To help promote his Sacramento, Calif-based cosmetic surgery practice, Patrick McMenamin, MD, recently produced an exquisitely polished video that was posted on his practice’s Web site. In the video, he waxes eloquent for approximately 30 minutes about various available facial- and body-beautification procedures.
The finished product drew praise from the men and techno-geeks who liked his straightforward, matter-of-fact, “here’s-what-we-do-and-why-we’re-so-good-at-it” narrative.
Alas, test audiences of women were less favorably impressed. “They panned it and begged me not to post it online,” McMenamin recounts, explaining that his female critics felt the lengthy presentation would deter visitors from quickly accessing information they needed and, in frustration, induce them to abruptly depart. “The point was well taken,” he says. “Women generally prefer to utilize a Web site in a manner different from that of most men.”
The solution was to create a second video, this time with women’s sensibilities uppermost in mind. Both videos were posted, which allows audiences to decide which of the two they prefer watching.
This considerate gesture demonstrates McMenamin’s abiding sensitivity toward those he serves. “The primary way cosmetic surgery practices stay in business is through satisfied customers,” he claims. “Patients who are satisfied come back, and they tell family and friends.”
HONESTY REALLY IS THE BEST POLICY
One way McMenamin achieves customer satisfaction is by making sure the opinions he gives are honest. “That’s the first step in being able to always act in the best interests of the patient, no matter that they have money burning a hole in their pocket or insecurities burning a hole in their psyche, and they have unrealistic ideas about what they need to do about their situation,” he says.
Another way McMenamin fosters satisfaction is by routinely giving patients his home phone and cell phone numbers, as well as an open invitation to call him whenever they have questions, concerns, or needs.
PRACTICE AT A GLANCE
Name: The Cosmetic Surgery Center of Sacramento
Owner: Patrick McMenamin, MD
Location: Sacramento, Calif
Specialty: Face and body
Years in practice: 19
Patients seen per day: 20
Days worked per week: 5-6
Days surgery performed per week: 3-4
Number of employees: 6
Office square footage: 3,640
Punctuality is also very important. “We usually run our schedule right to the minute,” he says. The secret? “A really well-organized and efficient office, which would be impossible without a great staff.”
In the case of his Cosmetic Surgery Center of Sacramento, the staff of six are long-timers all. “The one who’s been with me the least amount of time started here 18 years ago,” McMenamin adds.
His 3,600-plus-square-foot office is purposely nonclinical in appearance, which also contributes to customer satisfaction, he contends, by being inviting, comfortable, relaxing, and blissfully quiet. “It’s luxurious without being opulent,” he says.
The office building itself, a freestanding “business condominium,” is near the scenic American River (far upstream of which stands historic Sutter’s Mill, scene of the famous 1848 discovery of gold in California). Just visible through McMenamin’s office window is the superstructure of the river’s Guy West Bridge, which is a 1/10th-scale replica of San Francisco’s Golden Gate Bridge that is used by pedestrians and bicyclists crossing to and from the campus of California State University, Sacramento.
The office holds a pair of accredited operating rooms. McMenamin devotes a minimum of 3 days per week to surgeries, but no more than 4. His schedule puts him in the OR on Tuesdays, Thursdays, and Fridays, with Wednesdays available for overflow. The office floor plan emphasizes both efficiency and ergonomics so that McMenamin and his staff can perform tasks with the least possible expenditure of personal energy (thereby helping keep fatigue at bay).
Being located in the state capital all but guarantees local cosmetic surgeons plenty of business from lawmakers, political movers and shakers, and others in the public eye. McMenamin asserts that catering to them is not quite the same as dealing with celebrities in Beverly Hills, but he says one thing they and all patients share in common is the desire for a perfect result.
“Some want results that are unrealistic,” he notes. “That happens because of all the media hype about our profession. People believe that cosmetic surgeons can do anything for anyone anytime without respect to the limitations of technology, human tissue, age, and sun damage.”
McMenamin’s preferred technique for managing such overwrought expectations is to let prospective patients see pictures that illustrate what is and isn’t possible surgically for each contemplated procedure.
McMenamin came to Sacramento in the late 1980s by way first of Honolulu, where he was born and spent much of his childhood. The son of a military officer, McMenamin later moved to Massachusetts. At the end of his high school years, his home was near Washington, DC.
In 1978, he received his MD from the University of Maryland School of Medicine in Baltimore, then began general surgery residency at nearby Union Memorial Hospital. Residency in ear, nose, and throat surgery started for him a year later at Johns Hopkins Hospital in the Department of Otolaryngology/Head and Neck Surgery. In 1983, his residency training completed, McMenamin donned the uniform of the US Air Force and was assigned to medical duty at the major teaching hospital at Travis Air Force Base (near Sacramento).
While in the Air Force—where he eventually attained the rank of major—McMenamin participated in an academic medical practice staffed by doctors at the University of California Davis.
“It was a terrific experience for me,” he recalls, adding that, after his military service ended in 1987, UC Davis hired him to be its chief of head and neck surgery. “Just as at Johns Hopkins, I was surrounded by exceptionally brilliant individuals from whom I learned a great deal while working on some of the most difficult cases imaginable. As a head-neck cancer surgeon, I performed skull-base cancer surgeries that often stretched 15 to 30 hours. I operated on a total of 1,265 tumor patients in the course of my head-and-neck career.”
When his father-in-law developed prostate cancer, McMenamin grew acutely aware of how fleeting life is, leading him to switch from ear, nose, and throat to cosmetic surgery. “I felt the change would allow me to spend fewer hours in the operating room so that I could have more time to devote to family and self while still making full use of my surgical skills,” he says.
That same year, in 1989, Leslie Bernstein, MD, DDS (a venerated member of the American Academy of Facial Plastic and Reconstructive Surgery), invited McMenamin to spend a year with him in fellowship training. McMenamin was pleasantly surprised to discover that cosmetic surgery “actually meant taking care of people more intensively, because a person’s appearance is where that individual really exists on a day-to-day basis,” he notes.
For McMenamin, the leap to cosmetic surgery proved an astute choice. “I really believe I’m now making a bigger difference in people’s lives as a cosmetic surgeon than when I was saving them from cancer,” he says.
A few years after entering private cosmetic surgery practice in 1990, McMenamin augmented his skills by studying liposuction technologies and techniques. Subsequently, he obtained board certification from the American Board of Facial Plastic and Reconstructive Surgery, followed in 1997 by board certification from the American Board of Cosmetic Surgery.
LASERS UNDER THE MICROSCOPE
McMenamin’s case mix today is about 40% faces and 30% liposuction; the remainder is breast work. Laser systems play an increasingly important role in his practice.
“We’re now on our fourth generation of laser technology,” he says. “We were drawn into it originally by the growth in the number of patients interested in less invasive procedures. Some of these patients, driven by economic realities, wanted the benefits of cosmetic surgery but at lower prices. Others needed cosmetic work but not a lot of it, or else they wanted work involving easier recovery and minimal postprocedure downtime. Laser lipolysis seemed like a perfect match for these needs.”
An enthusiastic McMenamin soon found himself helping organize a laser study group among colleagues to disseminate information about the clinical science that supports that technology.
“In addition to reviewing published literature,” he says, “we share among ourselves photos of the laser work we perform in our individual practices so that we can critique one another’s techniques. The goal is to empirically validate what we’re doing in the procedure room and to improve our ability to do it so as to deliver the best possible result for each patient. I’m a huge proponent of the free exchange of information and ideas.”
Much has been learned through participation in this study group. “One of our observations is that laser lipolysis is most effective on inner thighs, triceps, and the face,” says McMenamin, who recently presented his findings about laser-based face work to an enthusiastic audience at Johns Hopkins. “For instance, we now have a clearer understanding of how to obtain more uniformly optimal results for patients with significantly different face composition—the patient with a thick neck versus the patient with one that’s thinner.”
McMenamin stands convinced that laser lipolysis is no flash in the pan. “The technology keeps getting better,” he notes, “but as an advancing technology it, of course, carries risks. Therefore, it must be carefully and thoroughly studied, and in increments.”
PLAYING IN “REEL TIME”
Earlier in 2009, McMenamin was installed as president of the Chicago-based American Academy of Cosmetic Surgery (AACS). He is pledged to continue the 2,400-member organization’s dual mission of promoting physician education in cosmetic surgery and advancing the cause of patient safety. “I see myself tasked simply with finding ways to facilitate the processes that allow our mission to go forward,” he shares. “One of the most important of those ways involves helping all of our different committees become as productive as possible.”
McMenamin notes that the AACS is the largest multispecialty cosmetic surgery organization in the nation and, as such, will strive to hold itself out as the biggest tent possible. “There are different types of practitioners who provide cosmetic surgery,” he says. “Cosmetic surgery and plastic surgery are different disciplines, and competence in these two disciplines is not interchangeable.”
Intriguing in McMenamin’s view is that “80% of all cosmetic surgery is done by non-plastic surgeons, and 16 of the 22 major advances in cosmetic surgery over the last 20 years—including laser-based procedures; hair transplantation and removal; fillers, tumescent anesthesia, and liposuction—have come from our colleagues in dermatologic cosmetic surgery. Where strides are made in any profession, most come from the interaction between groups of people with different training backgrounds and skill sets. We want to make sure that keeps occurring within the AACS.”
AACS duties consume just more than 2 hours of McMenamin’s time each business day and most Saturdays. “Fortunately,” he says, “I’m a high-energy guy.” This is a high-energy guy who also knows to recharge his batteries often. On Wednesday afternoons, you will typically find McMenamin out on the links, golf being among his favorite recreational pursuits, as are working out at the gym and going fishing.
“I have a regular fishing date with my buddies at least one evening a week on the river,” he says. “We get in our boat and angle for either steelhead or striped bass.”
Speaking of casting and lines, McMenamin and his wife, Dana (who helps run The Cosmetic Surgery Center of Sacramento), share a love of live theater. Thus, when visiting New York, they make a point of catching at least a couple of Broadway (or off-Broadway) stage shows. And, once a year, they make the drive from Sacramento to the southern Oregon town of Ashland for its acclaimed Shakespeare festival. “We see as many plays as possible while we’re there,” he adds.
EPICENTER OF THE RECESSION?
Not a day goes by without McMenamin receiving an unsolicited offer of one sort or another to improve his business. “They promise that if you buy this product or initiate that program, your life will change forever,” he says with skepticism while acknowledging that these come-ons can seem compelling in recessionary times.
See also “Patient Satisfaction Is Key,” by Rich Smith in the January 2009 issue of PSP.
In Sacramento, times are seriously bad if the pair of New York Times stories McMenamin read earlier this year can be believed. “Those articles identified Sacramento as the epicenter of the recession,” he says. “But they also contained some good news. The stories predicted my city would be at the epicenter of the eventual recovery of the national economy. Personally, I don’t think our local economy will return to the levels it was at during the boom years. But it should at least rebound enough that people—myself included—can make a reasonable living here.”
With or without a recovery, the key to practice success in McMenamin’s book remains customer satisfaction.
“Some critics of what we do in cosmetic surgery might want to discount the importance of changes in the patient’s outlook and self-image, but the reality is that these changes add significantly to quality of life,” he says. “My position is that if we can make someone feel better about life —maybe all it takes is a Botox injection or fixing a few lines and wrinkles—then we’ve more than done our job and will be rewarded accordingly.”
Rich Smith is a contributing writer for PSP. He can be reached at [email protected].