American Academy of Cosmetic Surgery (AACS): Annual Scientific Meeting

LAS VEGAS – You might not equate your waiting room with patient satisfaction, but marketing expert Risa Goldman Luksa says there may no greater reflection of your practice.

"Your waiting room is really an extension of you," Mrs. Luksa said at the annual meeting of the American Academy of Cosmetic Surgery. "Patients spend a lot of time in your waiting room, so make sure it conveys the impression you want to give. You want to keep it clean and professional. It’s a good idea for someone on your staff to walk through the waiting room every 30 minutes to make sure it is tidy. Pick up cups if someone left them, as well as any trash, newspapers, or magazines left behind."

Courtesy Risa Goldman Luksa

If you are running behind schedule, that person can remind patients that you haven’t forgotten about them. "It’s also a good idea to provide coffee, water, and other light refreshments," said Mrs. Luksa. "If you do that, make sure your front office staff asks patients if they can get them something to drink or eat. These are nice touches."

Mrs. Luksa, founder and president of Los Angeles-based Goldman Marketing Group, offered the following strategies to enhance the waiting room experience for patients:

• Ditch the magazines. "You’re not a nail salon," she said. "You’re selling high-end procedures, so I would get rid of all the magazines and display your own marketing materials instead. Your waiting room is your golden marketing opportunity, so don’t let it advertise for other people."

• Ditch the clocks. Just like the casino operators in Las Vegas prefer that you not keep track of time, "You don’t want people to be watching the clock and keeping track how late you might be running," Mrs. Luksa said.

• Create a peaceful atmosphere. Having a television show or radio station blaring, or allowing patients to talk on their cell phones while they wait can be distracting. "Move your practice telephones away from the front desk, especially if they’re loud and the phones ring off the hook," Mrs. Luksa advised. "When you do this, it allows people at the front desk to give their full attention to people in the waiting room. This is important. You want them to have that full attention. Equally, it allows whoever is answering the phones to give their full attention to people calling in."

• Offer amenities that showcase your practice. Branded water bottles are a nice touch, as are flash drives, containers of hand sanitizer, and tubes of Chap Stick. "These are all cost-effective solutions," Mrs. Luksa said. "Most of them you can order for $1 or $2 apiece." She also recommends investing in a custom entrance rug that sports your practice logo.

• Offer free Wi-Fi. Since most practices are likely to have a wireless Internet network, "why not let your patients know about that and give them a password? While they’re waiting, it’s really nice if they can log on and surf the Web on their iPhones."

• Use clean-looking intake and consent forms. "You would be surprised at how many offices I have walked into and they are using blotchy photocopies [of these forms]," Mrs. Luksa said. "Over the years, they get messy looking and they’re hard to read. Make your intake forms and your consent forms are clean looking and professional. Make sure they contain your branding and make the forms as short as possible."

• Ask patients to fill out a brief cosmetic questionnaire. This contains a checklist of services offered by your practice, along with a statement at the top of the page inviting the patient to please check any procedure below you are interested in learning about. "This is a great opportunity to cross market your services without a strong sales approach," said Mrs. Luksa. "Make sure to use these forms in your patient consultation and to record the results in your electronic health records for future targeted marketing efforts."

• Printed newsletters have a place. While some may view this means of communication as old-fashioned, a printed newsletter "is another great source of unique and relevant reading material for patients," Mrs. Luksa said. "You can repurpose the blogs on your website so you’re not re-creating something from scratch. It’s also a good way to advertise your promotions. Plus, you can easily spin it into an e-newsletter to e-mail to your patient database, which is great for patient retention."

• Publish hardback picture books that contain before and after pictures of the services you offer. Mrs. Luksa described this as "a classy way of educating patients about what you do and what the procedure entails" before their consultation with you. The same result can be achieved with an iPad book and/or a DVD reel, which eliminates printing costs.

• Display retail products. People won’t know what cosmetic products you sell unless they can see them. "Walk through any department store," Mrs. Luksa said. "Women love touching and sampling the products. They’ll want to do the same in your office. Create and display packages of products to up-sell."

• Ask for referrals. Word of mouth is crucial, especially in today’s economic environment. "You don’t want to come off as being needy, but don’t be shy to ask for referrals when the situation feels appropriate," Mrs. Luksa noted. "Maybe display a sign that says, ‘the highest compliment we can receive is the referral of your family and friends.’ The same goes for asking for reviews on Yelp and other review sites, which almost every doctor could use more of."

Mrs. Luksa said that she had no relevant financial conflicts to disclose.

[email protected]

LAS VEGAS – You might not equate your waiting room with patient satisfaction, but marketing expert Risa Goldman Luksa says there may no greater reflection of your practice.

"Your waiting room is really an extension of you," Mrs. Luksa said at the annual meeting of the American Academy of Cosmetic Surgery. "Patients spend a lot of time in your waiting room, so make sure it conveys the impression you want to give. You want to keep it clean and professional. It’s a good idea for someone on your staff to walk through the waiting room every 30 minutes to make sure it is tidy. Pick up cups if someone left them, as well as any trash, newspapers, or magazines left behind."

Courtesy Risa Goldman Luksa

If you are running behind schedule, that person can remind patients that you haven’t forgotten about them. "It’s also a good idea to provide coffee, water, and other light refreshments," said Mrs. Luksa. "If you do that, make sure your front office staff asks patients if they can get them something to drink or eat. These are nice touches."

Mrs. Luksa, founder and president of Los Angeles-based Goldman Marketing Group, offered the following strategies to enhance the waiting room experience for patients:

• Ditch the magazines. "You’re not a nail salon," she said. "You’re selling high-end procedures, so I would get rid of all the magazines and display your own marketing materials instead. Your waiting room is your golden marketing opportunity, so don’t let it advertise for other people."

• Ditch the clocks. Just like the casino operators in Las Vegas prefer that you not keep track of time, "You don’t want people to be watching the clock and keeping track how late you might be running," Mrs. Luksa said.

• Create a peaceful atmosphere. Having a television show or radio station blaring, or allowing patients to talk on their cell phones while they wait can be distracting. "Move your practice telephones away from the front desk, especially if they’re loud and the phones ring off the hook," Mrs. Luksa advised. "When you do this, it allows people at the front desk to give their full attention to people in the waiting room. This is important. You want them to have that full attention. Equally, it allows whoever is answering the phones to give their full attention to people calling in."

• Offer amenities that showcase your practice. Branded water bottles are a nice touch, as are flash drives, containers of hand sanitizer, and tubes of Chap Stick. "These are all cost-effective solutions," Mrs. Luksa said. "Most of them you can order for $1 or $2 apiece." She also recommends investing in a custom entrance rug that sports your practice logo.

• Offer free Wi-Fi. Since most practices are likely to have a wireless Internet network, "why not let your patients know about that and give them a password? While they’re waiting, it’s really nice if they can log on and surf the Web on their iPhones."

• Use clean-looking intake and consent forms. "You would be surprised at how many offices I have walked into and they are using blotchy photocopies [of these forms]," Mrs. Luksa said. "Over the years, they get messy looking and they’re hard to read. Make your intake forms and your consent forms are clean looking and professional. Make sure they contain your branding and make the forms as short as possible."

• Ask patients to fill out a brief cosmetic questionnaire. This contains a checklist of services offered by your practice, along with a statement at the top of the page inviting the patient to please check any procedure below you are interested in learning about. "This is a great opportunity to cross market your services without a strong sales approach," said Mrs. Luksa. "Make sure to use these forms in your patient consultation and to record the results in your electronic health records for future targeted marketing efforts."

• Printed newsletters have a place. While some may view this means of communication as old-fashioned, a printed newsletter "is another great source of unique and relevant reading material for patients," Mrs. Luksa said. "You can repurpose the blogs on your website so you’re not re-creating something from scratch. It’s also a good way to advertise your promotions. Plus, you can easily spin it into an e-newsletter to e-mail to your patient database, which is great for patient retention."

• Publish hardback picture books that contain before and after pictures of the services you offer. Mrs. Luksa described this as "a classy way of educating patients about what you do and what the procedure entails" before their consultation with you. The same result can be achieved with an iPad book and/or a DVD reel, which eliminates printing costs.

• Display retail products. People won’t know what cosmetic products you sell unless they can see them. "Walk through any department store," Mrs. Luksa said. "Women love touching and sampling the products. They’ll want to do the same in your office. Create and display packages of products to up-sell."

• Ask for referrals. Word of mouth is crucial, especially in today’s economic environment. "You don’t want to come off as being needy, but don’t be shy to ask for referrals when the situation feels appropriate," Mrs. Luksa noted. "Maybe display a sign that says, ‘the highest compliment we can receive is the referral of your family and friends.’ The same goes for asking for reviews on Yelp and other review sites, which almost every doctor could use more of."

Mrs. Luksa said that she had no relevant financial conflicts to disclose.

[email protected]

LAS VEGAS – You might not equate your waiting room with patient satisfaction, but marketing expert Risa Goldman Luksa says there may no greater reflection of your practice.

"Your waiting room is really an extension of you," Mrs. Luksa said at the annual meeting of the American Academy of Cosmetic Surgery. "Patients spend a lot of time in your waiting room, so make sure it conveys the impression you want to give. You want to keep it clean and professional. It’s a good idea for someone on your staff to walk through the waiting room every 30 minutes to make sure it is tidy. Pick up cups if someone left them, as well as any trash, newspapers, or magazines left behind."

Courtesy Risa Goldman Luksa

If you are running behind schedule, that person can remind patients that you haven’t forgotten about them. "It’s also a good idea to provide coffee, water, and other light refreshments," said Mrs. Luksa. "If you do that, make sure your front office staff asks patients if they can get them something to drink or eat. These are nice touches."

Mrs. Luksa, founder and president of Los Angeles-based Goldman Marketing Group, offered the following strategies to enhance the waiting room experience for patients:

• Ditch the magazines. "You’re not a nail salon," she said. "You’re selling high-end procedures, so I would get rid of all the magazines and display your own marketing materials instead. Your waiting room is your golden marketing opportunity, so don’t let it advertise for other people."

• Ditch the clocks. Just like the casino operators in Las Vegas prefer that you not keep track of time, "You don’t want people to be watching the clock and keeping track how late you might be running," Mrs. Luksa said.

• Create a peaceful atmosphere. Having a television show or radio station blaring, or allowing patients to talk on their cell phones while they wait can be distracting. "Move your practice telephones away from the front desk, especially if they’re loud and the phones ring off the hook," Mrs. Luksa advised. "When you do this, it allows people at the front desk to give their full attention to people in the waiting room. This is important. You want them to have that full attention. Equally, it allows whoever is answering the phones to give their full attention to people calling in."

• Offer amenities that showcase your practice. Branded water bottles are a nice touch, as are flash drives, containers of hand sanitizer, and tubes of Chap Stick. "These are all cost-effective solutions," Mrs. Luksa said. "Most of them you can order for $1 or $2 apiece." She also recommends investing in a custom entrance rug that sports your practice logo.

• Offer free Wi-Fi. Since most practices are likely to have a wireless Internet network, "why not let your patients know about that and give them a password? While they’re waiting, it’s really nice if they can log on and surf the Web on their iPhones."

• Use clean-looking intake and consent forms. "You would be surprised at how many offices I have walked into and they are using blotchy photocopies [of these forms]," Mrs. Luksa said. "Over the years, they get messy looking and they’re hard to read. Make your intake forms and your consent forms are clean looking and professional. Make sure they contain your branding and make the forms as short as possible."

• Ask patients to fill out a brief cosmetic questionnaire. This contains a checklist of services offered by your practice, along with a statement at the top of the page inviting the patient to please check any procedure below you are interested in learning about. "This is a great opportunity to cross market your services without a strong sales approach," said Mrs. Luksa. "Make sure to use these forms in your patient consultation and to record the results in your electronic health records for future targeted marketing efforts."

• Printed newsletters have a place. While some may view this means of communication as old-fashioned, a printed newsletter "is another great source of unique and relevant reading material for patients," Mrs. Luksa said. "You can repurpose the blogs on your website so you’re not re-creating something from scratch. It’s also a good way to advertise your promotions. Plus, you can easily spin it into an e-newsletter to e-mail to your patient database, which is great for patient retention."

• Publish hardback picture books that contain before and after pictures of the services you offer. Mrs. Luksa described this as "a classy way of educating patients about what you do and what the procedure entails" before their consultation with you. The same result can be achieved with an iPad book and/or a DVD reel, which eliminates printing costs.

• Display retail products. People won’t know what cosmetic products you sell unless they can see them. "Walk through any department store," Mrs. Luksa said. "Women love touching and sampling the products. They’ll want to do the same in your office. Create and display packages of products to up-sell."

• Ask for referrals. Word of mouth is crucial, especially in today’s economic environment. "You don’t want to come off as being needy, but don’t be shy to ask for referrals when the situation feels appropriate," Mrs. Luksa noted. "Maybe display a sign that says, ‘the highest compliment we can receive is the referral of your family and friends.’ The same goes for asking for reviews on Yelp and other review sites, which almost every doctor could use more of."

Mrs. Luksa said that she had no relevant financial conflicts to disclose.

[email protected]

LAS VEGAS – In the early 1980s, combining facelift procedures with chemical skin peeling was considered a no-no because of skin necrosis concerns.

But Dr. David M. Morrow, founder and director of the Rancho Mirage, Calif.–based Morrow Institute, had a hunch that chemical peels that were made from phenols might be causing the necrosis, not those made from trichloroacetic acid (TCA). So in the late 1980s, he started combining TCA peels with lifting procedures of the upper face, midface, and neck – a practice that he has continued to this day.

At the annual meeting of the American Academy of Cosmetic Surgery, Dr. Sheila C. Barbarino presented results from 1,118 men and women aged 35-89 years who have undergone the combined procedures at the Morrow Institute since 1988, "all without a single case of skin necrosis," said Dr. Barbarino, an ophthalmic plastic surgeon at the institute.

Photos courtesy Dr. Sheila Barbarino and Dr. David Morrow

Of the 1,118 procedures, 489 were performed using TCA 35%, 481 with TCA 18%, and 148 with TCA 15%. She noted that 483 of the procedures also involved the use of phenol 89%, which was applied to the lower eyelid and/or periorbital area. She said that the current practice at the institute is to use a moderately deep peel with TCA 18%.

The rationale for chemical skin peeling following lifting procedures is to improve skin color and texture "while creating new epidermis, dermal collagen, and elastic fibers," Dr. Barbarino said. "Combining these two procedures and performing them simultaneously is extremely efficient. It calls for only one operative setting for anesthesia [and] one window of healing time, and it saves the patient time and money."

In the upper face–, midface-, and neck-lifting procedures, undermining consisted of combined blunt and sharp dissection to create long, subcutaneous flaps of the neck and face. Suspension sutures were placed in a favorable vector via superficial musculoaponeurotic system (SMAS) plication and/or SMAS flaps. "The skin flaps were then trimmed and tailored and skin closure was performed, followed immediately by chemical skin peeling," Dr. Barbarino said.

Photos courtesy Dr. Sheila Barbarino and Dr. David Morrow

Chemicals used were TCA 18%-35% and phenol 89% to nonundermined areas. "You can safely use phenol after transconjunctival lower lid blepharoplasty, but not after transcutaneous lower lid blepharoplasty, because the flap is a little too thin," she said.

Patients who underwent the combined procedures had Fitzpatrick skin types I-IV. Postoperatively, the skin was evaluated based on thickness, color, and condition. "Skin flap thickness and condition [were] also evaluated immediately after the surgery was performed," Dr. Barbarino said. "If significant swelling, ecchymosis, and/or hematoma were observed, we would defer the peel for another day."

Anesthesia used for the procedures consisted of IV or general sedation, supplemented with local infiltration of 0.5% lidocaine with epinephrine or a dilute local anesthetic solution.

"The benefit of combining these procedures is that you can address two problems with one healing period of approximately 2 weeks," Dr. Barbarino said. "We observed no clinical differences in outcomes from simultaneously performing these procedures versus performing each procedure at separate settings."

A key to preventing complications is to consider if the patient’s skin thickness will tolerate the combined procedures. Assessment for feasibility would involve analysis of the skin texture, turgor, and the presence or absence of ecchymoses under the skin after the face-lifting procedure. "If a patient’s skin was already very thin preoperatively, then the surgeon would be well advised not to proceed with the combined procedure," she said. "Ideally, you’d like to treat with topical vitamin C solution and tretinoin 0.1% cream for 1 month prior to any peel. Sun avoidance is mandatory during the healing process."

Infection with herpes simplex virus is a common complication of all chemical peels. If this occurs, Dr. Barbarino recommends treating with valacyclovir. "You can reassure your patients that these lesions will resolve without any scarring," she said.

No incidence of necrosis was noted in the patients, nor were there any objectionable permanent pigmentary changes. "Transient hyperpigmentation is responsive to bleaching agents or simply re-peeling the patient," she said.

Dr. Barbarino said that she had no relevant financial conflicts to disclose.

LAS VEGAS – In the early 1980s, combining facelift procedures with chemical skin peeling was considered a no-no because of skin necrosis concerns.

But Dr. David M. Morrow, founder and director of the Rancho Mirage, Calif.–based Morrow Institute, had a hunch that chemical peels that were made from phenols might be causing the necrosis, not those made from trichloroacetic acid (TCA). So in the late 1980s, he started combining TCA peels with lifting procedures of the upper face, midface, and neck – a practice that he has continued to this day.

At the annual meeting of the American Academy of Cosmetic Surgery, Dr. Sheila C. Barbarino presented results from 1,118 men and women aged 35-89 years who have undergone the combined procedures at the Morrow Institute since 1988, "all without a single case of skin necrosis," said Dr. Barbarino, an ophthalmic plastic surgeon at the institute.

Photos courtesy Dr. Sheila Barbarino and Dr. David Morrow

Of the 1,118 procedures, 489 were performed using TCA 35%, 481 with TCA 18%, and 148 with TCA 15%. She noted that 483 of the procedures also involved the use of phenol 89%, which was applied to the lower eyelid and/or periorbital area. She said that the current practice at the institute is to use a moderately deep peel with TCA 18%.

The rationale for chemical skin peeling following lifting procedures is to improve skin color and texture "while creating new epidermis, dermal collagen, and elastic fibers," Dr. Barbarino said. "Combining these two procedures and performing them simultaneously is extremely efficient. It calls for only one operative setting for anesthesia [and] one window of healing time, and it saves the patient time and money."

In the upper face–, midface-, and neck-lifting procedures, undermining consisted of combined blunt and sharp dissection to create long, subcutaneous flaps of the neck and face. Suspension sutures were placed in a favorable vector via superficial musculoaponeurotic system (SMAS) plication and/or SMAS flaps. "The skin flaps were then trimmed and tailored and skin closure was performed, followed immediately by chemical skin peeling," Dr. Barbarino said.

Photos courtesy Dr. Sheila Barbarino and Dr. David Morrow

Chemicals used were TCA 18%-35% and phenol 89% to nonundermined areas. "You can safely use phenol after transconjunctival lower lid blepharoplasty, but not after transcutaneous lower lid blepharoplasty, because the flap is a little too thin," she said.

Patients who underwent the combined procedures had Fitzpatrick skin types I-IV. Postoperatively, the skin was evaluated based on thickness, color, and condition. "Skin flap thickness and condition [were] also evaluated immediately after the surgery was performed," Dr. Barbarino said. "If significant swelling, ecchymosis, and/or hematoma were observed, we would defer the peel for another day."

Anesthesia used for the procedures consisted of IV or general sedation, supplemented with local infiltration of 0.5% lidocaine with epinephrine or a dilute local anesthetic solution.

"The benefit of combining these procedures is that you can address two problems with one healing period of approximately 2 weeks," Dr. Barbarino said. "We observed no clinical differences in outcomes from simultaneously performing these procedures versus performing each procedure at separate settings."

A key to preventing complications is to consider if the patient’s skin thickness will tolerate the combined procedures. Assessment for feasibility would involve analysis of the skin texture, turgor, and the presence or absence of ecchymoses under the skin after the face-lifting procedure. "If a patient’s skin was already very thin preoperatively, then the surgeon would be well advised not to proceed with the combined procedure," she said. "Ideally, you’d like to treat with topical vitamin C solution and tretinoin 0.1% cream for 1 month prior to any peel. Sun avoidance is mandatory during the healing process."

Infection with herpes simplex virus is a common complication of all chemical peels. If this occurs, Dr. Barbarino recommends treating with valacyclovir. "You can reassure your patients that these lesions will resolve without any scarring," she said.

No incidence of necrosis was noted in the patients, nor were there any objectionable permanent pigmentary changes. "Transient hyperpigmentation is responsive to bleaching agents or simply re-peeling the patient," she said.

Dr. Barbarino said that she had no relevant financial conflicts to disclose.

LAS VEGAS – In the early 1980s, combining facelift procedures with chemical skin peeling was considered a no-no because of skin necrosis concerns.

But Dr. David M. Morrow, founder and director of the Rancho Mirage, Calif.–based Morrow Institute, had a hunch that chemical peels that were made from phenols might be causing the necrosis, not those made from trichloroacetic acid (TCA). So in the late 1980s, he started combining TCA peels with lifting procedures of the upper face, midface, and neck – a practice that he has continued to this day.

At the annual meeting of the American Academy of Cosmetic Surgery, Dr. Sheila C. Barbarino presented results from 1,118 men and women aged 35-89 years who have undergone the combined procedures at the Morrow Institute since 1988, "all without a single case of skin necrosis," said Dr. Barbarino, an ophthalmic plastic surgeon at the institute.

Photos courtesy Dr. Sheila Barbarino and Dr. David Morrow

Of the 1,118 procedures, 489 were performed using TCA 35%, 481 with TCA 18%, and 148 with TCA 15%. She noted that 483 of the procedures also involved the use of phenol 89%, which was applied to the lower eyelid and/or periorbital area. She said that the current practice at the institute is to use a moderately deep peel with TCA 18%.

The rationale for chemical skin peeling following lifting procedures is to improve skin color and texture "while creating new epidermis, dermal collagen, and elastic fibers," Dr. Barbarino said. "Combining these two procedures and performing them simultaneously is extremely efficient. It calls for only one operative setting for anesthesia [and] one window of healing time, and it saves the patient time and money."

In the upper face–, midface-, and neck-lifting procedures, undermining consisted of combined blunt and sharp dissection to create long, subcutaneous flaps of the neck and face. Suspension sutures were placed in a favorable vector via superficial musculoaponeurotic system (SMAS) plication and/or SMAS flaps. "The skin flaps were then trimmed and tailored and skin closure was performed, followed immediately by chemical skin peeling," Dr. Barbarino said.

Photos courtesy Dr. Sheila Barbarino and Dr. David Morrow

Chemicals used were TCA 18%-35% and phenol 89% to nonundermined areas. "You can safely use phenol after transconjunctival lower lid blepharoplasty, but not after transcutaneous lower lid blepharoplasty, because the flap is a little too thin," she said.

Patients who underwent the combined procedures had Fitzpatrick skin types I-IV. Postoperatively, the skin was evaluated based on thickness, color, and condition. "Skin flap thickness and condition [were] also evaluated immediately after the surgery was performed," Dr. Barbarino said. "If significant swelling, ecchymosis, and/or hematoma were observed, we would defer the peel for another day."

Anesthesia used for the procedures consisted of IV or general sedation, supplemented with local infiltration of 0.5% lidocaine with epinephrine or a dilute local anesthetic solution.

"The benefit of combining these procedures is that you can address two problems with one healing period of approximately 2 weeks," Dr. Barbarino said. "We observed no clinical differences in outcomes from simultaneously performing these procedures versus performing each procedure at separate settings."

A key to preventing complications is to consider if the patient’s skin thickness will tolerate the combined procedures. Assessment for feasibility would involve analysis of the skin texture, turgor, and the presence or absence of ecchymoses under the skin after the face-lifting procedure. "If a patient’s skin was already very thin preoperatively, then the surgeon would be well advised not to proceed with the combined procedure," she said. "Ideally, you’d like to treat with topical vitamin C solution and tretinoin 0.1% cream for 1 month prior to any peel. Sun avoidance is mandatory during the healing process."

Infection with herpes simplex virus is a common complication of all chemical peels. If this occurs, Dr. Barbarino recommends treating with valacyclovir. "You can reassure your patients that these lesions will resolve without any scarring," she said.

No incidence of necrosis was noted in the patients, nor were there any objectionable permanent pigmentary changes. "Transient hyperpigmentation is responsive to bleaching agents or simply re-peeling the patient," she said.

Dr. Barbarino said that she had no relevant financial conflicts to disclose.

LAS VEGAS – When treating tear trough deformities with hyaluronic acid fillers, Dr. Suzan Obagi makes it a point to have a set of sharp 30-gauge needles handy.

"There’s nothing worse than trying to do a treatment in the periorbital region, and then have your needles dull," she said during a demonstration on dermal fillers at the annual meeting of the American Academy of Cosmetic Surgery. "This can cause discomfort for the patient and probably more bruising. In a single session I may go through four or five needles. You’re better off having a sharp needle handy."

Courtesy Dr. Suzan Obagi

Dr. Obagi, who directs the University of Pittsburgh Medical Center's Cosmetic Surgery and Skin Health Center, likes to have an assistant on hand during periorbital injections of hyaluronic acid fillers, "so if you need to finish one side, the assistant can hold very gentle pressure on the treated area to minimize swelling and bruising," she said. "What you don’t want to do is push too hard. You’re in an area where you can easily move this filler to different regions. It should always be very light pressure on the area. I always tell patients not to rub or massage for 24 hours after the injection."

Some clinicians will treat the tear trough deformity without treating the rest of the orbital rim, she continued. "If patients have volume loss, it’s not just going to be the tear trough; it’s going to continue out to the sides of the orbit rim, especially in older patients," she said. "So it’s important to build up that area as well."

Dr. Obagi, who is also the immediate past vice president of the American Board of Cosmetic Surgery, prefers to use hyaluronic acid fillers that are smaller in particle size such as Medicis’ Restylane for tear trough deformities, adding lidocaine plus epinephrine prior to injection. "I use 0.3 mL 1% lidocaine with epinephrine and 0.2 mL sodium bicarbonate, and I use a Luer lock adapter to mix them together," she said. "I’m going to be working in an area where I want no bruising; in order to do that I need the epinephrine in there."

Dr. Obagi said that she had no relevant financial conflicts to disclose.

LAS VEGAS – When treating tear trough deformities with hyaluronic acid fillers, Dr. Suzan Obagi makes it a point to have a set of sharp 30-gauge needles handy.

"There’s nothing worse than trying to do a treatment in the periorbital region, and then have your needles dull," she said during a demonstration on dermal fillers at the annual meeting of the American Academy of Cosmetic Surgery. "This can cause discomfort for the patient and probably more bruising. In a single session I may go through four or five needles. You’re better off having a sharp needle handy."

Courtesy Dr. Suzan Obagi

Dr. Obagi, who directs the University of Pittsburgh Medical Center's Cosmetic Surgery and Skin Health Center, likes to have an assistant on hand during periorbital injections of hyaluronic acid fillers, "so if you need to finish one side, the assistant can hold very gentle pressure on the treated area to minimize swelling and bruising," she said. "What you don’t want to do is push too hard. You’re in an area where you can easily move this filler to different regions. It should always be very light pressure on the area. I always tell patients not to rub or massage for 24 hours after the injection."

Some clinicians will treat the tear trough deformity without treating the rest of the orbital rim, she continued. "If patients have volume loss, it’s not just going to be the tear trough; it’s going to continue out to the sides of the orbit rim, especially in older patients," she said. "So it’s important to build up that area as well."

Dr. Obagi, who is also the immediate past vice president of the American Board of Cosmetic Surgery, prefers to use hyaluronic acid fillers that are smaller in particle size such as Medicis’ Restylane for tear trough deformities, adding lidocaine plus epinephrine prior to injection. "I use 0.3 mL 1% lidocaine with epinephrine and 0.2 mL sodium bicarbonate, and I use a Luer lock adapter to mix them together," she said. "I’m going to be working in an area where I want no bruising; in order to do that I need the epinephrine in there."

Dr. Obagi said that she had no relevant financial conflicts to disclose.

LAS VEGAS – When treating tear trough deformities with hyaluronic acid fillers, Dr. Suzan Obagi makes it a point to have a set of sharp 30-gauge needles handy.

"There’s nothing worse than trying to do a treatment in the periorbital region, and then have your needles dull," she said during a demonstration on dermal fillers at the annual meeting of the American Academy of Cosmetic Surgery. "This can cause discomfort for the patient and probably more bruising. In a single session I may go through four or five needles. You’re better off having a sharp needle handy."

Courtesy Dr. Suzan Obagi

Dr. Obagi, who directs the University of Pittsburgh Medical Center's Cosmetic Surgery and Skin Health Center, likes to have an assistant on hand during periorbital injections of hyaluronic acid fillers, "so if you need to finish one side, the assistant can hold very gentle pressure on the treated area to minimize swelling and bruising," she said. "What you don’t want to do is push too hard. You’re in an area where you can easily move this filler to different regions. It should always be very light pressure on the area. I always tell patients not to rub or massage for 24 hours after the injection."

Some clinicians will treat the tear trough deformity without treating the rest of the orbital rim, she continued. "If patients have volume loss, it’s not just going to be the tear trough; it’s going to continue out to the sides of the orbit rim, especially in older patients," she said. "So it’s important to build up that area as well."

Dr. Obagi, who is also the immediate past vice president of the American Board of Cosmetic Surgery, prefers to use hyaluronic acid fillers that are smaller in particle size such as Medicis’ Restylane for tear trough deformities, adding lidocaine plus epinephrine prior to injection. "I use 0.3 mL 1% lidocaine with epinephrine and 0.2 mL sodium bicarbonate, and I use a Luer lock adapter to mix them together," she said. "I’m going to be working in an area where I want no bruising; in order to do that I need the epinephrine in there."

Dr. Obagi said that she had no relevant financial conflicts to disclose.

LAS VEGAS – There are two audiences to consider when creating an effective website design for a cosmetic dermatology practice: consumers and search engine robots, said Merrill Whatley.

"People and search engine robots want the same things from your design," Mr. Whatley, chief technical officer at Culver City, Calif.–based NKP Medical Marketing, said at the annual meeting of the American Academy of Cosmetic Surgery. "Both audiences like well-written, clean code using modern programming languages. This means that users are going to have the same experience across different browsers. So you want to make sure your website is operational on Internet Explorer, Firefox, Google Chrome, Safari, or however else they may be coming to you. They want it to be fast loading, and they want the content to be readable."

©Nastco/iStockphoto.com, screen image: Courtesy Merrill Whatley

Consider the following when developing a website:

• Set a tone and spark interest. "You want to talk about what makes you special," Mr. Whatley said. "Do you have any special deals on procedures that you’re offering? And how are the aesthetics of your website design? Is the website pretty?"

• Answer questions at a glance. A homepage should include information about who the physicians at the practice are, contact information, and testimonials from patients and other physicians. "The first thing [users] look for is your phone number in the upper right part of the screen," he said. "They’re also going to be looking for Facebook, Twitter, and YouTube icons. What this represents to people is that you’re out there: You’re not just broadcasting to them, but you’re interacting with them; you’re listening to them. Search engines are also figuring in your social media efforts by returning results from social media sites much more than they used to."

• Consider user experience. This involves anticipating the questions and concerns of visitors to a website, such as physician training, qualifications, and memberships and other affiliations; financing options; and access to before and after clinical photos.

"If you don’t have a photo gallery yet, or permission from patients to use their photos, still include a photo gallery link on your website," Mr. Whatley advised. "When users click there, you could have a message that reads, ‘due to patient confidentiality, we are not featuring photos at this time,’ and that message could go on to invite patients in for a consultation. You’d be surprised at the number of contacts some of our clients have received from a contact form like this."

Increasingly, website designers are creating device-specific displays for smartphones and other mobile devices. Mr. Whatley recommended not only device-specific displays but a device-specific experience for users. "You have to consider that the user’s needs are going to be different and more action oriented when they are visiting your site from a mobile device," he explained. "Both people and search engines recognize these efforts at improving the user experience."

A mobile-specific interface "helps bring people into your office and makes them feel like you are accessible," Mr. Whatley said. "They get an app-like experience without having to download an app." The site page should resemble an app, with a prominent call button, an e-mail button, and a way for users to send a text message. "This is going to get you better results when people are searching from a mobile device," he said of device-specific displays. "Up to 50% of visits to some of our clients’ websites come from mobile devices."

His list of features to avoid on a website includes autoplaying video and audio, splash pages, and bad navigation choices. "For example, alphabetic ordering of the procedures offered in your practice may seem elementary, but it’s important from the user’s standpoint," he said.

Mr. Whatley said he had no relevant financial disclosures.

LAS VEGAS – There are two audiences to consider when creating an effective website design for a cosmetic dermatology practice: consumers and search engine robots, said Merrill Whatley.

"People and search engine robots want the same things from your design," Mr. Whatley, chief technical officer at Culver City, Calif.–based NKP Medical Marketing, said at the annual meeting of the American Academy of Cosmetic Surgery. "Both audiences like well-written, clean code using modern programming languages. This means that users are going to have the same experience across different browsers. So you want to make sure your website is operational on Internet Explorer, Firefox, Google Chrome, Safari, or however else they may be coming to you. They want it to be fast loading, and they want the content to be readable."

©Nastco/iStockphoto.com, screen image: Courtesy Merrill Whatley

Consider the following when developing a website:

• Set a tone and spark interest. "You want to talk about what makes you special," Mr. Whatley said. "Do you have any special deals on procedures that you’re offering? And how are the aesthetics of your website design? Is the website pretty?"

• Answer questions at a glance. A homepage should include information about who the physicians at the practice are, contact information, and testimonials from patients and other physicians. "The first thing [users] look for is your phone number in the upper right part of the screen," he said. "They’re also going to be looking for Facebook, Twitter, and YouTube icons. What this represents to people is that you’re out there: You’re not just broadcasting to them, but you’re interacting with them; you’re listening to them. Search engines are also figuring in your social media efforts by returning results from social media sites much more than they used to."

• Consider user experience. This involves anticipating the questions and concerns of visitors to a website, such as physician training, qualifications, and memberships and other affiliations; financing options; and access to before and after clinical photos.

"If you don’t have a photo gallery yet, or permission from patients to use their photos, still include a photo gallery link on your website," Mr. Whatley advised. "When users click there, you could have a message that reads, ‘due to patient confidentiality, we are not featuring photos at this time,’ and that message could go on to invite patients in for a consultation. You’d be surprised at the number of contacts some of our clients have received from a contact form like this."

Increasingly, website designers are creating device-specific displays for smartphones and other mobile devices. Mr. Whatley recommended not only device-specific displays but a device-specific experience for users. "You have to consider that the user’s needs are going to be different and more action oriented when they are visiting your site from a mobile device," he explained. "Both people and search engines recognize these efforts at improving the user experience."

A mobile-specific interface "helps bring people into your office and makes them feel like you are accessible," Mr. Whatley said. "They get an app-like experience without having to download an app." The site page should resemble an app, with a prominent call button, an e-mail button, and a way for users to send a text message. "This is going to get you better results when people are searching from a mobile device," he said of device-specific displays. "Up to 50% of visits to some of our clients’ websites come from mobile devices."

His list of features to avoid on a website includes autoplaying video and audio, splash pages, and bad navigation choices. "For example, alphabetic ordering of the procedures offered in your practice may seem elementary, but it’s important from the user’s standpoint," he said.

Mr. Whatley said he had no relevant financial disclosures.

LAS VEGAS – There are two audiences to consider when creating an effective website design for a cosmetic dermatology practice: consumers and search engine robots, said Merrill Whatley.

"People and search engine robots want the same things from your design," Mr. Whatley, chief technical officer at Culver City, Calif.–based NKP Medical Marketing, said at the annual meeting of the American Academy of Cosmetic Surgery. "Both audiences like well-written, clean code using modern programming languages. This means that users are going to have the same experience across different browsers. So you want to make sure your website is operational on Internet Explorer, Firefox, Google Chrome, Safari, or however else they may be coming to you. They want it to be fast loading, and they want the content to be readable."

©Nastco/iStockphoto.com, screen image: Courtesy Merrill Whatley

Consider the following when developing a website:

• Set a tone and spark interest. "You want to talk about what makes you special," Mr. Whatley said. "Do you have any special deals on procedures that you’re offering? And how are the aesthetics of your website design? Is the website pretty?"

• Answer questions at a glance. A homepage should include information about who the physicians at the practice are, contact information, and testimonials from patients and other physicians. "The first thing [users] look for is your phone number in the upper right part of the screen," he said. "They’re also going to be looking for Facebook, Twitter, and YouTube icons. What this represents to people is that you’re out there: You’re not just broadcasting to them, but you’re interacting with them; you’re listening to them. Search engines are also figuring in your social media efforts by returning results from social media sites much more than they used to."

• Consider user experience. This involves anticipating the questions and concerns of visitors to a website, such as physician training, qualifications, and memberships and other affiliations; financing options; and access to before and after clinical photos.

"If you don’t have a photo gallery yet, or permission from patients to use their photos, still include a photo gallery link on your website," Mr. Whatley advised. "When users click there, you could have a message that reads, ‘due to patient confidentiality, we are not featuring photos at this time,’ and that message could go on to invite patients in for a consultation. You’d be surprised at the number of contacts some of our clients have received from a contact form like this."

Increasingly, website designers are creating device-specific displays for smartphones and other mobile devices. Mr. Whatley recommended not only device-specific displays but a device-specific experience for users. "You have to consider that the user’s needs are going to be different and more action oriented when they are visiting your site from a mobile device," he explained. "Both people and search engines recognize these efforts at improving the user experience."

A mobile-specific interface "helps bring people into your office and makes them feel like you are accessible," Mr. Whatley said. "They get an app-like experience without having to download an app." The site page should resemble an app, with a prominent call button, an e-mail button, and a way for users to send a text message. "This is going to get you better results when people are searching from a mobile device," he said of device-specific displays. "Up to 50% of visits to some of our clients’ websites come from mobile devices."

His list of features to avoid on a website includes autoplaying video and audio, splash pages, and bad navigation choices. "For example, alphabetic ordering of the procedures offered in your practice may seem elementary, but it’s important from the user’s standpoint," he said.

Mr. Whatley said he had no relevant financial disclosures.

LAS VEGAS – Soon after completing a cosmetic dermatologic surgery fellowship at the University of Pittsburgh Medical Center in 2001, Dr. Suzan Obagi stayed on to help launch one of the first academically based cosmetic surgery practices.

There was no previous business plan, no model at another university," Dr. Obagi said at the annual meeting of the American Academy of Cosmetic Surgery.

Courtesy Dr. Suzan Obagi

Today, toxin and filler treatments at the UPMC cosmetic surgery and skin health center are booked 4 months out, and Dr. Obagi said she treats about 1,200 patients with botulinum toxin type A each year and another 600-700 patients with dermal fillers. "If I’ve managed to build a successful cosmetic surgery practice in an academic setting, all of you can certainly do so in a noncampus setting," said Dr. Obagi, who directs the center.

Botulinum toxin type A and dermal fillers are the mainstays of any cosmetic surgery practice because patients strive for the instant results that come from using them. "Instant gratification: That’s what it’s all about," said Dr. Obagi. "Patients don’t want the prolonged down time or the stigma of looking like they’ve had something done. They love the natural look you can give them with injectables. For me, it’s a fun part of my practice. ... I get to be artistic."

Demand for injectables persists during times of economic uncertainty, she added. "When we had the downturn in the economy in 2008, we saw that the number of large [cosmetic surgery] cases dropped off, but the number of small procedures like injections of botulinum toxin type A and other fillers remained the same. What we did to get through some of that downturn was to open up more slots and get more patients in for these procedures."

She offered the following tips on how to enhance an injectables practice:

• Stand out from the competition. "Part of this is how your practice handles patients when they come in, but a bigger part of your practice is, how good are you with the needle?" Dr. Obagi said. "Your artistry is what’s going to speak volumes, so you have to differentiate yourself with your skill, and you have to make sure patients are able to come in every 3-4 months. If your schedule does not allow that to be booked, then you’re going to miss out."

• Set up rooms for efficiency. She said she equips each exam room with a wire basket full of needles, syringes, gauze, anesthetic, and other supplies she’ll need to treat every botulinum toxin type A and dermal filler patient who comes in. "I walk into a room and I can do two to three different things on that patient without having to step out of that room again," Dr. Obagi explained. "I don’t have to go fumbling for anything. I can spend all of that time talking to the patient, inquiring about their family, their adventures, learning about them. It diffuses the situation because patients know you’re going to come at them with a needle. They know they’re going to be feeling some pain shortly. Whatever you can do to calm them before you come at them with that needle really makes a difference."

To optimize the patient experience, she purchased powered procedure chairs for each exam room. "They’re about $10,000 per chair, but they have foot pedals for adjustment so you don’t have to touch anything with your hands," she said. "It’s all about comfort for you and the patient."

She also stocks the waiting room and each exam room with brochures that describe each procedure offered at the center.

• Evaluate each patient at every visit. If a patient has been treated with botulinum toxin type A for the last 5 years, she or he "may need it in other areas now that you’ve taken care of areas they were initially bothered by," Dr. Obagi said. "You need to keep reassessing the patient every time she or he comes in."

• Inject patients quickly and comfortably. Dr. Obagi said she uses the smallest needle possible and stabilizes the fingers on her nondominating hand "so my hand is steady; it’s not going to shake [during injection]," she said. "I have been on the receiving end of good and bad botulinum toxin type A treatments. What makes the difference is being quick with the injection. Make sure your hand is stabilized, and don’t go deeper than you need to. Botulinum toxin type A is not meant to be injected into the periosteum. Don’t go there; it hurts."

• Do the procedures yourself. This allows you to see the patient every 3-4 months to recommend ancillary treatments and surgery.

Dr. Obagi said she charges patients by the amount of toxin or filler used, not by the specific anatomic area she treats. That works well, she said, "because some patients may require 12 U in an area of the face while another patient may require 50 U in that same area."

She said she runs two parallel schedules to optimize efficiency. For example, her afternoon consultation times are at 1 p.m., 1:30 p.m., 2 p.m., 2:30 p.m., 3 p.m., 3:30 p.m., and 4 p.m., while her treatment times for botulinum toxin type A and filler patients are at 1:45 p.m., 2:15 p.m., 2:45 p.m., 3:15 p.m., and 3:45 p.m. "So after I finish a consult in one room, I go into another room and do a quick treatment," she said. "I come back out and go to the next consult."

Dr. Obagi said she had no relevant financial disclosures.

LAS VEGAS – Soon after completing a cosmetic dermatologic surgery fellowship at the University of Pittsburgh Medical Center in 2001, Dr. Suzan Obagi stayed on to help launch one of the first academically based cosmetic surgery practices.

There was no previous business plan, no model at another university," Dr. Obagi said at the annual meeting of the American Academy of Cosmetic Surgery.

Courtesy Dr. Suzan Obagi

Today, toxin and filler treatments at the UPMC cosmetic surgery and skin health center are booked 4 months out, and Dr. Obagi said she treats about 1,200 patients with botulinum toxin type A each year and another 600-700 patients with dermal fillers. "If I’ve managed to build a successful cosmetic surgery practice in an academic setting, all of you can certainly do so in a noncampus setting," said Dr. Obagi, who directs the center.

Botulinum toxin type A and dermal fillers are the mainstays of any cosmetic surgery practice because patients strive for the instant results that come from using them. "Instant gratification: That’s what it’s all about," said Dr. Obagi. "Patients don’t want the prolonged down time or the stigma of looking like they’ve had something done. They love the natural look you can give them with injectables. For me, it’s a fun part of my practice. ... I get to be artistic."

Demand for injectables persists during times of economic uncertainty, she added. "When we had the downturn in the economy in 2008, we saw that the number of large [cosmetic surgery] cases dropped off, but the number of small procedures like injections of botulinum toxin type A and other fillers remained the same. What we did to get through some of that downturn was to open up more slots and get more patients in for these procedures."

She offered the following tips on how to enhance an injectables practice:

• Stand out from the competition. "Part of this is how your practice handles patients when they come in, but a bigger part of your practice is, how good are you with the needle?" Dr. Obagi said. "Your artistry is what’s going to speak volumes, so you have to differentiate yourself with your skill, and you have to make sure patients are able to come in every 3-4 months. If your schedule does not allow that to be booked, then you’re going to miss out."

• Set up rooms for efficiency. She said she equips each exam room with a wire basket full of needles, syringes, gauze, anesthetic, and other supplies she’ll need to treat every botulinum toxin type A and dermal filler patient who comes in. "I walk into a room and I can do two to three different things on that patient without having to step out of that room again," Dr. Obagi explained. "I don’t have to go fumbling for anything. I can spend all of that time talking to the patient, inquiring about their family, their adventures, learning about them. It diffuses the situation because patients know you’re going to come at them with a needle. They know they’re going to be feeling some pain shortly. Whatever you can do to calm them before you come at them with that needle really makes a difference."

To optimize the patient experience, she purchased powered procedure chairs for each exam room. "They’re about $10,000 per chair, but they have foot pedals for adjustment so you don’t have to touch anything with your hands," she said. "It’s all about comfort for you and the patient."

She also stocks the waiting room and each exam room with brochures that describe each procedure offered at the center.

• Evaluate each patient at every visit. If a patient has been treated with botulinum toxin type A for the last 5 years, she or he "may need it in other areas now that you’ve taken care of areas they were initially bothered by," Dr. Obagi said. "You need to keep reassessing the patient every time she or he comes in."

• Inject patients quickly and comfortably. Dr. Obagi said she uses the smallest needle possible and stabilizes the fingers on her nondominating hand "so my hand is steady; it’s not going to shake [during injection]," she said. "I have been on the receiving end of good and bad botulinum toxin type A treatments. What makes the difference is being quick with the injection. Make sure your hand is stabilized, and don’t go deeper than you need to. Botulinum toxin type A is not meant to be injected into the periosteum. Don’t go there; it hurts."

• Do the procedures yourself. This allows you to see the patient every 3-4 months to recommend ancillary treatments and surgery.

Dr. Obagi said she charges patients by the amount of toxin or filler used, not by the specific anatomic area she treats. That works well, she said, "because some patients may require 12 U in an area of the face while another patient may require 50 U in that same area."

She said she runs two parallel schedules to optimize efficiency. For example, her afternoon consultation times are at 1 p.m., 1:30 p.m., 2 p.m., 2:30 p.m., 3 p.m., 3:30 p.m., and 4 p.m., while her treatment times for botulinum toxin type A and filler patients are at 1:45 p.m., 2:15 p.m., 2:45 p.m., 3:15 p.m., and 3:45 p.m. "So after I finish a consult in one room, I go into another room and do a quick treatment," she said. "I come back out and go to the next consult."

Dr. Obagi said she had no relevant financial disclosures.

LAS VEGAS – Soon after completing a cosmetic dermatologic surgery fellowship at the University of Pittsburgh Medical Center in 2001, Dr. Suzan Obagi stayed on to help launch one of the first academically based cosmetic surgery practices.

There was no previous business plan, no model at another university," Dr. Obagi said at the annual meeting of the American Academy of Cosmetic Surgery.

Courtesy Dr. Suzan Obagi

Today, toxin and filler treatments at the UPMC cosmetic surgery and skin health center are booked 4 months out, and Dr. Obagi said she treats about 1,200 patients with botulinum toxin type A each year and another 600-700 patients with dermal fillers. "If I’ve managed to build a successful cosmetic surgery practice in an academic setting, all of you can certainly do so in a noncampus setting," said Dr. Obagi, who directs the center.

Botulinum toxin type A and dermal fillers are the mainstays of any cosmetic surgery practice because patients strive for the instant results that come from using them. "Instant gratification: That’s what it’s all about," said Dr. Obagi. "Patients don’t want the prolonged down time or the stigma of looking like they’ve had something done. They love the natural look you can give them with injectables. For me, it’s a fun part of my practice. ... I get to be artistic."

Demand for injectables persists during times of economic uncertainty, she added. "When we had the downturn in the economy in 2008, we saw that the number of large [cosmetic surgery] cases dropped off, but the number of small procedures like injections of botulinum toxin type A and other fillers remained the same. What we did to get through some of that downturn was to open up more slots and get more patients in for these procedures."

She offered the following tips on how to enhance an injectables practice:

• Stand out from the competition. "Part of this is how your practice handles patients when they come in, but a bigger part of your practice is, how good are you with the needle?" Dr. Obagi said. "Your artistry is what’s going to speak volumes, so you have to differentiate yourself with your skill, and you have to make sure patients are able to come in every 3-4 months. If your schedule does not allow that to be booked, then you’re going to miss out."

• Set up rooms for efficiency. She said she equips each exam room with a wire basket full of needles, syringes, gauze, anesthetic, and other supplies she’ll need to treat every botulinum toxin type A and dermal filler patient who comes in. "I walk into a room and I can do two to three different things on that patient without having to step out of that room again," Dr. Obagi explained. "I don’t have to go fumbling for anything. I can spend all of that time talking to the patient, inquiring about their family, their adventures, learning about them. It diffuses the situation because patients know you’re going to come at them with a needle. They know they’re going to be feeling some pain shortly. Whatever you can do to calm them before you come at them with that needle really makes a difference."

To optimize the patient experience, she purchased powered procedure chairs for each exam room. "They’re about $10,000 per chair, but they have foot pedals for adjustment so you don’t have to touch anything with your hands," she said. "It’s all about comfort for you and the patient."

She also stocks the waiting room and each exam room with brochures that describe each procedure offered at the center.

• Evaluate each patient at every visit. If a patient has been treated with botulinum toxin type A for the last 5 years, she or he "may need it in other areas now that you’ve taken care of areas they were initially bothered by," Dr. Obagi said. "You need to keep reassessing the patient every time she or he comes in."

• Inject patients quickly and comfortably. Dr. Obagi said she uses the smallest needle possible and stabilizes the fingers on her nondominating hand "so my hand is steady; it’s not going to shake [during injection]," she said. "I have been on the receiving end of good and bad botulinum toxin type A treatments. What makes the difference is being quick with the injection. Make sure your hand is stabilized, and don’t go deeper than you need to. Botulinum toxin type A is not meant to be injected into the periosteum. Don’t go there; it hurts."

• Do the procedures yourself. This allows you to see the patient every 3-4 months to recommend ancillary treatments and surgery.

Dr. Obagi said she charges patients by the amount of toxin or filler used, not by the specific anatomic area she treats. That works well, she said, "because some patients may require 12 U in an area of the face while another patient may require 50 U in that same area."

She said she runs two parallel schedules to optimize efficiency. For example, her afternoon consultation times are at 1 p.m., 1:30 p.m., 2 p.m., 2:30 p.m., 3 p.m., 3:30 p.m., and 4 p.m., while her treatment times for botulinum toxin type A and filler patients are at 1:45 p.m., 2:15 p.m., 2:45 p.m., 3:15 p.m., and 3:45 p.m. "So after I finish a consult in one room, I go into another room and do a quick treatment," she said. "I come back out and go to the next consult."

Dr. Obagi said she had no relevant financial disclosures.

LAS VEGAS – When using fat and stem cell transfer for facial volume enhancement, it's disingenuous to tell patients a stem cell face-lift is being performed, said Dr. Mark Berman.

The accurate description is to tell patients a stem cell fat graft is being performed. "Tell them 'we're using a fat graft, and the reason it works is because your fat is loaded with stem cells, which can turn on, proliferate, and grow new fat cells,' " Dr. Berman said at the annual meeting of the American Academy of Cosmetic Surgery. "This is a dynamic process."

Courtesy Dr. Mark Berman

In 2008, Dr. Hee Young Lee introduced Dr. Berman to a system he created, known as the Lipokit (Medi-Khan, Korea and currently distributed as the Adivive system by Palomar), a closed device approved for condensed autologous fat transfer. Dr. Berman said he began using the system at his Beverly Hills, Calif.–based cosmetic surgery practice for facial volume enhancement.

A key component of the device, he said, is the fat-processing unit, a single-use, disposable syringe with a bidirectional moving piston, a microfilter, a fluid gate, and a weighted metallic ring. "What makes this syringe unique is that it allows you to compress and filter the fat at the same time, so you actually increase the concentration of cells," said Dr. Berman. "You can also put in tumescent anesthesia in this system real easily."

Early in his clinical experience with the Adivive system, he said he would spin harvested fat in a centrifuge at 4,000 rpm for 8 minutes. Now he spins the harvested fat at 2,800 rpm for 3 minutes. "The difference is, at the lower rate, the stem cells tend to have increased viability, while at the higher rate you get increased concentration of stem cells," Dr. Berman explained.

The results of stem cell fat grafting for facial volume enhancement are generally superior to those achieved with dermal filler injections because the process restores facial volume naturally. "Most of our face-lift patients don’t want to look different; they want to look like they used to," he said. "Aging is not about sagging skin caused by gravity. Gravity does not cause aging; it just affects how you look in different positions."

Aging, he continued, is caused by "loss of facial fat, loss of skin elasticity, and loss of bone volume very late in life or related to tooth loss. Your face is basically skin, fat, muscle, and bone. You have about 60% of fat between the first layer of skin and muscle, and the rest is under the muscle."

Stem cell fat grafting can restore a three-dimensional appearance to the patient's skin, said Dr. Berman, who coined the term "space lift" to describe the concept of lifting the skin away from the facial bones by fat-grafting techniques.

"I have traveled around the world talking with people who are experts on fat grafting, and we all agree on one thing: The variable is not our technique," he said. "The big variable is the quality of the stem cells mixed in with the patient's fat. I tell the patient, 'If you're not willing to repeat the operation, don't do it at all,' because at some point noticeable losses of the transferred fat may occur. Some people find that frustrating."

Dr. Berman disclosed teaching the technique in courses sponsored by Palomar.

LAS VEGAS – When using fat and stem cell transfer for facial volume enhancement, it's disingenuous to tell patients a stem cell face-lift is being performed, said Dr. Mark Berman.

The accurate description is to tell patients a stem cell fat graft is being performed. "Tell them 'we're using a fat graft, and the reason it works is because your fat is loaded with stem cells, which can turn on, proliferate, and grow new fat cells,' " Dr. Berman said at the annual meeting of the American Academy of Cosmetic Surgery. "This is a dynamic process."

Courtesy Dr. Mark Berman

In 2008, Dr. Hee Young Lee introduced Dr. Berman to a system he created, known as the Lipokit (Medi-Khan, Korea and currently distributed as the Adivive system by Palomar), a closed device approved for condensed autologous fat transfer. Dr. Berman said he began using the system at his Beverly Hills, Calif.–based cosmetic surgery practice for facial volume enhancement.

A key component of the device, he said, is the fat-processing unit, a single-use, disposable syringe with a bidirectional moving piston, a microfilter, a fluid gate, and a weighted metallic ring. "What makes this syringe unique is that it allows you to compress and filter the fat at the same time, so you actually increase the concentration of cells," said Dr. Berman. "You can also put in tumescent anesthesia in this system real easily."

Early in his clinical experience with the Adivive system, he said he would spin harvested fat in a centrifuge at 4,000 rpm for 8 minutes. Now he spins the harvested fat at 2,800 rpm for 3 minutes. "The difference is, at the lower rate, the stem cells tend to have increased viability, while at the higher rate you get increased concentration of stem cells," Dr. Berman explained.

The results of stem cell fat grafting for facial volume enhancement are generally superior to those achieved with dermal filler injections because the process restores facial volume naturally. "Most of our face-lift patients don’t want to look different; they want to look like they used to," he said. "Aging is not about sagging skin caused by gravity. Gravity does not cause aging; it just affects how you look in different positions."

Aging, he continued, is caused by "loss of facial fat, loss of skin elasticity, and loss of bone volume very late in life or related to tooth loss. Your face is basically skin, fat, muscle, and bone. You have about 60% of fat between the first layer of skin and muscle, and the rest is under the muscle."

Stem cell fat grafting can restore a three-dimensional appearance to the patient's skin, said Dr. Berman, who coined the term "space lift" to describe the concept of lifting the skin away from the facial bones by fat-grafting techniques.

"I have traveled around the world talking with people who are experts on fat grafting, and we all agree on one thing: The variable is not our technique," he said. "The big variable is the quality of the stem cells mixed in with the patient's fat. I tell the patient, 'If you're not willing to repeat the operation, don't do it at all,' because at some point noticeable losses of the transferred fat may occur. Some people find that frustrating."

Dr. Berman disclosed teaching the technique in courses sponsored by Palomar.

LAS VEGAS – When using fat and stem cell transfer for facial volume enhancement, it's disingenuous to tell patients a stem cell face-lift is being performed, said Dr. Mark Berman.

The accurate description is to tell patients a stem cell fat graft is being performed. "Tell them 'we're using a fat graft, and the reason it works is because your fat is loaded with stem cells, which can turn on, proliferate, and grow new fat cells,' " Dr. Berman said at the annual meeting of the American Academy of Cosmetic Surgery. "This is a dynamic process."

Courtesy Dr. Mark Berman

In 2008, Dr. Hee Young Lee introduced Dr. Berman to a system he created, known as the Lipokit (Medi-Khan, Korea and currently distributed as the Adivive system by Palomar), a closed device approved for condensed autologous fat transfer. Dr. Berman said he began using the system at his Beverly Hills, Calif.–based cosmetic surgery practice for facial volume enhancement.

A key component of the device, he said, is the fat-processing unit, a single-use, disposable syringe with a bidirectional moving piston, a microfilter, a fluid gate, and a weighted metallic ring. "What makes this syringe unique is that it allows you to compress and filter the fat at the same time, so you actually increase the concentration of cells," said Dr. Berman. "You can also put in tumescent anesthesia in this system real easily."

Early in his clinical experience with the Adivive system, he said he would spin harvested fat in a centrifuge at 4,000 rpm for 8 minutes. Now he spins the harvested fat at 2,800 rpm for 3 minutes. "The difference is, at the lower rate, the stem cells tend to have increased viability, while at the higher rate you get increased concentration of stem cells," Dr. Berman explained.

The results of stem cell fat grafting for facial volume enhancement are generally superior to those achieved with dermal filler injections because the process restores facial volume naturally. "Most of our face-lift patients don’t want to look different; they want to look like they used to," he said. "Aging is not about sagging skin caused by gravity. Gravity does not cause aging; it just affects how you look in different positions."

Aging, he continued, is caused by "loss of facial fat, loss of skin elasticity, and loss of bone volume very late in life or related to tooth loss. Your face is basically skin, fat, muscle, and bone. You have about 60% of fat between the first layer of skin and muscle, and the rest is under the muscle."

Stem cell fat grafting can restore a three-dimensional appearance to the patient's skin, said Dr. Berman, who coined the term "space lift" to describe the concept of lifting the skin away from the facial bones by fat-grafting techniques.

"I have traveled around the world talking with people who are experts on fat grafting, and we all agree on one thing: The variable is not our technique," he said. "The big variable is the quality of the stem cells mixed in with the patient's fat. I tell the patient, 'If you're not willing to repeat the operation, don't do it at all,' because at some point noticeable losses of the transferred fat may occur. Some people find that frustrating."

Dr. Berman disclosed teaching the technique in courses sponsored by Palomar.

LAS VEGAS – It is not uncommon for cosmetic dermatologists to follow their competitors when it comes to external marketing efforts, according to Tracy L. Drumm, an aesthetic medical marketing expert.

"Maybe it’s print advertising, pay-per-click online advertising, or maybe it’s social media," Ms. Drumm said at the annual meeting of the American Academy of Cosmetic Surgery. "The problem is external marketing – marketing to patients who don’t already know you – is the most expensive form of marketing."

According to Ms. Drumm, vice president of Chicago-based IF Marketing, a more effective way to generate new patients is through internal marketing, which she described as "talking to people who are already coming through the door, who already know you, who come to you every 3-4 months for their Botox treatments."

The best way to do this is to provide tools to patients that "empower them to talk to their friends about you." This may be in the form of business cards that contain practice information, such as how many neurotoxin treatments or specific cosmetic surgeries were performed last year, or a list of the procedures offered with corresponding columns for before and after photos. "Highlight what makes you special and unique," advised Ms. Drumm.

Another strategy is to have a dedicated space in the waiting room for a "referral station" stocked with business cards customized for each of the procedures offered, with a corresponding sign that reads: "The greatest compliment you can give us is a referral." One practice that adopted the referral station now replenishes the cards weekly. "People take the cards," she said. "They’re portable, small, and discreet to pass on."

Creating a "patient passport" card for existing patients is another way to advertise. This is a laminated business card–size tool that contains a before and after photo of the patient, along with office contact information. This strategy "reminds patients of how they looked before their procedure and provides a visual reminder of their improvement," Ms. Drumm said. "It’s also something they can share with their friends."

Profiling patients who consent to advertise their "transformation" on postcards, brochures, handouts, posters, or in a newsletter is another effective way to promote a practice. "The nice thing is that you can send these profiles to your existing patients to help keep them coming back," she said. "But you can also purchase data and have this sent out to people who match the demographics of your current patients."

In today’s business climate, relationship building is more important than ever, Ms. Drumm said, so she recommends mailing cards to mark patient birthdays, Mother’s Day, and other special holidays. Consider inserting a $50 gift certificate for patients in each card, as well as a $50 gift certificate for a friend. In 2 years of tracking results of this tactic at one practice, 17 new patients referred from friends spent about $35,000. "A qualified referral from a friend is a very powerful source," she said. "You want to keep encouraging these referrals."

For direct mail promotions, Ms. Drumm recommended the acronym TOIB for teaser, offer, immediacy, and brand.

The teaser should consist of a catchy phrase to get people’s attention, she said, such as "four ways to look younger overnight" or "four steps to a summer bikini." The offer, paired with the teaser, should be of perceived value, such as a free consultation or free microdermabrasion.

"Then, offer immediacy to make sure you are at the top of someone’s to-do list," Ms. Drumm said. "Maybe it’s something like, ‘the first 15 people to RSVP get a complimentary swag bag.’ Offer something to make that person want to take action."

The fourth component is brand. "Everything you do should be stamped with the logo and name of your practice," she said.

Ms. Drumm said that she had no relevant financial conflicts to disclose.

LAS VEGAS – It is not uncommon for cosmetic dermatologists to follow their competitors when it comes to external marketing efforts, according to Tracy L. Drumm, an aesthetic medical marketing expert.

"Maybe it’s print advertising, pay-per-click online advertising, or maybe it’s social media," Ms. Drumm said at the annual meeting of the American Academy of Cosmetic Surgery. "The problem is external marketing – marketing to patients who don’t already know you – is the most expensive form of marketing."

According to Ms. Drumm, vice president of Chicago-based IF Marketing, a more effective way to generate new patients is through internal marketing, which she described as "talking to people who are already coming through the door, who already know you, who come to you every 3-4 months for their Botox treatments."

The best way to do this is to provide tools to patients that "empower them to talk to their friends about you." This may be in the form of business cards that contain practice information, such as how many neurotoxin treatments or specific cosmetic surgeries were performed last year, or a list of the procedures offered with corresponding columns for before and after photos. "Highlight what makes you special and unique," advised Ms. Drumm.

Another strategy is to have a dedicated space in the waiting room for a "referral station" stocked with business cards customized for each of the procedures offered, with a corresponding sign that reads: "The greatest compliment you can give us is a referral." One practice that adopted the referral station now replenishes the cards weekly. "People take the cards," she said. "They’re portable, small, and discreet to pass on."

Creating a "patient passport" card for existing patients is another way to advertise. This is a laminated business card–size tool that contains a before and after photo of the patient, along with office contact information. This strategy "reminds patients of how they looked before their procedure and provides a visual reminder of their improvement," Ms. Drumm said. "It’s also something they can share with their friends."

Profiling patients who consent to advertise their "transformation" on postcards, brochures, handouts, posters, or in a newsletter is another effective way to promote a practice. "The nice thing is that you can send these profiles to your existing patients to help keep them coming back," she said. "But you can also purchase data and have this sent out to people who match the demographics of your current patients."

In today’s business climate, relationship building is more important than ever, Ms. Drumm said, so she recommends mailing cards to mark patient birthdays, Mother’s Day, and other special holidays. Consider inserting a $50 gift certificate for patients in each card, as well as a $50 gift certificate for a friend. In 2 years of tracking results of this tactic at one practice, 17 new patients referred from friends spent about $35,000. "A qualified referral from a friend is a very powerful source," she said. "You want to keep encouraging these referrals."

For direct mail promotions, Ms. Drumm recommended the acronym TOIB for teaser, offer, immediacy, and brand.

The teaser should consist of a catchy phrase to get people’s attention, she said, such as "four ways to look younger overnight" or "four steps to a summer bikini." The offer, paired with the teaser, should be of perceived value, such as a free consultation or free microdermabrasion.

"Then, offer immediacy to make sure you are at the top of someone’s to-do list," Ms. Drumm said. "Maybe it’s something like, ‘the first 15 people to RSVP get a complimentary swag bag.’ Offer something to make that person want to take action."

The fourth component is brand. "Everything you do should be stamped with the logo and name of your practice," she said.

Ms. Drumm said that she had no relevant financial conflicts to disclose.

LAS VEGAS – It is not uncommon for cosmetic dermatologists to follow their competitors when it comes to external marketing efforts, according to Tracy L. Drumm, an aesthetic medical marketing expert.

"Maybe it’s print advertising, pay-per-click online advertising, or maybe it’s social media," Ms. Drumm said at the annual meeting of the American Academy of Cosmetic Surgery. "The problem is external marketing – marketing to patients who don’t already know you – is the most expensive form of marketing."

According to Ms. Drumm, vice president of Chicago-based IF Marketing, a more effective way to generate new patients is through internal marketing, which she described as "talking to people who are already coming through the door, who already know you, who come to you every 3-4 months for their Botox treatments."

The best way to do this is to provide tools to patients that "empower them to talk to their friends about you." This may be in the form of business cards that contain practice information, such as how many neurotoxin treatments or specific cosmetic surgeries were performed last year, or a list of the procedures offered with corresponding columns for before and after photos. "Highlight what makes you special and unique," advised Ms. Drumm.

Another strategy is to have a dedicated space in the waiting room for a "referral station" stocked with business cards customized for each of the procedures offered, with a corresponding sign that reads: "The greatest compliment you can give us is a referral." One practice that adopted the referral station now replenishes the cards weekly. "People take the cards," she said. "They’re portable, small, and discreet to pass on."

Creating a "patient passport" card for existing patients is another way to advertise. This is a laminated business card–size tool that contains a before and after photo of the patient, along with office contact information. This strategy "reminds patients of how they looked before their procedure and provides a visual reminder of their improvement," Ms. Drumm said. "It’s also something they can share with their friends."

Profiling patients who consent to advertise their "transformation" on postcards, brochures, handouts, posters, or in a newsletter is another effective way to promote a practice. "The nice thing is that you can send these profiles to your existing patients to help keep them coming back," she said. "But you can also purchase data and have this sent out to people who match the demographics of your current patients."

In today’s business climate, relationship building is more important than ever, Ms. Drumm said, so she recommends mailing cards to mark patient birthdays, Mother’s Day, and other special holidays. Consider inserting a $50 gift certificate for patients in each card, as well as a $50 gift certificate for a friend. In 2 years of tracking results of this tactic at one practice, 17 new patients referred from friends spent about $35,000. "A qualified referral from a friend is a very powerful source," she said. "You want to keep encouraging these referrals."

For direct mail promotions, Ms. Drumm recommended the acronym TOIB for teaser, offer, immediacy, and brand.

The teaser should consist of a catchy phrase to get people’s attention, she said, such as "four ways to look younger overnight" or "four steps to a summer bikini." The offer, paired with the teaser, should be of perceived value, such as a free consultation or free microdermabrasion.

"Then, offer immediacy to make sure you are at the top of someone’s to-do list," Ms. Drumm said. "Maybe it’s something like, ‘the first 15 people to RSVP get a complimentary swag bag.’ Offer something to make that person want to take action."

The fourth component is brand. "Everything you do should be stamped with the logo and name of your practice," she said.

Ms. Drumm said that she had no relevant financial conflicts to disclose.

LAS VEGAS – Dermatologists who provide cosmetic services are well positioned to build and maintain a steady-stream of cash-paying patients, according to marketing strategist Catherine Maley.

"You are in an enviable position," she told attendees at the annual meeting of the American Academy of Cosmetic Surgery. "Your audience is an aging baby boomer group, people with all sorts of needs and wants. ... As the years go on the needs and wants just keep piling up. You have a good target market."

Ms. Maley of Sausalito, Calif., shared "must-haves" for a successful cosmetic practice:

• Focus on targeting mature, "preferred" patients. "Go after the patient who has the income and the age," she advised. The mature patient "has more needs, more wants, and more financial wherewithal than younger people," said Ms. Maley. "Go after the ones in your own zip code; you can’t be everything to everybody. The riches are in the niches."

• Have an A team. Receptionists, patient coordinators, and other staff members "have to offer awesome customer service," Ms. Maley said. "The patient has to be happy, or they’re not going to come back, and they’re certainly not going to refer their friends." She went on to note that a receptionist "is easily worth a quarter of a million dollars to you if you have her scripted correctly and she’s the right person on the phone. She has to have a warm voice that makes it inviting for callers. You also have to have the right patient care coordinator, a buffer between the physician and the patient. That patient has to have a bond with somebody in your office."

Another key for optimizing cosmetic surgery practice is to have the checkout staff book another appointment for patients before they leave the office. "Always book a patient when they’re standing smack in front of you," Ms. Maley said. If a patient says, " ‘I don’t know what my schedule is; I’ll have to call you later,’ you can reply, ‘It’s okay. Let’s go ahead and schedule you for the same day and time 4 months from now, and if we have to change the appointment, we’ll change it later.’ You have to get them on the books. It’s too easy for people to wander off nowadays."

She advised practices to carry certain retail products such as antiaging creams to offer patients upon checkout, as well as gift certificates, since they are perfect add-ons for the day’s purchase. The goal is to ensure that "every patient leaves your office smiling," she said.

• Build ways to retain patients so they return. "What’s the only difference between you and your competitors? The relationship you have with your patients," Ms. Maley said. "Hang on to that. It’s golden. You want to retain them so they’ll return and refer."

You can nurture patient relationships with personal e-mails, greeting cards, invitations to special events or lectures, patient letters, and social media. Optimal times to reach out, she said, include birthdays, Mother’s Day, New Year’s, and during changing seasons.

One "prop" to help spread the word about a practice is a photo note card that contains a before and after photo of the patient, with a message that says, "Thank you for your trust!" she said. "Don’t forget to include your name, website, and phone number right next to those photos so when they open up the card to show their friend, there you are."

Another effective way to build retention is to offer current patients a $50 gift card good toward their next treatment or procedure for referring new patients who book an appointment. "Your No. 1 asset is not just your patient – it’s your patient’s friends, coworkers, family members, hair stylists, and business partners," she said.

• Form strong alliances with potential referrals. Strong referral sources include hair salon owners, noncompeting aestheticians, retail shops, women’s clubs, health clubs, personal trainers, and other noncompeting clinicians. Ms. Maley spoke of one hair stylist who referred 250 of his clients per year to a dermatologist and plastic surgeon right down the street. "That guy alone was a goldmine," she said.

She recommended forming a "VIP club" for customers of alliance referrals. This might include no waiting for appointments, last-minute appointments, a free monthly peel, valet parking (if applicable), 15% off retail products, and a free surprise gift each quarter. "There’s some great psychology in this, because the hair salon owner or other referral source looks like a queen, because she got a deal for her customers through you, and then you got new patients out of it."

Ms. Maley said that she had no relevant financial disclosures.

LAS VEGAS – Dermatologists who provide cosmetic services are well positioned to build and maintain a steady-stream of cash-paying patients, according to marketing strategist Catherine Maley.

"You are in an enviable position," she told attendees at the annual meeting of the American Academy of Cosmetic Surgery. "Your audience is an aging baby boomer group, people with all sorts of needs and wants. ... As the years go on the needs and wants just keep piling up. You have a good target market."

Ms. Maley of Sausalito, Calif., shared "must-haves" for a successful cosmetic practice:

• Focus on targeting mature, "preferred" patients. "Go after the patient who has the income and the age," she advised. The mature patient "has more needs, more wants, and more financial wherewithal than younger people," said Ms. Maley. "Go after the ones in your own zip code; you can’t be everything to everybody. The riches are in the niches."

• Have an A team. Receptionists, patient coordinators, and other staff members "have to offer awesome customer service," Ms. Maley said. "The patient has to be happy, or they’re not going to come back, and they’re certainly not going to refer their friends." She went on to note that a receptionist "is easily worth a quarter of a million dollars to you if you have her scripted correctly and she’s the right person on the phone. She has to have a warm voice that makes it inviting for callers. You also have to have the right patient care coordinator, a buffer between the physician and the patient. That patient has to have a bond with somebody in your office."

Another key for optimizing cosmetic surgery practice is to have the checkout staff book another appointment for patients before they leave the office. "Always book a patient when they’re standing smack in front of you," Ms. Maley said. If a patient says, " ‘I don’t know what my schedule is; I’ll have to call you later,’ you can reply, ‘It’s okay. Let’s go ahead and schedule you for the same day and time 4 months from now, and if we have to change the appointment, we’ll change it later.’ You have to get them on the books. It’s too easy for people to wander off nowadays."

She advised practices to carry certain retail products such as antiaging creams to offer patients upon checkout, as well as gift certificates, since they are perfect add-ons for the day’s purchase. The goal is to ensure that "every patient leaves your office smiling," she said.

• Build ways to retain patients so they return. "What’s the only difference between you and your competitors? The relationship you have with your patients," Ms. Maley said. "Hang on to that. It’s golden. You want to retain them so they’ll return and refer."

You can nurture patient relationships with personal e-mails, greeting cards, invitations to special events or lectures, patient letters, and social media. Optimal times to reach out, she said, include birthdays, Mother’s Day, New Year’s, and during changing seasons.

One "prop" to help spread the word about a practice is a photo note card that contains a before and after photo of the patient, with a message that says, "Thank you for your trust!" she said. "Don’t forget to include your name, website, and phone number right next to those photos so when they open up the card to show their friend, there you are."

Another effective way to build retention is to offer current patients a $50 gift card good toward their next treatment or procedure for referring new patients who book an appointment. "Your No. 1 asset is not just your patient – it’s your patient’s friends, coworkers, family members, hair stylists, and business partners," she said.

• Form strong alliances with potential referrals. Strong referral sources include hair salon owners, noncompeting aestheticians, retail shops, women’s clubs, health clubs, personal trainers, and other noncompeting clinicians. Ms. Maley spoke of one hair stylist who referred 250 of his clients per year to a dermatologist and plastic surgeon right down the street. "That guy alone was a goldmine," she said.

She recommended forming a "VIP club" for customers of alliance referrals. This might include no waiting for appointments, last-minute appointments, a free monthly peel, valet parking (if applicable), 15% off retail products, and a free surprise gift each quarter. "There’s some great psychology in this, because the hair salon owner or other referral source looks like a queen, because she got a deal for her customers through you, and then you got new patients out of it."

Ms. Maley said that she had no relevant financial disclosures.

LAS VEGAS – Dermatologists who provide cosmetic services are well positioned to build and maintain a steady-stream of cash-paying patients, according to marketing strategist Catherine Maley.

"You are in an enviable position," she told attendees at the annual meeting of the American Academy of Cosmetic Surgery. "Your audience is an aging baby boomer group, people with all sorts of needs and wants. ... As the years go on the needs and wants just keep piling up. You have a good target market."

Ms. Maley of Sausalito, Calif., shared "must-haves" for a successful cosmetic practice:

• Focus on targeting mature, "preferred" patients. "Go after the patient who has the income and the age," she advised. The mature patient "has more needs, more wants, and more financial wherewithal than younger people," said Ms. Maley. "Go after the ones in your own zip code; you can’t be everything to everybody. The riches are in the niches."

• Have an A team. Receptionists, patient coordinators, and other staff members "have to offer awesome customer service," Ms. Maley said. "The patient has to be happy, or they’re not going to come back, and they’re certainly not going to refer their friends." She went on to note that a receptionist "is easily worth a quarter of a million dollars to you if you have her scripted correctly and she’s the right person on the phone. She has to have a warm voice that makes it inviting for callers. You also have to have the right patient care coordinator, a buffer between the physician and the patient. That patient has to have a bond with somebody in your office."

Another key for optimizing cosmetic surgery practice is to have the checkout staff book another appointment for patients before they leave the office. "Always book a patient when they’re standing smack in front of you," Ms. Maley said. If a patient says, " ‘I don’t know what my schedule is; I’ll have to call you later,’ you can reply, ‘It’s okay. Let’s go ahead and schedule you for the same day and time 4 months from now, and if we have to change the appointment, we’ll change it later.’ You have to get them on the books. It’s too easy for people to wander off nowadays."

She advised practices to carry certain retail products such as antiaging creams to offer patients upon checkout, as well as gift certificates, since they are perfect add-ons for the day’s purchase. The goal is to ensure that "every patient leaves your office smiling," she said.

• Build ways to retain patients so they return. "What’s the only difference between you and your competitors? The relationship you have with your patients," Ms. Maley said. "Hang on to that. It’s golden. You want to retain them so they’ll return and refer."

You can nurture patient relationships with personal e-mails, greeting cards, invitations to special events or lectures, patient letters, and social media. Optimal times to reach out, she said, include birthdays, Mother’s Day, New Year’s, and during changing seasons.

One "prop" to help spread the word about a practice is a photo note card that contains a before and after photo of the patient, with a message that says, "Thank you for your trust!" she said. "Don’t forget to include your name, website, and phone number right next to those photos so when they open up the card to show their friend, there you are."

Another effective way to build retention is to offer current patients a $50 gift card good toward their next treatment or procedure for referring new patients who book an appointment. "Your No. 1 asset is not just your patient – it’s your patient’s friends, coworkers, family members, hair stylists, and business partners," she said.

• Form strong alliances with potential referrals. Strong referral sources include hair salon owners, noncompeting aestheticians, retail shops, women’s clubs, health clubs, personal trainers, and other noncompeting clinicians. Ms. Maley spoke of one hair stylist who referred 250 of his clients per year to a dermatologist and plastic surgeon right down the street. "That guy alone was a goldmine," she said.

She recommended forming a "VIP club" for customers of alliance referrals. This might include no waiting for appointments, last-minute appointments, a free monthly peel, valet parking (if applicable), 15% off retail products, and a free surprise gift each quarter. "There’s some great psychology in this, because the hair salon owner or other referral source looks like a queen, because she got a deal for her customers through you, and then you got new patients out of it."

Ms. Maley said that she had no relevant financial disclosures.

LAS VEGAS – Tripling the concentration of epinephrine in tumescent anesthesia used during facelift procedures has its benefits, according to Joseph Niamtu III, D.M.D.

His preferred solution consists of 1 L normal saline, 1 g lidocaine, and 3 mL epinephrine 1:1,000. "Most clinicians use 1 mL of epinephrine 1:1,000," he said at the annual meeting of the American Academy of Cosmetic Surgery. Using a higher concentration of epinephrine "certainly has faster onset of branching, it’s more robust branching, and the branching lasts longer," said Dr. Niamtu, who has a cosmetic facial surgery practice in Midlothian, Va.

Courtesy Dr. Joseph Niamtu, III

"Over the years, I’ve shaved these procedures down from 4 hours to a little over 2 hours, and this is one of the things that have helped. You get a higher level of pain control, and I’ve not had any disadvantages – no discernible changes in blood pressure or epinephrine-related problems."

Dr. Niamtu also finds that facelift results can be optimized without using bulky dressings. "Patients hate dressings," he said. "They don’t prevent hematoma but they do prevent visualization of the flap. They can constrict the flap and lead to breakdown, and they abrade laser tissue."

Of the 71 facelift procedures he performed in 2011, 45% were done with simultaneous CO₂ laser. "The problem was, overnight, the dressings would abrade the freshly lasered skin," he explained. "It’s problematic because the treatment site would take longer to heal and sometimes would start to form a scar." He started decreasing his use of facelift dressings "until I just didn’t use any at all." Now, he said, "it’s certainly easy to promote facelifts [with this approach]. There’s less trepidation when patients know they don’t have to wear these bulky dressings after their surgery."

The need for postoperative drains to promote the release of serum, tumescence, and blood products can be another drawback to facelifts. However, Dr. Niamtu devised a solution: a "vent" system that consists of a 14-gauge Angiocath needle placed subcutaneously in the lowest part of the flap, parallel to the sternocleidomastoid muscle, and left overnight on the day of surgery. "These will drain," he said. "Most of these patients are sitting up in a recliner or have their head propped up on pillows the night of their surgery, so they really drain. It’s secured with a mesh elastic gauze and gauze fluffs. We give the patient a lot of these fluffs, because they have to change the dressing overnight, sometimes two or three times. We use these for 24 hours after surgery."

With this approach "I think I’m seeing less bruising, my patients have a tighter neck, and they’re really not bothered by the vent," he said.

In a later interview, Dr. Niamtu said that he is not a fan of short scar facelifts because "I think it is appropriate for only the smallest lifts, and most people – even those in their early 40s – would benefit from a more comprehensive lift. I think there is a trend to do anything to avoid a 4-inch postauricular incision, [but I] feel that without this incision, short scar lifts are flawed.

"It is this posterior incision that allows true tightening of the neck, and eliminating it causes bunching behind the ear as well as shortchanges [the patient] in terms of result and longevity. I am not saying there is never a place for short scar lifts, as there is, but I have seen too much relapse or compromise in results for many patients [who] got a small lift and in reality needed a bigger one."

Dr. Niamtu said that he had no relevant financial conflicts to disclose.

LAS VEGAS – Tripling the concentration of epinephrine in tumescent anesthesia used during facelift procedures has its benefits, according to Joseph Niamtu III, D.M.D.

His preferred solution consists of 1 L normal saline, 1 g lidocaine, and 3 mL epinephrine 1:1,000. "Most clinicians use 1 mL of epinephrine 1:1,000," he said at the annual meeting of the American Academy of Cosmetic Surgery. Using a higher concentration of epinephrine "certainly has faster onset of branching, it’s more robust branching, and the branching lasts longer," said Dr. Niamtu, who has a cosmetic facial surgery practice in Midlothian, Va.

Courtesy Dr. Joseph Niamtu, III

"Over the years, I’ve shaved these procedures down from 4 hours to a little over 2 hours, and this is one of the things that have helped. You get a higher level of pain control, and I’ve not had any disadvantages – no discernible changes in blood pressure or epinephrine-related problems."

Dr. Niamtu also finds that facelift results can be optimized without using bulky dressings. "Patients hate dressings," he said. "They don’t prevent hematoma but they do prevent visualization of the flap. They can constrict the flap and lead to breakdown, and they abrade laser tissue."

Of the 71 facelift procedures he performed in 2011, 45% were done with simultaneous CO₂ laser. "The problem was, overnight, the dressings would abrade the freshly lasered skin," he explained. "It’s problematic because the treatment site would take longer to heal and sometimes would start to form a scar." He started decreasing his use of facelift dressings "until I just didn’t use any at all." Now, he said, "it’s certainly easy to promote facelifts [with this approach]. There’s less trepidation when patients know they don’t have to wear these bulky dressings after their surgery."

The need for postoperative drains to promote the release of serum, tumescence, and blood products can be another drawback to facelifts. However, Dr. Niamtu devised a solution: a "vent" system that consists of a 14-gauge Angiocath needle placed subcutaneously in the lowest part of the flap, parallel to the sternocleidomastoid muscle, and left overnight on the day of surgery. "These will drain," he said. "Most of these patients are sitting up in a recliner or have their head propped up on pillows the night of their surgery, so they really drain. It’s secured with a mesh elastic gauze and gauze fluffs. We give the patient a lot of these fluffs, because they have to change the dressing overnight, sometimes two or three times. We use these for 24 hours after surgery."

With this approach "I think I’m seeing less bruising, my patients have a tighter neck, and they’re really not bothered by the vent," he said.

In a later interview, Dr. Niamtu said that he is not a fan of short scar facelifts because "I think it is appropriate for only the smallest lifts, and most people – even those in their early 40s – would benefit from a more comprehensive lift. I think there is a trend to do anything to avoid a 4-inch postauricular incision, [but I] feel that without this incision, short scar lifts are flawed.

"It is this posterior incision that allows true tightening of the neck, and eliminating it causes bunching behind the ear as well as shortchanges [the patient] in terms of result and longevity. I am not saying there is never a place for short scar lifts, as there is, but I have seen too much relapse or compromise in results for many patients [who] got a small lift and in reality needed a bigger one."

Dr. Niamtu said that he had no relevant financial conflicts to disclose.

LAS VEGAS – Tripling the concentration of epinephrine in tumescent anesthesia used during facelift procedures has its benefits, according to Joseph Niamtu III, D.M.D.

His preferred solution consists of 1 L normal saline, 1 g lidocaine, and 3 mL epinephrine 1:1,000. "Most clinicians use 1 mL of epinephrine 1:1,000," he said at the annual meeting of the American Academy of Cosmetic Surgery. Using a higher concentration of epinephrine "certainly has faster onset of branching, it’s more robust branching, and the branching lasts longer," said Dr. Niamtu, who has a cosmetic facial surgery practice in Midlothian, Va.

Courtesy Dr. Joseph Niamtu, III

"Over the years, I’ve shaved these procedures down from 4 hours to a little over 2 hours, and this is one of the things that have helped. You get a higher level of pain control, and I’ve not had any disadvantages – no discernible changes in blood pressure or epinephrine-related problems."

Dr. Niamtu also finds that facelift results can be optimized without using bulky dressings. "Patients hate dressings," he said. "They don’t prevent hematoma but they do prevent visualization of the flap. They can constrict the flap and lead to breakdown, and they abrade laser tissue."

Of the 71 facelift procedures he performed in 2011, 45% were done with simultaneous CO₂ laser. "The problem was, overnight, the dressings would abrade the freshly lasered skin," he explained. "It’s problematic because the treatment site would take longer to heal and sometimes would start to form a scar." He started decreasing his use of facelift dressings "until I just didn’t use any at all." Now, he said, "it’s certainly easy to promote facelifts [with this approach]. There’s less trepidation when patients know they don’t have to wear these bulky dressings after their surgery."

The need for postoperative drains to promote the release of serum, tumescence, and blood products can be another drawback to facelifts. However, Dr. Niamtu devised a solution: a "vent" system that consists of a 14-gauge Angiocath needle placed subcutaneously in the lowest part of the flap, parallel to the sternocleidomastoid muscle, and left overnight on the day of surgery. "These will drain," he said. "Most of these patients are sitting up in a recliner or have their head propped up on pillows the night of their surgery, so they really drain. It’s secured with a mesh elastic gauze and gauze fluffs. We give the patient a lot of these fluffs, because they have to change the dressing overnight, sometimes two or three times. We use these for 24 hours after surgery."

With this approach "I think I’m seeing less bruising, my patients have a tighter neck, and they’re really not bothered by the vent," he said.

In a later interview, Dr. Niamtu said that he is not a fan of short scar facelifts because "I think it is appropriate for only the smallest lifts, and most people – even those in their early 40s – would benefit from a more comprehensive lift. I think there is a trend to do anything to avoid a 4-inch postauricular incision, [but I] feel that without this incision, short scar lifts are flawed.

"It is this posterior incision that allows true tightening of the neck, and eliminating it causes bunching behind the ear as well as shortchanges [the patient] in terms of result and longevity. I am not saying there is never a place for short scar lifts, as there is, but I have seen too much relapse or compromise in results for many patients [who] got a small lift and in reality needed a bigger one."

Dr. Niamtu said that he had no relevant financial conflicts to disclose.

LAS VEGAS – Taking time to prescreen men and women who inquire about cosmetic surgery procedures can help maximize their chances of choosing your practice over others, and can help you weed out those who aren’t suitable candidates.

"There is no chance in securing a patient without having a consultation," Tracie Lance, director of finance for Southern Surgical Arts, said at the annual meeting of the American Academy of Cosmetic Surgery. "In order to avoid wasting the patient’s time, the physician’s time, and the staff’s time, we do some prescreening."

Courtesy Southern Surgical Arts

The first step, she said, is to find a time on the schedule that is most appropriate for the consultation. If someone inquires about breast augmentation, "you probably want to get them in as quickly as possible, to reduce the chances of their going to another practice," said Ms. Lance, also a patient care coordinator for the practice, which has locations in Chattanooga, Tenn., and Calhoun, Ga. If they inquire about a facelift, there’s less of an urgency to get them in right away, she said, because "they’ve probably thought about it a long time before they picked up the phone to call your office. If you respond, ‘We can get you in this afternoon,’ you may not give the best first impression of your office."

A second component of prescreening is gauging the person’s ability to pay for or finance the procedure. "This is nonnegotiable," Ms. Lance said. "In our experience, we have found that it can be unfair to set unrealistic expectations that all patients will qualify for financing. The frustration can be avoided by having patients apply before they come to the consultation." Consider options such as, "We have someone on staff that can help you with financing. Is that something you’re interested in?" and document the reply for the in-person consultation. "Being able to assist our patient in successful financing is a skill that has set our practice above others," she said.

A third component of the prescreening is asking people to complete a health history questionnaire before the in-person consultation. "There might be something like body mass index that [precludes them from] surgery," she noted.

Consultation appointments are complimentary at Southern Surgical Arts, yet a credit card is required to hold the appointment. "We have a 5% no-show rate, which is pretty low compared to the industry standard," Ms. Lance said.

To maximize the patient experience, physicians should be mindful of the appearance of their waiting room and reception area. "People pay attention to detail, so the office should be clean, with minimal clutter," she said. "In terms of patient flow, after our patients check in we try to get them into an exam room as quickly as possible with an iPad that contains before and after photos and patient testimonials."

After candidate patients at Southern Surgical Arts meet with the cosmetic surgeon in the exam room, they move to a dedicated postconsultation room, where the patient coordinator will review the estimated cost of the procedure and answer questions. Establishing a dedicated postconsultation room "is one of the best things we’ve ever done," Ms. Lance said. She described the room as a "warm environment," equipped with "a round table, MacBook Air, a wireless printer, and a phone."

Patients commonly cite fear, financing, timing, and multiple consultations as objections to cosmetic surgery procedures, Ms. Lance said, noting that financing is the biggest obstacle. "If you have a facelift patient, sometimes it’s easier to offer a no-interest plan, as the bill can be around $16,000," she said. "That’s up to each office, but in my experience, the no-interest plan has been extremely successful. Some patients do not use no-interest financing, but I hear facelift patients tell me all the time, ‘Oh my husband will love this,’ because they don’t feel like they’re taking all this money out of savings at once. Payments of $1,100 or $1,200 per month seem easier."

In her experience, patients considering cosmetic surgery for the first time "are nervous and they tell you they’re going to multiple consultations," Ms. Lance added. "I’m not sure that’s always the case. I think that they’re just nervous. It helps to say, ‘we understand that you’re nervous. If you get home and you have questions, don’t hesitate to call us.’ Sometimes it helps for them to hear about another patient’s experience with surgery. We have patients who will do that for us, which is wonderful."

She concluded her remarks by advising patient care coordinators and office staff to offer candidate patients a certain amount of grace and space as they make their decision. "I do not believe in being pushy in a consultation," she said. "I’ve seen that backfire many times; 65% of our patients will give me a deposit on the day that they come in, which is remarkable. But at the same time you have to know when to give someone space. You want to provide the benefits of the surgeons, the benefits of the facility, but not in a pushy way. You want a patient who is just as committed as you are. You want them to be compliant in their care and you want them to follow the rules."

Ms. Lance reported having no relevant financial disclosures.

LAS VEGAS – Taking time to prescreen men and women who inquire about cosmetic surgery procedures can help maximize their chances of choosing your practice over others, and can help you weed out those who aren’t suitable candidates.

"There is no chance in securing a patient without having a consultation," Tracie Lance, director of finance for Southern Surgical Arts, said at the annual meeting of the American Academy of Cosmetic Surgery. "In order to avoid wasting the patient’s time, the physician’s time, and the staff’s time, we do some prescreening."

Courtesy Southern Surgical Arts

The first step, she said, is to find a time on the schedule that is most appropriate for the consultation. If someone inquires about breast augmentation, "you probably want to get them in as quickly as possible, to reduce the chances of their going to another practice," said Ms. Lance, also a patient care coordinator for the practice, which has locations in Chattanooga, Tenn., and Calhoun, Ga. If they inquire about a facelift, there’s less of an urgency to get them in right away, she said, because "they’ve probably thought about it a long time before they picked up the phone to call your office. If you respond, ‘We can get you in this afternoon,’ you may not give the best first impression of your office."

A second component of prescreening is gauging the person’s ability to pay for or finance the procedure. "This is nonnegotiable," Ms. Lance said. "In our experience, we have found that it can be unfair to set unrealistic expectations that all patients will qualify for financing. The frustration can be avoided by having patients apply before they come to the consultation." Consider options such as, "We have someone on staff that can help you with financing. Is that something you’re interested in?" and document the reply for the in-person consultation. "Being able to assist our patient in successful financing is a skill that has set our practice above others," she said.

A third component of the prescreening is asking people to complete a health history questionnaire before the in-person consultation. "There might be something like body mass index that [precludes them from] surgery," she noted.

Consultation appointments are complimentary at Southern Surgical Arts, yet a credit card is required to hold the appointment. "We have a 5% no-show rate, which is pretty low compared to the industry standard," Ms. Lance said.

To maximize the patient experience, physicians should be mindful of the appearance of their waiting room and reception area. "People pay attention to detail, so the office should be clean, with minimal clutter," she said. "In terms of patient flow, after our patients check in we try to get them into an exam room as quickly as possible with an iPad that contains before and after photos and patient testimonials."

After candidate patients at Southern Surgical Arts meet with the cosmetic surgeon in the exam room, they move to a dedicated postconsultation room, where the patient coordinator will review the estimated cost of the procedure and answer questions. Establishing a dedicated postconsultation room "is one of the best things we’ve ever done," Ms. Lance said. She described the room as a "warm environment," equipped with "a round table, MacBook Air, a wireless printer, and a phone."

Patients commonly cite fear, financing, timing, and multiple consultations as objections to cosmetic surgery procedures, Ms. Lance said, noting that financing is the biggest obstacle. "If you have a facelift patient, sometimes it’s easier to offer a no-interest plan, as the bill can be around $16,000," she said. "That’s up to each office, but in my experience, the no-interest plan has been extremely successful. Some patients do not use no-interest financing, but I hear facelift patients tell me all the time, ‘Oh my husband will love this,’ because they don’t feel like they’re taking all this money out of savings at once. Payments of $1,100 or $1,200 per month seem easier."

In her experience, patients considering cosmetic surgery for the first time "are nervous and they tell you they’re going to multiple consultations," Ms. Lance added. "I’m not sure that’s always the case. I think that they’re just nervous. It helps to say, ‘we understand that you’re nervous. If you get home and you have questions, don’t hesitate to call us.’ Sometimes it helps for them to hear about another patient’s experience with surgery. We have patients who will do that for us, which is wonderful."

She concluded her remarks by advising patient care coordinators and office staff to offer candidate patients a certain amount of grace and space as they make their decision. "I do not believe in being pushy in a consultation," she said. "I’ve seen that backfire many times; 65% of our patients will give me a deposit on the day that they come in, which is remarkable. But at the same time you have to know when to give someone space. You want to provide the benefits of the surgeons, the benefits of the facility, but not in a pushy way. You want a patient who is just as committed as you are. You want them to be compliant in their care and you want them to follow the rules."

Ms. Lance reported having no relevant financial disclosures.

LAS VEGAS – Taking time to prescreen men and women who inquire about cosmetic surgery procedures can help maximize their chances of choosing your practice over others, and can help you weed out those who aren’t suitable candidates.

"There is no chance in securing a patient without having a consultation," Tracie Lance, director of finance for Southern Surgical Arts, said at the annual meeting of the American Academy of Cosmetic Surgery. "In order to avoid wasting the patient’s time, the physician’s time, and the staff’s time, we do some prescreening."

Courtesy Southern Surgical Arts

The first step, she said, is to find a time on the schedule that is most appropriate for the consultation. If someone inquires about breast augmentation, "you probably want to get them in as quickly as possible, to reduce the chances of their going to another practice," said Ms. Lance, also a patient care coordinator for the practice, which has locations in Chattanooga, Tenn., and Calhoun, Ga. If they inquire about a facelift, there’s less of an urgency to get them in right away, she said, because "they’ve probably thought about it a long time before they picked up the phone to call your office. If you respond, ‘We can get you in this afternoon,’ you may not give the best first impression of your office."

A second component of prescreening is gauging the person’s ability to pay for or finance the procedure. "This is nonnegotiable," Ms. Lance said. "In our experience, we have found that it can be unfair to set unrealistic expectations that all patients will qualify for financing. The frustration can be avoided by having patients apply before they come to the consultation." Consider options such as, "We have someone on staff that can help you with financing. Is that something you’re interested in?" and document the reply for the in-person consultation. "Being able to assist our patient in successful financing is a skill that has set our practice above others," she said.

A third component of the prescreening is asking people to complete a health history questionnaire before the in-person consultation. "There might be something like body mass index that [precludes them from] surgery," she noted.

Consultation appointments are complimentary at Southern Surgical Arts, yet a credit card is required to hold the appointment. "We have a 5% no-show rate, which is pretty low compared to the industry standard," Ms. Lance said.

To maximize the patient experience, physicians should be mindful of the appearance of their waiting room and reception area. "People pay attention to detail, so the office should be clean, with minimal clutter," she said. "In terms of patient flow, after our patients check in we try to get them into an exam room as quickly as possible with an iPad that contains before and after photos and patient testimonials."

After candidate patients at Southern Surgical Arts meet with the cosmetic surgeon in the exam room, they move to a dedicated postconsultation room, where the patient coordinator will review the estimated cost of the procedure and answer questions. Establishing a dedicated postconsultation room "is one of the best things we’ve ever done," Ms. Lance said. She described the room as a "warm environment," equipped with "a round table, MacBook Air, a wireless printer, and a phone."

Patients commonly cite fear, financing, timing, and multiple consultations as objections to cosmetic surgery procedures, Ms. Lance said, noting that financing is the biggest obstacle. "If you have a facelift patient, sometimes it’s easier to offer a no-interest plan, as the bill can be around $16,000," she said. "That’s up to each office, but in my experience, the no-interest plan has been extremely successful. Some patients do not use no-interest financing, but I hear facelift patients tell me all the time, ‘Oh my husband will love this,’ because they don’t feel like they’re taking all this money out of savings at once. Payments of $1,100 or $1,200 per month seem easier."

In her experience, patients considering cosmetic surgery for the first time "are nervous and they tell you they’re going to multiple consultations," Ms. Lance added. "I’m not sure that’s always the case. I think that they’re just nervous. It helps to say, ‘we understand that you’re nervous. If you get home and you have questions, don’t hesitate to call us.’ Sometimes it helps for them to hear about another patient’s experience with surgery. We have patients who will do that for us, which is wonderful."

She concluded her remarks by advising patient care coordinators and office staff to offer candidate patients a certain amount of grace and space as they make their decision. "I do not believe in being pushy in a consultation," she said. "I’ve seen that backfire many times; 65% of our patients will give me a deposit on the day that they come in, which is remarkable. But at the same time you have to know when to give someone space. You want to provide the benefits of the surgeons, the benefits of the facility, but not in a pushy way. You want a patient who is just as committed as you are. You want them to be compliant in their care and you want them to follow the rules."

Ms. Lance reported having no relevant financial disclosures.