What Changes When You Stop Doing Everything — Philip Solomon, MD, FRCS

- I think it's harder to be good at everything. So guys, you do eyes, nose, face, breast, body. It's harder to be good. It doesn't mean it's impossible to be good at all. Let me do that with a good training and be a good surgeon. - Hello, and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery. I'm your host, Katherine Maley, author of your aesthetic practice, which your patients are saying, as well as consultant to plastic surgeons to get them more patients and more profits. So today's special guest is Dr. Philip Solomon. He's a facial plastic cosmetic surgeon in private practice in Toronto, Canada, and he's been practicing over 25 years now. He's also established the Solomon, nasal, and facial plastic surgery center in Thornhill, which is just north of Toronto. Now, he's certified in Odin Lourdology head and neck surgery by the Royal College of Physicians and Surgeons in Canada, as well as certified by the American Bork of Facial Plastic or Reconstructive Surgery. Dr. Solomon speaks at medical conferences. He's been featured in major media outlets and has more than 650 YouTube videos. And he and his co-host, Nancy Heiber, also his operations manager, have their own podcast called Unfiltered, where they talk about the latest trends in facial aesthetics and what really goes on and what goes into a surgical transformation. Now, he also interviews industry experts, so I was on his podcast recently, talking about what cosmetic patients want. And I'll be sure to put that link in our notes so you can check that out. Dr. Solomon, welcome to Beauty in the Biz. I'm so glad to finally have you on. - Thanks so much for having me. - Sure, so I'm really glad to start with, after you're done with all the training and maybe you did a fellowship or not, what happens next? What was your journey to private practice was it a jagged road or was it straight in? You were just going private. Mine was more of a hybrid. I was going right in in terms of setting up an aesthetic practice, but I was also working part-time at the University of Toronto as a teaching program for otolaryngology and the Division of Facial Plastic Surgery. And I also was working to community hospital in the north end of the city, where I ultimately became chief of surgery and got involved in hospital politics for a number of years. So I wore a number of different hats. So that was in the first decade, I sort of fell into a lot of that where I was doing, had a neck surgery and a aesthetic practice in my own private facility. And I sent out my own operating room in private facility, probably within the first 10 years of practice. So the first 10 years was really a trampoline into many different regions. And I felt like I was a little bit spread thin 'cause I was trying to do a bit too much, I think. Now I held on to all three of those hats. Academic Facial Plastic Surgery, with teaching and residence and fellows. I continued to do some head neck surgery, primarily endocrine type surgery and salivary tumors and skin cancers. And then was slowly building up my aesthetic practice, which fortunately was relatively busy right away, but obviously got busier and busier as my practice evolved. And probably around five to 10 years ago, I started cutting back on different things. So currently my practice is 100% aesthetic. And I no longer work at an academic hospital, but I still held on to our community hospital, which is near my office just in case we have a need to send a patient there. - So when you went on your own, did you rent, did you buy, how did you set up your practice? - I initially set up a practice with a colleague, who was a plastic surgeon and another facial plastic surgeon who was near middle age at that stage. And we share an office for a number of years. And then ultimately, everyone in their own directions due to other multiple factors. And we all stayed friends, but I ended up buying my own facility and employing my own staff and decided to have a total control over my practice. - Nice. I used to do some speaking interviews and you had a lot more rigorous regulations there when it came to ORs for even marketing. But did you get your own OR? Was it a big deal, was permitting a big deal? - It was a bit of a big deal, but it was actually during the time period where a lot of things were changing in Ontario. That's a province that Toronto's located in. And each province regulates their out of hospital facilities. So they're called the OHP's out of hospital premises. And there's different levels from level one, which is like local anesthesia of minor procedures to level three. We ended up applying for level three. The regulations of level three honestly rolled out during the first 10 years of my practice due to an adverse outcome at a non-plastic surgeon who was doing aesthetic medicine out of her practice. So she was four and trained. It was in the media. She was only licensed as a family doctor in Canada. But she had a bad surgical outcome, which led to a lot of pressure on the college to regulate tighter terms of not only facilities, but scope of practice. So I ended up being on the regulatory bodies, representative for otolaryngology, facial plastics. And we said what would be reasonable scope of practice for our specialty, everything in the collarbone app, for reconstructive anesthetic surgery. There were plastic surgeons on that committee, dermatologist on the committee, ophthalmologist, ocular plastics. And we sort of set out standards for what would be considered scope of practice. And what would be considered as change of scope of practice, meaning doctors working outside of their traditional training. And there are processes in place by the college now for doctors who wish to change their scope of practice. And then there were similarly lots of regulation regarding facilities, including audits. I'm sure it's similar to many states in the United States. But every five years, we have an auditor come. It could be usually as a team of nurse physicians, anesthesiologists and surgeons, to inspect, go over policy and procedure manuals, physical plant, and a lot of paperwork and stuff like that to make sure that you're up with standards. So I think it's pretty well regulated. Some doctors felt it was almost over regulated. I think it's sort of trying to find that sweet spot. But it does make us all stay pretty current to make sure that we're up to standards, because none of us will have our facilities shut down or anything like that. I know I'm hearing those states is getting more popular to do in-house procedures. So if you don't have an OR, you're doing like IV sedation or awake procedures, are you on that bandwagon or where you are with that in Canada? Well, level three, you can do everything. So we do general anesthesia and IV sedation and local. We do all of the above. We get patients different options, depending on what procedure, what their needs are. Some facilities are rated at level two, meaning they're doing IV sedation, not GA. They may be more limited in the types of procedures that they can offer at that facility. There's a number of new facilities sort of popping up in Ontario. Ontario is being always, you know, it's a public health care system. And then the private stuff sort of worked out of the public system often. And then the private facilities were really set up by individual doctors. Now there's some corporations setting up some private facilities throughout the province and they're hiring physicians to be their physician leads. So the sort of three categories is hospital-based surgery. We still can potentially do operations of cosmetic procedures. But I think surgeons who have a busy cosmetic practice typically either have their own facility or rent of other physicians. Very difficult nowadays to run a full-scale plastic surgery aesthetic type of practice out of a hospital. Sure, sure. What about the, like, bringing more people on? It looks like do you have another surgeon or an associate with you? And if so, what's that relationship? - We've had a few doctors rent our OR from time to time. Usually it's people that are in friends within the industry who don't have their own facilities who do IV sedation primarily, but occasionally I wanna have a place to do GA. Like I have a colleague who is a close friend of my new drug to a plastic surgeon. Some of them like him at his own facility for eyelid surgery, which he does primarily under sedation. But the odd patient may wanna do it under GA. So, some of like that I would rent too, but I haven't got a significant relationship like on a regular basis. So that would be sort of one-offs. I do have an associate for hair transplantation, which we offer at our facility and that's sort of a partnership. And that's been very busy and doing well over the last five years. So, that's sort of a separate business run within my facility. Branded differently. It's called follicle.ca. And Dr. Mark Corman's my partner in that business and we have a different team of technicians that come in. So I feel like here's the one thing that I've been able to sort of have as a separate business within our facility. But I haven't added in like a dermatologist or a general plastic surgeon who does body work, although it's been something that I've contemplated, that I need to find, I guess the right person. Gotcha. (indistinct) Location that for rhinos? Sorry, I missed that. The second location. (indistinct) That second location and it seems to be focused on nose. Well, both our facilities are focused on facial plastic surgery. I do have two facilities and that's just for location. So I have one near downtown Toronto. We have an area that's called the Yorkville area. That area has a lot of plastic surgeons that would be like, I guess, in New York City being on our Avenue or being in Beverly Hills. So in Toronto, being in York, there's kind of the destination place for aesthetic medicine. But my main facility where I have my surgical facility is uptown sort of in the first suburb North of city. It's really easy to access. We have a lot of parking. It's often number of major highways and subway lines. So why would I have two? So it was sort of probably an eagle purchase that is wanted to have a downtown location. And also I lived in downtown Toronto. The traffic's becoming horrendous in Toronto. So some days it's nice to be close to work. - Right. - I've noticed that surgeons get older. They like to shorten their commute, you know? It's a lot less wear and tear on their mental and physical health. - I visited a colleague in New York City recently and was spending a day hanging out with him in his hour. And he started like crazy early. I thought like six a.m. everyone was there. And I said, why do you start so early? And he said just to avoid traffic. He said that if he leaves at that time, it's like 10 minutes from home. It becomes for 9 a.m. It's like an hour and a half. So I guess as the cities get busier and busier, your decisions or what time you want to start and run your practice change as well. - Before or before. Now you also have a lot of nonsurgical, how many providers or what's that makeup about? Because now you've got to manage not just the surgical profit center that you have and the different locations, but now also the different providers. - Yeah, so we have mathematicians, laser technicians, we have nurse nurses who are trained in aesthetic medicine, those that do PRP, injectable both toxins and filler. I've had a number of nurse injectors for many, many years. Unfortunately, I've gone off on their own. Some people come here and they get started in the business, get trained, get comfortable, maybe learn areas of anatomy that they weren't necessarily comfortable treating before they came here. And then they become sort of experts in the field within the nurse injector world. And that's sometimes it's hard to keep those people. So one of my main injectors was here over 10 years, set up her own practice and she's quite successful and we're still close, I mean, it didn't really get the way of our friendship, but obviously it's hard when you have staff coming and leave. I had another nurse downtown Toronto at that office go on her own as well. She's being sort of on and off working for me for over 15 years, but she just felt that she wanted to put her hand in the ring of running her own business. So sometimes it's some people want to do their own thing and then they may be able to live to regret it. Other people, I guess it was in the cards for them that they want. Sort of a plan all along that they wanted to work for someone for a while, get experience and go off on their own. But I think that's one of the big challenges of this business in general is you have to find someone who's comfortable, who's ambitious enough and hard working and left to make your practice successful and give the best care to your patients, but then maintaining those staff and keeping them happy so that they're not going to necessarily leave and go on their own is also a challenge. Frankly, I would like to do it the other way around. I would rather they have gone out in the real world and then beat up and then like they realize, oh my gosh, I do not want to run a business because it's a whole different ball game. They think they're just going to inject. No, they're not. They have to learn marketing and business and leadership and management and social media and all of that. I like it better when they've been humbled. Boy, frankly, yeah, well, do you think my next time that I do similar true studies? I think it's when a really good nurse injector, like the one who was there 10 years, when she leaves, is it palpable that she took everyone with her or is it just a little blurp for you, a little blip, or is it a big deal? I wouldn't say it's a little blip, but it's sort of something you have to manage and sort of be able to react to in a good way. I mean, some patients follow the provider because they get comfortable with that provider. Sure, I've done it myself several times. I'll follow the provider. I mean, fortunately, the provider that didn't leave, at least one of them was somewhat respectful and made an effort not to go actively after our client base. But some people find-- nowadays, people can find you easily just online. One provider, I'm referring to, moved quite a distance, so I think it was sort of reasonable, like patients. We do draw from that area as well. Surgical patients, but the non-surgical patients may be would have dispersed anyways. When I first started practice patients, I would see a patient who we did a face lift or run it last year on, and they would-- if they said they were going somewhere else for an injectable filler Botox, I'd be all offended. And nowadays, it's almost like common conversation. They're like, oh, when can I get my Botox from a provider after my face lift? And I don't really give it too much thought anymore. I mean, sometimes I encourage them to stick with our practice. But some people in traveling distances for surgery that they wouldn't travel for non-surgical stuff. So we're sort of understanding of that. That's partially why we have the two locations. So if we see someone from downtown, they come up to our north office and have the surgery, but they can maintain the follow-up with our downtown office. I guarantee you a group of patients who would love to stay under your one roof, if they can. Definitely the locals, but as a busy professional, I'm not dying to move around a lot. I just want to find the providers I like, the practice I like. They treat me well, they don't make me wait. They're smooth processes. I think of my surgery and my non-surgical. I think a lot of people want to be under one roof if someone takes good care of them. I think so. I think they get confidence in trust in your practice. But no, you have to distinguish yourself from other meddyspons for the non-surgical stuff. The only thing that the surgical offices and the dermatologist can offer is that they have more expertise, more training, more that they can manage complications better. But separate from that, because the delta, the difference between the injectors as narrow of extra training over decades, people have always a lot of clinics that have good injectors. The one thing that can distinguish it is that we can combine therapy. So not everyone can combine as well as physicians who maybe have all the surgical stuff, all the non-surgical stuff, including energy devices and the fillers, bio-stimulants and Botox. So I don't know, I find some clinics in the States, maybe just the way they're set up. And Canada, they may just want to do one thing really well and refer everything out and build out a good platformer for furls coming in, but they won't hold on to anything. We have to deal with that, too. If we get a referral from a trusted colleague who's a dermatologist, we try our best to send the patient back to them, because we want to maintain good relations. But patients are coming to us directly, not through the medical community and they're finding us. We obviously want to hold on to them and give them whatever we can to maintain them. But occasionally, they'll ask for services that we don't offer and we'll refer them out to whoever we think is best at that service as well. So ultimately, we want the patient care to be paramount and then building, maintaining relationships with colleagues that are secondarily as well. The smartest practices know a big part of their practice grows comes from retention, referrals, and repeat treatments, not just from new internet stranger leads. That's why I created the Kiss Loyalty Club, a done for you system that keeps your patients returning, referring, reviewing, sharing on social media, and completing surgery. Discover how Kiss can grow your own practice revenues by visiting kissloyalty.com today. - So you have a place practice there. You have the surgical center. You have the non-surgical. You have the hair. You have two locations, acting two or three. What's been the biggest challenge of playing at that level? - Biggest challenges, I think the busier get in this industry. One is HR, like maintaining good staff and dealing with office and drama and politics, which we can talk about. Second biggest challenge is the busier are, you almost become vulnerable because you may end up getting more of the complex cases coming your way and some of those cases may be not fun to deal with. I mean, you can always turn them away, but then sometimes you're sort of fighting your own ego that you want to maintain work that comes your way and offer them the best service you can. But sometimes you lift your regret and take on cases, maybe you would have preferred not to deal with it as well. So I think the busier surgeons in every jurisdiction probably sees the most challenging work out there, and then there's maintaining their brand in their own reputation. The busier are, the more people are gonna love you, but the more people may not like you as well. With the online sharing, you may end up getting, you know, reputation on damage if you're too busy as well. So I've got colleagues who are super busy surgeons who have bad reputations who I thought were really, really good surgeons. I'd seen them operate, but they weren't being cautious on their house elective. They were with bringing patients in. So every year we have a meeting, you know, you're maybe twice a year and we talk about the selection criteria for intake of patients 'cause we are busy, but we almost want to be delicate on who we turn away, but cautious on who we bring on board as well. - I completely agree. And a lot of times you have to let go of what you used to like to do, but it's just not who you are now. You know, I've watched so many surgeons still try to get into the mose and the scar revisions, and I don't want to turn anyone away, but then you're back to the quantity game instead of the quality game. So there's no true answer here. It's just, it's complicated. What would you say is one of the biggest mistakes you made that others could learn from? - I think probably not focusing on a few specific procedures. I mean, I thought I did, but in hindsight, I probably could have been even more focused earlier on and spreading myself a little bit thin in terms of the type of practice I ran while I found it, helped me evolve as a surgeon by doing different types of things. And I probably did a five to 10 years too long. So probably, although nowadays, I see some surgeons coming out of fellowship and immediately going into the hardcore aesthetic arena and they have absolutely zero interest whatsoever of doing some of the other procedures that they may have trained in a residency, which is fine. I just found it. It's definitely a shift, whereas most of the people in my generation would do sort of a broader range of things that they trained in. One, to make a living until they got busy. And two, aesthetic medicine took time to build up. You couldn't become an overnight success with marketing or online stuff. It probably took five to 10 years to get busy with that. So whereas you could potentially get busy within a few years, if you're well trained, to have a good set up and have a good online presence. So we've seen that phenomenon more than we ever did 20 years ago for sure. - I still think you need multiple years to grow a thriving practice. I don't think it happens overnight. Quite a few of the younger people, you're right. They came in and said, "I'm not doing ENT. "I'm not doing any insurance. "I'm going straight to facelifts and rhinos." And I think, wow. Okay, my often, a lot of their part-time jobs, you know, trying to make it while they're being, while they're making this new branding of, I'm a facial specialist, you know? That's not what's not easy to do. And it takes a minute. - I'm sure it's more competitive than I realize it. So we hear of the successes and all of us online seem to be doing pretty well. And especially people with mature practices. But I think maybe mentioned to you recently, I had a couple of surgery childhood, moved to the United States wanting to work part-time in Canada and I was sort of surprised to hear that. And they basically said that it is more competitive to get busy than they almost said. There was a few people who were super busy in each jurisdiction, each city. And then there were a lot of people in a competitive range just below that. And it takes a while. So that was sort of more in line with what my expectations would have been. - For sure. By the way, how competitive is it in your area? - You're kind of like our LA or Miami or what's Toronto like and what's the competition like? - I think it's less than those cities, but it's becoming like those cities. So Toronto's really grown into one of the biggest cities in North America by population. I think it's like New York LA Toronto. The population-wise, I think that the training in Canada and I'd like to become a qualified surgeon in Canada, you'd have to train in Canada and it was more difficult to move to Canada surprisingly if you trained abroad. So if you went and did a residency in the United States and had done medical school in the United States or in England or in Ireland, you may be qualified in good surgeon, but it may be actually you were caught between immigration rules and training and credentialing rules. So it's sort of like the population of aesthetic surgeon seemed to be quite stable for a long time and now they've sort of loosened up on some of the regulations because there's a doctor shortage or presumed doctor shortage in Canada. Also, there's way more training programs at a fellowship level for aesthetic surgery, both in plastics and in facial plastic surgery and inocular plastic surgery. So there's more and more people who are graduating who are seeking out those types of training programs. So I would say it's becoming more competitive. I don't think it's like oversaturated. I've heard some parts of the world they're oversaturated, but I get to see it sort of heading that way. We have a number of well-trained surgeons who graduated at the University of Toronto from my program that I work at. And some of them went on to do fellowships in the United States. But a couple of them are there right now in Los Angeles. And I've heard that some of them want to come back to Toronto and it'll be interesting to see how long it takes them to get busy here. I'm not sure if I would move back to Canada so quickly if I had trained in facial plastic surgery. I stayed because I had family reasons. And back then, I thought Toronto was an amazing city, which I still do. But there was kind of a list you'd have in your head of the bandages of living in Canada versus the United States. And that list isn't quite as robust as it used to be because some of the same negatives that the United States may have been plagued with right now, President Canada. We used to be able to say, oh, we have gun control and we have no violent crime. And we can leave our doors open and Toronto Super State. And it's not really that way anymore. I don't want to bash it on this podcast. But the truth is we've had like liberal governments in for over a decade. And we've had huge immigration into Canada. And our crime rates gone through the roof. And they were on the biggest car theft capitals in the world. And I don't see it ending soon. People are buying private security to protect their cars and their houses, their home invasions. So those are the negative things about Toronto that I look like grew up here. I've lived here most of my life. None of that was sort of character of Toronto that I grew up in. But Toronto's a multicultural giant city with a huge population now. So it comes with more complex problems. There's also a lot of people here that live here part time often they're from other parts of the world and they're a wealthy class. And some of those patients will do aesthetic surgery while in live while they're in Spain, time in Canada. Often they have kids like in university here and things like that. Like I don't do facelifts on patients or rhinoplasty on Saudis, Kuwaitis, Katari patients from the Middle East. We've had quite a few people who were visiting for a few years from England. And we've come up here with relocation for job within North America as well. So we have sort of a growing element of that where people are expats from other areas and want to do their procedures while they're living here. - Kuwaitis, and you don't do surgery on them? - No, we do, we do. And the path that was more complicated 'cause of insurance issues, but now we have private insurance that covers us to work on patients from the world. - Okay, you and I had talked about that. In Canada, people are so used to the insurance taking care of things. And then because the medicine you wanna do the fun side of medicine, where it's cash only. And we love financing here in America. I don't know if you guys do as much as we do, but that's usually how people are paying for it. Not I should say usually. Quite a few patients want this. Everybody seems to want cosmetic surgery, but can they afford it? And so financing is a big deal down here or can be. I don't think it's as popular or is it in Canada? - It's growing here, so it's been around for most of my career. There were only two finance companies, and one of them wasn't doing great, and the other one seems quite successful. I think they fund or provide finances to dentistry, like private dentistry, cosmetic surgery, and some other services like that. There's a new one on the block, I think, to beautify and they're offering patients of 0% financing, but it basically, the physician pays for it on the other end, and it looks like it looks seductive to the patient. The physician may raise the fee and then charge them 0% financing to upset it, but that's kind of it. I think it's a strategic model to sort of make the procedure seem affordable to people. So I think less in the states, but it's definitely a growing thing that we see here. It's usually for, in my practice, more for younger patients wanting to get rhinoplasty done, the patient doing aging face and face left procedures is usually more mature and usually a bunch of it for it. - I would take a look at the numbers on that before you decide if it makes sense or not, because too many surgeons say I'm not paying that fee, but then you miss the hope, the big fee, like you miss your hope, you miss all of it then, you know? So I would just take a look at the numbers. When I offer financing, am I closing more procedures and is that, or am I still leaving money on the table by saying we don't offer financing, you know? I would just, the numbers will tell you the answer to that. Speaking of numbers, you have pricing on your website, which I love, but you're also a mature practice, you know, and you can do that, you can say what you want, but what was your theory about that? And when did you start putting pricing on your website? And what kind of feedback do you get from the patients? - So sort of a double-edged store pricing and the industry's interesting because, you know, if you're priced too low, it's a problem, if you're priced too high, it's a different problem. We've tried to always position ourselves as sort of mid-to-up or market pricing with high-level surgery, you know? But sometimes you almost feel like some of the procedures that you offer pricing for need to be re-evaluated on a more regular basis. So there's definitely been price inflation throughout our economy, the US economy, and some of the prices have just gone through the roof for certain procedures, but you don't want to look like you're the cheapest guy if you forget to up your prices. So we've sort of done price review. So the reason I mentioned that is when we post prices online, and if we start raising our prices, which we've had too, 'cause of our costs have gone up dramatically from anesthesiologists, nursing, drugs, everything, if we don't update it quick enough, then some people will phone and say, "Oh, so I was this and you've been now saying it's that and we get into a whole discussion." The entire reason that I put it on out there in the first place was we were getting a lot of phone calls for prices, and I felt it was just wasting staff's time. And so I thought maybe if I put it out there, it would reduce the number of phone calls just inquiring about prices and that the patients who didn't make consults with us knew the price information before wasting the time of the consult, they felt something that was out of their league. But the other problem we have is that we offer almost, I think, too many procedures. So within facial plastic surgery, it seems like there's only antelope procedures, but we offer variations of procedures. So for instance, blepharoplasty I'll offer like upper and lower blepharoplasty, you'd say, "Okay, that's simple enough." But then we offered upper and lower with fat grafting as a separate fee. They might be not 100% of patients need fat grafting, but they have a significant percentage, do need fat grafting. So I mean debating this with colleagues who do, and they're just charged one fee and whether you do fat grafting or not, it's up to you. But then you have some people who can't afford the fee with the fat grafting, and they probably would look pretty good without the fat grafting. So do you lose those clients because you've raised your fee to a higher number than was within their budget? So we're sort of playing around with some of those things, but I think sometimes it creates some complexity too. So we'll do CO2 laser resurfacing as one option for eyelid rejuvenation. We'll do blepharoplasty as another option for eyelid rejuvenation. We'll do CO2 blepharoplasty and fat grafting as probably the most common combination that we do for eyelid rejuvenation, and they all have different pricing. And then each procedure will have different pricing sort of in that range. Faceless, we try to keep one fee, but then combining fees like doing a brow lift, blepharoplasty, face lift, and maybe fat grafting and maybe will be a different fee where we sort of discount some of the secondary fees. Some of the fee in the US is below my mind. I mean, I'm just thinking like, wow, I'm really living the wrong location because I'm like probably one of the busiest surgeons in the country for a long time. And I do pretty well, but then when I see how hard I work, I'm doing hundreds and hundreds of cases a year, which is great, like my fellows love it because they get massive experience for rhinoplasty and face lift and eyes, but we work pretty hard. And I'm not saying that American doctors don't work hard. I think all doctors work super hard. It's just, sometimes I see the fees being posted in the hundreds of thousands. And I'm just like, wow, I'd be a gazillionaire if I had, if I had my volume with those prices. I guess there are some guys like that that have similar volumes. - There are many though, honestly. And the heavy hitters like that, they make a big deal out of it. It's become an ego thing down here. And I mean, not everyone does that and not everyone wants that. You know, I just spoke to somebody the other day who's very, very booked out for like two and a half years. And he said, but I don't wanna work with only the rich. I wanna work with normal patients, you know? So it's all in what you're trying to accomplish, but I guarantee they're an anomaly that is not normal, what they're doing. - Yeah. - But let me ask you this, regarding the reasons to advertising or marketing, because you're really a good marketer, but you have two very distinct target markets. You know, typically it's a younger, reino patient or an aging-faced mature patient. So how do you, how do you do it? You just have two different things. - Because I think that you've hit the nail on the head with some of our challenges for my practice, because it's very tough to market multiple procedures and look like an expert in both. What I was starting, you'd be an expert if you just had face, so you didn't know his eyes face. And now it's sort of like the guys who say, oh, I only do nose. You know, the guys who only do nose better at noses than guys who do eye-nose face. I mean, you can be good at all. I think you can be good at all three of those procedures and you may want to have a mixed practice. I think it's harder to be good at everything. So guys who do eyes, nose, face, breast, body, it's harder to be good. They meet up with a good training and be a good surgeon. It's certainly possible there are guys out there that are good at all of those things. So I think it's harder to do. It's harder to market expertise than it, I guess. So that's one of the challenges. So I've seen the first 15 years of my practice was like heavy, heavy rhinoplasty volume. For the last decade, it's been heavy, heavy, face, left, and anti-aging surgery. And I like noses. I don't want to give up noses. But I think we did switch gears on marketing a little bit towards the aging face. I think partially because we were just very busy with noses because we've been doing it for so long. I think our nose volume is still very busy, but it's definitely not as busy as it was when I was only doing noses. Part of me accept that. I think it's fine because there's only so much work you can do in a given week. And I like having a bit of a mixture. And I think it may keep the creativity a little bit flowing. I think when you're doing factory work of just mass volume of noses or one procedure alone, while you become a real expert in it, sometimes it can become a bit repetitive and boring, too. So sometimes you meet up at your top of your game because you're doing just one thing day and day out. So I find-- and yeah, it's individual. I find I'm most creative when I'm doing a few different procedures. I like doing my day like today. I did a face lift, brow lift, rhinoplasty, and a blood for a plastic. So it was a very, very busy day. But I covered sort of the full gamut of things that I really like to do. So when it comes to marketing channels, you're very, very good at being in all of them. You've done a good job with a website, copy, and SQL for organic, because you have so much copy, although that's going to diffuse a lot. Now that AI is on board, they're not going to care as much about your copy, because anybody could have written that. But you've been so good about the videotaping. So you have killer videos, lots of social media. You've been at that a while. You also used to get a lot of PR. What's working right now? To get your name out there, what's working? I think it's usually a combination of things. I think some of the things that we've done in the past, we've just done because we've sort of enjoyed it. And I'm always open-minded if someone approaches me within the industry who wants to provide something new and it sounds like we could benefit from it or something that I would find fun, like a photo shoot for a magazine. I would find fun to do, or at least try it out. So I used to say yes to most things. Now we would assess that, what worked for us, and then stick with that. So the most recent thing was we were approached to a podcast. We ended up being, as you mentioned earlier, that unfiltered series. And I encountered that there weren't a lot of plastic surgery podcasts. So we talked just frankly, kind of like we're doing right now. And you were on it. So I think it's sort of a refreshing, easy, chill thing to do. We do it with a professional filming crew so that we can make it as, you know, meaningful to the audience who's taking the time to listen to us. We added out a little bit here and there. But most of it's sort of free-flowing, just with different guests. We're me talking with patients that we've operated on. And I think those are really helpful for patients to sort of get a sense of whether they want to work with me as their chosen surgeon. It gives them a sense of what other patients' experiences relate. So those are probably the most organic type of marketing, like you're actually seeing examples of our work and hearing from our patients. So I like doing those. We do those also on Instagram, where we do little videos asking people how they were covering. So I think those are probably my favorite type of marketing, more so than just adding pictures to our website or new call-be even though that used to be sort of essential so people could find you. Are you really looking at your results? Can you tell if they came from the podcast versus TikTok? I'm not sure I can. Probably our marketing team that we work with can. They have told us that our podcast has performed really well and was ranked. I don't know if you type in plastic surgery podcasts. And you're in Canada. I think it shows up very high in the top. One or two podcasts for that type of podcast. So I'm not sure if it would show up in the United States as favorably because there's probably so many competitors. No, I guarantee you. Those people like you who have their poll and a lot of different ponds, like you have a podcast and it's a consumer podcast which makes so much sense. So many surgeons interview other surgeons. And they're talking to surgeons like I do. And but my audience is surgeons. I don't know why you wouldn't have a podcast talking about consumers and having consumer guests on, talking about their experience. That just makes a lot of sense to me. But when they start interacting with you, they start watching and they start leaving comments. And then you send them over to your Instagram and their Instagram sends them over to your website. It's that synergy of you connecting these all together. And synergistically, Google says, oh, wow. They're really popular in lots of different formalities or formats. That's how we win that. That's how you win right now in SEO and Google search and chat, chat, etc. By the way, have you heard your patients saying that yet? I heard about you on chat, TTP. It's coming. Yeah, we've had a few people send us. So interesting. By the way, do you have any thoughts on how you get so many of your patients to show their faces and give you photo consent and video consent? Because you're doing a really good job with that, too. Any secrets? I don't think we have a ton of secrets. I'll be honest with you. I'd say some of our best results I haven't been able to share. And I find it very, very hard. Some doctors have said that they won't operate. Some people unless they have license or to use their images. I've never taken a hard line like that. I'd say that probably only 30% to 40% of our patients are agreeable. Some people want to be on it and be featured. Some people are very shy. The nose patients are more agreeable than the face of the patients in Canada. And just because of the demographic, I think are more comfortable sharing. Some of the older patients find it a little bit not familiar with it or maybe nervous, although that seems like it's changing. Our younger face of patients, again, that's two categories. Some of them want to show that they've taken, that they've been gutsy enough to do it. And others have been or don't want anyone to know that, anything done. So you get into these dilemmas. I've had like one person who was on their podcast and we interviewed her. I'd done a run-to-plasty on. And then she called and said she didn't want us to bear it because she had a stalker. So we didn't bear that one. It was one of my favorite podcasts we did. Make-go-layer, she says, she's still working through that. But it was sort of, you know, you get all sorts of different scenarios. We've had some people, we put their images up on their website and then a couple of years go by and they phone us and say, can you please take them down? I got a new job. I don't want anyone knowing that I had my nose done. So we run into different situations. We're always sort of agreeable if someone asks us to do something we comply. We're not looking to upset anyone. So we want to, we'll use images of patients have been happy enough to share them. Yeah, a lot. Would you do the consent forms too? Like we consent on our regular consent form. It's one of the items on our regular consent for surgery. So it'll say you agree to this, this, this, and this. One of the items will be, I agree, do photo consent forms for use for social media marketing, whatever. They have the option of saying they don't agree with us. It's not going to prohibit surgery. But at least we can go back and refer to that. And then when we see people after surgery, you seem happy. And we have good before and after as we may ask them. And then we'll frequently refer back to the original consent or sometimes I've been assigned another consent form just relating to that. Well, I've been doing an informal survey on the aging face patients. And even the big hitters say, one out of 10 will give me permission. And they say, the secret is to just do a whole bunch of surgery and ask a whole bunch of people. And hopefully they will. So if you're getting 30%, you're way ahead of the game. So congratulations. Yeah. Maybe that number's off top of my head. I think 30% of people are put minded to sharing. It doesn't mean that we're necessarily going to share. But I think what you see with our practice is that we put a ton of before and after it's out mostly because we're busy. So we've been doing hundreds and hundreds of cases for years and years and years. So we have a lot of content to work with, which I think sort of gives us one of the few competitive advantages that we can draw from is that we've been busy during it for a long time. For sure. So we're going to wind it down now. Please tell me a great patient or staff story. You care to share. Oh my god, I have a lot of stories about staff and patients. But some of them will get me into trouble. So it's a little bit trickier. Let me just think for a second. We mentioned stalkers. I did have-- I've had a number of stalkers as patients. I had one patient many years ago who had been a patient for some time and sort of became obsessed with dealing with some issue. I'll say it's some potential medical issue. And I'll do my best to manage it. But the amount of communication became excessive. And I don't know, it's not even that funny. It's all right. It's not that amusing only because I was finding the patient was getting a bit much. And I was having to make it more difficult to sort of see them in consultation because it would take hours each one later, right? And then one day I got a phone call from-- I was at the hospital working. And I got a phone call from an unknown number. And I picked up the phone. And it was the patient. But I think I'd phone the patient and not block my number. So she had my number. And then I turned my head while I was like going to get coffee and I turned my head, and they were on a pay phone. Because I was back in the day of pay phones. They were on a pay phone down the hall, phoning me at the hospital. I just, like, for years. I kind of freakied. Anyway, that was one story that comes to mind. Terms of staff, I have lots of staff. I think the comedy in my staff is primarily related to the fact that the majority of them are all women. And I think-- I don't know-- other surgeons who watch her show probably would agree that managing an office filled with that. Women in this industry may be challenging. And there's usually some drama going on in the background. So they would argue that I can trim it to the drama. I do have a little bit of a warp sense of humor. But I have to caution myself now to avoid the drama. Because I think it's like I can step into drama pretty much at any moment. So I'll leave it at that. I can tell you more specific drama humor next time we see you. Last question. Tell us something you just think we don't talk about you. I don't know. I feel like I'm mostly a workaholic. I don't even know if I'm that interesting anymore. All I do is seem to work lately. I don't know. Married have two boys, one's 22, one's 19. They're both in university. I try to stay active like when I'm not working. I like travel a lot. I wish I traveled more. I hate traveling. But I like being away. But I hate to process to places. Took my kids to Africa a few years ago because I was born in South Africa. We had a fantastic show. We had three families. I was one of the best trips I've had with family. It was terrific. What else? I'd bike ride a fair bit. I've gone with a number of excursions. I've been on bike rides in the last 15 years. And at the different parts of the world to bike. And what else? I'm an avid World War II history buff. So I really like World War II history for whatever reason. So whenever there's documentaries or books on World War II, I tend to gravitate to wanting to have my knowledge base. And I'm also, I think, a closet sort of biblical history. And I like archaeology stories about the Middle East. And there's a couple on YouTube that I seem to be a little bit focused on lately where I'm learning. Let's bits and bobs where they try to tie in stories of the first and second testament to archaeological finds. So I find that interesting too. That's about it, otherwise, I'm pretty boring. I hope your kids appreciated the trip to South Africa. Not many kids get that kind of perspective. Did they love it? Yeah, they love that trip. That trip is a must. If you can do it, especially with family, it's sort of a must. Anywhere in Africa where there's safari is definitely worth, I think, taking your family. Do you think any of the kids are going to follow in your footsteps? My younger son wants to do what I do. He's hoping to one day join my practice. And I can retire and give it to him. So that's his goal. We'll see if he changes mine. He's only in second year university, but he does seem pretty motivated right now. Nice. Well, I'll go through that because a lot of the kids today say, I don't want to work as hard as you did, you know? Good for you. Maybe I want to work as hard, but I think he does thing. I said to him, I don't have a business to give you unless you do what I do. And then he goes, OK, I guess we'll do that. So he seems legitimately focused on it. So he has reason to want to do medicine. I think he is. We have a bunch of family members who are in health care medicine. And I think he looks up to it. He had two uncles who were dead this myself. My sister-in-law is a doctor. So I think he's sort of surrounded by it. And I think he thinks it's good. Yeah. He also had some minor medical issues, which were part surgery when he was really young. So I think he got freaked out by that, which probably made him thankful for the care he got. He had some bone tumor, which thankfully, ended up being benign. So I think all these little things can influence how you end up in medicine. I got broke my leg when I was 12, but I was in an old-fashioned traction for two months, which I broke my femur. And I think that probably impacted me wanting to be a doctor. So many surgeons that have been on the podcast started out with an incident as a kid, and they just were hooked. They couldn't believe the transformation that they went through, and then they wanted to become a surgeon as well. So your website is SalomonFacialPlatte.com. And so is your Instagram, SalomonFacialPlatte. And that is going to rack it up for us today, everybody. Dr. Salomon, thank you so much. And anybody, if you would, Aver, if you like what you heard, if you could review us and share us with your colleagues, I'd love to grow the audience even more. And then if you've got any feedback or comments for me, please leave them on my website at KatharineMaley.com, or you can certainly DM me on Instagram @CatharineMaleyMBA. And with that, I will say thank you and we'll talk again soon. The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there. So you continue to jump from one thing to another, hoping to find something that will work for you too. But it rarely does. So try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years, into one playbook of the most successful practices and what they do to win. Go to cosmeticpracticeball.com and let's grow your cosmetic revenues. (upbeat music)