Diagnosis of the Cosmetic Facial Surgery Patient: The Art of the Consult and the Office Patient Experience

The Physical Plant

If you perform cosmetic surgery, you must have an office that is similar to your competitors. It is not uncommon for cosmetic surgery patients to seek multiple consultations. Patients are likely to see your competitors, and if the competitor’s office grossly outshines yours, you are already at a disadvantage. Having said this, a poor surgeon with a great office will not succeed, but cleanliness and presentation can go a long way. Always remember that these are elective patients seeking upper-class luxury surgery. They shop at high-end stores, stay at high-end hotels, and go on high-end vacations. They are used to being pampered and being in pleasant surroundings. The cosmetic surgery office must be set up with this in mind. Having said this, many of my patients are middle class or blue collar, but they are spending outside of their means and expect the same environment as do wealthier patients. Figures 1.1–1.5 show well-done cosmetic surgery spaces.

The cosmetic surgery office should be clean, pleasant, and in most practices decorated to accommodate female patients, as the majority of cosmetic patients are women. Consider your experience at a very high-class hotel, and try to duplicate it in your business. Concierge care is a new buzzword, but most successful practices have known these secrets for decades. The entire goal is to get the patient’s attention. They should come and go with positive impressions. They must realize that you are special and “do it differently.” Having a patient greeter, providing drinks and snacks, assisting patients with paperwork, and having educational materials available underline your commitment to patient service. Conveniences such as available computers or iPads and wireless connection and charging stations are all amenities appreciated if not expected by potential cosmetic patients.

If you are looking for a model of what to do, consider Las Vegas casinos. They totally have it right. They know how to treat their high rollers to keep them coming back. Cosmetic surgery patients are also high rollers, and successful practices know how to make them feel special. Everything is clean and bright, and they have beautiful furnishings, great smells, a comfortable temperature, and extremely friendly staff. Everyone likes to feel special. It is like a vacation or holiday. If you figure out how to make your patients feel special, you will be way ahead of the pack.

The surgeon and/or staff should regularly sit in the reception room and observe all of the senses. Does everything look good, smell good, and sound good? Are the magazines current? Is the space spotless? Every several years, our administrator has a “secret shopper” who comes to the office to evaluate the entire experience. This can be very eye-opening as we sometimes fail to see the negative things around us. Fish cannot see water because they are in it! Many practice management specialists say that there should be no magazines in the office and only promotional material about services offered. Personally, I think patients need some diversion. Every single patient has seen my website and marketing before arriving. Sometimes it is nice just to chill and not feel you are getting “sold” at every angle. First-time cosmetic patients are usually nervous, so I want them to feel as relaxed as possible. They can use our computers, watch TV, read a variety of magazines, or have drinks and snacks, which about 99% do. The COVID-19 pandemic has shattered traditional patient service, but it will return with vigor.

One of the goals of a well-run office is to not make people wait for long periods. In my office, we have five evaluation and treatment rooms and a relatively small reception room. My goal is to move the patient from the reception room to an evaluation room as soon as possible. No one likes to wait, but the wait seems shorter if you break up the experience and keep the patient busy. Once they get to the evaluation room, they have the company of a staff member and also can watch TV or review our website while waiting for the surgeon. One of the biggest simple innovations of the past decade has been the development of affordable, high-quality widescreen TVs. We have 15 in our office and use them for many purposes including recreation, patient education, anesthesia monitoring, and teaching. If a doctor is running behind, it is a great courtesy to call patients and let them know. Most are relieved as they too usually run late.

Office Accreditation

In the 1970s, an uncomplicated facelift required a 4.5-day hospital stay. There have been huge paradigm shifts in hospital stays for all surgical procedures, and currently most cosmetic surgeries are not performed in the hospital environment. There are numerous reasons for this including exorbitant hospital costs, risk for nosocomial infections, lack of insurance coverage for cosmetic surgery, a need to reschedule surgeries because of emergencies or other surgeons running behind, and lack of privacy for elective cosmetic procedures.

Having a fully accredited surgery center in one’s office offsets the need to operate in a hospital and all of the negatives associated with it. It gives the surgeon total control of the operating environment. There are no other surgeons to run late or bump your case. Surgery is much more cost-effective compared with hospitals. Safety is usually enhanced because the same people do the same job all day every day, which eliminates shift changes and related problems. There is no worry about infections from other patients. Because cosmetic procedures are usually very personal and discrete, patients can come and go without exposure to scores of employees who work in a hospital environment. Also, small offices usually have one or two anesthesia providers who work on a continual basis, and this prevents surprises that can occur with random anesthesia providers. Finally, convenience for the doctor, staff, and patient is unparalleled. I spent a lot of time driving back and forth from the hospital before I had an office surgery center, and now my operating room is just several steps away.

Office accreditation is not a panacea and has relative drawbacks. First and foremost, the surgeon is the captain of the ship, and every good and bad thing falls on his or her shoulders. If an emergency occurs in the hospital environment, there are dozens of trained personnel immediately available. In your office, it is you and your staff. For this reason, the surgeon must use discretion as to which cases are not suitable for the office surgery center. I never take a chance, and I cancel cases 5–6 times per year because the patient has a medical condition that may put them at risk. As I have stated many times, a big part of having a good reputation and being safe is choosing the right patients. Never take a chance with a patient’s health. We do not operate on American Society of Anesthesiology (ASA) class III patients. Significant comorbidities can ruin lives.

One of the best things I have ever done in my professional career was having my office and surgery center accredited. I have hundreds of colleagues who will echo the same remarks. Many surgeons are hesitant to pursue this because of the perceived extra work and expense. Also, many surgeons mistakenly believe they must physically rebuild their facility. In reality, bona fide accreditation is attainable for the average practitioner and facility if the surgeon and staff are willing to rise to the requirements. The biggest misconception is that accreditation is a bricks-and-mortar undertaking, when in reality it is actually more about policies and governance ( Fig. 1.6 ).

The basis of accreditation is to ensure a safe, efficient, and accountable facility to better serve patients, surgeons, and staff by meeting or exceeding nationally recognized standards. In effect, you are making your office function as a small hospital. This definitely ups the ante for work and paperwork and is not something to be taken as casual. In short, it is a lot of work, mostly paperwork, but it unequivocally will make you a better and safer surgeon with a better and safer staff, facility, and patient experience.

The most common organizations for outpatient office ambulatory surgery center accreditation are the Accreditation Association for Ambulatory Health Care ( www.AAAHC.org ), the Joint Commission on Accreditation of Healthcare Organizations ( www.jointcommission.org ), and the American Association for Accreditation of Ambulatory Surgery Facilities ( www.AAAASF.org ).

Examples of changes to routine office protocols include required dictation of all surgical operative reports, quality review studies for sterilization, rehearsal of a malignant hyperthermia scenario, infection prevention and reporting, studies for patient waiting times, peer chart review, impaired physician and operating room fire rehearsals, and credentialing all users of the operating facility. Again, this is all very paperwork intense. Trying to become accredited on your own can be a task of awesome proportions. I highly recommend that any practice that is interested in becoming accredited seek the services of professional accreditation consultants. It is not excessively expensive, and they coach the office and staff through every step of the way, including a mock accreditation site visit. Although I know doctors who have become accredited without a consultant, I can speak from experience that the consultant route is much easier on the doctor and staff. Finally, one drawback to accreditation is the fallacy that the surgeon must do all the work. In actuality, the staff does 90% of the work and recordkeeping, and the surgeon is the team leader. Having one nurse or exceptional employee to handle all of the accreditation work makes this task very straightforward. Because accreditation comes in 3-year cycles with office inspections, having a stable employee who will be there for a long time is preferable.

Cosmetic Surgery Staffing

I have always said that a surgeon can be no better than the sum of his or her staff. In elective surgery, there is no doubt that a great staff will enhance the experience, and a poor or apathetic staff will drive patients away. Choosing the correct staff is never happenstance and takes years for the average doctor to figure out. Cosmetic surgery is very different than many specialties as it is an upper-class luxury of mostly female patients and totally elective. Your staff must understand and relate to the biopsychosocial needs of this clientele. Some of my best cosmetic staff were not trained in surgery but rather worked at high-end women’s stores. They know how to talk to and sell to upper-class women. Some of my best front desk representatives previously worked at hotels or travel agencies. Again, they are used to catering to people who have elective money to spend and value exceptional service.

When it comes to building a great staff, the word team says it all ( Fig. 1.7 ). We have a cosmetic team in my office, and we all represent exceptional patient service with optimal safety and predictable and reproducible outcomes. No team becomes good by happenstance. Any winning team in any sport takes hours and hours of practice and working together. A cosmetic team is no different. Each “player” must have a distinct job description and also understand the job of other team members. This can achieve synergy. This is when the total is greater than the sum of the parts. Success is greatly simplified when you build a great team with everyone on the same page. This entire text could deal with staffing, but needless to say, we want team players who are “win-win” people. They represent health and beauty and should look the part. They should radiate happiness, warmth, and compassion and should be able to make conversation with anyone at any time. In interviews, I look for bubbly conversationalists with a great smile. Their demeanor is much more important than their job experience. I want to hire a “people” person. The job of my staff is to make me look good, and they do an excellent job.

Germane to the team concept is consistent use of logos, trademarks, photos, etc. for all office and marketing materials. This includes scrub logos (see Fig. 1.7 ), printed materials ( Fig. 1.8 ), and promotional items ( Fig. 1.9 ).

The Art of the Consult

Cosmetic surgery is my passion, and like many of my colleagues, I love to operate. If we could all go to our offices and simply operate, life would be perfect, but to have surgery you must have consultations, postoperative visits, and follow-up visits. As enjoyable as time in the operating room can be, the profession becomes complex after the surgery.

The cosmetic consultation is usually the first face-to-face meeting with the cosmetic team and the surgeon. It is an extremely important appointment, and making the best impression is paramount because many patients will see multiple providers. Because most consultations begin on the phone, the front desk patient service representative can be a great adjunct. They can set the stage for great patient service, explain what will happen at the consult and obtain information in advance from the patient.

Patients must be impressed from the time they enter the parking lot, and the doctor and team must make sure that everything is in order. Are you easy to find? Is the traffic negotiable? Is it easy to park? Are the grounds and building clean and classy? All of these small elements serve to add to a final analysis and choice on the part of the patient.

When patients walk in our door, they are greeted personally, and our staff signs them in, serves them snacks and/or drinks (almost everyone wants some), and makes small talk. If we are running behind, patients are informed and kept up to date. It is not appropriate to make a new consult patient wait; it sends a very bad signal, so it is important to schedule new patients during predictable times when the office does not run over. If you are running behind, you can give the patient something to do. Getting them from the reception room to a consult room breaks up the wait.

The patient should be escorted from the lobby to the consult room by the person who will be assisting the doctor at the consult. Furthermore, the same person should accompany the patient throughout the entire surgical experience. This one-on-one bonding is extremely powerful at building relationships. The prospective patient should see smiles and positive energy from every employee. Once in the consult room, the patient needs something to do if there will be a wait. Having informational literature or, better yet, having the patient spend time on your website obtaining information about perspective procedures that will be discussed is a great occupier. Many surgeons have videos discussing procedures, and this is a great time to use them.

In my current practice, the assistant takes the patient to the consult room to begin the process. In the last edition of this text, I recommended using a specific cosmetic surgery coordinator to perform all cosmetic consultations. Although there are some positives with this type of consultation model, it is difficult for a single person to be available for all consultations. As a result of this bottleneck in my practice, we reverted to having all of our nurses and surgical assistants perform consultations. There are numerous advantages to this. First and foremost, five or six people are able to perform consultations, so you eliminate the bottleneck of a single cosmetic coordinator. In addition, the surgical assistants are actually present at the cosmetic surgery and are well versed in each procedure. Some of my assistants are better suited to consult with older patients, while others are more aligned with millennials. It is up to the leader of each practice to decide who is capable of performing quality consultations, but it is a huge convenience in efficiency and cross-training for all of your staff to be proficient in performing consultations.

We do have a dedicated employee who performs all scheduling for surgeries. This staff member wears dress clothes and meets patients in a formal business office after the clinical consultation. The scheduler is much more than a “scheduler” as she has a lot to do with proceeding the patient to the booking phase for surgery. She has the ability to further bond with the patient and to follow up with undecided patients. This staff member also hands out formal branded material pertaining to formalized fee estimates and the surgical experience.

In terms of the consultation suite, this room should be the fanciest one in your office and should have a comfortable temperature and pleasant smell. Aromatherapy is a powerful stimulation of the senses. The first order at hand is for the assistant to bond with the patient by making small talk and relaxing the patient ( Fig. 1.10 ).

As a sidebar, when patients are serious about having a large procedure or are considering multiple procedures, it is frequently helpful to have their spouse at the consult. So often, the spouse (usually the husband) may have considerable concerns about the need for surgery, the finances, and other questions. In addition, the spouse will most likely be the caregiver, and it is important to know what will happen.

For many patients, meeting a new doctor makes them very nervous. With cosmetic patients, they not only must meet a stranger, but must show them and tell them about their biggest physical insecurities. Many patients have problems with aging and do not handle it well. This apprehension can add up to a patient who is perspiring by the time the doctor examines them. The best thing the staff can do before the surgeon enters the room is to relax the patient. It is also very important for the staff to compliment the surgeon. They can make the doctor look good in advance so the doctor does not sound arrogant. People want to know that they are seeing a compassionate, experienced, and popular surgeon, and your staff can really help with this. Although patients are here to discuss cosmetic surgery, having your staff discuss pro bono or community work impresses them and lets them know you are compassionate.

The assistant will also ask the patient what they wish to discuss and can make cursory suggestions such as, “I believe Dr. Niamtu will want to discuss eyelid surgery, cheek implants, and a facelift with you.” She will then open our website on the widescreen TV and walk the patient through the specific procedure pages to discuss what we do and how we do it. She will also show the patient before and after photos of relative cases. This interaction is important as it gives the patient an idea of what the doctor will discuss, provides information on the procedures, and can shorten the surgeon’s consultation time. Having awards, publications, and similar accolades in plain view can be very impressive to patients ( Fig. 1.11 ).

Meeting the Surgeon

When the staff consultation is completed, the surgeon enters the room and introduces himself or herself. I always shake hands with the patient (pre–COVID-19) and introduce myself by my first name. I believe friendly communicative contact puts patients at ease and subliminally enhances the doctor–patient relationship. Showcasing a friendly, smiling, and energetic persona and engaging in small talk with the patient before getting to the cosmetic problems is time well spent. As stated, patients are frequently nervous. To relax them, I may ask about what they do for a living, their hobbies, how they heard about our office, how they are enjoying their summer, and so on. Again, putting a patient at ease is an art form. If the patient states that they love playing tennis (or whatever topic), we note that in the patient record, and next time we can ask, “How is the tennis game?” Patients are always impressed that we remembered. The world is full of arrogant, stuffy physicians. A smiling, energetic, down-to-earth surgeon is an attention getter.

Most of our patients register online and are asked to list their cosmetic facial concerns in advance and bring a list with them. Nervous patients often forget to ask key questions.

The most important instrument used in the consult is a hand mirror. I ask patients to tell me what bothers them when they look in the mirror at home and what they would like to change. I ask them to show me in the hand mirror. At this point, I always begin with a compliment like “you have a great jawline” or whatever positive feature you can start the conversation with. Because you are going to be discussing negatives, it is best to begin with a positive. Occasionally a patient will say, “Doctor, what do you think I need?” The novice surgeon should never fall into this trap. It is imperative that the patient take ownership of what bothers them or what they would like to change. Patients who cannot communicate their cosmetic problems may have other underlying problems. Some patients are embarrassed to discuss the topic and need some prodding. The other problem with answering the question “What do you think I need” is that the surgeon may suggest a problem that the patient does not see and offend the patient.

Some practice management experts say that you should not hand a woman a mirror as it is offensive to make her look at her flaws. I do not agree with this. Every single patient looks in the mirror at home, and most of them pull their facial skin back. The mirror (and now the cell phone) is where the rubber meets the road. An alternative to using a mirror is to take several photos of the patient just before the consult and project the images on the widescreen monitor. This can have significant impact on showing patients their aging changes. Also giving the patient a copy of the photos to take home can go a long way in having them realize their aging problems, especially in the lateral view, which no patient likes to see. A simpler means of avoiding the mirror is to use a tablet to take front, three-quarter, and side views and share them with the patient.

Although I marketed one of the original digital imaging systems in the 1990s, I am not a fan of surgical predictions. First, they are time-consuming. Having the doctor or staff play around with digital surgery can waste precious patient time. At one time, digital imaging would help promote a doctor or sell a case, but today I feel that it is blasé. Secondly, it is simply a digital cartoon. You can make any patient look good, but not necessarily produce that result. The accuracy is often suspect and can also give the patient a false hope of what to expect. Having said this, some of my colleagues love surgical predictions and feel that it truly enhances their consults.

The best way to discuss cosmetic deficiencies is to make the consult an educational experience. I explain to patients that I will discuss their entire head and neck in terms of diagnosis and potential treatments. This does not mean that I feel they need all of the discussed procedures, but they are possible options.

The most orderly means of systematically discussing facial aging and potential treatment is to explain to the patient that the face is divided into thirds and that we will discuss the upper, middle, and lower third, and then discuss the skin as a separate unit. During this discussion, the surgeon should never assume, for example, that the patient understands the difference between brow aging and eyelid aging. The best thing is to stay elementary when explaining diagnosis and treatment. Many patients have never heard of cheek implants or understand what a browlift or facelift does. If the patient is put off by discussion of multiple procedures and I sense the conversation going that way, I consider this patient more conservative and stay closer to their main concerns as opposed to additional options. As I talk with the patient, I include my assistant in the discussion. I may say, “Mrs. Smith, I think you are a great candidate for laser skin resurfacing; don’t you agree, Jenny?” ( Fig. 1.12 ). This adds a second opinion to the discussion, puts the patient at ease, and reinforces my diagnosis. This also implies a team approach. My assistant continually records the consultation discussion and prepares a form that lists the discussed procedures and their respective fees to give to the patient when they leave.

I prefer to do my cosmetic facial consults in a plush, contemporary dental chair that can also double as a treatment platform for injectables or minor procedures. In almost every consult, I recline the chair and have the patient elevate their chin and look in the hand mirror ( Figs. 1.13 and 1.14 ). This takes gravity out of the equation and provides a surprisingly accurate estimation for a facelift, browlift, or cheek implants. I have done this for years, and it goes a long way to help the patient understand and preview a potential result. At this point in my career, I feel that telling patients that their appearance when reclined is an accurate prediction of a facelift and neck lift.

A very important concept is not to assume that any patient really has an appreciation as to what any procedure is or does. We do surgery all day, every day, but they may do it once in their lifetime. It is our job to clearly define the correct diagnosis and explain in an elemental way what procedures are available and what each one will and will not do. The more “props” you have on hand, the easier it is to convey how procedures are performed. In this digital age, the standard for consultations includes animations, videos, and photos. The best place in the world for me to get all of this is from my own website. Our standard protocol is to have the assistant open our website on a widescreen TV in the consult room ( Fig. 1.15 ). Then, the staff member will review the procedures that interest the patient. While on the web page, they can view and discuss procedural examples, animations, surgical videos, and thousands of before-and-after images. The consult should definitely be an educational experience, and I think this is a great way to do it.

I feel the best way to perform a consultation is to tell the patient, “Today we are going do a full examination and discuss what aging changes you have and what nonsurgical and surgical options are available.” I further explain that “cosmetic surgery is totally elective and just because I point out some aging or discuss a procedure, it does not mean that you need or want that procedure.” I further explain that the list of procedures is a “menu, and they can “order” only the procedures that interest them.

It is very important for the staff and surgeon not to appear “pushy” in terms of having surgery. No patient likes a high-pressure sales pitch. There are many aggressive offices out there that push too hard, and it is very apparent to the patient. I make a point to tell the patient that I do not care what procedures they do or do not do. I love doing surgery, and if the procedure is good for the patient, it is good for me. I may make suggestions, but if I see that a patient is very conservative or resistant to multiple procedures, I immediately refrain from discussing a comprehensive treatment plan. Of utmost importance is to address the patient’s primary concern first. If a patient presents and says, “I hate my neck,” then you would not begin the conversation about their eyelids. Stay focused on what is important to the patient, and other areas can be addressed after their major concern is thoroughly discussed. As stated, patients are frequently nervous, and the office has a lot of information to present, so it is easy to confuse the patient or skip over important details. The best way to avoid this is to do the same thing in the same order at every consult.

I frequently use myself as an example saying, “When I look in the mirror, I see a big bald head, so I would love to have hair.” That usually brings out a giggle, and then they relax and tell me what bothers them. I must say, as I have gotten older and now have some early jowling and neck skin, I can use myself as a model to discuss aging, which helps the conversation because I “feel their pain.” Light, self-deprecating humor can be an ice breaker. Once I address the main problem, I tell the patient we are going to do an educational aging analysis in a specific order, addressing four distinct areas. The areas to be discussed are the upper face, middle face, lower face, and skin. I then repeat the list to make sure the patient understands the order.

While the patient looks in the mirror or at a picture, I point out aging problems in the following areas:

• Brow and forehead complex

• Upper eyelids

• Lower eyelids

• Cheeks and nose

• Lower face and neck

• Skin

After I discuss each area, I present nonsurgical and surgical options, and my staff records the procedures and the appropriate fee. Once we discuss all problem areas, I tell the patient that we will build a personalized “cosmetic menu” that is unique for every patient, and that some patients order everything on the menu and others may order only one item. I reinforce that they should only consider procedures that are important to them and not let our list influence their decisions. By this time, we have also discussed their health history, recovery window, and budget. My average patient is a candidate for 3 L s and a C . This translates to lift, lids, laser, and cheeks. These are the most commonly combined cosmetic procedures in my practice.

At this point, I tell the patient that “I have done all the talking,” and I ask for their input and sit back and listen. Once again, I review their “menu” and then tell them that my staff will discuss further details (e.g., finances, scheduling) when I leave. Before leaving the room, I personally hand each patient my business card with my personal cell phone number and email. Most patients are quite surprised by this as many doctors hide from their patients. I tell my patients if they cannot call their surgeon, then they chose the wrong surgeon. This availability has a large impact on a patient choosing a surgeon. I shake the patient’s hand, thank them for coming, ask how they heard about our office, and once again ask if there are any further questions. The average time for the consult is 45–60 minutes, and the actual face time with me is about 20 minutes.

Some key points for the surgeon and patient at consultation include health, psychological stability, recovery, and budget.

Budget

Patients must have adequate finances for the procedure(s). Cosmetic surgery is expensive, and I tell my patients that it is a good long-term investment. Some patients desire cosmetic surgery, but in reality they cannot afford it. In normal circumstances, there is significant stress for the patient when having cosmetic surgery. Add the stress of a poor financial situation, and this may put some patients over the edge. In addition, patients who cannot afford a procedure tend to skimp on details that are important, such as not purchasing expensive antivirals or antibiotics, or using private duty nurses. If the financial stress causes family problems, the experience can turn into a negative one. Some patients should simply postpone surgery until they can afford it; otherwise they may ask the surgeon to compromise throughout the surgical experience. Offering alternate financing options to patients is helpful but occasionally enables them to do something that is impractical at this point in their life. Although senior surgeons with excellent reputations often command extreme fees for facelifts, most parts of the country have similar fees for a facelift. Some surgeons will discount secondary procedures such as facial implants or laser skin resurfacing when performed simultaneously with a facelift.

Although I did not charge for consults for years, as we became busier, I instituted a $75 consultation fee that is applicable to any product or service. I initially worried about this as many other surgeons in my area do not have a consultation fee. Most professional practice managers will tell you that your time is worth money, and you should charge for that, but when you are beginning a practice most people will take all comers. Most surgeons fear that the consultation fee may limit patients coming to the practice. Although I am sure that I lose an occasional patient because of the fee, I can say from experience that this has not limited patients because I am more productive. This is because having a consultation fee has eliminated many “tire kickers” (patients who are curious but not serious about having cosmetic surgery). It has greatly improved our schedule to concentrate on more serious patients. Since the last edition of this text, I have raised the consultation fee to $125 for in-town patients and $225 for out-of-town patients, and my practice continues to get busier. The consultation fee is applicable to injectables, skin care, and scheduled surgeries. Some of my colleagues do not allow the consultation fee to be redeemed for services. My personal recommendation to those starting a practice is not to charge a consultation fee because you need all the exposure you can get.

When I leave the consultation room, the assistant sits down again and continues the conversation with the patient. My assistant provides handwritten fee estimates to our cosmetic scheduler, who, in turn, provides a formalized printout for the patient. The patient is passed from the assistant to the scheduler and meets with the scheduler in her business office, away from the clinical space. The scheduler discusses finances and provides literature about payment plans (if asked) and gives the patient a professionally made presurgical packet that contains comprehensive information about our office, our doctor, and the presurgical experience ( Figs. 1.16 and 1.17 ). This will also include forms for medical clearance, caregivers, and lodging (if pertinent). Like many other mature practices, my practice involves many out-of-town patients who will require an increased level of communication as they will be coming from another city and staying for a specified time after their surgery. These patients not only need more planning but more TLC as many are going through this experience without family present.

We encourage patients to carefully study our website in relation to their anticipated procedures as it is a great educational tool. Serious patients are given information about required preoperative history and physical and laboratory tests so they can begin planning their surgery.

Before patients leave the consult room, we also ask about their skin care regimens, and many will show interest and purchase products at the appointment ( Fig. 1.18 ). I do not have a spa or aesthetician in my office, but for surgeons who do, this is an excellent time to promote these services and tour these spaces.

Finally, when a new patient leaves the office, we want them to remember us. We give all new surgical consults a gift bag with small logo gifts, office brochures, and product information ( Fig. 1.19 ).

Before the patient leaves the office, the assistant gives them a tour of our surgical facility if time permits and we do not have patients in the surgery center. We discuss all the attributes of having a fully accredited surgery center and explain that all of our facilities, equipment, procedures, and emergency equipment are the same as those at local hospitals ( Fig. 1.20 ).

On the same day as the consult, we send a personal note card thanking the patient for coming to the office and invite them to contact us with further questions or assistance. If we do not hear from the patient in 6 to 8 weeks, a “tickle” letter is sent to remind them that we are at their service for questions or concerns, and the staff member who participated in the evaluation calls the patient to see if there are any questions she may answer.