Skilled assessment and effective, safe technique are lifelong learning processes and crucial to your success as an aesthetic dermatologist. However, to successfully build an aesthetic practice, you need more than just skilled hands and eyes, you need to be able to reach and retain the type of patients you want to treat. Realize that the experience your aesthetic patients have with you encompasses many touchpoints, many of these occurring before the two of you ever meet. When you market effectively, set up your office attractively, and train your staff well, you make the entire experience of the patient one they will want to return to for a lifetime. It is also important to find patients who will have success with you and not treat those who will not be a success for varying reasons. This chapter should serve as a guide in creating successful consultations that lead to lifelong patients.

Begin by considering what services you will offer and what sort of patients you would like to treat. Ask yourself: what do I enjoy doing? What are my costs in offering these procedures? You may want to offer products, procedures, and devices to improve texture, pigment, and overall quality of skin. If you like to use your artistic eye and skilled hands to restore youthfulness or improve facial proportions, you will offer injectable
neuromodulators and fillers. The cosmetic market is enormous. There are many potential patients out there and the market is growing. Based on 2019 data,¹ 65 million people in the United States are “considerers”, meaning that they have thought about having a cosmetic procedure. In 2019, four million people were treated with injectables, a number that is predicted to double by 2025. The patient population is diversifying as well, with more men being treated every year as well as a widening of the age distribution we are treating—both younger and older patients are coming in. This means the patients are out there. Do not focus on competition, focus on being great and there will be patients for you.

How do you recruit patients? Chances are, many of your best aesthetic patients are already in your office seeing you as patients or bringing a family member in to see you. Healthy skin and beautiful skin are interchangeable terms, and no one understands skin health better than a dermatologist does. Doing aesthetic procedures is a natural evolution from the care you are giving your existing patients. Consider using a questionnaire (Table 1.1) to screen for patients’ interest or lack thereof in your cosmetic services. This information can be very helpful in uncovering patient needs and wants and in previewing appropriate options for the patient. Marketing what you do internally (to patients in your office or your database) is very effective. You can put information on fliers or screens in your office, have a menu of services so people know what you offer, and of course have an attractive, informative website. You can host events at your office to tell people about what you offer. To reach new patients, word of mouth will help you, but you should consider
some sort of external marketing. Social media is effective and inexpensive when done with care and authenticity. In addition to social media, actually be social! Be active in your medical and local community, you are your own best advertisement. Be cautious before turning to paid advertising including paid ads online, paper media ads, billboards, and so on. Whatever marketing device you employ, be sure you have some way to track whether it is profitable for you. As you design any marketing material, keep your brand in mind. Credential yourself as an expert, use language and imagery that convey the experience people will have with you, and be consistent. A brand (in this case, you and your practice) is not a logo or a tagline. It is truly what people think of when they hear your name, and every touchpoint your aesthetic patient has with you and your practice should intentionally reflect your brand.

Train your staff well. Realize the aesthetic patients’ experience with you begins well before you walk into the exam room. If you have marketed effectively, the patient has an idea of your aesthetic practice and your style. Your staff is a direct reflection of you as well. Effective staff training will help the right patient get to you and make the entire experience more successful for everyone. Start by making sure your staff gets to know you. I recommend you have all of your employees shadow you regularly. In my practice, I require each employee who is not regularly in the rooms to spend a half day each quarter just following me and observing. This helps my employees better understand my personality and how I interact with patients, and they learn about the products I recommend and the procedures I do just by listening. The questions your patients are asking you are often the same ones they ask your staff. Watching you inject or use devices demystifies the procedures and gives your staff an inside peek at what you do and how you do it. You should treat all of your employees and make sure they are on effective skin care regimens, as they are a reflection of your expertise and can also teach you about the day-to-day patient experience of your recommended regimens and procedure.

When considering training for specific roles, start with the person booking appointments. This employee is incredibly powerful. Often this is a patient’s first contact with the practice and the experience should be friendly, warm, professional, and informative. The goal is to make patients feel welcome and confident in their choice to come see you. Train those booking appointments to credential you, to book patients for the proper amount of time they need, and to set expectations for the visit. To properly credential you, your staff should know your education, years of experience, and the number of procedures you have performed. They should know about your ongoing education including articles published, lectures given, and special talents you have. In teaching your staff to credential you, teach them that the goal is to differentiate you and your practice and to let patients know why your office is the place they want to be. They can give feedback on you, your technique, or on their personal experiences from the procedure. As the staff member and patient discuss what type of appointment to book, they can say, “Oh Dr X just came back from a conference on this topic, or they can say Dr X is amazing at injections! She just published an article on this technique.” Ask your staff to try to work one credential of you or your practice into every conversation.

When it comes to putting the patient on your book, be sure your staff captures exactly why the patient is coming in and educates the patient on what to expect during the visit. You can separate consultations and services or offer same day services. Many patients want to be treated the day they come in. They have done their research, estimated a budget, and are ready to go. Others are completely in the dark about what they want, and many are somewhere in the middle. Train your staff to ask pertinent questions and to educate patients about what to expect from their appointment. We provide average costs and average time spent in the office, noting that these things are always variable. If patients do not have the budget for procedures, they can book a skin care consult only. If patients want to have procedures done that day, we provide a pretreatment planning document that
includes contraindications to treatment and downtime expectations. When patients are fully informed, most of the time those that book same day consults and procedures end up being treated, but we always advise patients that it is completely up to the physician’s discretion to treat that day. As I will discuss later in this chapter, you may determine it is in neither of your best interests when the time comes. Once the patient is booked, your staff should wrap up the booking with an overview of what to expect of the time they will spend in the office. For example, in my practice, I utilize a skin care expert and aestheticians who operate devices, so most cosmetic visits involve meeting with more people than just me. My staff will tell the patient, you will spend about 60 minutes in the office. You will start by speaking to a medical assistant about your medical history. You will be photographed. The doctor will come in, listen to you, and discuss your goals. She will assess you and make recommendations. Next, you will meet our skin care concierge and aestheticians who will review details and make sure you get every question answered. Finally, we review our policies and payment expectations. Patients who know what to expect are always happier, better patients, and you will have more fun doing what you love.

Finally, it is time for the appointment! At this point, your patient has probably looked at your website and social media. He or she has spoken to your staff. He or she has an expectation of what is going to happen and how he or she is going to feel. Be sure your office environment supports these expectations—this is your brand. As patients enter your office, it takes only a few seconds to form either a positive or a negative impression. You do not have to spend a fortune, but your reception area must be clean and attractive. Consider working with an interior designer to choose colors and make sure your furniture is scaled for the space. Fresh flowers, water, and tea can complete the mood. The office décor should be clean and in excellent condition, showing the patient (and your staff) that details are important to the practice.

Remind your front desk employees regularly that they are the CEO of first impressions and be sure you thank them for their attitude when you hear them being kind, or when patients give you good feedback. The front desk should know they are there to welcome patients and answer any questions. Hopefully you are not running behind, but if you are, your front desk can give your patients the Wi-Fi password, a cold or warm beverage, and of course you will have information on the services you provide available for them to read. Information should be available about the philosophy of the practice, the physicians and their backgrounds, and the services provided. Crisp-looking patient information forms are a must! This shows that the practice cares about details. Patients can interpret sloppy documents as a sign that the practice is careless about medical details also.

When the time comes, your assistant should check your patient in, welcome them, and get a sense of their expectations. Part of the check-in process should include quality photography. Good photos require good equipment and consistency.² Reproducing the settings of before photos after interventions allows more accurate evaluation of treatment outcomes. Standards for the studio, cameras, photographer, patients, and framing are all part of the process. Your background should be a solid color (I prefer black) with no equipment or furniture in the background. Only artificial light should be used. Natural light is subjected to weather conditions and seasonal changes. Ask the patient to remove earrings and makeup. Use a headband to pull the hair back from the face and have the patient sit or stand in front of your background. Align the patient’s face; it should be straight. Take a series of pictures, employing protocols for photos depending on the patient’s concerns and treatment you will be providing. Generally, for injection patients, take frontal and lateral pictures (45° and 90° to the left and right). For the lateral pictures (45°), the nose can be aligned with the malar eminence or zygomatic cheek (Figure 1.1) to facilitate the reproduction of the photos. When photographing the entire face, the photographer must focus at the area between the hairline and the lower edge of the chin (Figure 1.2). For photos of the upper third, the photographer must focus at the area between the nasal tip and
the hairline (Figure 1.3A); for midface, between the brows and mouth (Figure 1.3B); and for photos of the lower third, between the nasal tip to the lower edge of the chin (Figure 1.3C). Other pictures of specific areas can also be taken. Of note, when the goal of the photographs is to record the evolution of a treatment for dynamic wrinkles, two sequences of photographs with all the different positions have to be done: one with facial muscles relaxed and another with facial muscles of each area contracted at a time (Table 1.2). Set up a photography room with a dedicated employee if possible. Photography is essential when evaluating results with a patient and when publishing or presenting data. It is (usually) fun to show the patients their before and after images, and in the case of an unhappy patient, you will thank yourself over and over again when the patients come back saying they look exactly the same. If you are good at natural results, their face will be totally familiar—just from 5 years ago! Photography is also helpful in showing the patient where they have come from over years of visits.