Medical News Today has this week published an article that defines the most popular cosmetic surgery procedures, which is something that is of interest to laypeople and consumers. In addition, it defines the differences between plastic and cosmetic surgery in a concise manner: What Is Cosmetic Surgery? What Is Plastic Surgery?:

Plastic surgery has two branches, cosmetic surgery and reconstructive plastic surgery. Cosmetic surgery is concerned with improving the aesthetic appearance of a person, while plastic surgery may include this, or just the reconstruction (reconstructive surgery). Reconstructive plastic surgery is concerned with improving function; however, it may also involve trying to approximate normal appearance, but that is not its primary function. Reconstructive plastic surgery is often referred as simply reconstructive surgery.

Some parts of the world completely separate cosmetic surgery and plastic surgery and term cosmetic surgery as elective surgery, non-essential surgery, surgery which the patient chooses to have; while plastic surgery is understood to mean surgery to reconstruct or improve appearance after injury or illness.

Lawrence Martin, MD, is a board-certified facial plastic surgeon in Arlington Heights, Ill, which is a Northwest suburb of Chicago. Though Martin’s surgical procedure revenues are down almost 50%, minimally-invasive procedures performed on current patients are holding steady.

“I’m seeing more of my surgical patients holding off on surgery but still opting to do something. They are resistant to committing to surgery and are waiting for a turnaround in the economy.”

To help sustain him through these rough times, insurance-based procedures are holding steady, as well. Martin has always maintained an equal balance of cash-paying cosmetic patients and insurance-based patients. 

Although he hasn’t seen any major change in his patient demographics, Martin is seeing a trend in working patients in their 40s and 50s. They are unwilling to take the week or two off for surgical downtime for fear of losing their job. “They want quick fixes with no downtime,” he remarks. “I have gotten very proficient with injectables and the art of fine-tuning faces for maximum result with little or no downtime.”

Amid the dark clouds of the recession, Martin’s silver lining is in how creative and resourceful he has become to sustain his revenues. Rather than performing the volume of facelifts he was performing, he’s doing substantially more perioral rejuvenation. Using Botox to raise the corners of the mouth and a variety of fillers to smooth lip and marionette lines and plump lips—and then peels around the mouth—is giving his patients what they want. “I’ve even been injecting permanent silicon in lips for my established patients who want a long-lasting result,” he adds.

In addition, Martin and his staff are getting better at increasing the average order size per patient by adding Botox and retail to the treatment.

Martin has noticed lots of competitors vying for the same patients by using large-scale advertising efforts. To combat the competition, Martin has increased his promotional budget and is spending more on patient mailings and in-house patient seminars, where he sees a really good return. “I can seat 20 patients for one of my seminars and 12 to 14 of those attendees book procedures,” he says.

Concentrating on current patients is a strategy that is working well during this difficult time. Martin sends out patient newsletters with lots of before-and-after photographs, an e-mail campaign and evening hours to attract patients and increase the revenues per year they spend with him. He and his staff are also concentrating on word-of-mouth referrals like never before— “I have placed much more emphasis on referrals from my patients and it’s paying off,” he says.

Though Martin has not yet cut staff, he is looking to hire someone who could take on all aspects of the marketing. That person, he says, “should be the practice manager and fill in as a scrub nurse.”

While business has slowed down, Martin is like many other practitioners, including McMenamin—he now has the extra time to spend with his patients and that’s paying off in referrals. “I’ve always done my own injectable procedures and I know that will lead to more when times improve,” Martin says.

In addition, he has been able to cut his overhead expenses, redoing the health insurance policy at a lower rate and renegotiating the office rent. All of these efforts have kept Martin’s practice alive during a hard-hit time.

Martin has mixed feelings for those wanting to get into aesthetic medicine at this time. “Most physicians wanted to be a doctor as far back as grade school, but now, you need to ask yourself how much you want to compete? Is it worth it? As Yogi said, ‘When you get to a fork in the road, take it,” meaning explore and cover all options,” he says.

As part of my research for an article that will appear in the June 2009 issue of PSP, I asked several physicians the following question: "In terms of your practice, what have you learned from the recession, and how will you apply what you've learned to improve or enhance or change your business practices as the economy recovers?"

J. Kevin Duplechain, MD, FACS, a plastic surgeon based in Lafayette, La, and recently the subject of a PSP cover story, responds:

The recession has allowed us to closely focus on what we do every day.  The cosmetic business in our economy is good and although the very high level procedures such as total facial rejuvenation have slowed slightly, patients still want the chance to look their best.  Currently they are opting for procedures that are a little less invasive because of downtime.  I think everyone values their job right now and so time off needs to be minimized and predictable.  

I have also increased the number of patients that I see on a daily basis.  Rather than having a patient who calls in for an injectable and put them on for a regular appointment in a month we try to get them in sooner.  A month may just be too long for a new patient to wait these days.  We have actually changed the way the nurses work when I see patients.  I had 2 nurses working with me and one nurse who answered phones etc.  With the increase in number of patients we have all three nurses working with patients on days when I am in.  I think patients are still wanting high level of service when they see a plastic surgeon and having more manpower available does that.  They can spend more time establishing a relationship, and I can see a few more people each day.  I have also starting liposuction.  We had planned to do this when we moved into the office, and this added service has definitely increased patient  traffic.

We have looked at advertising cost and what works.  I think right now internet seems to be the best, along with internal marketing with the video loops Candace Crowe created for me.  The internal marketing helps spark interest.  With so much fluctuations in the economy and no real quick end in sight, I think these things will help us prosper during this period of time.  I am definitely not trying to hold on but to offer things to patients in a way that will keep them coming back, when things do get better.