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.

In the past few months, I have heard from readers who are seeing business bounce back in spite of what the media says about the current recession and despite their being located in even the worst hit areas, economically speaking.

One physician in southern Michigan recently told me that his workload has been increasing lately due to his increased efforts to trump his competition via improved media exposure, taking a more hands-on role in the day-to-day business, and working harder to develop ongoing relationships with patients by simply spending more time with them during consultations and beyond.

This is just one person’s approach. Don’t dwell on the negatives of the recession. Identify the places where you can drive business upwards and tale responsibility for making changes.

People are really stressed over the economy, and they are so stressed it is beginning to affect behavior. There's a real loss of faith in the American government—not only the political system but also the financial system. Many Americans are on edge when they witness and observe the fragility of all these systems.

You have the power to implement the constant change that must be on the permanent agenda of a successful practice of the future. It's not whereas before, that constant change might have been wilting. However, once you can embrace change and become proactive, you create opportunity.

It is the recovery that we must now turn to, as economists versed in the intricate arithmetic behind finance have predicted the recovery. Where will you be when the recovery starts?

That was one of the questions asked of several physicians whom we interviewed for one of our feature articles in this issue. In this issue, we address a few of the relevant issues that you and your practice face in coming to terms with the financial markets, both now and in the coming few years.

The theme is, be ready for the recovery and be an active part of it.

There's a generalized angst about the economy, from those who are just starting out to well-established practices teetering on the edge.

However, the pace of change in the aesthetic industry has sidelined even that drama. Even if you are the most progressive, thoughtful person who thought he or she was embracing change, and has come to realize the pace is too fast; and maybe the changes happening in your field, the marketplace, and the world are happening so fast you don’t want to deal with it. Don’t give it a second thought. You have to change. The good news is that not only is that situation not bad, it’s an opportunity.

A self-reliant drive has been reactivated in our field. Physicians and other practitioners are becoming a lot more involved in their practices and in embracing the changes that are coming. Washington DC is not going to save us.  Wall Street is not going to save us. The equity in your home is not going to, either.

According to author Thomas Friedman, in the past countries ruled the world. Then corporations ruled the world.  Interest groups and ideologies currently rule the world. Now it is time for the individual to rule the world.  

You are 100% responsible for your life, and socio-economic ups and down have forced you to master your own domain. Only you can help you. Even if someone else wanted to help, they are too busy taking responsibility for themselves first.

The current situation is an opportunity to embrace the technology and a new perspective. You need to stay alert and do some thinking—intellect matters. Even if economies of the world and globalization of those economies are dragging down your business and your investments, you do not have to be a loser.

The potential to embrace change is an inspiration and challenge during the dark days of the recession. One must, however, take action. What that means for the plastic and cosmetic surgeon is that you can learn a whole host of new technologies and approaches in that context of that change. You can take this opportunity to evolve and to grow.

Now is a great time to return to the basics—to determine your own success based on self-reliance.