relationship with Rady Children’s Hospital. And it works fairly well. I think as I as I look to the future fresh start, there will be certainly opportunities for partnerships and new satellite clinics. And it’s just a matter of getting involved with whatever pediatric hospitals in whatever host city we we, we are operating in,

Alison Werner 11:57
what would your final message be to any plastic surgeons, any of your peers who are listening to this, who are you know, thinking about getting involved or looking for a way to give back.

Dr Sal Pacella 12:05
So I would say that, you know, we’re always in need of a dedicated surgeon or a dedicated individual. And, you know, this is an opportunity to, to really get back to that doctor patient relationship, as I described. And that’s clearly important. But another point I’d like to make with the organization is very unique to charities, in general, many times any sort of philanthropy organization or charity. There are certain operating expenses that have to be covered by the donations fresh started and is unique in the fact that we had some very, very generous donors early on in the, in the infancy of the organization, we have a very large endowment, and the interest on that endowment is able to pay for all our administrative overhead. So what that means is that when you donate $1, for freshstart, surgical gifts, 100% of that dollar goes to patient care. And that’s it’s very unique from what I’ve seen with philanthropy organizations in the past.

Alison Werner 13:07
So what’s ahead for you this year with fresh start?

Dr Sal Pacella 13:10
So quite a bit, actually, we we have quite a few cases on the agenda here. I’m in the midst of working with my colleague, Asa Morton, who’s a them logic plastic surgeon. We’re rebuilding an eye socket for a gentleman who’s out of Colombia young, 14 year old guy named Juan has been back and forth a couple times for our surgeries. I’m also going to be caring for in a few short weeks young girl from Tijuana, she’s 16 she’s had extensive body surface area wounds throughout her chest and abdomen and we’re going to hopefully do some some expansion of her regular skin in order to cut out some of that burned skin and replace it so so a lot of sort of, you know, extensive surgery and multiple surgeries on the on the agenda in the next few months.

Alison Werner 14:02
Well, I can tell that you’re really passionate about this and really excited about the work you have ahead. So thank you so much for taking the time to talk to me about freshstart surgical gifts and with our listeners.

Dr Sal Pacella 14:10
My pleasure, thank you for having us.

Keri Stephens 14:12
As always, thank you for joining us and be sure to subscribe to the plastic surgery practice podcast to keep up with the latest episodes. And also please check out plastic surgery practice.com for the latest industry news. Until next time, take care

Keri Stephens 0:10
Hi, welcome to the plastic surgery practice Podcast. I’m Keri Stephens, your host today and I’m here with Dr. Elisabeth Potter, a Board Certified Plastic Surgeon in Austin, Texas who specializes in breast reconstruction. And I really wanted to talk to Dr. Potter because she’s been very vocal about advocating for insurance coverage of the DIEP flat procedure, where skin fat and blood vessels are harvested from a woman’s abdomen to create new breast and breast reconstruction. So, Dr. Potter, thank you for joining me today.

Dr Elisabeth Potter 0:39
I am thrilled to be here. Thank you so much.

Keri Stephens 0:41
Yeah, I’m thrilled to so just to start, I found you because I had preventative double mastectomy in 2020. And I have been part of the breasties community and was really taken aback when I found out that, you know, women’s access to DIEP procedure to breast reconstruction was being threatened, because I’ve talked about in the podcast before, but I really want my implants out in the next few years and would love to have a DIEP procedure. And, you know, I know for a lot of women that have had breast reconstruction, whether it’s preventative or you know, from breast cancer, that’s, that’s a procedure they want. Because if they’re afraid to have implants, they you know, implant illness is all over the news. And, you know, they still want to have breasts. So can we can you just start to talk about exactly what happened with this CMS coding for DIEP procedures?

Dr Elisabeth Potter 1:36
Absolutely. And, you know, I think, as someone who’s been doing breast reconstruction as the cornerstone of my professional life for over a decade, the issues that you bring up issues of wanting an implant and not wanting an implant, really wanting to have choice, those things have been at the center of my practice for years. So I’ve always been really tuned in to what patients around the country in different areas are, are presented with as options and what they’re nudged towards, and what’s what’s really available, which truly available in a community. Right. So, you know, the women’s health and cancer Rights Act guarantees that an insurance company has to cover your reconstruction if they cover your mastectomy, but it doesn’t really guarantee access and access is practically when you go to the doctor in your community, can you find someone who’s willing to perform natural tissue DIEP flap breast reconstruction for you in your community? Or is it just implants? Same thing for aesthetic flat closure? Real access is what are you faced with when you go to see your doctors and your team and your community? So and that’s something that I’ve been thinking about since I finished fellowship at MD Anderson, right? I chose not to stay in academics, I chose to go into private practice because I saw a need for high level microsurgery breast reconstruction, in communities outside of big academic centers where it really has always existed. So I, you know, I was following on carefully when I got a newsletter from something called the Coding Corner. It sounds like, you know, like middle school newsletter, and in this Coding Corner for plastic surgeons, it was a little blurb. And the blurb couple of years ago just said, sort of announced quietly that the code that we use, when we submit to an insurance company and ask, Can I do this surgery for Mrs. Jones? They say what surgery and we say S2F68. And that’s, that translates into that I want to do a DIEP flap. Well, they changed. And they said we’re not going to honor that code anymore. We’re going to only honor the old code that describes everything, every possible type of breast reconstruction using our own tissue. And and the problem is that that code really was invented when we were doing barbaric procedures that remove a patient’s muscle. So, you know, reading the tea leaves, when I saw that little blurb, I started to get nervous. Because if I can’t demonstrate to an insurance company, that I’m doing a better surgery that I’m doing the right surgery for my patient, I knew that they were just going to they wanted to pay one rate, they wanted to pay the lesser rate for all breast reconstruction and so that was the first time I heard of it. Since then, I’ve gotten an education in coding and I I know that this has been going on for more than a decade sort of laying the groundwork for this change to come. But it was it was alarming. And yeah, I reached out right away to folks at my society and asked for help.

Keri Stephens 4:53
Well, I have to say thank you as a mastectomy patient. I I know there’s been a really large community of women that are behind this. And I’m just really, because I know as a patient, I mean, I’m, you know, you’re coming from the doctor perspective, I’m coming from the patient perspective, it’s like, maybe you don’t want implants. I mean, let’s talk about that, like a lot of women don’t you know, and I think I think that there’s definitely, I hate to say maybe misogyny there. I don’t know, what would you say?

Dr Elisabeth Potter 5:22
Listen, I think that as a female microsurgeon, that for most of my career, I have been dealing with misogyny, the male gaze, in plastic surgery is very real, and implants have been at the center of that. And while that may not be a popular view, among the majority of plastic surgeons, I feel that intensely as a female with my own experiences, you know, wanting to feel good about my body, and trying to find people to talk to me about that. Yeah, I think that, you know, we have a problem in plastic surgery, and we’re trying to evolve. And there, there’s a huge component of female plastic surgeons now that are pushing that in a healthy and more empowered direction. But even as soon as, or, as recently is, like, 12 years ago, when I was in conferences, and they would describe plastic surgery outcomes, the terminology and the tone of describing women’s bodies in a medical setting was offensive. That was that the top plastic surgery program in the country. So we have a long way to go in a short amount of time. It’s not hard to be better than that, though. You can make really clear direct steps forward just towards respect and empowerment, and not tolerating conversations that are belittling of women, and that seek to put us in boxes.

Keri Stephens 6:53
Well, I want to get to more the DIEP, why is access to DIEP so important in a reconstruction field?

Dr Elisabeth Potter 6:59
Well, I think that there’s a couple of reasons. One is simply choice, it’s so important for patients to have choice, it’s important that at a time when patients are facing surgery to prevent or treat breast cancer, and so much power is sort of being taken away, that there’s power given back when you get to choose what your body is going to be like in the future. Right. And I think it’s really important that that’s not up for debate, these surgeries are not cosmetic surgeries, we settled that and put that to bed in 1998. That is done and dusted. Okay. So if anyone wants to visit that I would just refer you to the women’s health and cancer Rights Act, and then meet me when you’ve absorbed with that material.

Keri Stephens 7:37
No, I appreciate you doing that again. I mean, you know, I’ve even felt people have said, Oh, you know, when I had a masectomy, oh my gosh, a free boob job. It was like this. It was, you know, and there’s nothing that makes me madder but I definitely heard that, you know, or you’re so lucky. Like, because I’m, you know, I nursed my kids. Oh, you gotta get new pair. And it’s like, it’s just so not true. I mean, going through mastectomy for a woman is, it was awful. And I feel like the fact that, you know, they were trying, CMS was trying basically to take these, you know, the the choice away from women when you know, I know a lot of women don’t want implants. And I think we I think that needs to be more of a conversation because it’s just, well, let’s just give them breast implants. Oh, you’re gonna new breasts.

Dr Elisabeth Potter 8:26
I mean, listen, breasts. Yeah, breast implants are not normal. They’re not normal. But even when you think about just, you know, since the 1970s, right, this is a short period of time that we have been placing implants and to women to achieve a certain body type. And that’s, you know, cosmetically as well as reconstruction. This is not normal. And I think when you think about your lifetime, we we sort of are fooled, were deceived into thinking that this is something we’ve been doing forever. We have not, I’m not saying that it’s not safe to do in a reasonable way. But but let’s just let’s move past thinking that the majority of time breast implants have been an option for women they have not, this is an artifice, and we need to recognize that breast implants have medical issues, right? There’s breast implant illness, there’s breast implant associated cancers, so important for women who are in patients who are facing the decision for mastectomy, we’re thinking about reconstruction. I mean, for God’s sakes, I mean, think about the risk that you’re willing to assume as part of your reconstruction. So many patients would say, I will not accept any additional risk of a cancer in my reconstruction, and that, to me, is simply enough reason to have an option other than implants period.

Keri Stephens 9:49
Well, I mean, it makes sense especially, you know, for for those that are that have had the chosen have a mastectomy to prevent illness. I mean, then to say, well, you know, but this this could cause you could also get. It’s like, it’s just wild. And I know, but people don’t I don’t think every plastic surgeon is telling their patient that.

Dr Elisabeth Potter 10:07
Oh, they’re not.

Keri Stephens 10:08
I can say, from my patient perspective, I did not hear it once. And it’s taken me being in this job and be doing these podcasts to really realize how uninformed I was when I did what I went through my journey. So I think it’s amazing that you’re talking about this.

Dr Elisabeth Potter 10:23
It’s, it’s not that you were uninformed, honestly, I think that for a lot of the reality is that a lot of that information was is withheld and was withheld from patients. And I’ll tell you that when the recall initially happened, for breast implants and breast implant associated lymphoma, I spoke out publicly and said, that I felt that my patients who were having risk reducing mastectomies or mastectomies to room to remove a breast cancer should be offered the option or should be counseled about the risk of breast implant associated lymphoma if they had textured implants. And I said, I went further, I said, I think that we should be removing those implants, if patients haven’t considered that risk, want them removed. And I got, I’ll say, harassed by leadership in the American Society of Plastic Surgeons, and this was in 2019, for saying that, right, so then I’m a I’m an MD Anderson, top program, micro fellowship, I did that UT Southwestern top program in the country for plastics, I’m you know a Princeton grad, like, I’m a smart lady. And I was getting harassed for defending my patients. No, not not by everybody, but by leaders.

Keri Stephens 11:34
You heard that you heard the pushback.

Dr Elisabeth Potter 11:36
I heard it and, and it just adds fuel to the fire. So for me, as someone who does breast reconstruction, we need choice. Women need to be able to choose to have reconstruction using their own tissue, they want surgeries that last a lifetime, that involve a foreign body. And then there’s also really there’s the clinical issue, right. So when someone needs to have radiation as part of their treatment, implants and radiation do not mix well. Regardless of the fact that there are lots and lots of women out there with irradiated implants. That’s not a great idea. And when I was in training at MD Anderson, we would not offer that unless we had absolutely no other options. And that is still the case. irradiated implants have an extremely high complication rate, and extremely high failure rate, and never counsel a patient that’s a good idea. If we have another option. So simply for the vast number of women who need to have radiation as part of their treatment, we need a clinically superior outcome with natural tissue reconstruction. So it’s not just choice, it’s also health.

Keri Stephens 12:40
Can you I want to get back into just the new CMS or you know, the reversible decision. Can you talk about that a little more, because I think that’s amazing.

Dr Elisabeth Potter 12:49
And it is amazing. And I’ll tell you, so CMS really was the agency that stepped up and took action here to reverse course. And I want to make it pretty clear here that CMS wasn’t the organization that initially set us on this path.

Keri Stephens 13:03
Right.

Dr Elisabeth Potter 13:03
Initially, CMS approved us codes they they created, they created them in response to a request and maintain to them. And it wasn’t until the American Medical Association, and like our societies, the American Society of Plastic Surgeons, and, and others, you know, had dealt with this other set of codes, which are called CPT codes. And they were trying to be do their due diligence with their codes and simplify them. And there was some discussion over the last decade of whether breast reconstruction should all be fit under under one code. And the AMA and ASPS really came down on the side of saying it’s really all the same. We really just need that one code. So that’s where this came from. This didn’t come from CMS. Once, once the AMA approved a new definition of the CPT code that really clearly stated DIEP flaps are the same thing as TRAM flaps. So removing muscle and saving muscle are the same once they said that, CMS then said, Okay, well, if that’s what you guys have said, then BlueCross BlueShield, which has asked us to remove the S codes. Because there’s this other code that the AMA and the American Society of Plastic Surgeons says as the one we should use, we’ll sunset it, we’ll let it go away. They didn’t, they didn’t actively seek that out. But they said okay, in response to what you guys have done, if that’s what you think societies, if that’s what you think AMA, then then we will go along with what you’re saying we’ll remove this code, and that’s where the problems really set in. But thankfully, CMS was willing to consider how they were how removing those codes was going to remove access for patients around the country and how they also had the power to reinstate the code. So even though AMA and our society still have the other code, and that code still is confusing, CMS said, we recognize after hearing from patients and doctors, we recognize that deleting this code has caused a crisis in access. And that is not our intention. And since this thing is in our power, at CMS, we will do this thing to help patients. We still more to get more to do because that confusing code still exists out there. But um, I was, I can’t tell you what it’s like to see that kind of a decision evolve over a year.

Keri Stephens 15:35
I mean, that’s, it’s amazing. But I really as a last question, when I say do you think there are further steps that need to be taken to make sure there’s equitable access to DIEP flap and other specialized surgeries that don’t include implants?

Dr Elisabeth Potter 15:48
Absolutely. So I think I can spell them out really clearly, we need, we need an update to the women’s health and cancer Rights Act. So that act, which I would prefer, we call the patient’s health and cancer Rights Act, we need to protect specifically access to all types of reconstruction that includes these muscle saving reconstructions. And we need to protect access to aesthetic flat closures as well. So those are two glaring absences. And that act, we also need to ensure that patients are required to be counseled adequately regarding their options. So have some requirement for Informed Consent documented in the medical chart, before someone has breast reconstruction. And I would say honestly, that we should really refer to that as chest wall reconstruction because a lot of patients don’t want their breasts reconstructed, but they want to look as pretty as possible or smooth as possible. So that’s number one, update that number two is that we really do need for that that CPT 19364 that had an editorial change, to add DIEP flaps and equate those with TRAM flaps and old time flaps, we need that code to get revised. We need for them to undo that. And that’s not CMS. That’s the American Medical Association. They need to recognize that this hurts women and do the right thing. And then we need for private payers for the insurance companies to to act honorably and reimburse appropriately across the country equitably and appropriately for this reconstruction. There’s no one is blameless here, there are doctors out there charging $100 – $200,000 for DIEP flap surgery, and that’s highway robbery. At the same time, there are insurance companies that only want to pay me $2,000 to do that surgery. And that’s highway robbery. So we have to be reasonable adults recognize that the doctors and the insurance companies are not the most important part of this equation. The patients are. Let’s come up with a reasonable reimbursement for this surgery and set that as a new benchmark so that nobody is getting taken advantage of especially patients.

Keri Stephens 17:51
I think you summed it up perfectly. Well thank you so much, Dr. Potter, you are amazing, and I really appreciate this conversation.

Dr Elisabeth Potter 17:57
Awesome. Thanks for having me.

Keri Stephens 17:58
As always, thank you for joining us and be sure to subscribe the plastic surgery practice podcast to keep up with the latest episodes. And also please check out plastic surgery practice dot com for the latest industry news. Until next time, take care.