Thank you for being on the call today. We are doing our monthly question-and-answer session. It looks like we have a great group. Of course, the course is going on now, and we have been online for about a year.

My intention is to do once a month for as long as I'm walking around and you guys express interest; we'll keep doing once a month where I answer questions and give you tips and pearls about how to get things rolling in your office, some of which could change over time as the prices of the products change and things happen with the science.

Today, I thought I would go over one of the most important things my mentor taught me when I first started doing botulinum toxin, Mark Bailey, who changed my life in important ways.

At a meeting at the Age Management Medical Group in Las Vegas, someone said, "That man changed my life. And I'm the top injector in Dallas.”

He was a family practitioner, so I went to see him. Mark Bailey was up in Toronto and did a two-day course where you worked all day, working while you were eating lunch on the fly. I did that twice, and I came back, and things went very well for me.

And one of the things that he taught me was that botulinum toxin has to be a concierge service. It's not something that people have to do unless they're getting it for one of the medical reasons: bruxism, migraine, sexual dysfunction, or depression, all of which are strong medical reasons, hyperhidrosis. But the majority of your patients will be coming to see you for cosmetic reasons so that they could do something else or they could go somewhere else.

And by making it a concierge service, they're more likely to return to you and not elsewhere or give up the practice altogether.
Here are some tips that have been helpful, one of which is I think it's very useful to have; food makes people happy. And since oftentimes, while they're getting filler, part of their treatment is because they've lost significant weight, especially these days with the new drugs. But in my case, I was running a weight loss clinic. It's part of the reason I started doing this. And so you don't want to serve them cake if you're pushing a normal weight.

So, we always like to have protein bars that are of the right consistency, either Zone bars or Atkins bars. At one time, we had a line of weight loss products in our office, Health Management Resources, until they eventually went out of business.

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So you have that there, and then I think you get yourself a cappuccino machine, and whoever's helping you with patients should offer them a cappuccino or a coffee. You have the snacks for sitting out, and the cappuccino or coffee is offered on their arrival. Hopefully, there's not much wait time, but even if there is no wait time, they're offered that. There are two reasons for doing that. One is you don't want them with a low-caffeine headache because they were rushed to get to your office.

The other is that caffeine can induce some euphoria, and then they associate your office with good feelings; even though you cheated some with the caffeine, it wasn't all your personality the way you were doing your injections, but still, they go home remembering it being pleasant. One of our providers offers sublingual oxytocin, which could have a similar effect.

In theory, it could make them more likely to fall in love with you so that they return and get another Botox treatment: Xeomin, Dysport, Daxxify, or Jeuveau. What I'm using these days is Xeomin, and there's a way to use Daxxify in a way that is fully transparent to your patients, that you're doing it differently.

Still, you get the normal longevity instead of the extended one, which helps your profitability tremendously—we talked about that in the last Q&A session.

Then the other thing you can do that's huge is to have same-day appointments. Make sure that your scheduled appointments don't fill up your whole day. Always have some time that is not scheduled, left open until that morning, even the day before, can't happen. The morning... Well, maybe before. You have some space not open until that day, and by doing that, you have... Is this recording? Yeah, okay, good. My computer just did something stupid. I was making sure you're still there.

So, by doing that, you can accept same-day appointments.

It doesn't have to be three hours, but a 30-minute block here, a 30-minute block there.

When people work into your schedule, they realize you won't have as much time to spend with them, but they're just grateful that you gave them the same-day appointments. Without that, if you don't offer same-day appointments, it doesn't matter if they've been seeing you for 20 years; the day that you don't offer them the same-day appointment for a botulinum toxin, you're very likely to lose them as a patient at least for that procedure. So very important. It can't always be done, but you can usually work someone in for cosmetic Botox, especially if you already have their recipe in your chart.

Always ask them about skincare because if they're getting cosmetic botulinum toxin, they're using some sort of skincare product. Hopefully, you have your own line that you're recommending that you have in your office, and they replenish their supplies when they're there. If you don't, I would be looking for something.

We have a Vampire Facelift® line that you could use. But we have a line. I think you need a hydroquinone sunscreen and some sort of Retin-A product, at minimum.

So you always ask them about that, and sometimes they'll say, "Oh yeah, my skin's beautiful because they use ____.
It'll be something you can buy at Walmart." In that case, if their skin looks great, so they keep doing it, and we'll do a bunch of non-toxic with it; that's one way to do it. It opens up the idea that you're not just about doing the procedure but also caring about their skin.

One of the most important things is that every time someone comes to see you, you try to do something a little bit more than what they expected. That's all. So, one extra thing. So it could be they are paying you for procerus and corrugators, yet you see that one eye is smaller than the other, and you treat that. You say, "I'm going to give you this today. If you like it, you can pay me next time, but this is a present." Or you give them one of your skin creams that you get a wholesale discount, but the value to them is $100 or so. So by doing that, they go home thinking, "Wow, not only did they do the thing that I was scheduled for excellently, I got something extra."

That happens when you have a concierge service; you get exactly what you pay for at Burger King. It's good. If you like Burger King, which I do, it's a good hamburger, but they don't ever give you anything more than what the cashier puts into the cash register when you're paying for it. But when I checked into a five-star hotel a month ago in New York City visiting my sons, we came to the room, and I had told them I wanted a refrigerator in the room when I got there; when I booked the appointment, I put that, and I wanted milk in it because I like milk.

So it showed up to the room; the refrigerator was already there and had a gallon of milk in it. But they also had a Thank You note and a bottle of champagne with glasses there. I don't drink alcohol, but it was still a nice gesture and my wife enjoyed some of it.
And so we had a beautiful room that was clean with the extra that I had asked for, but then extra on top of that, that was unexpected. That's the concierge five-star service. Another way of putting it is that if you do what people pay you to do, you've only done what was expected, and they don't have something to go home and be wowed about when they talk to their friends and family. So, always something extra. You can do every visit; it doesn't have to cost you a lot. You'll still have a good profit. In the end, you'll make more profit because they'll keep coming back and sending their friends.

And then the last thing is to have a practice of every time someone visits with you, you look at your chart, and you see what you noticed or learned about them and their family and their life on the last visit, and if it feels appropriate and you have time, you ask about it, "How did the wedding go? How did your first month back in school with your third-grade class go? How are you doing after you lost your baby sister to cancer?" All of those are questions I have asked my patients. I'm not making that up. I'm recalling actual conversations. They're there for cosmetic botulinum toxin, but I am not thinking it. I'm legitimately interested, affectionate, and attached to the people who trust me with something as sacred as their faces.

And if you're interested and attached, then you're curious and empathetic to what's happening with them. So you ask about it.
And that not only brings them back to see you, but it makes life more soulful, more valuable, more enjoyable. There's enough stuff in medicine that beats us up. You're paying taxes to the state, to your city, to your government. You have to think about the IRS, the DEA, the pharmacy board, the patient's family. You have staff to think about and a competition to think about. You have your marketing and you still have to get your CMEs to keep your boards and ensure you're not behind. And all of that can come at you in one day. So how do you make it? Part of it is keeping it so that every day a deeper understanding of the people who trust you to take care of them. And that's why we went into medicine, so many of us as children thought, "Wow, that'd be nice to take care of people," not cars or bank accounts or real estate.

I won't get into politics, and I'd rather not tell you who I vote for. Still, I think it's curious that Donald Trump, who is tremendously successful financially and organizationally, can build skyscrapers with success or try to build a house and keep contractors and tradesmen in line; imagine having thousands of people working on the structure and having to keep them in line. I think he's bright. If you read his book, any of his books, he reads voraciously, crazy amounts of energy. And in the two or three books I read that he wrote, in all of them, he said that he hates doctors. Hates them. He never tells why. It could be because he lost a brother to alcoholism. Maybe he's resentful that no one was able to help his brother. That's the reason he doesn't drink alcohol, the reason he gives, but he hates doctors.

I speculate that no matter how many skyscrapers you build or what you do regarding changing the tax structure, perhaps something you do to prevent a war might equal it. But on an individual one-to-one basis, there's nothing that a politician, a real estate agent investor, or a real estate developer, or a teacher, or a professor, there's nothing they do that compares with being responsible for caring for the body of a living person—huge responsibility and tremendous soul satisfaction, even without a monetary reward. And I think that could cause envy in many people, so it could be the reason. I don't know. I made that up, but that's my guess. I think that that is amplified by the practice that I just told you about, giving a concierge service that includes connecting to everyone who comes to see you.

Okay, I think with that; let me see if there are other questions in a moment. I don't see anything. Okay, we'll call it a day. I hope that's helpful and I'll shoot the video out in the next few days.

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