As people become increasingly mobile and are more willing to travel for aesthetic procedures, virtual consultations and real-time medical networking may soon become the norm. These patients are asking more questions, doing more research, and comparing multiple physicians at a rate never seen before.

Increasingly, these patients want to converse with physicians on their terms—terms that include convenience, time savings, comfort, and self-learning.

Over the past year or so, the so-called virtual consultation has become popular with even the well-entrenched plastic surgeons. The phenomenon got its start in the medical tourism business, in which overseas-based surgeons and clinics would conduct Internet-based consultations, guiding the geographically distant patient from an introduction to the physician’s services to initial discussion of procedures desired to filling out the requisite paperwork (and, in some cases, booking travel and hotel accommodations).

Medical tourism aside, the implementation of virtual consults by US-based plastic surgeons allows you to remain congruent with technology-savvy patients.

The virtual consultation can create opportunities for innovative physicians to utilize new ways to connect with their prospective aesthetic patients. And, according to the physicians interviewed for this article, despite some potential pitfalls that can be managed with some foresight, you can realize increased bookings as well as expand your national (or even international) reach by embracing the virtual consultation.


Jack P. Gunter, MD is a world-renowned, double-board-certified plastic surgeon and otolaryngologist with a specialty in nose surgery, located in Dallas.

Gunter began virtual consultations in 2002 simply because he was receiving patient referrals from all over the world and needed to establish a process to accommodate them. His patients came from as far as Australia, Iceland, Russia, and Hong Kong. The usual process for dealing with local patients would not work for these out-of-state or out-of-country patients.

Were they supposed to visit once for a consultation and then another time for surgery? Gunter remedied this concern by making it easier for his prospective patients to access him and his expert services virtually—online.

The process starts when a prospective patient visits Gunter’s practice Web site, pays the same consultation fee as his live consultation, and uploads their multiangle photos as instructed. Within 1 week, Gunter responds with a letter explaining what he sees and what he believes can be done, and quotes the associated costs based on the images.

Gunter’s virtual consultation can reach qualified patients when, for example, they seek a primary, straightforward rhinoplasty, have no breathing problems, and are realistic with their expectations.

Following up on the consultation and quoting of prices, Gunter will schedule a live surgical consultation. The patient pays a nonrefundable fee to reserve the OR and staff—at 50% of the total value of the treatment.

According to Gunter, around 70% of all patients who send in their photos, pay the consulting fee, and travel to his Dallas practice move forward with the surgery.

It’s important to note that Gunter always has the final say in deciding if the virtual patient is a good candidate and has realistic expectations. Ultimately, he says, he cannot make such a determination until he sees the patient in person.

The biggest drawback to the virtual consultation is the photographs taken by the prospective patient. Because the photos may not be in focus or taken at bad angles, Gunter says, he may not be able to make a proper diagnosis. In these cases—around 5% of the time—the patient must retake and resubmit them. Additionally, Gunter is limited in his ability to diagnose breathing problems virtually.


E. Gaylon McCollough, MD, FACS, a facial plastic surgeon in the resort town of Gulf Shores, Ala, enthusiastically embraces virtual consultations (see “True to His Profession,” Page 14). He does them at a rate of three to four per week. In fact, he was late to our interview because he was on the phone speaking with a prospective patient who was away at college in Texas and his parents, who were at another location.

Through his international speaking, lecturing, and writing—and by simply being in practice for decades—McCollough has developed a world-renowned reputation and receives inquiries globally from physicians who refer family, friends, and patients, as well as former patients who refer their friends to him.

How does he know if he can help a prospective patient via long distance?

As soon as an individual contacts him, McCollough asks the patient to send photographs taken from different angles. In a follow-up telephone conversation, he listens carefully to the prospective patient’s questions to get a sense of his or her objectives and expectations. In like manner, the patient gets to understand McCollough as a surgeon.

McCollough’s “secret weapon” in this process is a book. He has an advantage most of his colleagues do not: his consumer information book, The Appearance Factor, is available to the prospective patient via regular mail or download from his Web site.

If the doctor-patient “connection” is made, he then has a computer-generated quote prepared and “assumes” the patient is moving forward with surgery. His staff then follows up to learn: 1) if the prospective patient received the quote and pre-operative information and 2) if they have any additional questions.

McCollough uses Skype Internet-based video phone technology when doing some of his virtual consultations. However, the remaining virtual consults do not allow him to look the prospective patient in the eye. As such, he says it is more of a challenge to create the trust and confidence that he normally does in a hands-on setting—normally he would place his hands on the potential client as they stood in front of a three-way mirror. “That is a powerful bonding method,” he adds.


Facial plastic surgeon Randall Waldman, MD, and his plastic surgeon partner Stephen A. Schantz, MD, of Louisville, Ky, make considerable use of the Internet to attract new patients to their practice. This has led to virtual consulting.

Similar to the other examples described here, a prospective patient sends photographs to Waldman and Schantz via e-mail. Both physician and prospective patient exchange contact information in order to discuss preliminary recommendations via e-mail or phone. Although virtual consultations are, at present, free of charge, Waldman is seriously considering charging a fee if and when the virtual meeting graduates to becoming a live Web-based conference, which would take more of his time.

During the virtual consultation, Waldman makes sure the patient understands that prior to his or her arriving for consultations and surgery—usually a day in advance—that he can decline the surgery and that he makes the final decision.

When asked about conversion rates, Waldman reports that the time and expense of virtual consulting is “more than worth it. The Internet gives significant exposure to prospective patients who would otherwise be reluctant to come in for a typical consultation,” he says. As such, Waldman and his partner embrace virtual consultation as a comfortable way for the patient to get to know them, their staff, and their expertise.

The real challenge of virtual consultation is in finding computer-literate staff who can make this process go smoother.


In a virtual consultation, the surgeon cannot put his hands on a patient and literally and figuratively touch the patient’s particular concerns. This hampers what McCollough calls the bonding experience—at early stages of the virtual consultation process, he also cannot look a patient in the eye to determine who he or she is as a person. That may cause a breakdown in communication that can lead to disagreements.

To combat that, the physicians all preface their recommendations with statements such as, “Based on the photographs in front of me, here are my recommendations. However, I will not finalize my plan until I see you personally.”

None of the physicians interviewed had the patient sign anything to stipulate these are only preliminary diagnoses and not completely valid until they actually meet face to face. However, these physicians have not experienced legal problems as a result of virtual consultations—and do not anticipate any.

As this article concerns the patient as a consumer and what he or she wants, needs, and demands from aesthetic enhancement advisers, I turned to an expert on social marketing media.

In researching a prospective aesthetic practitioner, the patient’s first goal is to identify reliable and credible sources of information on physicians, according to Tom Seery, president of, a Web site devoted to helping consumers find that information online.

Seery reports that the next step in the prospective patient’s fact-finding process is to obtain information relevant to his or her own concerns and wants, then use personal photographs and focus on specific procedures in which he or she is interested. Although does not allow virtual dialog between physicians and the prospective patients, physicians are allowed to comment on patient photographs. The physicians may also offer course corrections to the prospective patients and guide them toward a range of options and alternatives. The main caveat is that no self-promotion by the physician is allowed.

A significant drawback to patients and physicians operating in this “virtual world” is that some patients do not fully appreciate the constraints of virtual feedback, which can cause unrealistic and disappointing experiences, notes Seery.


The next step in virtual consulting will be video conferencing. For anyone who does not have a built-in video camera (or Web cam), for less than $10 anybody can have an external Web cam sitting on their desk, attached to their computer.

For the ambivalent or skeptical patient, video conferencing will be a more attractive point of entry to virtual consultation prior to an in-person consultation.

Although the physicians interviewed for this article say that video conferencing is the likely next step as well, they view this technology as extremely time-consuming for them. The inevitable, that physicians will ask for payment for virtual Web conferencing, will no doubt affect consumer demand.

Another technological approach to virtual consultations, Webinars, can be valuable in working with the long-distance patient.

Catherine Maley, MBA, is president of Cosmetic Image Marketing, which trains practitioners in marketing, advertising, and PR strategies. She can be reached at (877) 339-8833.