The Edge | February 2014 Plastic Surgery Practice

Torn in the USA

Does new research out of the Netherlands on how patients choose surgeons apply to the US?

By David Evans, PhD, MBA DavidEvans

Patients have more aesthetic treatments and providers to choose from than ever before, so how do you stand out from the burgeoning fray? And how do patients really go about selecting a surgeon?

A recent study published in Plastic and Reconstructive Surgery® attempted to answer these very questions.

The study found that the single most important factor in a patient’s selection of a private aesthetic clinic is the surgeon’s experience (35.6%). Other important factors included: method of referral (21.5%), travel time (14.2%), cost of the procedure (12.9%), online presentation (9.7%), and size of the clinic (6.1%). These data imply that your marketing efforts should focus primarily on promoting your years of experience, and that cost and online presentation, while important, are secondary.

Not so fast. This is the USA, not the EU.

At first glance, this data make sense, and support the concept that consumers are smart buyers who understand and can evaluate the level of a surgeon’s experience. But, this study was conducted in the Netherlands by a nationwide private aesthetic practice with 16 specialized clinics.


Board certification is not an issue in Europe, and never has been. All European plastic surgeons have a similar level of education and training, so there is no confusion among consumers about board certification. With that factor removed from the analysis, consumers gravitate toward the simple “years of experience.” In the US and Canada, type of board certification, specialization in procedures, and additional training outside of board certification all play a major role in decision-making.

Perhaps the most confusing result of the study, from a US standpoint, is that “online presentation” accounted for only 9.7% of the surgeon selection process. This type of result may be attractive to surgeons because it suggests that consumers evaluate surgeons on their merits, as opposed to on their website and online presence. But it doesn’t work like this in the US.

Where do review sites fit in?

Most European countries have restrictions against presenting before-and-after photos and testimonials on the Web. Data from more than 100 aesthetic surgeons’ websites show that the before-and-after galleries are the most popular pages, and the testimonial pages typically have the longest “time on page.” In Europe, these pages are nonexistent. So it makes sense that the study results would show that Web presence plays a lesser role in patients’ selection of a private aesthetic clinic.

Review sites, such as Yelp and RateMDs, are not commonly used in the Netherlands and other parts of Europe. But they make up a significant part of a surgeon’s online presence in the US. Recent data by BrightLocal showed that US consumer use of reviews to select doctors and dentists skyrocketed between 2012 and 2013, growing by 51%. Doctors and dentists are now second only to restaurants when it comes to online review fodder.


Another surprising result from the study is that “cost of the procedure” accounted for only 12.9% of the decision weight.  Aggressive promotion of discounted
plastic surgery procedures is widespread in the US. Heavy discounting of popular procedures, such as breast augmentation, distort consumer perception in
many ways, and certainly make cost a crucial factor.

Cost-cutting promotions—whether via the Web, print advertising, Groupons, or other group discount platforms—create the impression that plastic surgery procedures are commodities. This perception affects the most important factor seen in the study—“years of experience.” As the perception that plastic surgery procedures are commodities increases, the perceived importance of years of experience and training decreases significantly. That trend has not hit Europe—yet!

This study shows that conjoint analysis can be applied to aesthetic practice marketing. A similar study of prospective US plastic surgery patients, focusing on factors unique to the US market, could be very beneficial to enhancing marketing strategies on this side of the pond.

David Evans, PhD, MBA, is the CEO of Ceatus Media Group, based in San Diego. His column, “The Edge,” appears in every issue of Plastic Surgery Practice. He can be reached via [email protected].

Original citation for this article: Evans, D. Torn in the USA: does new research out of the Netherlands on how patients choose surgeons apply to the US?, Plastic Surgery Practice. 2014; February: 8