Recently, I got a call from Dr Smith, who was frustrated and nervous about his and his family’s future. For years, he enjoyed a lively, lucrative aesthetic practice, and he was well-known in his community, well-liked by his patients, and well-respected by his colleagues.

His schedule was full of cash-paying patients who were loyal to him. They referred their friends so that he didn’t really have to do much in the way of promoting himself or his practice—it was just “happening naturally,” and he was making a great living.

Then the economy fell apart. Almost overnight, Smith felt his aesthetic practice slow.

Patients who came in regularly were disappearing or coming in less frequently. They were buying less—eg, patients were increasing the time between their injectable appointments. Others were putting surgeries on hold, opting instead to do nothing or get lesser and/or cheaper treatments.

Symptoms of the fall-off in business: He was seeing openings in his schedule for the first time in his career, often saw his staff hanging around waiting for patients to show up, and “no-shows” were becoming an issue.

Additional symptoms included struggles to make payroll and problems converting consultations into paid procedures. Perhaps worst of all, he struggled to sleep through the night without waking up saying to himself over and over, “What am I going to do?”

Ultimately, Smith experienced a painful revelation: If something didn’t change soon, he was going to have to lay off staff, cut back drastically on his business expenses, and cancel the annual family vacations.


For Smith and those of you in a similar situation, here’s a brief dose of brutal reality. You may have had it easy before now because you did not have to try very hard to fill your office with cash-paying patients.

Symptomatic of that bygone era—a mere year or 2 ago—is that demand for aesthetic medicine was over the top; consumers were spending like drunken sailors; bank credit was available for whatever you wanted to expand your practice; and television shows such as Extreme Makeover made it possible for everyday people to envision a new life of love, wealth, and health via cosmetic enhancement.

When the party ended, many of Smith’s patients had lost their jobs or were afraid they would lose their jobs soon. They stopped spending on aesthetics or could no longer afford your services.

With the media pouring on doomsday stories about stocks sliding, businesses closing, and the world coming to an end, physicians continued to lament, “Where did the patients and the money go?”

The answer? There has been a shift in wealth. The money is still there, but it’s now in different hands. As a service provider, the aesthetic practitioner must now work at it to get the same results that used to come effortlessly.

That’s the difference, and that’s why only the strategic will survive.

Remember those sayings: There’s a silver lining in every cloud; and when one door closes, another one opens. The current state of the economy spells doom for some and opportunity for others. In which group do you fall?

I asked Smith to not let highly publicized pessimism stop him from being excited and enthusiastic about his future in aesthetic medicine. With the right mind-set and strategies, there is much he can do to survive and even flourish during this shaky time.


I shared the following success strategies with the good doctor in order to guide him out of his slump:

You cater to a very hungry market—namely, those who want to look and feel better and will invest their time, money, and effort to make that happen. For them, it is not a one-time feeling but an ongoing, innate desire among an aging population.

This patient has a built-in need now and for years to come. If they care about how they look right now, their concern will only grow as the aging process takes an even bigger toll.

Spend the effort upfront to attract that aesthetic patient to your practice and then nurture that relationship. This is time well spent, and your patient will return for additional procedures, treatments, and products to help him look and feel good.

Keeping It Simple

Target the right patients … meaning your older, more mature patients.

Create a great patient experience … and remain in a constant state of improvement within your practice.

Attract new patients … by strategically educating your would-be patients so that they believe you are the expert they need to solve their medical problems.

This is not a one-time transaction. The first transaction should always lead to another. It may cost a small fortune to acquire that new patient, but it costs next to nothing to keep her. The financial beauty of this relationship-based practice is that your costs will dramatically decrease if you simply maintain the patient database you spent time, money, and effort to build.

There are only a few ways to grow your practice’s revenues. You can increase the number of patients, increase the average transaction per patient, and increase the number of times a patient visits your practice.

If implemented, the next set of strategies will result in doubling or tripling your personal income without much impact on your operating costs.

First, target the right patients. A true aesthetic patient will do whatever is necessary to look and feel better, which includes paying out of pocket and even borrowing money for your services.

For now, they may pull back on more extreme and expensive procedures. However, they will do something to regain what they believe they have lost in order to look as good as they feel.

Keep in mind that 76 million Baby Boomers are getting older every day. They are not looking forward to old age or to slowing down. They want to feel and look youthful.

Many of them are experiencing new phases in their lives, such as a new job or a job layoff, a new marriage or divorce, or an upcoming wedding or high school reunion, among many other possibilities.

Target older, more mature patients versus younger people. Your mature patients have more obvious concerns, such as increasing wrinkles, crepe skin, sagging body parts, and sun damage. They are also more likely to have the financial wherewithal to afford your services.

The mature patient is least likely to be affected by what’s going on in the economy. They have the means to dig deeper for a reason to see you—and they will find the money for rejuvenation procedures because they are very motivated.

When new patients begin working with you, do everything you can to create a great patient experience.

Should they call your office or appear in person, every patient should come away with a memorable and good experience. The patient experience is the moment of truth, when the patient decides if they like you and trust you, and also decides if they are going to move forward with a procedure or service. Part of cultivating that experience for them includes encouraging them to tell their friends about you, as well.

They must be comfortable with the experience they have in your office. That includes a pleasant receptionist, friendly staff, smooth processes, and a comfortable physical environment.

As a “reality check,” walk through your office. See, hear, smell, and “experience” your office as a new patient would. Next, ask a friend or neighbor to do the same and act as a mystery shopper. Ask them to report their findings to you. What did they like about your office? What can be improved?

This will help push you to be in a constant state of improvement so your patients enjoy their time with you enough to return again and again.

Do you have the right team in place?

It’s imperative that every employee believes in you, your services, and your success in aesthetic medicine. They must represent you to the best of their ability, and they must care. They must work as a team to provide the best service possible. That means they must follow systems and processes like a well-oiled machine—even when you’re not there.


I’m sure you are feeling the urge to cut down on your marketing and advertising efforts and lay low while the economy is down and gloomy.

Hold that thought while I mention the story of Kellogg versus Post. At the time of the Great Depression, these two cereal companies dominated the packaged cereal industry. When the market decreased demand for packaged cereals, Post did what most businesses and practices do when the demand declines—it tightened its belts and reduced its marketing and advertising budgets.

However, Kellogg did the opposite. It doubled its ad budget. As a result, Kellogg increased sales nearly 30% and today remains at the top of the packaged cereal industry.

When times are tough, most physicians and medical practices behave as Post did in the 1920s—that is, they cut back on investments, marketing, and practice promotion. On the surface, it sounds more logical and reasonable than what Kellogg did.

On the other hand, college professor and ex-advertising executive Roland Vaile, who studied companies’ responses to the Great Depression, found businesses that maintained or increased advertising spend saw sales hold up significantly better than companies that pulled back and cut spending.

A study of advertising during the 1981-’82 recession found that companies that increased ad budgets sales grew precipitously in the following 3 years, compared with only slight increases at firms that had slashed their budgets.

A McKinsey & Co study of the 1990-’91 recession found that companies that remained market leaders or became serious challengers during the economic downturn had also increased their acquisition, R & D, and ad budgets; whereas companies at the bottom of the pile had reduced those budgets and cut expenses in marketing.

Back to your practice. Everything about marketing a medical practice can seem counterintuitive. It starts with very basic questions, such as “I’m a doctor; why do I have to market?” and “All my colleagues around me are marketing, so should I copy what they are doing?”


Promoting your services is not about yelling the loudest to the world that you are brilliant or the best in town. It isn’t about putting an ad in the local newspaper that lists all of your services. That is the “push” method of marketing—you are pushing yourself onto the world and hoping that it will see you as an expert.

A much better approach is the more subtle “pull” method. This involves strategically educating your preferred, would-be patients. You want them to seek you out because they believe you are the expert and they need your expertise to solve their medical problems.

Do you know where we’re going with this? It’s actually time for you to step up your promotional efforts to avoid dips and inconsistencies in your aesthetic patient flow.

Let your competitors lay low while you actively engage in attracting new patients and re-engage with old ones.

You can even attract your patients defecting from your competitors, some of whom will likely impose cost-cutting measures.

How do you get more aesthetic patients? Your aesthetic patients go to you because they know, like, and trust you. They get a consistent experience every time, a consistent result, and a relationship with you and your practice that keeps them coming back for more (and bringing friends).

The point here is not to see how big you can grow your database, but to attract your preferred patient and then nurture that relationship. Build your practice from within rather than by random, expensive, external efforts.


You are leaving money on the table if your patients don’t realize everything you offer.

I guarantee, if they don’t buy from you they will buy from someone else—the local aesthetic surgeon, the medspa down the street, etc.

Have strategies in place so you never hear a patient say, “I didn’t know you did that,” after they had it done by your competitor.


I conducted a case study and went back through a plastic surgeon’s practice records and documented one of his favorite patients. I was able to piece together her history with this practice for almost 10 years.

What I found was that this one patient not only was worth $40,000 in minimally invasive as well as surgical procedures, but she was worth more than an additional $90,000 in terms of referrals from her friends, family members, coworkers, a woman’s business group in which she was a member, and her hairstylist—that does not even include all of their referrals.

It’s imperative you have a system in place to attract referrals, especially from your existing patients.


Want to know why your patients disappear? You thought you had a good relationship but now realize you haven’t seen them in more than a year. What happened?

The number 1 reason patients leave your practice is not because of a bad result; it is because of your indifference. They are being ignored by you, so they don’t feel compelled to return.

Make your patients feel your concern for them and their welfare by keeping in touch with them and reaching out to them continually. I promise they want to hear from you. Most likely, you have a database full of prospective patients who came in for a consultation but didn’t book, who came in a couple of times and then wandered off. And then there are those you haven’t seen in months or years. I guarantee they did not stop wanting to look good. They just went somewhere else where they weren’t ignored and received better treatment.


Perhaps they were having a bad day when they visited and couldn’t connect with your staff. Maybe your staff was having a bad day and scared them off. Did they get sticker shock? Perhaps they went to your competitor and want to return to you but are too embarrassed.

You are never going to know unless you reach out to them. There is a good chance they were not saying no; they were simply saying, “Not yet” or “Not now.” Since it’s always faster, cheaper, and easier to reconnect with patients who have visited you before than it is to attract total strangers to your practice, reconnect with these patients now.


Today’s fragmented media outlets have your preferred patients scattered all over the universe. There’s no easy way to get to them, so you have to spend much more money trying to be everywhere they are—such as on the radio, television, and magazines—which is very expensive, tiring, and ineffective.

Truly successful aesthetic practices know that word-of-mouth referrals are the lifeblood of their practice and are worth the effort.

On The Web!

See also “The Biggest Threats Facing Your Practice,” by Catherine Maley, MBA, in the October 2008 issue of PSP.

Aesthetic patients I have interviewed said they would have referred you to others if they were only asked. You cannot take patient referrals lightly. As much as you think (and hope) that patients will gush about you to their friends and family, do not leave it to chance.

It is imperative to your financial future that you set up a system that keeps patient referrals flowing so that at least 70% of your new patients come from other patients.


The top aesthetic practices know something that others don’t. The secret is to set up systems and processes that have you regularly attracting new patients to your practice, in which they come back for more and more often. You must take care of them so well that they refer others.

You will not find that result in any number of e-mail blasts, monthly newsletters, or a single in-house event.

The financially successful aesthetic physicians consistently keep their names in front of their patients, who return repeatedly and bring their friends. These physicians and staff continuously pay attention to patient attraction and retention. These referrals keep the practice’s schedule filled with cash-paying patients.

Catherine Maley, MBA, is president of Cosmetic Image Marketing, a Sausalito, Calif-based firm that specializes in helping aesthetic practices grow. She can be reached at .