Slow Down or Double Down — with Steven J. Pearlman, MD (Ep. 229)

Beauty and the Biz

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and whether to slow down or double down.

I’m your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients and more profits.

Now, today’s episode is called "Slow Down or Double Down — with Steven J. Pearlman, MD".

After being in practice for many years, some surgeons have had enough. While they enjoy surgery, they do not enjoy the ups and downs of running the business size of their practice.

Or figuring out how much to spend and who to spend it with to get them new patients.

Or, they have had enough of staffing and HR issues to last them a lifetime ;-)

But other surgeons love a challenge and have no intention of slowing down. They see their cosmetic practice more like a puzzle. The puzzle pieces are their resources and assets, so they are constantly fitting the pieces together to make up a smooth running, profitable money-making machine.

This week’s Beauty and the Biz Podcast guest was Dr. Steven Pearlman, a facial plastic and reconstructive surgeon in private practice on the upper eastside of NY.

Dr. Pearlman has been in practice over 34 years and instead of slowing down, he chose to double down.

We talked about how he scaled by doubling his space in Manhattan, adding another surgeon, as well as bringing on more technology and staff to run it, and where social media fits into his marketing plan.

We also talked about how he got 256 legitimate reviews from some of the toughest patients in the world (rhino), and his amazing wardrobe and shoe collection.

Visit Dr. Pearlman’s website

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Transcript:

Slow Down or Double Down — with Steven J. Pearlman, MD

Catherine Maley, MBA: ​

Hello everyone, and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery, and whether to slow down or double down. I'm your host, Catherine Maley, author of "Your aesthetic practice, what your patients are saying", as well as consultant to plastic surgeons to get them more patients and more profits.

Now, today is a very special guest that I've known for a very long time, and it took me forever to get him on there. So, I'm very excited to introduce Dr. Steven Pearlman, who chose to double down instead of slow down. He's a facial plastic and reconstructive surgeon in private practice on the Upper East Side of New York for more than 34 years. He's got a focus on facial rejuvenation, rhinoplasty, as well as revision rhinoplasty.

Now, Dr. Pearlman is director for the Center of Aesthetic Facial Surgery for the New York Head and Neck Institute, attending surgeon at Lenox Hill and Manhattan Eye, Ear and Throat Hospitals and Clinical Professor at Columbia University College of Physicians and Surgeons. Now, Dr. Pearlman writes for medical journals and lectures all over the world.

He's also a fellowship director and preceptor as well as past President of the American Academy of Facial Plastic and Reconstructive Surgeons, and founding President of the New York Facial Plastic Surgery Society. And if that isn't enough, Dr. Pearlman also donates his time and surgical skills to Face to Face, Little Baby Face Foundation, and the National Domestic Violence Project.

Dr. Pearlman, welcome to Beauty and the Biz.

Steven J. Pearlman, MD, FACS: Thank you for having me.

Catherine Maley, MBA: Sure. So, why facial plastic surgery? It's been a long time, but why not plastic surgery or orthopedic surgery? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Well, when I, when I was training, when I was resident, actually in medical school, you wanted to decide your specialty. And I was at Mount Stein as a medical student and the program in ENT otolaryngology was extremely strong, had some excellent role models.

So, I went into an ENT residency and in a residency, it was basically head and neck cancer surgery and cosmetic surgery. We did major reconstructive surgery with Dr. Hugh Biller, who is literally one of the leading head and neck cancer surgeons in the world. But also, facial plastic surgery, and actually during my residency, we looked at numbers compared to plastic surgery residents and found we did three times as many rhinoplasty, twice as many facelifts and blepharoplasty as a plastic surgery resident.

So, we were certainly qualified, both from our surgical skills, our anatomy, and our practices. To continue. So, I went into practice and was doing both head, neck and cosmetic, and you really can't master everything. So, I decided to hone in my skills and advance my practice in cosmetic surgery.

Catherine Maley, MBA: That's a really good point. How did or does this impact or relate to your choice to double down instead of slow down?

Trying to balance more than, you know, you can be the jack of all trades, or you can get really good at a certain few things. Did you immediately go into private practice after fellowship, or did you do that journey where you bounced around with other practices for a while? What was that like?

Steven J. Pearlman, MD, FACS: Well, actually none of the above.

I did a fellowship in facial plasticity with Dr. Bill Friedman, who came to New York from St. Louis. And early on in the fellowship, he had just come to New York and wanted to As a chief St. Luke's Roosevelt Hospital and wanted to build his, his, his faculty and asked me to join him on the faculty there.

So, is it St. Luke's Roosevelt in the hospital based private practice. We also had for the 11 Columbia residents, so we were fully academically involved. He was also shifting from St. Louis. So, literally, I was. I was in New York five days a week. He's in New York, three and a half, two and a half days a week.

And as early as my fellowship, I was basically overseeing five resident clinics and, and rounding twice a day with residents and teaching in, in addition to learning. So, I, I started as an academic when he left, which is a year and a half after my fellowship because the hospital left in St. Louis gave him basically an offer, couldn't refuse.

And so, I relocated back to St. Louis. They made me acting chief of the NT a year and a half out of my fellowship. So, I'm sitting on the medical board with all these senior people and sort of running the program until they brought in a new chief. And so, I stayed with that group, Dr. Yoseph Crespi, who specializes in head and neck surgery, brought in some other surgeons with him.

I stayed with that group from, you know, again, 88 to 90 with Friedman, 90 to 2000. And that's when I said, you know, I'm with this hospital-based group. And I still gave up the head and neck cancer. I called myself a facial plastic surgeon. I had already been committee chairman of the AFPRS for a number of committees.

I'd already been regional vice president. But it was still less than half my practice, because within a group ENT practice, we were up to about seven or eight doctors. Even though I called myself a facial plastic surgeon, I was still an otolaryngologist first. And I over half my practice was general ENT things.

So, when I went, I basically left and went solo, stopped accepting insurance plans, called all my ENT, all my first and second patients, I'm no longer accepting ENT patients. And that's when I sort of went solo, it was the 2000s, about 12 years after being in practice.

Catherine Maley, MBA: Did you go straight to the Upper East side of New York? How did or does this impact or relate to your choice to double down instead of slow down?

You were on Park Avenue. Did you start there? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Well, I had, I had a small consult office that I bought that the group actually rented for me. because when I was the hostile based group, we were on West 59th Street and we had a big office, but we wanted an east side presence. So, I had purchased a, a group on an office down the Upper East side because there's nothing for rent since I had a stake in it.

And then when I went solo, I sold that office. Took that money I made on the office and then built Austin Park in 60th, about a 2, 000 square foot office with an operating room, a certified OR.

Catherine Maley, MBA: And at that point, did you go strictly cosmetic or were you still trying to do both? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: I went strictly cosmetic. I mean, some of my referrals would send me patients, I wouldn't turn them away, but I was dropping out of all the insurance plans, I was dropping, you know, I was no longer participating in any of the plans.

And so, I went cosmetic really in 2000 and then, you know, a year later it was, was, was 9 11 just as I was starting to ramp up, you know, I went from quiet to starting busy and then quiet again. And so, it was a lot of time sitting around that office. Everybody was, so everything was quiet in New York.

But, you know, they, it takes time. With a medical practice, you know, ENT, you can, if you do quality work, you need a half a dozen referrers. You're nice to people, you're nice to your patients, you do quality work, you send them referral letters. You can build a medically related practice within a couple years because medic surgery takes Eight to 10 years.

And that's what it took me to 12 years and they went down and back up again. And literally I'm still building. I'm still going up from when I went solo in 2000.

Catherine Maley, MBA: The younger guys say to me all the time, their vision of what they want and their vision that used to take 10 years, they've got it down to one or two. How did or does this impact or relate to your choice to double down instead of slow down?

And I just, I can't imagine how realistic that is because I do think it takes, it takes a minute. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: For most people, it's 10 to 12. The one to two is the very rare individual who is very good at marketing and social media and TikTok and Instagram and, and is getting, putting themselves out there. It used to be, you know, when I started, people would find their surgeons, the top surgeons, by who's publishing, who's teaching, who's in clinical practice, who's writing, who's going to meetings, who are the officers in the academies.

And then. After I was, you know, in about the 90s, mid to late 90s, public relations, I actually did PR, and it was, who was being mentioned in the magazines, who was being viewed in the newspapers, who was on TV. Then it was, who has the best websites. Now it's social media. And if you are a giant that's really good at it, you can build a practice fast, but it's a small minority.

The problem line is you still have to provide quality work to back it up. You know, you can't fake it when it comes to academics. 20 years ago, unfortunately, some people can fake it. Oh, the best nose job in New York. You've been out a year. The best facelift in New York. You've been out a year. Gain some skills.

Get some good before and after’s. Get a little bit of humility before you start touting yourself as the best as.

Catherine Maley, MBA: I see that a lot. Yeah. So, you, you always like facelifts and rhinoplasty. It feels like rhinoplasty. What do you prefer more facelifts or rhino? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: I prefer for rhinoplasty. I find it, it's a more challenging operation, more exciting.

Unfortunately, the patients are more difficult than facelift patients because, you know, nowadays with, with social media and selfies from every angle. People are much pickier about their results. It used to be, you have a bump, you have a big tip, the nose looks better, you're happy. Now, well, it's better, but.

So, I'm going to ask you to go to me, I do give talks on, on crooked noses and on happy patients. So, it's, it's a more difficult era nowadays dealing with a rhinoplasty patient than it ever was before. You know, I have some colleagues who were actually thrilled, I won't mention their names, but they, they have mostly facelift practices and said, I'm so glad not to do rhinoplasty anymore, because I love the operation.

But I found the patients to be quite challenging.

Catherine Maley, MBA: I hear that a lot. Yeah. They used to say the facelift patients were particular until they did Rhino. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: All relative. Yeah.

Catherine Maley, MBA: Yeah. Then they changed their marketing plan. So, you did something very interesting that I have toted forever, but I just love that you have added an associate. How did or does this impact or relate to your choice to double down instead of slow down?

So, can you just talk about how you're scaling? Because you're doing your thing, you know, you're. Rhino and facelift. What did you do to scale? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Okay, so first, my first associate was within my own specialty. I was approached by my patient coordinator and my wife who got together and said, we really liked your fellow.

Very personable. We think he's skilled. If we could take one quarter of the patients say you're too expensive for rhinoplasty or facelift and convert them for him, he'll be busy right away. So, I brought my then fellow on and it was working, it was a slow process because unfortunately that 25 percent of patients, they didn't want him, they wanted me at his price.

So, he was starting to build a press meantime. He's doing a lot of fillers. A lot of injectables. He became a filler injectable expert. He was, he was giving lectures for the companies, which is great because, you know, I did E and T to build my practice. He's doing fillers and injectables. I had him doing the minimally invasive, the face tights.

And, you know, our turning point was probably around when COVID hit. And at that point he was basically a single guy living in a one-bedroom apartment in New York City. He's from L. A. He called me and said, you know, I really like working for you, but I, I miss having room. So, he, he departed. And now he's practicing part time in L.

1. and part time in Vegas. Medicina, good skilled guy, nice guy. And more power to him because Vegas needs him. Facial plastic surgeons have a lot of plastic surgeons, but you know, no high-end facial plastic surgeon. He will be the guy So, then I decided, you know, it's time to replace him and say, you know what instead of trying to Fit them into my mold.

Let me add somebody who provides a service that I don't offer Because I’m kidding how many times I’m sending out; you know names They want press liposuction. I have a scar on my belly. I want, you know, various. And so, we're referring it all out and said, let's bring it in house. So, I had one associate didn't quite work.

And I brought another one on who started in July, started August 1st. Brian Basiri Tarani, who is real gentlemen. And I called the fellowship director, Ford Nahai, and Ford, who's the press president of Everything Plastic. And a true, a true gentleman. Look at, you know, a diction gentleman has a picture of him and he says, listen Steven, if he works for you and it doesn't work out, you don't like him.

He's not a good person, isn't a great surgeon. I tell you; he is a great surgeon. He's a good kid. He learns, he's humble. If any of those things don't come true, I don't want you calling me back saying, Why you misleading. He says, I stake my reputation on this young man. And so far, he's been right. He, he's a, he's a, he's a rising star.

And a nice person too, which is easy, which makes it a lot better to deal with.

Catherine Maley, MBA: That was a huge referral that you got there. It was, it was. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: There's a reference. Yeah, it was a reference. I got.

Catherine Maley, MBA: I mean, a reference, you don't need to vet as much, but you know, you want to make sure that they share your values are similar, but I just. How did or does this impact or relate to your choice to double down instead of slow down?

Love the fact that you thought outside the box and went with a non-competing surgeon. That's half the problem. Like you guys couple, but you're the same specialty and then you're almost competitors rather than associates or partners or I just think that's a great idea. So, now are you kind of like a one stop shop? How did or does this impact or relate to your choice to double down instead of slow down?

Is that the point?

Steven J. Pearlman, MD, FACS: That's our goal. Yes, and I mean, I just got a call today about, you know, patient with, with a, with a, with a cheek fracture. I haven't done a facial fracture in, in, in 20 years, but that's it. Call, talk to Dr. Baier. Tara, you they're going go about the BBT, I'm sure he did lots of those in residency and, and happy to have ha have him do it.

And patients say, you know what, while I'm having my rhinoplasty, how about these love handles? So, these things we can coordinate together instead of trying to bring in someone from outside to come and coordinate and do it at the same time.

Catherine Maley, MBA: Yeah. And is he sharing in the cost of the OR and? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Well, it's, it's a, you know, he's on a salary basis and a percentage after each is that.

So, you know, his patients are, are, are charged an OR fee, which goes to practice. And then. Whatever his surgical fees are, are based on, you know, whatever his, you know, employment contract.

Catherine Maley, MBA: And does he live off of your reputation and credibility and marketing efforts, or does he do his own, have you decided how the marketing works on that? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Both. So, we have pretty strong, well, pretty strong website presence, not for body, but I have a very good presence. For our website, we have tens of thousands of patients in our databases have been practiced so long for, for our, our email blasts. And social media is getting up there. It's 14, 000, which is, which is, you know, compared to some of the big, big shots.

It's small time, but we're getting good presence. So, he's got his own, but he has to tag us. But half of this half the physician posts from our practice are about him and building his practice. And it compliments me. I mean, if he trains from four and a half, he gets a facelift patient. I'm happy to have him do the facelift.

I know he's trained it. I'm not going to tell him. Oh, you're not a facial plastic surgeon. He's trained. He's skilled. So, I'm not restricting them. And a lot of plastic surgeons are told that if you go work for a facial plastic surgeon, they won't let you do noses and faces. So, I'm sure you can. We're not.

Someone calls and says, I want a rhinoplasty. He's not getting that consult unless they say, I want to see Dr. BBT. Then it's his patient.

Catherine Maley, MBA: So, so far, so good. How long has he been on board? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Only, only for about a month and a half. But it's a breath of fresh air. He's a gentleman patients like him; the staff loves him.

Very easy going. And it just, we're just, you know, I, I see a nice future here.

Catherine Maley, MBA: Oh, good for you. I have noticed though, it's around the two-year mark that things can go sideways because they get their legs, you know they start thinking I can do this on my own. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: And he might, which is, which is, you know, that happens and I think maybe.

I don't know the statistics. It's well under 50 percent stay. We'll see what happens. But right now, it's too early to tell. It's my job to build them up and get them as busy as it can be.

Catherine Maley, MBA: But you also brought on other revenue generators like your NP. And she's doing the non-surgical. She's doing a killer job on Instagram and TikTok. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Forget that. She's a killer job in the office. She's booked solid. She's It's about a week or two to get an appointment with her. We had someone who was very good before her that, you know, when someone leaves, she left because she was offered a great opportunity. You know, I say, gee, how are we going to fill those shoes?

And she's filled those shoes and more. So, Lisa's a great, great nurse practitioner. She does great quality work. And Christine, who used to run my OR for like 10 years, Then said, you know, I'm, I'm, I'm done. I'm done with this. I'm tired of, you know, babysitting pages. I want to be more active. She spent the last few years in the OR learning lasers and fillers and toxins, going to really high-quality meetings and courses, cadaver dissection courses.

She moved to Florida because that's where her boyfriend moved. Her, her, actually her family got her boyfriend his ideal job. But in Florida, she's an RN. RNs cannot inject and they cannot do lasers. And so, she said, no, I, I miss treating patients. All I'm doing is like giving like vitamin cocktails and doing facials and hydro facials.

So, she now works for us Tuesday, Wednesday, Thursday. She comes up Monday night, works three days and goes home on, on Friday mornings. And can't tell how many patients who are thrilled that Christine is back. So, now we have two superb people, you know, who are here treating a patient. I'm doing very little Botox and fillers now because, you know, I'm told I'm better off spending my time doing consults and seeing my post ops, but otherwise, if I'm too busy with Botox and fillers, it takes the time away from consults and taking the best care of my surgical patients.

So, you know, I, if someone sees me, it costs more and not because I'm better, but because. I want, I want to go down the hall and I'll tell patients, you know, when my wife comes into the office for Botox and fillers, she walks by and says, hi, and walks down the hall to them. So, you know, my wife and my wife knows where to go.

So, she can have, I do if she said so, but she's going to them. That's where my patients go.

Catherine Maley, MBA: So, now, oh, do you also have a hair restoration? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: John Frank comes in a couple of times a month. He's not part of the practice. We support him in terms of, you know, rent of space. He's on my website. He's got a bio there.

He's independent and he does, he does hair restoration. Yeah, he's actually, he's a super nice guy. He has two Super Bowl rings.

Catherine Maley, MBA: Yeah. Why? For hair restoration? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: No, no, no. The Super Bowl. He was He was a tight end for the 49ers.

Catherine Maley, MBA: He went from being a football player to a hair restoration doctor? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Pro football player after his second Super Bowl ring with 49ers back in their heyday.

He went back to medical school and then went to you know, after his full ENT residency, went into facial plastics fellowship in hair restoration. Yes.

Catherine Maley, MBA: Oh, you got to be kidding. I moved out here in, I think 84 in San Francisco. And the 49 ERs were just the, you know, the bomb. Yeah. And everybody loved like what's his name?

Montana and Dwight.

Steven J. Pearlman, MD, FACS: He was on that team.

Catherine Maley, MBA: No kidding. What's his last name?

Steven J. Pearlman, MD, FACS: John Frank.

Catherine Maley, MBA: Huh? Do you use him in your marketing? You might want to. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Well, he's, I, he, he's on our, he's, you know, our, in our, he is on the website. It's got a page, but really marketing here because he's not. He's not part of the practice, but so, you know, suddenly go to my website and look at providers.

He's got, he's got a page and you click on it. It'll, it'll take you to his, to his, you know, information, how to reach him.

Catherine Maley, MBA: Yeah, but I didn't know he was a football player. Anyway.

Steven J. Pearlman, MD, FACS: I got to check. All right. Yeah.

Catherine Maley, MBA: So, you know, so now, this is how you do it through. You're trying to not be the sole revenue generator in your practice. How did or does this impact or relate to your choice to double down instead of slow down?

So, you bring on others who can make money while you're not there or even while you're there, but that brings along some challenges. You have to make sure everyone's happy, good quality work. You get, everyone's getting along. The money makes sense, you know, the overhead, the salaries have that been challenging or what do you think with all the very, you'll learn and grow. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: You know, you're not taught the business of medicine. They teach the business of dentistry and dental school, chiropractors, huge amount of teaching on business medicine. We're not taught the business of medicine, but I learned from my previous practice. I spent a lot of time with the administrator, learn how to do it.

When I went solo, you started small. I built up, you learn how to keep, you do it. And until three years ago, I was not just the owner and principal surgeon, but I was also I'll call myself. I was the office manager. I had office managers. I finally got someone who's so outstanding that she has taken so much off my plate.

I can spend most of my time just operating, seeing patients and leaving and playing golf. And the key is surrounding yourself with good quality staff to attract staff. You know, you go to, you go to all the meetings and you're on the panels at, at, at all the meetings in the, in the no practice management.

And I can't tell you how many panels all witness. How do you, how do you keep staff? I can't hire new staff. Oh, I can't keep staff. Well, you know, when we have someone on staff, basically, most of the time when they leave, they're crying, but not for a bad reason. They're crying because they want, either they're moving, or they got an administrative job elsewhere that's paying double, and they're leaving, but they love working here.

And if you read my reviews, Easily over half my reviews in my surgical patients are about how great the staff is from the phones to the front desk, my office manager, my coordinator, you just got to surround yourself with good people. And you have to create that culture of support for your patients and support for each other and hopefully to perpetuate itself.

I've been, I've been blessed and I've, I've. Able to do that.

Catherine Maley, MBA: I think the game changer can be that office manager, the one that is just excellent because now she's the buffer between you and the staff. Yeah. And you can always be the good guy and you can actually focus on what you do and be in a good mood when you're trying to manage the staff and be the surgeon and be the visionary. How did or does this impact or relate to your choice to double down instead of slow down?

That's a lot of pressure, and that's, you're not always in a good mood doing that. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Yes, and unfortunately, it's hard to find, but I got lucky. Well, hopefully she stays put.

Steven J. Pearlman, MD, FACS Yeah, she's staying put. She doesn't have a choice. Ha ha ha.

Catherine Maley, MBA: What would you say is the biggest challenge of running a cosmetic practice?

Steven J. Pearlman, MD, FACS: Well, the biggest challenge is really that, that you know, you're by, by the, by the little guys. And, you know, I think I have got a reasonable reputation of practice long enough. And like you said, you have these upstarts who were, who were, you know, eclipsing you in social media and, and trying to take your patients who like have a fraction of the experience, a fraction of the skill, and are trying to, you know, pass themselves off as being these, these, these venerated surgeons.

And it's not just, you know, just doing quality work and deciding when you want to take them on or just. quality work and let that

Catherine Maley, MBA: Well, I would say the tw in a cosmetic patient's u usually are the reviews a you have plenty of both. of photos into the one ye practice. So, they can't w Don't worry about that little guy, you just keep building up all, like, the problem is, is you, when you've been around for a while, you, you kind of forget about doing the photos and the reviews, you're like, oh, we'll get around to it, and that is your holy grail, you get that proof. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: We still, we still chase it down, and I still ask patients to do, you know, you know, I used to give a talk, and you know, nowadays, people are finally getting better at it, but years ago, say, you know, you want good reviews, ask.

story You know, people are, you know, when someone is unhappy, they're, they're thrilled to go all over the internet bashing you, but when they're happy, they don't go, I love my surgeon, I had a great surgery, and people come and say, oh, there are all these bad things about revision rhinoplasty. No, you only hear about it because tiny majority, minority of patients who are unhappy.

I'll roll over the internet. The ones who are happy, don't spend hours blogging everywhere, how fabulous things are and how world is lovely and their nose is great.

Catherine Maley, MBA: So, by the way, I want to congratulate you. You have something like 256 reviews at a 4. 8 rating. I know you wish you were a five. I swear to God, it's so much more authentic at 4. 8. And you're absolutely right. They talk about your staff a lot. And I thought that's how you do it. That's how you know, your culture is good and your staff's happy because.

The patients are talking about how great their experience was with you with the result and with the staff. Yeah. Congrats. Are you asking yourself or do you have any kind of a process for reviews and photos? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: I, I ask my post op patients and same thing. And I, I also have Stephanie, my patient coordinator, she, she will also ask, but generally it comes from me.

And you know, and one of the ways, one of the ways they used to get a review is that. It'll be, you know, a year post-op instead of someone say, well, can I use your photos? What I really don't want? Well, I don't want my pictures used. Well, then you've got to gimme a really good review. Yeah. . So, you, Hey, you know what I said, but even if you weren't going to let me use your pictures, if I didn't ask, you should be insulted.

You go home and say, well, you didn't, it wasn't even proud enough to ask me to use the pictures. So, like, not, you sort of mean that's, that's that. I sort of say, well, if you're not, then let me use your pictures and your hat at least give me a good review. And they go, okay, I'll do that.

Catherine Maley, MBA: That's actually a really good tip. How did or does this impact or relate to your choice to double down instead of slow down?

Don't leave empty handed, you know, try for the whole shebang and just work your way down. If you won't give me your photos, give me your reviews. If you won't give me your reviews, can I use your photos in the office? At least, you know, I would just keep asking until you get something out of it. Yeah. How did or does this impact or relate to your choice to double down instead of slow down?

Yeah. So, what's your, I know you're not retiring. You don't look like you should be retiring. You have plenty of life left, but is there any kind of exit strategy down the road? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Well, exit strategies have changed. It used to be, you know, you, you, you, you sell, you buy, buy or sell a practice for one and a half times a previous year's gross.

That's long gone. With the internet, with social media, on the medical side, with, with insurance plans, with in network, out of network with hospitals and groups buying up positions, There's very little left in a practice when you can down people retire and they're lucky if they get, you know, get cab fare for their for their for their charts, you know, so what is the potential as a strategy is private equity.

It's a slippery slope because you want to find the group that will treat you well, that will respect you and respect your practice after you after you sell. It's something I've looked into. I've talked to a couple people some things that I'm potentially considering because if I wait 10 years, which when I may consider starting to retire, it may be too late.

You know, the, the, the, they, they don't want you with, they don't want to buy you out if you're leaving right away, unless you're like a med spa, the med spas, those still big. Parliaments without Surgery is about Parliament and the culture I've created. So, now that I have at least a good 10 years left in practice.

I'm saleable, so instead of getting my buyout in 10 years, I get the buyout now. It's a matter of finding the right situation, the right people, and finding out, is this something that I really want to do, and is it going to be the best thing for me, my practice, and my family? But it, I never would have entertained it a year ago, but conversing, having conversations with a lot of people, I, I find this something which is, is attractive.

Catherine Maley, MBA: Yeah. Would you, because they want that earn out, they want you to stay put for 3, 5, 10 years. But have you thought about that? Like, could you let go of the reins and let somebody else call the shots? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: For the right situation. Right situation. And there's some situations that will actually let you still call most of the shots.

You know, some, some you hear about, you know, They all come in and they want to like, you know, go through your staff, they start cutting salaries, you can't buy a pencil, you know, I would never go to a group like that, but there are. Situations that are now arising, really realizing you want a high-quality surgeon, you have to match their environment and maintain their environment, which got them there.

In order to keep that reputation up, which will keep the money falling into the practice.

Catherine Maley, MBA: I think it's still very new, so it's very exciting. And personally, if I were going to do it, I'd do it sooner rather than later. Yeah. Because as some of them fail, and most will, because that's just the way business is, it won't be as sexy as it is at the moment. How did or does this impact or relate to your choice to double down instead of slow down?

Yeah. No. Yeah. Who knows, you know. Yeah. But let's go back to marketing because that's actually a very big part of your exit strategy. You're trying to build a practice now. way more than just facial plastics. We have facial plastics, plastics, non-surgical hair restoration. And the issue with that is now your, your target market is everybody, you know, it's all gender, all ethnicities, all of it.

That's not easy to market to without a bucket load of money. So, how are you handling that attracting the right patients to keep all these service providers busy? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: It isn't, it isn't cheap, but you just have to make sure you have you know, good, you know, tracking, you want to track all your expenses and find out what works and what doesn't work.

You know, as I spent a lot more on marketing now than I used to spend, but there was a time when I was spending a lot of money on PR, but that was my only marketing money. Now I'm spending more than that probably on, you know, internet and, and, and social media combined. But that's, that's what it takes.

There's only, there's only a very small minority of people who... Have thrived on just their surgical reputation alone, and they're getting fewer and far between also and have a nice environment. I mean, to go back to some we talked about in the beginning is, you know, I had a nice office that was in from 2000 and then about after I took that set that scene on, I had a nurse injector in 2000 square foot office, too crowded for two physicians and nurse injectors.

So, I started looking and I went from 2000 to almost 5000 square feet around the corner. And so, I now have, you know, have you know, two physician's offices. I have a consultation room for my coordinator. I have five exam rooms, a laser room, OR, tubular recovery, a separate recovery room for surgical families, which is, which is a very important idea.

Can I being the third office I built the second with an OR. I learned what it takes, and it also worked beautifully for COVID because the, the flow, patients could go in a single direction and never have to cross paths with another patient. So, it, it, it's really well designed. I was, you know, I'm a great architect, but I was very hands on with, with the plan and design and got this working.

And there's literally almost nothing I changed from what I did. I moved here in 2019. So, it'd be, it was just four years that I'm here. Are you, you're glad you made the change? Absolutely. I mean, it was not wasn't cheap, but it took you get to the next level. And most of the time people when you build an office, you always want it bigger than what you have because you're going to grow into it.

You know, you talk to anybody started in practice, they're scrapping and scraping to get a small office and then within no time they outgrow it. So, you want to have room to grow. And if you know you're doing quality work, you're going to fill it, you know, you know, if you build it, they will come, you feel the dreams, you know, but it's true.

And I don't know anybody who has ever regretted going to be, you know, not the same as Ed Williams or Mike Nyack, but, but they're, they're the outliers. I'm talking about doing this just for my practice and people work for me. I'm not looking to have numerous other doctors renting and buying and working in my space.

Catherine Maley, MBA: For those of you who don't know, Ed Williams, I used to do some marketing consulting with him. We would, we would teach the doctors the business and marketing side of surgery. And Ed Williams has five physicians five profit centers, 75 staff at this point. And it was 22, 000 square feet. And he was just floating this big boat.

And most of the surgeons don't want to do that. That's why he's an outlier. Yeah.

Steven J. Pearlman, MD, FACS: Oh, right, right. But to me, 5,000 is plenty. In New York City, it's, it's equal to 12 outside of New York City.

Catherine Maley, MBA: That's the Taj Mahal in New York City. Yeah. It's not just in New York. You're off of Park Avenue. Holy cow. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Yeah, yeah.

It's a nice space. It cost it, but, but you know, it, it's worth it.

Catherine Maley, MBA: How much cachet do you get from having that kind of an address? Has that played any part in this? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Well, I, it, I know it's cachet, but it's almost like... Yeah, it's just the way it's supposed to be, you know New York is supposed to be on or on or near Park Avenue.

And that's just, you know, I know people have offices on 3rd Avenue. Oh, it's Park Avenue. It's too two blocks apart. No, it's right off the park, you know.

Catherine Maley, MBA: That's great. So, the social media, here's what I'm learning and you've already said it. The websites used to be the end all be all and get put all your money in SEO. Then Google decided you can't be an international search and you have to be a surgeon in your zip code kind of thing. So, they really strangled the reach that you can go for and I think that's why everyone turned to social media because now you have a huge reach. How did or does this impact or relate to your choice to double down instead of slow down?

Do you find that, are you, are you, do you have a lot of out of towners? And if you do, is it because of social media or how are they finding you? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: My out of towners are mainly for revision rhinoplasty. I always, I've had a cashman for that for a long time. I don't know if it's from social media or the website.

I think it's more web still website related, not social media. Maybe because my, my, you know, my website has had good positioning. I, for so long, I've always been near the top of the first page there for a glitch back in in 2020 that I dropped, but then, you know, we, that was fixed and I, and worked my way back up again.

I, I can't say is it because of my marketing or my reputation or my skills, but I think it all, it all sort of blends together.

Catherine Maley, MBA: But do, would you say, I did see you on TikTok? I did. I was sur surprised. You're not, you're not dancing, but you're busy. You know, has that been, I assume you're going for the rhino patients on tick tock and then maybe Instagram and the website are more for the more mature. How did or does this impact or relate to your choice to double down instead of slow down?

Do you find that is, is that the game plan? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Well, again, I will unlikely tell you, you have to do different videos for tick tock versus Instagram. I'll do one video and they'll put it on multiple. And so, if it, if it catches on tick tock fine, if not, not, you know, I'm not, I don't specifically gear videos towards tick tock because they know I'm not.

You know, I'm not juggling noses or juggling, you know osteotomes and the OR because that's what you're supposed to do. You know, I'll say breast implant, but I don't do breasts, you know, but I'm not, I'm not doing that, which is what people want to see on TikTok, supposedly, but you know, I'll just do something a little more quality, a little more educational and again, as I said, before and after’s.

Which is the most important thing was you said it was the article I just read in the in the aesthetic surgery journal about again, before and after’s is the number one thing people looking for. Unfortunately, the quality of the before and after’s is not what it should be. How many of the before and after’s before is, is a patient has no makeup with poor lighting and the after they're covered in makeup doing a beauty shoot.

And of course, they're going to look fabulous, but that's, you know, I want to see serial real before and after’s with the same lighting, the same background, same amount of makeup. And that's it. That's where, I'm not saying surgeons are falsifying or modifying their actors when they're slathered in makeup and lighting is different.

The background is different. There's just the way they look is different. It's the clothes are different. It's a lot. It's not as accurate as having a good quality before and after on your website, which should be, you know, equal, equal lighting and backgrounds.

Catherine Maley, MBA: I would say from a marketing perspective, I would do both.

I would. The patient, the way she wants to be seen out in the world. Like you can do those photo shoots on park Avenue. Like, like that's how she is up and running. But in the corner, I would also have her before and after photos, just like the medical ones, but I'm doing it. Patients love to see like the end result, like the end result, like now back up and love and life. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: You know, you're right.

Yeah, just take that for what it is. That's one way of doing it, put it in the corner so you say, Hey, we have that, and go to the website, we have the real before and after’s, not just the glamour shot.

Catherine Maley, MBA: Yeah, but I think the glamour shot super helpful to, you know you had a really good video, by the way, it was a patient journey and she was also walking down the street. How did or does this impact or relate to your choice to double down instead of slow down?

And do you remember that? I don't think you have it up anymore, but I love that. I, people want to, we, we patients want to see people in their real lives, you know, doing their real thing before and after, you know, so do you still have that? Cause that was actually —

Steven J. Pearlman, MD, FACS: We do. We just, we sort of rotate videos in, you know, and yeah.

And to answer another question you haven't asked yet is, is that we do social media in house.

Catherine Maley, MBA: Ah, that's a good point. Like, I was going to ask you how much time do you spend on it, and who doesn't? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: So, I've used agencies, I've used companies, and, and there's some very good ones. And I'm not saying they're not, they're, they're all they'll just take your money, but they don't know your voice.

And when someone is in house... They know your voice. They know what you say. They can run down the hall, grab you in the morning and say something to the camera. They get an idea of what, you know, what you can joke about, what you don't joke about. And it's better to show your practice. When they, when they work for you?

Catherine Maley, MBA: I couldn't agree more. I think you have to have the roving reporter. I say it all the time. You need the roving reporter in the office because that's what makes it so authentic and transparent. And you don't have to be a, a superstar. You all, you just be you and let something capture that, you know? How did or does this impact or relate to your choice to double down instead of slow down?

Right. Yeah. Good job on that though. How much time are you spending on social? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Not a lot. Yeah, everyone wants to know if I'm like if I travel or doing something about something fun. I'll quickly upload a photo or video to my stories, but I try. I don't want to spend any of my time doing that. The only drawback is that is that now that my daughters are teenagers.

I can't do any family photos anymore because their friends follow me and I'm not allowed to show their pictures unless I get permission.

Catherine Maley, MBA: Oh, that's so right. Oh, boy.

Steven J. Pearlman, MD, FACS: People say, Oh, I love seeing your family pictures. Why don't you post more? Of course, I can't. I'm not allowed.

Catherine Maley, MBA: Oh, my God. It's so funny.

Although they must see you on TikTok, right? Not much. No, they're more I don't know what the, what the, what they do. How did or does this impact or relate to your choice to double down instead of slow down?

I will say though, the, the young guys who think they're going to hit the ground running at one or two years. I must say the ones who are the anomalies that are I just had him on a couple of weeks ago. He's spending 30 hours a week doing it.

Steven J. Pearlman, MD, FACS: Right. Yeah, it's full-time job.

Catherine Maley, MBA: There's, it's going to take time or money.

Pick one, you know? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Yeah.

Catherine Maley, MBA: You know, just knowing what's happening in today's world, like just let's talk about the patients for a second. Have you noticed any trends in patient desires, patient expectations? Has that become more challenging? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: I think patients are being more demanding. And because of that.

Now, I, I, I do minimally invasive treatments, do face tight, we have Ulthera, I have my Elevate for next, and I'm talking to patients less and less about those things because people really want the results of a facelift without a facelift. The answer is you're not going to get a facelift result without a facelift.

Ulthera will give you 20 percent of the result. Face tight, 25 to 30 percent and Morpheus, 35 percent my elevate may help under here, but it was nothing for the jowls and this is not, if you have a big floppy neck, it'll be a smaller floppy neck. But if really people want the surgical results without surgery and that does not exist.

So, I'm, I'm tending more towards recommending the facelifts and the surgeries. Where I was trying to push on minimally invasive treatments, thinking, A, they'll accept less for less money, but they don't want to accept less. They want, want the best, want the ultimate.

Catherine Maley, MBA: Yeah. And that social media created a lot of that, the, the crazy expectations.

The I want no downtime, but I want a transformation. And yeah, you'll, that you'll always have to combat that, you know, somehow some way. But so just to wrap it up now, tell us something interesting about you that we don't know. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Oh, well, I, I'm not sure what, what I could tell you here other than, other than that for, until I was out of college, I was pretty shy.

So, people think I'm pretty outgoing and yeah, you don't seem shy. President of the Facial Plastics Academy, President of the New York Academy, starting it, New York Facial Plastics Academy, I was, I was very shy. So, it's like, I think I've been making up for it ever since.

Catherine Maley, MBA: Yeah. Cause I've known you for a long time.

I will tell you; you win for the most incredible shoe collection I've ever seen with socks as well. When did that happen? Cause you really are well known for that. How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: I like dressing well. And, and despite what people think, I actually dress myself. I buy my own suits. So, actually one of my closest friends is, is a As a men's clothing store, all my suits are made to measure.

So, I'll pick the fabrics from all the best, you know, suit makers, and he'll make me my suits sport jackets. I go, you know, high end fashion stuff. And I don't know. I like to dress well. Nothing wrong with looking good.

Catherine Maley, MBA: Oh my God. You always are like the most put together. Like all the details. I seriously thought your wife was handling that.

Steven J. Pearlman, MD, FACS: Nope. Nope. She, she, she stays out of that. She controls everything else, but then the clothes she stays out of.

Catherine Maley, MBA: Well, that's really interesting because you really are a sharp dapper dresser or you're dapper, right? I haven't, yeah, I haven't said that word in a long time. And you also have fancy socks, right? How did or does this impact or relate to your choice to double down instead of slow down?

Steven J. Pearlman, MD, FACS: Yes, well, I've been wearing, I've been wearing, before, now they never wear them, but I, I don't know where I got it from, but I started, you know, I started wearing, wearing bright socks, long before they, before they were trendy.

Catherine Maley, MBA: You're bringing out your colorful crazy side, I guess.

Steven J. Pearlman, MD, FACS: Oh yeah, there's no way expressing myself.

Catherine Maley, MBA: Right? All right. Well, thank you, Dr. Pearlman. It's a pleasure to see you. I'm sure I'll see you at a conference coming up soon. And if anybody wanted to get ahold of you, your website is MDFace.Com.

Steven J. Pearlman, MD, FACS: Right. Absolutely.

Catherine Maley, MBA: Is there any other way they should get a hold of you?

Steven J. Pearlman, MD, FACS: Well, there's [e-mail] go right to my office.

If it's, you know, physicians [e-mail]. Gotcha. You know, Instagram is @PearlmanAestheticSurgery. And I, I, messages on Instagram, I'm the one to get those. I, I check those off and my own emails.

Catherine Maley, MBA: That was a good move too. You, you went to Pearlman Aesthetic Surgery to kind of Open this up the umbrella up to more than just face. How did or does this impact or relate to your choice to double down instead of slow down?

So, that was a good. Right? Yeah. All right. Well, thank you so much for being here. I really appreciate it.

Steven J. Pearlman, MD, FACS: Thanks for having me. Sorry it took so long. Get me on.

Catherine Maley, MBA: All right.

Steven J. Pearlman, MD, FACS: And the book that I wrote the foreword to.

Catherine Maley, MBA: Oh my God. Dr. Pearlman wrote the foreword to my book. I, I had to get a hold of him. I would call his office.

This is years ago. I was trying to get a foreword because he has a really big name and I really was hoping he would give me the foreword. And I would call his office at six in the morning out at my... My place could to get ahold of him because I was, I would call a little early to see if he would pick up the phone.

And he picked up one day and he said, aren't you in California? And I said, yeah. And he said, is it six in the morning? I said, yes, I really want to talk to you. I really appreciate that. Thank you so much.

Everybody that’s going to wrap it up for us today, a Beauty and the Biz and this episode on whether to slow down or double down.

If you’ve got any questions or feedback for Dr. Pearlman you can reach out to his website at, MDFace.com.

A big thanks to Dr. Pearlman for sharing the experience on his choice to double down instead of slow down.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you’ve enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don’t miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

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 www.CosmeticPracticeVault.com and let’s grow your cosmetic revenue.

-End transcript for “Slow Down or Double Down — with Steven J. Pearlman, MD”.

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