Amy Snyder is CEO of Unity Custom Care, the leading provider of perioperative patient care services ( Prior to co-founding Unity Custom Care, she was a partner at two international management consulting firms where she provided strategy advisory services to multinational corporations. She holds a BSE degree magna cum laude from Princeton University, and an MBA from Stanford Graduate School of Business. Reach her at

Businesses constantly search for ways to differentiate themselves. Marketing strategy teaches us that price and value are the two dimensions along which the competitive battle takes place. This article describes how aesthetic surgeons can achieve competitive advantage in each of these dimensions, and posits that surgeons are neglecting some key sources of advantage that offer new ways to gain a leg up on the competition.

The diagram on page 25 depicts the various sources of competitive advantage that aesthetic surgeons can leverage. Practitioners have to decide which levers to pull based on their unique capabilities and interests. For instance, some choose to focus on price leadership by building high-volume practices that benefit from economies of scale, while others compete on the value side of the ledger by seeking to achieve superior surgical results and becoming known for specific types of procedures.

The color coding indicates the degree of attention that practitioners typically devote to each lever, with green shading suggesting the basis of competition tends to revolve around surgical results and brand image—two related but independent ways to distinguish an aesthetic surgery practice.

Why follow the herd? Let's review each source of competitive advantage shown in the diagram, and identify underexploited ways to compete in today's marketplace.


Most surgeons providing elective aesthetic procedures prefer not to compete on price, but unfettered access to information and opinion has empowered and emboldened patients, making it more difficult to avoid. As a result, surgeons are appropriately focused on cost control. Surgeons have three levers they can pull to compete in an increasingly price-conscious market.

Operational Efficiency. Thriving in today's market requires continuous improvement in operational efficiency through:

• Carefully hiring, training, and motivating staff members;

• Refining and streamlining clinical processes by employing rigorous performance metrics and results measurement;

• Automating clinical and administrative workflows;

• Ensuring that capital assets (such as surgery centers, treatment rooms and expensive devices) are used to their fullest capacity.

None of the above ideas are particularly new or innovative. But physicians rarely enjoy these practice management tasks, and it is too easy to become complacent. It pays to be reminded that practices that do not continuously improve their operational efficiency will suffer more during economic downturns than those that do.

Speed. Price competition is spurring innovations that speed up surgeries and healing. For example, new fat processing devices are shortening the time it takes to perform fat transfer procedures, and new three-dimensional imaging technology helps facial surgeons customize more efficient surgical plans for each patient. On the healing side, practitioners have recently embraced more advanced healing protocols which combine modalities such as hyperbaric oxygen, lymphatic drainage, and vitamin infusions.

Since time is money, any innovation that speeds up surgery or healing without affecting outcomes will reduce costs and allow surgeons to compete more aggressively in a price-conscious market.

Economies of Scale. Aesthetic surgeons have not fully exploited the opportunity to reduce costs through economies of scale. There are two ways to accomplish this: first, by outsourcing certain processes to entities that can perform them more efficiently and effectively, and with a greater accountability for achieving results. Practitioners typically outsource IT support, bookkeeping and legal services to outside firms. Other candidates for selective outsourcing include inventory control and supplies ordering, human resources, and perioperative patient care (more on this one later). Complete outsourcing of all non-medical activities is also an option via partnerships with practice management organizations.

Another means to exploit economies of scale is via consolidation into multi-physician practices that share staff and infrastructure. Consolidation is gradually taking place in the cosmetic dermatology field. In aesthetic surgery, it remains to be seen if the advantages of scale outweigh the branding challenge of multi-physician groups, as this is a specialty where brand value resides primarily with the practitioner and not the umbrella practice—at least for now.

Perceived Value

The more interesting competitive battlefield lies along the dimension of perceived value. For aesthetic surgeons, value is driven by three factors: surgical results, brand image, and the patient experience.

Surgical Results. It goes without saying that surgical results come down to technical skill, aesthetic vision, and the practitioner's willingness to innovate and continuously improve his or her procedures. As value is in the eye of the beholder, it is equally important for surgeons to convincingly articulate why their results are different and better. More than any other competitive dimension, superior surgical skills provide a unique advantage that cannot be copied or procured by competing practices.

Brand Image. Brand image is all about the patient's perception of the practitioner's reputation and results as reflected by his/her:

• Patient testimonials and population;

• Website and social media presence;

• Articles and appearances;

• Office setting (location, appearance, technology infrastructure).

Aesthetic surgeons devote considerable attention to these drivers of brand value. For example, social media is the latest brand-strengthening innovation, and early movers are benefitting. At some point, everybody will be in the game and social media will no longer provide as large a boost as it does today. As with operational efficiency, practitioners must continuously burnish their brands and exploit new modes of electronic outreach.

Patient Experience. The patient experience is a neglected source of value for aesthetic surgeons. Why are innovations in the patient experience so difficult to find? Physicians want to practice medicine and consider patient care to be the sphere of nurses and assistants. As a result, surgeons perceive expenditures that improve the patient experience as costs, not revenue-producing investments. This is a mistake. Just as with social media today, the opportunity for innovators to create competitive advantage in this area is simply too large to neglect.

The patient experience can be divided into three phases, with plenty of opportunities for differentiation in each.


Preoperative. Men ask fewer questions, so intake staff need to ensure thoroughness. Female intake staff must be sensitive to gender-specific recovery issues.

Intraoperative. At discharge, men without intimate partners face greater challenges securing help from friends.

Postoperative. Men are not as accepting of downtime and might try to rush their recoveries. They are not as comfortable expressing their concerns, so caregivers must inquire more. Men tend to be less tolerant of the pain associated with elective cosmetic procedures, so proactive pain management is important. And men do not have the means to conceal the signs of surgery as effectively as women do.

Sales Phase. Practitioners obviously devote considerable attention to converting consultations into booked cases by exploiting their brand image and reputations and explaining how they achieve superior results and faster healing. Innovators are using technology to educate prospective patients, and some are even training their sales consultants to explain how their surgical approaches are superior. But there is more to be gained during the sales phase.

Another goal should be to make patients feel they are joining a community of caring providers and other patients just like themselves and that joining this community confers tangible benefits. The starting point should be during the initial consultation, when patients receive a suggested long-term treatment plan, an orientation to all the services that the office can provide, and an introduction to their patient care coordinator.

Retention Phase. The retention phase involves cultivating the long-term patient relationship. Especially in aesthetic surgery, the opportunity to maintain lifelong relationships with patients is significant. The effects of aging mean that a properly cultivated patient should return again and again for follow-up treatments and procedures (see the sidebar for further discussion). But few aesthetic surgery offices have adopted sophisticated customer loyalty and retention programs, and even fewer seek to embed a patient retention culture, data collection, and reward mechanisms in their offices.

Technology has an important role to play. During every patient interaction—no matter how trivial—clinic staff should have ready access to patient records, photos, and previous consultations, so they can make patients feel as though they have a personal relationship with them. And systems for managing long-term patient treatment plans should automatically trigger appointment reminders, callbacks, surveys and more.

Other approaches for creating a sense of community include:

• Keeping in touch (social media, blogs, educational newsletters, staff news, holiday greetings);

• Rewarding your best patients (VIP events, package pricing);

• Seeking periodic input (reviews, testimonials, surveys).

Perhaps more than any other field of practice, aesthetic surgeons face an enormous opportunity by improving their patient retention and marketing programs, processes, and supporting infrastructure.

Perioperative Phase. Unlike other aspects of the patient experience, the perioperative phase has not changed much in decades. Consequently, this phase offers the richest source of opportunity for increasing the perceived value of a surgeon's services. Moreover, this is the time when patients are most vulnerable and impressionable, so a superior perioperative experience will have an outsized impact on the patient's overall impression. To put a sharper point on this, shortcomings in the perioperative experience dramatically influence the patient's overall satisfaction, even when surgical results are excellent—perusing online reviews will underscore this point.

Opportunities for Improvement

There is a lot of opportunity for improvement here. Let's review some typical shortcomings of the perioperative experience in aesthetic surgery today.

Preoperative. Harried staff rush through patient intake, education and in-home recovery planning. They give patients an overwhelming amount of paperwork. Because of time constraints, patients are unable to digest all the information shared during intake. Accordingly, patients come away with a limited understanding of their aftercare instructions and are uncertain how and where to procure required supplies for at-home recovery.

Intraoperative. Surgical staff do not take the time to communicate status with family members throughout the surgical procedure, leaving these caregivers anxious and uncertain of when to expect discharge.

Postoperative. Aftercare facilities are expensive, difficult to book and frequently need to contact the surgeon because they lack familiarity with aftercare instructions. Same with personal nurses. Neither provide support beyond the first day or two. Once patients are on their own, they struggle to follow aftercare instructions. When questions arise, they have difficulty receiving timely responses from their surgeons. Office staff are not sufficiently trained to offer authoritative answers, and cannot devote sufficient time addressing the patients' emotional needs due to other job responsibilities. If issues arise after hours, patients often wait until the next day because they feel bashful about disturbing their surgeons. In the end, patients feel alone, vulnerable, and frustrated.

These shortcomings are even more problematic now that men are seeking aesthetic procedures in greater numbers. The generally accepted belief is that men ask fewer questions and are less likely to express their concerns. These and other behavioral differences pose additional challenges for perioperative care providers (see the sidebar for further discussion).

One way aesthetic surgeons can improve their patients' perioperative experiences is to devote staff members full time to this job, without other duties that diminish patient focus and availability. But most aesthetic surgeons lack the volume to do this cost effectively, and even when they do, providing 24/7 support is a challenge. Because of this, partnering with a specialist perioperative patient care service provider is an option that aesthetic surgeons should seriously consider.

Either way, aesthetic surgeons who get the perioperative patient experience right will distinguish themselves from the competition and reap significant rewards.


Aesthetic surgeons can differentiate themselves from the competition in a number of ways. Each practitioner needs to assess his or her unique capabilities and interests and devise a competitive strategy accordingly. Regardless of how they choose to compete, there are a couple of sources of competitive advantage that most aesthetic surgeons neglect. These areas represent significant opportunities for practitioners willing to pioneer new ways to achieve differentiation in an increasingly competitive marketplace.

© Copyright 2017 by Amy Snyder. All rights reserved.