Choosing the best cosmetic dermatology candidates and appropriate interventions for each appears deceptively simple at first glance. Ideally, objective assessment of the individuals’ skin and relevant cosmetic units is performed. This objective data are compared to the culturally determined “norms for beauty” and areas of discrepancy are targeted for correction. Once adequate correction is achieved, patient satisfaction and “happiness” should be a certainty.
Not So Simple
Well, unfortunately, as it turns out, it’s not that simple. To begin with, both patient and physician assessments often lack objectivity. All individuals suffer some alteration or distortion in self-perception. These distortions tend to magnify perceived imperfections and minimize positive attributes of the skin and body. Since cultural norms of beauty are in a constant state of flux, any assessment can be viewed as ephemeral and subject to rapid change. And despite attempts at objectivity, clinicians are at least, to some degree, biased by their own perceptions of beauty as well as the clinical outcomes they have observed with given products and procedures.
Sometimes, the area(s) deemed most in need of amelioration by a physician’s “objective assessment” may be one of little or no concern from the patient’s “subjective perspective.” Sometimes, the areas of cosmetic dissatisfaction and cosmetic wishes of the patient are clear and easily attainable. For example, improvement in glabellar furrows, dyspigmentation, acne scarring, or periorbital rhytids are concrete wishes. The choice of interventions is clearer. The physician can review available treatment modalities i.e. Botox, peels, laser, intense pulsed light, fractional resurfacing and make solid treatment recommendations.
However, all too often, the patient’s wishes for skin improvement are vague, unrealistic, or differ from those deemed possible by the clinician. This may be in large part due to the overwhelming amount of information that permeates their consciousness from radio, television, Internet, billboard, and print media. Exaggerated claims of efficacy with overnight rejuvenation and restoration create unrealistic expectations. Lack of congruence in physician/patient assessment and expectation will likely result in an extremely miserable patient. Please recall that it is best to avoid these outcomes because extremely miserable patients are anxious to share their misery and inevitably produce extremely miserable clinicians!
Therefore, expectations must be trimmed and shaped before any cosmetic procedure is initiated. Skillfully lowering expectations can increase post-procedure satisfaction. Lowering expectation is best accomplished while the patient observes him or herself in a mirror.
A 30-second explanation of the pathophysiology helps the patient understand the limitations of improvement and ludicrous nature of the miracle claims. It is always more emotionally gratifying to believe that you got more than expected, rather than less.
Unfortunately, in the final analysis, it is only the patients’ subjective assessment that determines their satisfaction with cosmetic outcomes.
Another Dimension to Treating Cosmetic Dermatology Patients
The late Eugene Farber wrote in the 1990s about the other dimension in the management of psoriasis; that intrapsychic factors and stress can affect treatment outcomes. Dermatologists are increasingly recognizing the importance of this “other dimension” in many of the common disease states that burden our patients. Stress reduction techniques such as biofeedback, progressive muscle relaxation, guided imagery, and hypnosis have been demonstrated to decrease the severity of disease flares and the rapidity of response to dermatologic treatment.
Another dimension of growing number and importance are our cosmetic patients. They frequently present to our offices complaining of stress and unhappiness regarding their appearance. However, they are often overwhelmed with numerous sources of information, tantalizing images, and exaggerated claims. This sensory overload makes it difficult for patients to make well-chosen cosmetic interventions that maximize the likelihood of achieving their desired result.
Achieving Success
The following cover story covers several topics. The first, which is based on the “STEP program”, is designed to help you choose the best patients. Another part of the cover article offers a patient questionnaire designed to screen for high-risk cosmetic patients. You can copy and use it for your own patients.
The third piece highlights a multidisciplinary team of providers that, based on a group selection process, targeted patients for a multitude of cosmetic intervention. Not only does this “makeover team” share its patient selection process, but they share insight into how they developed a successful collaborative effort to treat patients while also gaining recognition for their practices.
These articles embrace the winning combination of cosmetic dermatology and psychodermatology.
> The S.T.E.P. Program
A new way to select cosmetic dermatology patients — and to identify patients you should avoid treating.
By Richard Fried, M.D., Ph.D.
The S.T.E.P. program encompasses medical, surgical, and psychodermatology.
The “S” — Stress
• You or your staff can help patients to specify area/areas that cause them stress or distress.
• Important to be specific i.e. glabellar wrinkles, dyspigmentation, telangiectasia, etc. Avoid vague references such as “getting older” and “unhappy with my skin”.
• Be sure you can see them (are they observable and realistic versus grossly exaggerated or even non-existent).
• Be sure their expectations are realistic and that you have the tools to meet their expectations.
The “T” — Target
• Help patients to target specific areas for intervention/correction/amelioration.
• Be sure that ideas, goals are realistic and attainable.
• Limit focus to a few specific areas i.e. glabellar furrows, dyspigmentation, ectasias, fine lines, rhytids, volume loss, etc.
The “E” — Envision
• Ask patient to envision how their perceptions, emotions, and life would be different/better after intervention. Specifically ask them “if you correct these areas, how will your life be different?”
• Are “fantasies” realistic?
• Can you deliver?
• Have previous clinicians?
• Has anyone?
The “P” — Proactive
• If clear attainable goals and realistic expectations are present, be proactive and devise specific treatment plan for patient i.e. Botox, Restylane, and microdermabrasion. Proactive implies concrete and timely plan of action. Botox, Restylane and Radiesse today, microdermabrasion commencing next Tuesday.
You may consider utilizing an additional tool to identify “high-risk” cosmetic patients. These are patients considered to be inappropriate candidates for cosmetic intervention due to their unrealistic expectations and/or underlying psychopathology. They represent that small percentage of patients that can drain you and your staff of time, emotional energy, and happiness. Choosing patients wisely is essential because we all love stories with happy endings.
The following is a general cognitive framework for identification of appropriate versus inappropriate cosmetic patients. The information gleaned from your clinical impression and the STEP program may be adequate, or you may choose to use the CSP-D (Cosmetic Procedure Screen-Derm) on page 45. The CSP-D (Fried & Werschler) is a more structured interview or self-administered questionnaire that can be a valuable tool to identify high-risk patients.
Overall Cognitive Framework:
Absolute Contraindications:
• Body dysmorphic disorder
• Borderline personality disorder
• Active self-mutilation
• Major depression
• “Troubling” agitation on day of procedure (excessive to the point of causing the clinician distress”
• Suicidal thoughts
• Psychotic
Relative Contraindications:
• Narcissistic personality disorder: probably unpleasable
• Doctor shopper
• Subtle or overt derogatory statements about you, your colleagues, or the medical profession in general.
• Tough customer; excessively demanding of physician, staff
• Exaggerated expectations
• Motivation is to please another person
• Depression
Ideal Candidate:
• No obvious psychopathology
• Clearly defined area(s) of dissatisfaction
• Procedure(s) you offer can give objective improvement
• Realistic expectations
• Motivation is from self and for self.
Download PDF of screening survey tool.
> The Story of the Spokane Makeover Team
A success story of a multidisciplinary team of providers offering cosmetic services.
By Wm. Philip Werschler, M.D.
Before telling this story, an overview of the development of the “cosmetic marketplace” from the consumer perspective seems in order.
The Evolution of Non-Surgical Treatments
Beginning several decades ago, relatively simple “cosmetic” dermatology procedures began to appear in the United States. As perhaps best typified by collagen injections in the 1980s, it became possible for the average patient to walk into a dermatology office, and in a reasonably short visit with minimal downtime and modest cost, walk out with a specific site of enhancement, rejuvenation or restoration.
While typically this injection procedure was for lower-face rhytids, especially lip augmentation, the important concept, from the patient perspective, was that cosmetic procedures had now become non-surgical.
For the next decade non-surgical cosmetic enhancement remained primarily soft tissue augmentation (STA) by injection, virtually always bovine collagen.
Then, in the 1990s, a new treatment became available. Implausible as it seemed, minute quantities of a highly refined bacterial toxin, known as Botox Cosmetic, could effectively minimize dynamic facial rhytids.
Again, from the consumer’s view, treatments were now available for both STA and wrinkle reduction. While fondly termed “wrinkle poison” by the fashion industry, Botox was a sensational hit with treated patients. In many ways, it was the proverbial “gateway drug” for cosmetic patients. In a few years, the very word “Botox” itself became iconic, representing essentially any beautifying treatment to the face.
Even the OTC cosmetics industry jumped on the bandwagon, with advertising claims such as “Better than Botox?” and “The Botox alternative”. There were games played with the name such as “Fauxtox” (cream) and even “Bochox” (delicious chocolate for the relief from the symptoms of wrinkles and crow’s feet)!
Confusing Choices
While Botox was on its way to becoming a verb, noun, adjective, adverb, etc., the consumer seeking public was on its way to confusion — confusion over what product causes what action, where different products are supposed to be used, who should (or shouldn’t) inject, and so forth. Adding to this mix of consumer turmoil were advances in parallel industries, especially the world of lasers and light source devices.
Suddenly, the consumer, who was trying to perform her due diligence prior to seeking treatment, was faced with a bewildering array of treatment choices. How, where, what, why, and who had become almost impossible to answer without resorting to Sherlockian-like sleuthing.
Unfortunately, broadcast media only added to this problem with shows such as “The Swan”, and “Extreme Makeover”, where results went beyond realistic expectations and budgets of the average, or even well-to-do, consumer.
Why we Developed the Spokane Makeover Team
An attempt was made to break through this fog of cosmetic seeking consumer confusion by Spokane Dermatology Clinic, in association with two forward thinking marketing partners, Collins Cosmetic Dentistry and Dogstar Media, both of Spokane, WA.
Essentially, the challenges faced by cosmetic dentists and cosmetic dermatologists are identical: Educate the consumer-prospect about treatment options available, what conditions they treat, who is qualified to perform them, who is a good candidate, and how to access the proper office(s).
The problem faced by both specialties is how to reach out and communicate (educate) with the prospective patient base in such a way as to maximize resources to achieve a high return on investment (ROI) without going broke in the process.
Marketing experts generally agree on the following three principles:
1. Free publicity is better and more believable than paid advertising.
2. That everyone loves a good story, especially if someone who deserves help is rewarded (i.e. “little old lady wins lottery”).
3. It is better and easier to solve a problem than to sell a benefit.
Enter Dogstar Media, a marketing, advertising and communications (MAC) agency specializing in health care. Together with Dr. Ken Collins, a highly respected cosmetic dentist and Spokane Dermatology Clinic and Aesthetic Image Premier Medical Spa, Dogstar began the development of a print and broadcast media-based marketing campaign focused on real-life cosmetic makeovers.
How it Works
Interested individuals access the program by logging onto a Web site, SpokaneMakeoverTeam.com, and apply by filling out a 12-page application that identifies specific cosmetic interests, among other demographic data.
Included in this process is the subjective personal story of why and what a makeover would mean to the applicant.
Once the application is completed, it is submitted for review. At the initial screening, candidates are reviewed by screening for applicable procedures. For example, if someone is interested in breast augmentation and that procedure is not offered, then the applicant would not be selected.
The Next Steps
Once screening identifies potential candidates, interviews are conducted to confirm identity and continued interest. Following this, the selected candidates are scheduled for personal interviews, and then referred to the appropriate “partners” offices for what in dermatology would be a “cosmetic consultation”.
Once all of the selected partners agree on a candidate, and the candidate agrees to participate, a final interview process is completed. This includes signing a talent release consent that allows for identification for advertising and marketing purposes. It also includes a background investigation and interview with a psychologist (who is not a team member) to assess the suitability and stability of the candidate for the procedures planned.
Once all of these steps are completed, the new candidate is scheduled for professional photography, and the baseline photos are posted on the Web site. It is also at this time that press releases are written for the media, so that the candidate may be scheduled for interviews.
Throughout the duration of the makeover, periodic interviews are arranged with the media to update them on progress being made and to showcase the talents of the team members working on the makeover recipient.
Finally, a highly scripted “coming out” party is scheduled to coincide with live television coverage. There are friends, family members, team members, office staff and previous makeover candidates all present in a festive atmosphere. (For examples of patients we’ve treated through the Spokane Makeover Team, see photos.)
The new makeover recipient is given the opportunity to thank everyone involved, and the team members each give a brief description about what services they provided. All television footage is compiled and used to provide raw material for future editing for advertising, DVDs, business cards, etc.
Increasing Awareness
Essentially, the program works to increase public awareness of procedures and skills available in the local market by promotional advertising offering interested prospects the chance of winning a free makeover. The makeover is supplied by the principals, as part of the investment in the marketing campaign.
Advertisement costs are shared by the members of the group. “Tiers” of partnerships exist in which the highest level is the investor/owners. Other tiers assume less in cost and benefit and include hair salons, fitness facilities, make-up studios, fashion clothiers, hotels, restaurants, limousines, florists, etc.
The possibilities are almost endless in terms of who may become involved in the process of the makeover. As each candidate is unique in terms of needs and potential benefits, each makeover becomes a new opportunity to cross market to other businesses.
Because everyone who applies to the program has some level of interest in some type of self improvement procedure, whether it is dental, dermatological, weight loss, hair, fitness, make-up, etc., there exists a great opportunity to cross-market other procedures and/or services to each candidate. For example, the applicant who desires cosmetic dental restoration may be an excellent candidate for lip augmentation. Or the applicant with interest in weight loss and fitness training may be also interested in liposuction. The list goes on and potentially benefits every partner involved in the program on a repeat basis.
Why does the “Local Makeover” Concept Work?
The concept generates publicity in many ways. As mentioned, the makeover candidate process is typically deemed newsworthy by local media because the makeover process itself is an altruistic endeavor, provided at no charge to the recipient.
The individuals involved enjoy real and lasting value from the experience. The selected candidates offer a good credible story (breast cancer survivor, mom re-entering workforce, domestic violence victim, etc.) that appeals to the mass media audience. Each candidate represents a fresh story that is exciting and relevant to the local community.
In addition, the timeline is reasonable, usually it takes 12 to 16 weeks to follow a candidate through the process from beginning to end. Also, local businesses are involved, and they buy airtime and ad space for advertising.
How Partners Benefit
Essentially, this program is a highly sophisticated method of capturing a detailed email database. Because each candidate applies online, and the application process is quite detailed, an informational database is created that allows for future mining for follow on marketing and promotional activities. Because anyone can apply, and the motivation to complete the 12-page application has to be considerable, those respondents are typically truly interested in products, procedures and programs offered.
Because not every applicant is selected, large pools of “pre-qualified” online addresses are available for follow-up communication.
Calculating the Return on Investment
As an example, we accessed our applicant database for interest in facial wrinkles. We used culling criteria of less than 1 hour distance from Spokane by ZIP code, age 35 to 55, female, and no previous history of Botox.
Of the 6,000-plus addresses in our database, we had 982 hits. E-mail invitations were sent for an educational evening event. There were 173 responses, 87 R.S.V.P.s and 68 attendees. Afterward, 37 patients were booked for treatment, a >50% closing rate.
Of these patients, 34/37 completed appointments, 31/34 were Botox naïve, and 12/34 received a secondary treatment (8 fillers, 2 chemical peels, 1 Thermage, 1 liposuction).
Total cost for the event was less than $1,000 (funded by co-op marketing dollars by vendor partners), and revenue generated was >$18,000. This resulted in a gross ROI of 18:1, and after product costs, a net ROI of 12:1. The secondary procedures yielded an additional $16,000 plus in revenue.
Based on previous experience, the amount of funds to generate this revenue, when used in non-selective, non-targeted blind advertising would be in the range of $5,000 to $10,000, for an ROI of 3.5 to 7:1. An example of this type of program would be a series of newspaper ads.
Would this be a bad ROI? Not necessarily, as costs would be recovered and the patient base would be expanded.
However, from a business perspective, successful practice promotion is not just about recouping costs; it is about leveraging identity,
it is about branding, and it is about financial success.
Marketing cosmetic services is a potential minefield of mistakes. If you are too aggressive, you risk credibility with the very public you wish to trust you; if you are timid, you may be passed by those who are perhaps less skilled medically, but more business savvy.
The makeover team concept has proven to be a durable, reliable, credible source of cosmetic identity branding in an increasingly competitive, and difficult to distinguish, professionally robust growth market of medical spas, medical beauty salons, paraprofessional cosmetic practices, and the like.
Creating a Targeted Audience for the Future
Because prospects select themselves, through on-line application, they represent a targeted audience. They are available for communication, education and even realistic goal setting prior to ever entering your office.
They are also taking the first step in a cosmetic journey, where they are almost certainly less informed than they think they are, regarding the products and procedures they think they desire.
By allowing these prospective cosmetic patients to initiate the contact with you and your office via a neutral Web site, you also avoid the common mistake of “recommending” or “suggesting” to a non-interested, non-cosmetic patient a cosmetic procedure that is potentially an uncomfortable situation for both of you.
Much more than Technical Skills
Cosmetic office practice (COP) success is much more than just technical skill in procedures performed. Indeed, that is just the beginning of success.
Cosmetic practice requires a significant level of understanding of the consumer mindset, the psychological motivations of the patient, the challenges involved in deconstructing the false beliefs of mass media advertising of exaggerated claims; of “painless, no down time, no complications” misinformation of competitors who are frequently less skilled than the dermatologist, and finally of screening for those patients who may not be suitable candidates for cosmetic treatment. (See the STEPS article beginning on page 44.)
Additionally, dermatologists who desire to establish cosmetic practices need to think long and hard about their qualifications and personality attributes in the context of cosmetic practice.
In addition to the mentioned technical skill set, you will need excellent communication skills. You will need to be likable, have persuasive skills and be comfortable with selling yourself to the prospective patient. You will need to stay abreast of fast-paced technical advances, frequently attend CME courses, and be aware of fashion trends.
Perhaps most of all you will need to be comfortable in a setting of fee-for-service desire dermatology where, unlike disease-based dermatology, the patient’s ability to pay in large part determines the type or extent of treatment.
Forming Your Own Team
The makeover team concept has several critical components, not the least of which is the complexity of having a team of professional equals. Properly constructed and implemented, it uniquely allows for local control of participants, candidates, media relations, and messaging. If there is conflict or competition within the team, then success is virtually impossible.
There is an old saying about “all politics are local,” and this could be amended to “all cosmetic services are local” where the “yourhometownmakeover team” is concerned. Good luck.
Choosing the best cosmetic dermatology candidates and appropriate interventions for each appears deceptively simple at first glance. Ideally, objective assessment of the individuals’ skin and relevant cosmetic units is performed. This objective data are compared to the culturally determined “norms for beauty” and areas of discrepancy are targeted for correction. Once adequate correction is achieved, patient satisfaction and “happiness” should be a certainty.
Not So Simple
Well, unfortunately, as it turns out, it’s not that simple. To begin with, both patient and physician assessments often lack objectivity. All individuals suffer some alteration or distortion in self-perception. These distortions tend to magnify perceived imperfections and minimize positive attributes of the skin and body. Since cultural norms of beauty are in a constant state of flux, any assessment can be viewed as ephemeral and subject to rapid change. And despite attempts at objectivity, clinicians are at least, to some degree, biased by their own perceptions of beauty as well as the clinical outcomes they have observed with given products and procedures.
Sometimes, the area(s) deemed most in need of amelioration by a physician’s “objective assessment” may be one of little or no concern from the patient’s “subjective perspective.” Sometimes, the areas of cosmetic dissatisfaction and cosmetic wishes of the patient are clear and easily attainable. For example, improvement in glabellar furrows, dyspigmentation, acne scarring, or periorbital rhytids are concrete wishes. The choice of interventions is clearer. The physician can review available treatment modalities i.e. Botox, peels, laser, intense pulsed light, fractional resurfacing and make solid treatment recommendations.
However, all too often, the patient’s wishes for skin improvement are vague, unrealistic, or differ from those deemed possible by the clinician. This may be in large part due to the overwhelming amount of information that permeates their consciousness from radio, television, Internet, billboard, and print media. Exaggerated claims of efficacy with overnight rejuvenation and restoration create unrealistic expectations. Lack of congruence in physician/patient assessment and expectation will likely result in an extremely miserable patient. Please recall that it is best to avoid these outcomes because extremely miserable patients are anxious to share their misery and inevitably produce extremely miserable clinicians!
Therefore, expectations must be trimmed and shaped before any cosmetic procedure is initiated. Skillfully lowering expectations can increase post-procedure satisfaction. Lowering expectation is best accomplished while the patient observes him or herself in a mirror.
A 30-second explanation of the pathophysiology helps the patient understand the limitations of improvement and ludicrous nature of the miracle claims. It is always more emotionally gratifying to believe that you got more than expected, rather than less.
Unfortunately, in the final analysis, it is only the patients’ subjective assessment that determines their satisfaction with cosmetic outcomes.
Another Dimension to Treating Cosmetic Dermatology Patients
The late Eugene Farber wrote in the 1990s about the other dimension in the management of psoriasis; that intrapsychic factors and stress can affect treatment outcomes. Dermatologists are increasingly recognizing the importance of this “other dimension” in many of the common disease states that burden our patients. Stress reduction techniques such as biofeedback, progressive muscle relaxation, guided imagery, and hypnosis have been demonstrated to decrease the severity of disease flares and the rapidity of response to dermatologic treatment.
Another dimension of growing number and importance are our cosmetic patients. They frequently present to our offices complaining of stress and unhappiness regarding their appearance. However, they are often overwhelmed with numerous sources of information, tantalizing images, and exaggerated claims. This sensory overload makes it difficult for patients to make well-chosen cosmetic interventions that maximize the likelihood of achieving their desired result.
Achieving Success
The following cover story covers several topics. The first, which is based on the “STEP program”, is designed to help you choose the best patients. Another part of the cover article offers a patient questionnaire designed to screen for high-risk cosmetic patients. You can copy and use it for your own patients.
The third piece highlights a multidisciplinary team of providers that, based on a group selection process, targeted patients for a multitude of cosmetic intervention. Not only does this “makeover team” share its patient selection process, but they share insight into how they developed a successful collaborative effort to treat patients while also gaining recognition for their practices.
These articles embrace the winning combination of cosmetic dermatology and psychodermatology.
> The S.T.E.P. Program
A new way to select cosmetic dermatology patients — and to identify patients you should avoid treating.
By Richard Fried, M.D., Ph.D.
The S.T.E.P. program encompasses medical, surgical, and psychodermatology.
The “S” — Stress
• You or your staff can help patients to specify area/areas that cause them stress or distress.
• Important to be specific i.e. glabellar wrinkles, dyspigmentation, telangiectasia, etc. Avoid vague references such as “getting older” and “unhappy with my skin”.
• Be sure you can see them (are they observable and realistic versus grossly exaggerated or even non-existent).
• Be sure their expectations are realistic and that you have the tools to meet their expectations.
The “T” — Target
• Help patients to target specific areas for intervention/correction/amelioration.
• Be sure that ideas, goals are realistic and attainable.
• Limit focus to a few specific areas i.e. glabellar furrows, dyspigmentation, ectasias, fine lines, rhytids, volume loss, etc.
The “E” — Envision
• Ask patient to envision how their perceptions, emotions, and life would be different/better after intervention. Specifically ask them “if you correct these areas, how will your life be different?”
• Are “fantasies” realistic?
• Can you deliver?
• Have previous clinicians?
• Has anyone?
The “P” — Proactive
• If clear attainable goals and realistic expectations are present, be proactive and devise specific treatment plan for patient i.e. Botox, Restylane, and microdermabrasion. Proactive implies concrete and timely plan of action. Botox, Restylane and Radiesse today, microdermabrasion commencing next Tuesday.
You may consider utilizing an additional tool to identify “high-risk” cosmetic patients. These are patients considered to be inappropriate candidates for cosmetic intervention due to their unrealistic expectations and/or underlying psychopathology. They represent that small percentage of patients that can drain you and your staff of time, emotional energy, and happiness. Choosing patients wisely is essential because we all love stories with happy endings.
The following is a general cognitive framework for identification of appropriate versus inappropriate cosmetic patients. The information gleaned from your clinical impression and the STEP program may be adequate, or you may choose to use the CSP-D (Cosmetic Procedure Screen-Derm) on page 45. The CSP-D (Fried & Werschler) is a more structured interview or self-administered questionnaire that can be a valuable tool to identify high-risk patients.
Overall Cognitive Framework:
Absolute Contraindications:
• Body dysmorphic disorder
• Borderline personality disorder
• Active self-mutilation
• Major depression
• “Troubling” agitation on day of procedure (excessive to the point of causing the clinician distress”
• Suicidal thoughts
• Psychotic
Relative Contraindications:
• Narcissistic personality disorder: probably unpleasable
• Doctor shopper
• Subtle or overt derogatory statements about you, your colleagues, or the medical profession in general.
• Tough customer; excessively demanding of physician, staff
• Exaggerated expectations
• Motivation is to please another person
• Depression
Ideal Candidate:
• No obvious psychopathology
• Clearly defined area(s) of dissatisfaction
• Procedure(s) you offer can give objective improvement
• Realistic expectations
• Motivation is from self and for self.
Download PDF of screening survey tool.
> The Story of the Spokane Makeover Team
A success story of a multidisciplinary team of providers offering cosmetic services.
By Wm. Philip Werschler, M.D.
Before telling this story, an overview of the development of the “cosmetic marketplace” from the consumer perspective seems in order.
The Evolution of Non-Surgical Treatments
Beginning several decades ago, relatively simple “cosmetic” dermatology procedures began to appear in the United States. As perhaps best typified by collagen injections in the 1980s, it became possible for the average patient to walk into a dermatology office, and in a reasonably short visit with minimal downtime and modest cost, walk out with a specific site of enhancement, rejuvenation or restoration.
While typically this injection procedure was for lower-face rhytids, especially lip augmentation, the important concept, from the patient perspective, was that cosmetic procedures had now become non-surgical.
For the next decade non-surgical cosmetic enhancement remained primarily soft tissue augmentation (STA) by injection, virtually always bovine collagen.
Then, in the 1990s, a new treatment became available. Implausible as it seemed, minute quantities of a highly refined bacterial toxin, known as Botox Cosmetic, could effectively minimize dynamic facial rhytids.
Again, from the consumer’s view, treatments were now available for both STA and wrinkle reduction. While fondly termed “wrinkle poison” by the fashion industry, Botox was a sensational hit with treated patients. In many ways, it was the proverbial “gateway drug” for cosmetic patients. In a few years, the very word “Botox” itself became iconic, representing essentially any beautifying treatment to the face.
Even the OTC cosmetics industry jumped on the bandwagon, with advertising claims such as “Better than Botox?” and “The Botox alternative”. There were games played with the name such as “Fauxtox” (cream) and even “Bochox” (delicious chocolate for the relief from the symptoms of wrinkles and crow’s feet)!
Confusing Choices
While Botox was on its way to becoming a verb, noun, adjective, adverb, etc., the consumer seeking public was on its way to confusion — confusion over what product causes what action, where different products are supposed to be used, who should (or shouldn’t) inject, and so forth. Adding to this mix of consumer turmoil were advances in parallel industries, especially the world of lasers and light source devices.
Suddenly, the consumer, who was trying to perform her due diligence prior to seeking treatment, was faced with a bewildering array of treatment choices. How, where, what, why, and who had become almost impossible to answer without resorting to Sherlockian-like sleuthing.
Unfortunately, broadcast media only added to this problem with shows such as “The Swan”, and “Extreme Makeover”, where results went beyond realistic expectations and budgets of the average, or even well-to-do, consumer.
Why we Developed the Spokane Makeover Team
An attempt was made to break through this fog of cosmetic seeking consumer confusion by Spokane Dermatology Clinic, in association with two forward thinking marketing partners, Collins Cosmetic Dentistry and Dogstar Media, both of Spokane, WA.
Essentially, the challenges faced by cosmetic dentists and cosmetic dermatologists are identical: Educate the consumer-prospect about treatment options available, what conditions they treat, who is qualified to perform them, who is a good candidate, and how to access the proper office(s).
The problem faced by both specialties is how to reach out and communicate (educate) with the prospective patient base in such a way as to maximize resources to achieve a high return on investment (ROI) without going broke in the process.
Marketing experts generally agree on the following three principles:
1. Free publicity is better and more believable than paid advertising.
2. That everyone loves a good story, especially if someone who deserves help is rewarded (i.e. “little old lady wins lottery”).
3. It is better and easier to solve a problem than to sell a benefit.
Enter Dogstar Media, a marketing, advertising and communications (MAC) agency specializing in health care. Together with Dr. Ken Collins, a highly respected cosmetic dentist and Spokane Dermatology Clinic and Aesthetic Image Premier Medical Spa, Dogstar began the development of a print and broadcast media-based marketing campaign focused on real-life cosmetic makeovers.
How it Works
Interested individuals access the program by logging onto a Web site, SpokaneMakeoverTeam.com, and apply by filling out a 12-page application that identifies specific cosmetic interests, among other demographic data.
Included in this process is the subjective personal story of why and what a makeover would mean to the applicant.
Once the application is completed, it is submitted for review. At the initial screening, candidates are reviewed by screening for applicable procedures. For example, if someone is interested in breast augmentation and that procedure is not offered, then the applicant would not be selected.
The Next Steps
Once screening identifies potential candidates, interviews are conducted to confirm identity and continued interest. Following this, the selected candidates are scheduled for personal interviews, and then referred to the appropriate “partners” offices for what in dermatology would be a “cosmetic consultation”.
Once all of the selected partners agree on a candidate, and the candidate agrees to participate, a final interview process is completed. This includes signing a talent release consent that allows for identification for advertising and marketing purposes. It also includes a background investigation and interview with a psychologist (who is not a team member) to assess the suitability and stability of the candidate for the procedures planned.
Once all of these steps are completed, the new candidate is scheduled for professional photography, and the baseline photos are posted on the Web site. It is also at this time that press releases are written for the media, so that the candidate may be scheduled for interviews.
Throughout the duration of the makeover, periodic interviews are arranged with the media to update them on progress being made and to showcase the talents of the team members working on the makeover recipient.
Finally, a highly scripted “coming out” party is scheduled to coincide with live television coverage. There are friends, family members, team members, office staff and previous makeover candidates all present in a festive atmosphere. (For examples of patients we’ve treated through the Spokane Makeover Team, see photos.)
The new makeover recipient is given the opportunity to thank everyone involved, and the team members each give a brief description about what services they provided. All television footage is compiled and used to provide raw material for future editing for advertising, DVDs, business cards, etc.
Increasing Awareness
Essentially, the program works to increase public awareness of procedures and skills available in the local market by promotional advertising offering interested prospects the chance of winning a free makeover. The makeover is supplied by the principals, as part of the investment in the marketing campaign.
Advertisement costs are shared by the members of the group. “Tiers” of partnerships exist in which the highest level is the investor/owners. Other tiers assume less in cost and benefit and include hair salons, fitness facilities, make-up studios, fashion clothiers, hotels, restaurants, limousines, florists, etc.
The possibilities are almost endless in terms of who may become involved in the process of the makeover. As each candidate is unique in terms of needs and potential benefits, each makeover becomes a new opportunity to cross market to other businesses.
Because everyone who applies to the program has some level of interest in some type of self improvement procedure, whether it is dental, dermatological, weight loss, hair, fitness, make-up, etc., there exists a great opportunity to cross-market other procedures and/or services to each candidate. For example, the applicant who desires cosmetic dental restoration may be an excellent candidate for lip augmentation. Or the applicant with interest in weight loss and fitness training may be also interested in liposuction. The list goes on and potentially benefits every partner involved in the program on a repeat basis.
Why does the “Local Makeover” Concept Work?
The concept generates publicity in many ways. As mentioned, the makeover candidate process is typically deemed newsworthy by local media because the makeover process itself is an altruistic endeavor, provided at no charge to the recipient.
The individuals involved enjoy real and lasting value from the experience. The selected candidates offer a good credible story (breast cancer survivor, mom re-entering workforce, domestic violence victim, etc.) that appeals to the mass media audience. Each candidate represents a fresh story that is exciting and relevant to the local community.
In addition, the timeline is reasonable, usually it takes 12 to 16 weeks to follow a candidate through the process from beginning to end. Also, local businesses are involved, and they buy airtime and ad space for advertising.
How Partners Benefit
Essentially, this program is a highly sophisticated method of capturing a detailed email database. Because each candidate applies online, and the application process is quite detailed, an informational database is created that allows for future mining for follow on marketing and promotional activities. Because anyone can apply, and the motivation to complete the 12-page application has to be considerable, those respondents are typically truly interested in products, procedures and programs offered.
Because not every applicant is selected, large pools of “pre-qualified” online addresses are available for follow-up communication.
Calculating the Return on Investment
As an example, we accessed our applicant database for interest in facial wrinkles. We used culling criteria of less than 1 hour distance from Spokane by ZIP code, age 35 to 55, female, and no previous history of Botox.
Of the 6,000-plus addresses in our database, we had 982 hits. E-mail invitations were sent for an educational evening event. There were 173 responses, 87 R.S.V.P.s and 68 attendees. Afterward, 37 patients were booked for treatment, a >50% closing rate.
Of these patients, 34/37 completed appointments, 31/34 were Botox naïve, and 12/34 received a secondary treatment (8 fillers, 2 chemical peels, 1 Thermage, 1 liposuction).
Total cost for the event was less than $1,000 (funded by co-op marketing dollars by vendor partners), and revenue generated was >$18,000. This resulted in a gross ROI of 18:1, and after product costs, a net ROI of 12:1. The secondary procedures yielded an additional $16,000 plus in revenue.
Based on previous experience, the amount of funds to generate this revenue, when used in non-selective, non-targeted blind advertising would be in the range of $5,000 to $10,000, for an ROI of 3.5 to 7:1. An example of this type of program would be a series of newspaper ads.
Would this be a bad ROI? Not necessarily, as costs would be recovered and the patient base would be expanded.
However, from a business perspective, successful practice promotion is not just about recouping costs; it is about leveraging identity,
it is about branding, and it is about financial success.
Marketing cosmetic services is a potential minefield of mistakes. If you are too aggressive, you risk credibility with the very public you wish to trust you; if you are timid, you may be passed by those who are perhaps less skilled medically, but more business savvy.
The makeover team concept has proven to be a durable, reliable, credible source of cosmetic identity branding in an increasingly competitive, and difficult to distinguish, professionally robust growth market of medical spas, medical beauty salons, paraprofessional cosmetic practices, and the like.
Creating a Targeted Audience for the Future
Because prospects select themselves, through on-line application, they represent a targeted audience. They are available for communication, education and even realistic goal setting prior to ever entering your office.
They are also taking the first step in a cosmetic journey, where they are almost certainly less informed than they think they are, regarding the products and procedures they think they desire.
By allowing these prospective cosmetic patients to initiate the contact with you and your office via a neutral Web site, you also avoid the common mistake of “recommending” or “suggesting” to a non-interested, non-cosmetic patient a cosmetic procedure that is potentially an uncomfortable situation for both of you.
Much more than Technical Skills
Cosmetic office practice (COP) success is much more than just technical skill in procedures performed. Indeed, that is just the beginning of success.
Cosmetic practice requires a significant level of understanding of the consumer mindset, the psychological motivations of the patient, the challenges involved in deconstructing the false beliefs of mass media advertising of exaggerated claims; of “painless, no down time, no complications” misinformation of competitors who are frequently less skilled than the dermatologist, and finally of screening for those patients who may not be suitable candidates for cosmetic treatment. (See the STEPS article beginning on page 44.)
Additionally, dermatologists who desire to establish cosmetic practices need to think long and hard about their qualifications and personality attributes in the context of cosmetic practice.
In addition to the mentioned technical skill set, you will need excellent communication skills. You will need to be likable, have persuasive skills and be comfortable with selling yourself to the prospective patient. You will need to stay abreast of fast-paced technical advances, frequently attend CME courses, and be aware of fashion trends.
Perhaps most of all you will need to be comfortable in a setting of fee-for-service desire dermatology where, unlike disease-based dermatology, the patient’s ability to pay in large part determines the type or extent of treatment.
Forming Your Own Team
The makeover team concept has several critical components, not the least of which is the complexity of having a team of professional equals. Properly constructed and implemented, it uniquely allows for local control of participants, candidates, media relations, and messaging. If there is conflict or competition within the team, then success is virtually impossible.
There is an old saying about “all politics are local,” and this could be amended to “all cosmetic services are local” where the “yourhometownmakeover team” is concerned. Good luck.
Choosing the best cosmetic dermatology candidates and appropriate interventions for each appears deceptively simple at first glance. Ideally, objective assessment of the individuals’ skin and relevant cosmetic units is performed. This objective data are compared to the culturally determined “norms for beauty” and areas of discrepancy are targeted for correction. Once adequate correction is achieved, patient satisfaction and “happiness” should be a certainty.
Not So Simple
Well, unfortunately, as it turns out, it’s not that simple. To begin with, both patient and physician assessments often lack objectivity. All individuals suffer some alteration or distortion in self-perception. These distortions tend to magnify perceived imperfections and minimize positive attributes of the skin and body. Since cultural norms of beauty are in a constant state of flux, any assessment can be viewed as ephemeral and subject to rapid change. And despite attempts at objectivity, clinicians are at least, to some degree, biased by their own perceptions of beauty as well as the clinical outcomes they have observed with given products and procedures.
Sometimes, the area(s) deemed most in need of amelioration by a physician’s “objective assessment” may be one of little or no concern from the patient’s “subjective perspective.” Sometimes, the areas of cosmetic dissatisfaction and cosmetic wishes of the patient are clear and easily attainable. For example, improvement in glabellar furrows, dyspigmentation, acne scarring, or periorbital rhytids are concrete wishes. The choice of interventions is clearer. The physician can review available treatment modalities i.e. Botox, peels, laser, intense pulsed light, fractional resurfacing and make solid treatment recommendations.
However, all too often, the patient’s wishes for skin improvement are vague, unrealistic, or differ from those deemed possible by the clinician. This may be in large part due to the overwhelming amount of information that permeates their consciousness from radio, television, Internet, billboard, and print media. Exaggerated claims of efficacy with overnight rejuvenation and restoration create unrealistic expectations. Lack of congruence in physician/patient assessment and expectation will likely result in an extremely miserable patient. Please recall that it is best to avoid these outcomes because extremely miserable patients are anxious to share their misery and inevitably produce extremely miserable clinicians!
Therefore, expectations must be trimmed and shaped before any cosmetic procedure is initiated. Skillfully lowering expectations can increase post-procedure satisfaction. Lowering expectation is best accomplished while the patient observes him or herself in a mirror.
A 30-second explanation of the pathophysiology helps the patient understand the limitations of improvement and ludicrous nature of the miracle claims. It is always more emotionally gratifying to believe that you got more than expected, rather than less.
Unfortunately, in the final analysis, it is only the patients’ subjective assessment that determines their satisfaction with cosmetic outcomes.
Another Dimension to Treating Cosmetic Dermatology Patients
The late Eugene Farber wrote in the 1990s about the other dimension in the management of psoriasis; that intrapsychic factors and stress can affect treatment outcomes. Dermatologists are increasingly recognizing the importance of this “other dimension” in many of the common disease states that burden our patients. Stress reduction techniques such as biofeedback, progressive muscle relaxation, guided imagery, and hypnosis have been demonstrated to decrease the severity of disease flares and the rapidity of response to dermatologic treatment.
Another dimension of growing number and importance are our cosmetic patients. They frequently present to our offices complaining of stress and unhappiness regarding their appearance. However, they are often overwhelmed with numerous sources of information, tantalizing images, and exaggerated claims. This sensory overload makes it difficult for patients to make well-chosen cosmetic interventions that maximize the likelihood of achieving their desired result.
Achieving Success
The following cover story covers several topics. The first, which is based on the “STEP program”, is designed to help you choose the best patients. Another part of the cover article offers a patient questionnaire designed to screen for high-risk cosmetic patients. You can copy and use it for your own patients.
The third piece highlights a multidisciplinary team of providers that, based on a group selection process, targeted patients for a multitude of cosmetic intervention. Not only does this “makeover team” share its patient selection process, but they share insight into how they developed a successful collaborative effort to treat patients while also gaining recognition for their practices.
These articles embrace the winning combination of cosmetic dermatology and psychodermatology.
> The S.T.E.P. Program
A new way to select cosmetic dermatology patients — and to identify patients you should avoid treating.
By Richard Fried, M.D., Ph.D.
The S.T.E.P. program encompasses medical, surgical, and psychodermatology.
The “S” — Stress
• You or your staff can help patients to specify area/areas that cause them stress or distress.
• Important to be specific i.e. glabellar wrinkles, dyspigmentation, telangiectasia, etc. Avoid vague references such as “getting older” and “unhappy with my skin”.
• Be sure you can see them (are they observable and realistic versus grossly exaggerated or even non-existent).
• Be sure their expectations are realistic and that you have the tools to meet their expectations.
The “T” — Target
• Help patients to target specific areas for intervention/correction/amelioration.
• Be sure that ideas, goals are realistic and attainable.
• Limit focus to a few specific areas i.e. glabellar furrows, dyspigmentation, ectasias, fine lines, rhytids, volume loss, etc.
The “E” — Envision
• Ask patient to envision how their perceptions, emotions, and life would be different/better after intervention. Specifically ask them “if you correct these areas, how will your life be different?”
• Are “fantasies” realistic?
• Can you deliver?
• Have previous clinicians?
• Has anyone?
The “P” — Proactive
• If clear attainable goals and realistic expectations are present, be proactive and devise specific treatment plan for patient i.e. Botox, Restylane, and microdermabrasion. Proactive implies concrete and timely plan of action. Botox, Restylane and Radiesse today, microdermabrasion commencing next Tuesday.
You may consider utilizing an additional tool to identify “high-risk” cosmetic patients. These are patients considered to be inappropriate candidates for cosmetic intervention due to their unrealistic expectations and/or underlying psychopathology. They represent that small percentage of patients that can drain you and your staff of time, emotional energy, and happiness. Choosing patients wisely is essential because we all love stories with happy endings.
The following is a general cognitive framework for identification of appropriate versus inappropriate cosmetic patients. The information gleaned from your clinical impression and the STEP program may be adequate, or you may choose to use the CSP-D (Cosmetic Procedure Screen-Derm) on page 45. The CSP-D (Fried & Werschler) is a more structured interview or self-administered questionnaire that can be a valuable tool to identify high-risk patients.
Overall Cognitive Framework:
Absolute Contraindications:
• Body dysmorphic disorder
• Borderline personality disorder
• Active self-mutilation
• Major depression
• “Troubling” agitation on day of procedure (excessive to the point of causing the clinician distress”
• Suicidal thoughts
• Psychotic
Relative Contraindications:
• Narcissistic personality disorder: probably unpleasable
• Doctor shopper
• Subtle or overt derogatory statements about you, your colleagues, or the medical profession in general.
• Tough customer; excessively demanding of physician, staff
• Exaggerated expectations
• Motivation is to please another person
• Depression
Ideal Candidate:
• No obvious psychopathology
• Clearly defined area(s) of dissatisfaction
• Procedure(s) you offer can give objective improvement
• Realistic expectations
• Motivation is from self and for self.
Download PDF of screening survey tool.
> The Story of the Spokane Makeover Team
A success story of a multidisciplinary team of providers offering cosmetic services.
By Wm. Philip Werschler, M.D.
Before telling this story, an overview of the development of the “cosmetic marketplace” from the consumer perspective seems in order.
The Evolution of Non-Surgical Treatments
Beginning several decades ago, relatively simple “cosmetic” dermatology procedures began to appear in the United States. As perhaps best typified by collagen injections in the 1980s, it became possible for the average patient to walk into a dermatology office, and in a reasonably short visit with minimal downtime and modest cost, walk out with a specific site of enhancement, rejuvenation or restoration.
While typically this injection procedure was for lower-face rhytids, especially lip augmentation, the important concept, from the patient perspective, was that cosmetic procedures had now become non-surgical.
For the next decade non-surgical cosmetic enhancement remained primarily soft tissue augmentation (STA) by injection, virtually always bovine collagen.
Then, in the 1990s, a new treatment became available. Implausible as it seemed, minute quantities of a highly refined bacterial toxin, known as Botox Cosmetic, could effectively minimize dynamic facial rhytids.
Again, from the consumer’s view, treatments were now available for both STA and wrinkle reduction. While fondly termed “wrinkle poison” by the fashion industry, Botox was a sensational hit with treated patients. In many ways, it was the proverbial “gateway drug” for cosmetic patients. In a few years, the very word “Botox” itself became iconic, representing essentially any beautifying treatment to the face.
Even the OTC cosmetics industry jumped on the bandwagon, with advertising claims such as “Better than Botox?” and “The Botox alternative”. There were games played with the name such as “Fauxtox” (cream) and even “Bochox” (delicious chocolate for the relief from the symptoms of wrinkles and crow’s feet)!
Confusing Choices
While Botox was on its way to becoming a verb, noun, adjective, adverb, etc., the consumer seeking public was on its way to confusion — confusion over what product causes what action, where different products are supposed to be used, who should (or shouldn’t) inject, and so forth. Adding to this mix of consumer turmoil were advances in parallel industries, especially the world of lasers and light source devices.
Suddenly, the consumer, who was trying to perform her due diligence prior to seeking treatment, was faced with a bewildering array of treatment choices. How, where, what, why, and who had become almost impossible to answer without resorting to Sherlockian-like sleuthing.
Unfortunately, broadcast media only added to this problem with shows such as “The Swan”, and “Extreme Makeover”, where results went beyond realistic expectations and budgets of the average, or even well-to-do, consumer.
Why we Developed the Spokane Makeover Team
An attempt was made to break through this fog of cosmetic seeking consumer confusion by Spokane Dermatology Clinic, in association with two forward thinking marketing partners, Collins Cosmetic Dentistry and Dogstar Media, both of Spokane, WA.
Essentially, the challenges faced by cosmetic dentists and cosmetic dermatologists are identical: Educate the consumer-prospect about treatment options available, what conditions they treat, who is qualified to perform them, who is a good candidate, and how to access the proper office(s).
The problem faced by both specialties is how to reach out and communicate (educate) with the prospective patient base in such a way as to maximize resources to achieve a high return on investment (ROI) without going broke in the process.
Marketing experts generally agree on the following three principles:
1. Free publicity is better and more believable than paid advertising.
2. That everyone loves a good story, especially if someone who deserves help is rewarded (i.e. “little old lady wins lottery”).
3. It is better and easier to solve a problem than to sell a benefit.
Enter Dogstar Media, a marketing, advertising and communications (MAC) agency specializing in health care. Together with Dr. Ken Collins, a highly respected cosmetic dentist and Spokane Dermatology Clinic and Aesthetic Image Premier Medical Spa, Dogstar began the development of a print and broadcast media-based marketing campaign focused on real-life cosmetic makeovers.
How it Works
Interested individuals access the program by logging onto a Web site, SpokaneMakeoverTeam.com, and apply by filling out a 12-page application that identifies specific cosmetic interests, among other demographic data.
Included in this process is the subjective personal story of why and what a makeover would mean to the applicant.
Once the application is completed, it is submitted for review. At the initial screening, candidates are reviewed by screening for applicable procedures. For example, if someone is interested in breast augmentation and that procedure is not offered, then the applicant would not be selected.
The Next Steps
Once screening identifies potential candidates, interviews are conducted to confirm identity and continued interest. Following this, the selected candidates are scheduled for personal interviews, and then referred to the appropriate “partners” offices for what in dermatology would be a “cosmetic consultation”.
Once all of the selected partners agree on a candidate, and the candidate agrees to participate, a final interview process is completed. This includes signing a talent release consent that allows for identification for advertising and marketing purposes. It also includes a background investigation and interview with a psychologist (who is not a team member) to assess the suitability and stability of the candidate for the procedures planned.
Once all of these steps are completed, the new candidate is scheduled for professional photography, and the baseline photos are posted on the Web site. It is also at this time that press releases are written for the media, so that the candidate may be scheduled for interviews.
Throughout the duration of the makeover, periodic interviews are arranged with the media to update them on progress being made and to showcase the talents of the team members working on the makeover recipient.
Finally, a highly scripted “coming out” party is scheduled to coincide with live television coverage. There are friends, family members, team members, office staff and previous makeover candidates all present in a festive atmosphere. (For examples of patients we’ve treated through the Spokane Makeover Team, see photos.)
The new makeover recipient is given the opportunity to thank everyone involved, and the team members each give a brief description about what services they provided. All television footage is compiled and used to provide raw material for future editing for advertising, DVDs, business cards, etc.
Increasing Awareness
Essentially, the program works to increase public awareness of procedures and skills available in the local market by promotional advertising offering interested prospects the chance of winning a free makeover. The makeover is supplied by the principals, as part of the investment in the marketing campaign.
Advertisement costs are shared by the members of the group. “Tiers” of partnerships exist in which the highest level is the investor/owners. Other tiers assume less in cost and benefit and include hair salons, fitness facilities, make-up studios, fashion clothiers, hotels, restaurants, limousines, florists, etc.
The possibilities are almost endless in terms of who may become involved in the process of the makeover. As each candidate is unique in terms of needs and potential benefits, each makeover becomes a new opportunity to cross market to other businesses.
Because everyone who applies to the program has some level of interest in some type of self improvement procedure, whether it is dental, dermatological, weight loss, hair, fitness, make-up, etc., there exists a great opportunity to cross-market other procedures and/or services to each candidate. For example, the applicant who desires cosmetic dental restoration may be an excellent candidate for lip augmentation. Or the applicant with interest in weight loss and fitness training may be also interested in liposuction. The list goes on and potentially benefits every partner involved in the program on a repeat basis.
Why does the “Local Makeover” Concept Work?
The concept generates publicity in many ways. As mentioned, the makeover candidate process is typically deemed newsworthy by local media because the makeover process itself is an altruistic endeavor, provided at no charge to the recipient.
The individuals involved enjoy real and lasting value from the experience. The selected candidates offer a good credible story (breast cancer survivor, mom re-entering workforce, domestic violence victim, etc.) that appeals to the mass media audience. Each candidate represents a fresh story that is exciting and relevant to the local community.
In addition, the timeline is reasonable, usually it takes 12 to 16 weeks to follow a candidate through the process from beginning to end. Also, local businesses are involved, and they buy airtime and ad space for advertising.
How Partners Benefit
Essentially, this program is a highly sophisticated method of capturing a detailed email database. Because each candidate applies online, and the application process is quite detailed, an informational database is created that allows for future mining for follow on marketing and promotional activities. Because anyone can apply, and the motivation to complete the 12-page application has to be considerable, those respondents are typically truly interested in products, procedures and programs offered.
Because not every applicant is selected, large pools of “pre-qualified” online addresses are available for follow-up communication.
Calculating the Return on Investment
As an example, we accessed our applicant database for interest in facial wrinkles. We used culling criteria of less than 1 hour distance from Spokane by ZIP code, age 35 to 55, female, and no previous history of Botox.
Of the 6,000-plus addresses in our database, we had 982 hits. E-mail invitations were sent for an educational evening event. There were 173 responses, 87 R.S.V.P.s and 68 attendees. Afterward, 37 patients were booked for treatment, a >50% closing rate.
Of these patients, 34/37 completed appointments, 31/34 were Botox naïve, and 12/34 received a secondary treatment (8 fillers, 2 chemical peels, 1 Thermage, 1 liposuction).
Total cost for the event was less than $1,000 (funded by co-op marketing dollars by vendor partners), and revenue generated was >$18,000. This resulted in a gross ROI of 18:1, and after product costs, a net ROI of 12:1. The secondary procedures yielded an additional $16,000 plus in revenue.
Based on previous experience, the amount of funds to generate this revenue, when used in non-selective, non-targeted blind advertising would be in the range of $5,000 to $10,000, for an ROI of 3.5 to 7:1. An example of this type of program would be a series of newspaper ads.
Would this be a bad ROI? Not necessarily, as costs would be recovered and the patient base would be expanded.
However, from a business perspective, successful practice promotion is not just about recouping costs; it is about leveraging identity,
it is about branding, and it is about financial success.
Marketing cosmetic services is a potential minefield of mistakes. If you are too aggressive, you risk credibility with the very public you wish to trust you; if you are timid, you may be passed by those who are perhaps less skilled medically, but more business savvy.
The makeover team concept has proven to be a durable, reliable, credible source of cosmetic identity branding in an increasingly competitive, and difficult to distinguish, professionally robust growth market of medical spas, medical beauty salons, paraprofessional cosmetic practices, and the like.
Creating a Targeted Audience for the Future
Because prospects select themselves, through on-line application, they represent a targeted audience. They are available for communication, education and even realistic goal setting prior to ever entering your office.
They are also taking the first step in a cosmetic journey, where they are almost certainly less informed than they think they are, regarding the products and procedures they think they desire.
By allowing these prospective cosmetic patients to initiate the contact with you and your office via a neutral Web site, you also avoid the common mistake of “recommending” or “suggesting” to a non-interested, non-cosmetic patient a cosmetic procedure that is potentially an uncomfortable situation for both of you.
Much more than Technical Skills
Cosmetic office practice (COP) success is much more than just technical skill in procedures performed. Indeed, that is just the beginning of success.
Cosmetic practice requires a significant level of understanding of the consumer mindset, the psychological motivations of the patient, the challenges involved in deconstructing the false beliefs of mass media advertising of exaggerated claims; of “painless, no down time, no complications” misinformation of competitors who are frequently less skilled than the dermatologist, and finally of screening for those patients who may not be suitable candidates for cosmetic treatment. (See the STEPS article beginning on page 44.)
Additionally, dermatologists who desire to establish cosmetic practices need to think long and hard about their qualifications and personality attributes in the context of cosmetic practice.
In addition to the mentioned technical skill set, you will need excellent communication skills. You will need to be likable, have persuasive skills and be comfortable with selling yourself to the prospective patient. You will need to stay abreast of fast-paced technical advances, frequently attend CME courses, and be aware of fashion trends.
Perhaps most of all you will need to be comfortable in a setting of fee-for-service desire dermatology where, unlike disease-based dermatology, the patient’s ability to pay in large part determines the type or extent of treatment.
Forming Your Own Team
The makeover team concept has several critical components, not the least of which is the complexity of having a team of professional equals. Properly constructed and implemented, it uniquely allows for local control of participants, candidates, media relations, and messaging. If there is conflict or competition within the team, then success is virtually impossible.
There is an old saying about “all politics are local,” and this could be amended to “all cosmetic services are local” where the “yourhometownmakeover team” is concerned. Good luck.
