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Taking the leap: 6 steps to successfully adding a new aesthetic service

September 4, 2009 |

With today’s uncertain economy, does it make sense in a “demand lull” for cosmetic surgeons to explore adding an aesthetic procedure to try to maximize revenue from their current patient base? One expert answers with a cautious yes, but stresses that such an expansion must be a specifically directed business move — much more than hanging an announcement in the reception area and hoping for patient uptake. Rather, physicians need to invest their energy, time and money into making it work.

Cindy Graf, of Cindy Graf Consulting, LLC, Milwaukee, Wis., says that physicians who are thinking about adding a new cosmetic service should first determine their goals. “I always say, start with the end result and work backwards….What do you hope to accomplish? What is your goal for adding this to your business? Is it to raise the profile of your business? Is it to add a certain dollar amount of revenue? Or [more] to keep your cosmetic surgical patients in your practice rather than lose them to medical spa competitor? All that really determines whether it is going to work or not [number one] and whether it should be done onsite or off,” she tells Cosmetic Surgery Times .


Once you’ve determined your goals, she advises, decide what you would like to add in the way of services. Ms. Graf asks her clients about their skill sets and what they enjoy doing.

“If you enjoy working with women in their middle years, maybe you want to do weight management/minimal incision liposuction [if you have a surgical background]. But if you do not like working with overweight women, that’s the last thing you want to do,” she says.

The choice(s) you elect to add to your menu is a starting point. From there, Ms. Graf suggests polling patients in the practice, to ask them what they think of the proposed service additions. She’s developed a 30-second questionnaire, which she instructs physicians to give to patients who come in the office. After about two weeks of accumulating patients’ answers, Ms. Graf compiles results, honing the new service offerings to not only what physicians know and love, but also to what patients want and are willing to have performed in their practice.


Armed with this data, physicians can then budget for requisite equipment and supply needs, staffing, space and more. Enter, the business plan.

Ms. Graf says most practices can absorb the financial brunt of additions to their aesthetic repertoire by utilizing existing space and some of the facility’s overhead. But most may need to lease equipment and obtain minimal ancillary supplies for the new procedure.

Staff is clearly another financial consideration, she says. It often makes sense to add a staff member, especially in plastic surgery practices that still rely heavily on reimbursement (where the staff is lean and busy). “Often, if they want to successfully integrate the procedure, they need to add one key personnel who is able to direct [the additional service], do the financials, marketing, implementation and make sure the whole…thing is running.”

Ms. Graf suggests that one of the first people you may want to consider for the job may be your favorite pharmaceutical representative.

“Drug reps are excellent people to do seminars, network and learn the treatments. They have a great skill mix. They know medicine, treat people well, know sales and, generally, speak well,” she says.


Ms. Graf recommends to her noncore physician clients, as well as to cosmetic surgeons who have not added new services to their practices recently, that they spend a few days at a course specifically designed to facilitate the aesthetic service expansion. She serves as a faculty instructor at the International Association for Physicians in Aesthetic Medicine’s (IAPAM) weekend retreat. There, physicians can learn not only the latest tips in the business of aesthetic medicine, but can also be oriented to aesthetic add-ons such as skin care, fillers and chemical peel treatments.

While this training can help physicians launch their new cosmetic service, it is not meant to serve as an end-all to learning what they need to know to be successful. Physicians should also be prepared to attend related meetings and explore continued training.


Be strategic about the launch of the new services, Ms. Graf recommends. “The key is not to roll it out too quickly,” she advises. “Most people want to have a big open house in week two and invite everyone they know into this new business. But, at that point, they are not well versed in the procedure yet. They do not talk well about [it] yet; they are not yet confident, experienced or polished…because it is all too new.”

Instead, Ms. Graf recommends a “soft launch” at the one-month mark, during which physicians treat family and friends and do internal marketing. This gives both practitioners and staff the opportunity to smooth out any service delivery wrinkles. At the end of the one-month mark, she counsels physicians to consider conducting an educational seminar for patients and the community on the new cosmetic addition.

She also advocates that physicians have in place a long-term (at least a year) marketing plan. “I tell doctors that they get out of this exactly what they put in,” she relates. “There are so many low-cost marketing tools we can use to promote within our own patient base…still, that has to be very direct [with] very specific marketing every month.”


Ms. Graf has found that cosmetic service additions take about six months to get up and running at most practices. She recommends that physicians opt for deferred equipment leases, so that they have more money in the initial stages for marketing. She adds that, as a rule of thumb, they should count on the endeavor costing 20 percent more than they think and taking 20 percent longer to launch.

“…You always have to make sure to have a line of credit of at least three months’ operating expenses to pull from,” she adds.

Don’t panic, she says, if, at six months, revenue from the new service seems to be lagging. Analyze what is working and what is not and put your energy, money and marketing into those services that are making a profit.

Obviously, pulling the plug is not an easy option when physicians have committed to three- and five-year equipment leases, she says.

“It’s almost impossible to sell used equipment because there is such a glut of used equipment for sale online right now,” Ms. Graf notes. “Most used equipment is already obsolete. Cosmetic medicine is a new technology business and you cannot afford to start behind your competition.”


But Ms. Graf emphasizes that today’s tough economy should not necessarily deter physicians from adding cosmetic options. She polled her clients in 2009 and found that those who had healthy, established cosmetic service businesses before the recession are maintaining those businesses — although, to date at least, they tend not to be growing.

Ms. Graf recommends that physicians who add new services in this still uncertain economic climate keep overhead low and start the services within their existing practices, rather than branching out into off-site medical spas. Instead, build a monthly revenue stream to support your in-house medical spa, then consider taking the services offsite when they are generating their own overhead.

If they’re willing to pay attention to nurturing the new business, physicians can expect what Ms. Graf calls a “passive” revenue stream from adding to aesthetic services. In summary, aesthetic expansion is an active — not a passive — process.

“What you cannot do is buy a machine, stick it in a treatment room and expect a sign in the waiting room to drive your patients to these procedures,” she says. “There needs to be a lot more education [of existing patients], staff training and focus to make a big enough difference to make it worth your while.”

Cindy Graf
Cindy Graf has spent the last 20 years in the medical equipment industry, focusing for the past eight years on teaching and performing cosmetic laser procedures. As a faculty member of the International Association for Physicians in Aesthetic Medicine (IAPAM), and as the marketing director for a $4 million/yr cosmetic practice, Ms. Graf shares her valuable clinical and marketing experience, giving physicians the industry-leading insight and knowledge needed to create a successful aesthetic medicine practice. Ms. Graf is author and host of a 16 topic educational video training series for the aesthetic medicine industry called “Building a Successful Cosmetic Business.” Ms. Graf also serves as the Executive Director for “Loose the Tattoos”, a non-profit gang related tattoo removal program in the state of Wisconsin.  Cindy is also the chief blogger on cosmetic lasers at

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