Increasingly, patients are comparing fees, analyzing Web sites, visiting bulletin boards, asking friends and other specialists for referrals, and are programmed to shop around for plastic surgery procedures. They are frighteningly well informed, knowledgeable about the specifics of procedures and techniques, and often know (or at least think they know) what they need before they get to your office.

This is why the consultation process is so critical. It serves a dual purpose, allowing the patient to interview you and allowing you to identify patients who are either not suited for cosmetic procedures or are likely to be unhappy about the outcome.

It is common for you to begin the consultation by correcting misconceptions the patient has culled from the above-mentioned sources. An initial consultation should last a minimum of 20 minutes, with the cutoff point somewhere shy of 1 hour. Patients will often show up with a legal pad containing a list of questions and concerns, as well as pages ripped from magazines or pulled off the Internet—all of which will need to be addressed by either you and/or your staff.

No matter how banal or insipid the patient’s questions may seem to you, they are important to her. For example, a blepharoplasty consultation today may take three times as long as it used to, in light of the variety of surgical techniques and alternative treatments available. Even if you don’t recommend a particular technique, you should be prepared to explain your position as another physician may have suggested it to the patient.


Ultimately, the patient has to be appropriately motivated to undergo surgery or a cosmetic procedure. In this era, it is also important to discuss alternatives to surgery where appropriate. Patients expect to learn about a wide array of options because they have heard about them. If you are programmed to limit your consultation to surgical options, you may risk alienating patients who want to at least consider less invasive and less expensive choices.

The consultation is your best opportunity to sell yourself, but not so much that you come across as arrogant or self-absorbed. Take a moment to assess the patient, find some common ground, make good eye contact, and vary your approach accordingly. The patient who presents as nervous and uncertain about surgery might require more time and more simplistic or visual explanations. It is your job to control the consultation from introduction to closing and to pass the patient back to a cosmetic coordinator or staff member.

It is not always advisable to discuss multiple procedures in one consultation visit. Try to get the patient to prioritize his or her key concerns and attempt to cover these in detail before moving on to procedures they may be less serious about. Patients also have an extremely low retention rate, and repetition is critical. Following the first one or two procedures discussed, they may not remember a lot of what was mentioned and will need to come back a second time anyway.

When possible, have printed instructions, customized brochures, and other relevant take-home handouts. Some of this general information can also be posted on your Web site to save even more time in consultation. It is not recommended that you quote fees to patients, as financial and scheduling matters are best left to key staff.

On The Web!

See also "Examining Virtual Consulting" by Catherine Maley, MBA, in the December 2009 issue of PSP.

If you are not charging a consultation fee, you may be experiencing a high rate of no-shows. In some markets, where many practitioners are waiving a consultation fee, it may be difficult to compete if you are charging even a nominal amount. However, if you have a well-established practice, then it is reasonable to charge something for a consultation. A good, happy medium to overcome objections to the consultation fee is to offer to apply it to the purchase of a product, service, or treatment. Similarly, if there is no charge for seeing you, patients may assume that they can come back indefinitely for free consultations.

Another effective strategy is to offer a complimentary consultation with a member of your staff for initial screening purposes. The staff member who assumes this pivotal role can cut your consultation time in half, discuss fees, reinforce what you have told the patient, and troubleshoot for you— including identifying problem patients before they become your problem.

Although it is generally not necessary for injectable or laser treatments, it is helpful for you to see surgical patients twice prior to surgery in order to ensure you have answered all of their questions. Two visits may also be necessary to complete the required paperwork for a big-ticket procedure, as well as to carefully review preop and postprocedure instructions.

Wendy Lewis is president of Wendy Lewis & Co Ltd Global Aesthetics Consultancy, author of 10 books, and a regular contributor to PSP. She can be reached at . Follow her on