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Part 3: Big Ticket Procedures vs. Office-based Aesthetic Alternatives

Posted March 22, 2024 in Uncategorized | 7 minute read

I look at aesthetic plastic and cosmetic surgery differently today after 30 years in the industry than I did initially. This is because consumers have changed dramatically how they shop for aesthetic procedures, which resembles how they buy anything related to beauty or fashion in 2024.

I view aesthetic medicine as a retail business instead of a medical one. Because once you move into a non-insurance-based practice, you have moved into a fee-for-service or, as anyone outside of medicine sees it, a retail environment.

We can draw different conclusions from these two points of view, which have nothing to do with your surgical quality, skill, or talent and everything to do with one’s retail perspective or economic understanding of how business works. I have often said, “Patients rarely know the difference between mediocre and good results.” You only need to walk down Park Avenue to see this played out in real-time.

Let me start by saying that I do not mean to understate that what you, as physicians and surgeons, do is anything less than critical ethical medical care, nor that it is serious medicine in every respect. That should be a given. When I say retail medicine, a whole new set of business and marketing issues comes into play.

This blog will attempt to reveal the economics of the aesthetic field and how patients drive what you do and how you do it. You can achieve lofty goals, and there are no ceilings on one’s income level in the US.

According to ASPS and The Aesthetic Society Statistics 2022, the average price range of a facelift in the US is between $15,000 and $35,000 depending upon where you are located, with Southern California (Newport Beach and Beverly Hills) and New York (Manhattan and Long Island) probably being on the higher prices regionally.  I understand some surgeons reading this blog receive six figures for their procedures, but let’s acknowledge that these fees are not average.

This procedure will generally take between 3 and 6 hours, depending on what is being done. If you add fat grafting, it will be closer to the 5- and 6-hour mark. If it is more like a mini facelift, it will take around 2 to 3 hours. These are general timeframes, and your surgical abilities may differ significantly from these averages.

There are many variables to big-ticket items such as breast augmentation with a lift, Mommy Makeovers, and Brazilian Butt Lifts; all these procedures are generally done in the OR and, in most cases, are time-consuming, taking a minimum of 4 hours or more.

In my 30 years of consulting, the goal was always to try and maintain a surgeon income of around $2500 per hour, and to do this took the whole team. This is not the gross income figure and does not account for any other overhead. This was the goal when I quit consulting in offices, and as I talk with private practice surgeons today, this number is now much closer to $3500 per hour. This applies only to the physician fee and nothing else that goes into pricing. I’ve never considered myself a math whiz, but I calculate a reasonable surgeon’s fee of around $21,000. Now we add anesthesia and OR, pre-and post-op care, and we land much closer to $35,000 to $45,000.

In working closely with ASAPS and ASPS, we always looked at average incomes for plastic surgeons, which varied significantly from city to city and state to state, ranging from as low as $300K per year up to $900K and much more in some cases. Overall, plastic surgeons are well-paid hourly workers coast to coast.

That said, which aesthetic physicians are best suited to adding micro and nanofat into their practice, and why?

Aesthetic alternatives like micro and nanofat procedures can be done in the office and take less time to complete. Not only that, but they can also be an excellent way for aesthetic physicians to grow their practice and increase their income by meeting patient demands for alternatives to fillers and reducing scars, which almost all patients care about.

I spoke with a dear friend in the San Diego area who is part of a four-surgeon group, and they have started adding nanofat to numerous surgeries and an additional $1500 for every case. The fees are quoted showing a quote with nanofat and one without. The lower fee is the basic fee, and the nanofat procedure is the premium procedure. It’s a lot like whether you want to fly coach or first class, and more patients opt for the premium product than they did in the past.

For thirty years, I coached and trained surgeons on the art of consultations and their patient coordinators on the art of quoting. Nothing has changed today other than pretty much everything!

Patients are smarter and much more knowledgeable about their procedure options and what things should cost in their community. What distinguishes practices today is their customer service and patient experience, as well as how good of a communicator the doctor is. Those practices that have mastered excellent communication skills and know nothing matters more than their 5-star reviews (the real ones) are statistically more successful than their competitors.

If I had a crystal ball, I could tell you where patients would go next, but unfortunately, I can’t. However, I can tell you all signs lead to regenerative therapies in aesthetics and many other specialties. Whether it is pain management, orthobiologics, scar prevention and arthritis, faster healing and treating burns, regenerative medicine is here to stay, and you have opportunities to advance your practice by being ahead of the pack.

As a marketer, I see many opportunities to claim how your practice differs from the practice next door. I have always been intrigued by the fact that physicians consider marketing a necessary evil instead of a means to stand out in the crowd. Or a vehicle to tell your story. Instead, I see many cosmetic surgeons copy their competitors; they market the same procedures and lower their prices to compete. I also see physicians try to cut corners on marketing and go for the cheapest marketing they can find instead of who is the best in the field. You would never tell your patients to do that; you’d encourage them to do their homework and evaluate the quality of outcomes; cost should not be the only consideration to buy anything of value.

I happened to listen in on a sales conversation with a cosmetic surgeon and a website company recently; it took everything I had to keep from laughing out loud. The salesperson never asked the doctor anything meaningful about herself, how she saw her practice, what was important to her, what her favorite procedures were, and why. He never asked how she wanted to be portrayed in her community or if she considered her training or experience unique. What he did focus on was that he could give her a great website for less money than any other web company she was considering.

I guarantee he had no idea how that would happen because the same sales pitch had just been given on the previous call. Marketing is so much more than slapping a pretty woman on the page and hoping and praying the right potential patient at the exact right time saw your ad and called you. There is a science to marketing, like there is a science to where you make the incision. No one ever died from a bad marketing campaign. With that said, I have seen practices bleed marketing dollars and have yet to move the needle.

My parting thought is you have a unique opportunity to grow your practice by adding regenerative aesthetic services with nanofat, and this would be an excellent time to evaluate your current marketing and ensure you are ready to take advantage of this fast-growing trend.

Check out the SDARTS Conference this August and see the post-conference marketing workshop that Marie Olesen and I will present. Here is a link to our course and CVs.

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