Insights from the 2024 ASPS Statistics Report: Top Trends and Tough Calls with Dr. Patrick Basile

You are listening to the Aesthetically Speaking podcast presented by Nextech.

Welcome back to the Aesthetically Speaking podcast presented by Nextech. I'm Robin Ntoh, and today we have a special guest, Dr. Patrick Basile. Excited to have you here today.

Thank you.

I know that there's so much going on with respect to the industry, but before we get started there, let's just tell the audience a little bit about who you are and how long you've been in practice.

Sure. Well, we can go way back, but really I did my training at the University of Rochester and when I was done there, I went to become an active duty plastic surgeon with the US Navy. I had a military commitment and that was really amazing because I had to be exposed to so many different injury patterns from the war. After doing that, we ended up settling in Jacksonville Beach, Florida, and after being with a group for a small period of time, we started our own practice and kind of just hung a shingle and really build from the ground up, which everybody said was a bad idea, and we just didn't listen, but certainly took some bumps, but we're really happy with what we've done and what we've learned.

I've had the unique perspective of also getting to know your practice over the last several years and seeing you move into a larger space and really expanding in that area, and I think that there's just so congratulations is what I should say.

Thank you.

Because it's just been a journey that I've seen you go through and I've watched your practice grow and you've been very successful at not just building a very patient-centric practice, but a culture within that I noticed to be just so well deserving of what you should get with respect to the type of team that you've built, and that's impressive. You just don't see that always so kudos to you and to your team.

Thank you. I think, again, when you enter it with a little bit of negativity and you don't really, obviously you have expectations to be successful, but when you don't really know what you're actually getting into and doing it, but I think from the very beginning we wanted to have a sort of patient-centered boutique practice that almost felt like a family practice, but within a surgical subspecialty and wellness center. And again, just hiring people that believed in that and really every day wanted to bring it. And I tell them all the time, I'm like, don't do what we do to try to please me, but it's where we're trying to serve the patient and do it to absolutely best.

Yeah. I know we've got a lot to talk about today, but I think I was impressed with one of the things that you did is that you really focused on getting to a four day work week for you because you knew for your own self-sustaining component of being a great surgeon, but also having that work-life balance is what you needed, but you did it with a finesse that I don't always see in practices because they just don't understand efficiencies that they really need when they start to think about how do I consolidate, how do I still provide the best experience? How do I grow my practice, but how do I actually have a life outside of my practice?

It took a little bit of creativity, but in the end when we looked about how we were going to do it, it made total sense. And now having that day, that extra day to do things for me, but also for our practice on a business side as opposed to just grinding away with seeing patients and operating that alone has helped us to be more efficient and more successful. And also having just a little bit of a change of pace in a very robust surgical practice from a physical standpoint allowed me to rest an extra day. And so almost four days where I'm either in the operating room or in the office, I can really be 110%.

Well, yeah, and you also did a great job of really focusing how your staff drive those efficiencies, so they do a lot of pre qualification of the patients, which you don't see that always, and I admire the fact that they really did do a great job of thinking about, I want the right patients in here, so we're spending the right time with them. We're not wasting the patient time or prospect time, but at the same time we're looking at building a team that focuses on that appointment being very intentional.

Yeah. Well, it starts again with, again, that patient-centered experience from the time they walk in, you want them to feel cared for, not that their time is being wasted, that their time is valued and that they're going to get the face time with me that they deserve. So we get a lot of good feedback about that. But yeah, I mean, prequalification is very important. I work very hard with our patient care coordinator and honestly, the majority of the new patients we see actually have already had or signed up for surgery months from now. So it makes my job a little easier, but it allows us to just spend that time to really figure out what we're going to do. So from an educational standpoint, we use social media. Again, I always say it's not to sell, it's to educate because if you educate, you'll sell. And so the education component of what we do and having those resources for patients to learn so much before we really get them in there makes the consultation process very seamless.

You actually though have built a workflow that you've invested the time in so that as we went into the economic shift as we're seeing right now, and a lot of practices are talking about being slow and they don't have the bookings, and if people are canceling surgery, you've actually almost built into that and didn't really focus just on low hanging fruit. You really continued to focus on what was best for the patient and cultivated their experience such that now when we're looking at this slowdown that a lot of people are talking about, it's a big buzz here at the show. We're seeing that that's not necessarily something within your practice because you've invested in how you actually communicate, how you lean into building that relationship before they ever come in, and then how you cultivate that experience, which is kudos to, you don't see that always these days.

Yeah, I think it was very important from the very beginning that we knew to grow the practice the way we wanted to. It was slow and steady was going to win the race.

Totally, yes.

And it was, again, if every patient has an exemplary experience, what are they going to do? They're going to talk about it, and there is nothing more powerful than a patient to patient recommendation. It takes all the uncertainty out of it. So having that, and again, that patient experience is a huge thing for us, and it builds confidence early allows us to provide that experience. And yeah, I mean, I think again, just having that algorithm of how we do it has allowed us to kind of weather this slowdown, whatever it is. So yeah, I mean, again, speaking with other surgeons, I think there is some trends, but yeah, I think overall we've done well with that.

No, I love talking about your practice, but I'd like to talk a little bit about what's really, let's go back to the industry. So the industry report came out. I know that there's other podcasting that's been done on this, but I wanted to talk to you a little bit about, let's just briefly talk about the top five cosmetic procedures. I know that there's always a race for which procedure is going to be number one, but liposuction was at the top of the charts there, kind of go back and forth between that and breast aug.

Yes.

Why do you think liposuction was the winner this past year?

Well, I think people are taking health and how they look a lot more seriously, and we will dive into that a little more later on, but I think as people are also losing weight for any type of reasons, there are those stubborn areas that just don't go away. So everybody, when they lose weight, we all know those fat cells shrink down, you don't lose them, they just shrink down. And there are definitely areas of the body that don't respond. And so now it's like, I feel good, I feel healthy, I lost all this weight, I dropped dress sizes, but I still have those areas around my waistline or in the submental area and diet and exercise and medications aren't going to get rid of that. So that's why I think we're seeing that.

Yeah, I know. I mean, there's a lot around weight loss as we know with all the weight loss drugs, so it makes sense that that would actually propel that up to number one. But I mean if you think about it, the other body procedures here, we only really see eyelids, one facial plastic procedure in the top five. Any thoughts on why?

For a facial?

Just from the, yeah.

Again, I think building on the trend of weight loss and also with younger people, I think what's happening is the changes in the face may not be as robust as in the rest of the body. And when you have, and this is different than an older population, if you have an older population who's losing weight, I think you see it more in the face. We've all heard of that Ozempic face.

Yes.

So yeah, I think that's probably what it is, where when people lose a bunch of weight and they're younger, I think the face can handle it a little better.

Yeah, I mean it makes sense. It doesn't seem too surprising though, when I think about it. Do you see any surprises when you think about the top five in the procedures?

No. So liposuction breast aug, that's always going to be up there, tummy tuck, breast lift, again, going along with weight loss and eyelid surgery. Now, I think those are, what we see over the years is those top five kind of change spots, right?

Yeah.

One year might be breast aug. And so I think what we're going to see in the next few years is definitely, I would say more body contouring than necessarily augmentation, making things bigger. I think that trend is sort of changing.

Yeah, I mean, I think one of the call outs was the ballet body.

Yes.

Let's talk about that a little bit. That's a unique term, and I had not heard it before. I hadn't even heard it spoken at all in this industry. First time I saw it was in the industry reports. Talk about that a little bit.

So the ballet body, if whoever's listening isn't familiar with it, it's really kind of trying to create balance. With dancing and with ballet, you think of balance, you think of nice lines, you think of symmetry, you think of flow. So all those things with ballet we're extrapolating them and applying them to kind of body contouring. So instead of people seeking out, which traditionally in the past they might've wanted to make their gluteal area much bigger or their breasts much bigger or things like that. The trend now is balance, and people want those lines, and it has to do with, it's multifactorial because obviously people are taking their health a lot more seriously.

(10:51)
So again, along with the weight loss, drugs, surgery, people just losing weight because, and those areas that are just lingering that need some toning or tightening, you're going to see just again, trying to create that balance in symmetry. And also the other thing is when you look from a functional standpoint too. I have so many patients in our area, we're in northeast Florida that are very active and they want to do their ballet, their yoga, their Pilates, they're working out, they're CrossFit. And I think we all know that you can't really put a giant breast implant in there and expect everything to be easy, right? Running isn't easy when you have heavy implants. So if you have someone who is very toned or whatever and doesn't have much size to their chest, we're seeing a trend towards smaller implants and that goes along with this ballet body. Again, create balance. We're trying to match the lower part of the body with the upper part of the body in a nice form. So I think again, we're going to continue to see that trend.

So not necessarily people are looking for huge emphasis or overemphasis going back to, as you said, a natural looking appearance, but I think it's like you said, natural, but the word you said that made sense was flow.

Yes. And also when you think about it, let's dive a little deeper, plastic surgery comes from the word plastikos, which is to shape or remodel. And I always tell patients what we do in our specialty is restore form and function. So when you have a cohort of patients that have lost weight, and again, some might have skin that's hanging, some might have fat that's not responding to create that nice flow, to restore that flow, that nice form and function, or even people that didn't have that to begin with. That's what the trends are showing is that people have a more interest in that.

Yeah. Yeah, I mean it seems like it just kind of goes in line with everything we're even seeing with the nonsurgical side of things.

Absolutely. And I think that you're going to have those areas of the country where it's still not as hot. People are still like bigger breasts,

Right, yeah.

Bigger bums and stuff like that.

Of course, to be expected.

But again, going along with that kind of Ozempic face, I hate to use that word, but

But it's there.

Well, we all hear it. We all know what it is, is going to be, again, to restore form and function in the face. If someone's lost a bunch of weight and all the fat in their midface is gone, we're not trying to make 'em look fake. We're trying to make 'em look balanced, take those thirds of the face and balance out a chin, a midface, and a forehead so that they can look as back to normal as possible.

That makes more sense. And I think that we're also seeing the whole generational impact. So you've got the younger generation that's really thinking about contouring to gain that ballet type of body,

Yes.

Whether it's adding implants or reducing their breast size, and we're seeing that younger patient. In your practice, where are you seen an uptick in that as well?

Oh, definitely. And I think that's why it's not surprising for me to see breast lift on there or even breast reduction with younger patients. And I think they're learning or they've talked to older people and they've said, Hey, don't wait. If you have large breasts that inhibit you from wearing what you want to wear or doing what you want to do, then there's something you can do. And it's becoming a lot more talked about and accepted in younger patients to have, otherwise they wouldn't have scars on their breasts. But now it's just, now it's more important for me to be able to wear the clothes I want to look proportional, to be able to run without having to wear two or three sports bras. All those things I think go along with that of people kind of wanting to look very balanced, I mean.

Yeah. I also think about, not to go down a rabbit hole, but you think about the younger generation and the bullying and the presence on social media, and you're always front and center or you're trying to be accepted. And so this is, I think just going to extend itself as we see into the plastic surgery market because again, like you said, it's more acceptable and it's allowed, it's permitted these days.

It is. And again, what I think we've seen, or some of the things I've noticed is that especially on social media, that sort of shock value of what people were doing, maybe really inflated lips, a lot of filler in the face, big breasts, the big BBLs we've all seen. And there was a lot of emphasis on that. I see that changing, at least on good social media, that's not there for shock value. You're still going to have that, and there are some people that still like to see that stuff of like, oh my gosh, what's going on? But I think a lot of what we're seeing again is just going back to people want to look normal and balanced.

(16:02)
Which for me in the specialty, I absolutely love that because one of the things we'd always battle is people get the stigma of plastic surgery with air quotes. It's just like, cuz I think there was a misconception that someone who had plastic surgery was going to look fake, and that's absolutely not the case. And so when we had the opportunity to do educational things, that really makes a big difference because people now, the barrier to entry is like, okay, I feel comfortable talking about it. And they talk to their friends who may have had it or have seen some of our before and afters and know like, oh, you can get this and actually look good and normal and not weird.

Yeah, I totally agree with you. It's still, I go back to the word ballet body and you just think grace and elegance, and I think form is a really great way to describe it. Let's shift a little bit and talk about that whole non-surgical arena, because I know that's a big part of this. I know we talked about it's all about natural. We're not going to make our lips three times our normal size. We want them to be natural and the proportion to fit within the face. I mean, I've worked with surgeons for years. The point is to not necessarily notice the nose, the nose should fit within the face so it isn't noticeable. And so I think that that's a lot about what we're trying to see and what we see with practices that are starting to offer these services more. Where do you see the med spa market and this nonsurgical arena? Just what is your take on it?

Well, I think we all know that Covid is largely responsible for this. Everybody was now on FaceTime or Zoom and looking at their face and talking more about it. There's a lot more social media involved and ask anybody, look around how many med spas have popped up by you? So in our town alone, it's incredible. And it hasn't changed, the population hasn't changed that much.

Good point.

I think the demand has gone up a little bit, maybe not as linear as the amount of med spas opening. So I think if you talk to most med spas or practices that do a lot of nonsurgical, they might tell you that their volume is down a little bit, but I think that's diluted. But I mean, this is a 17 billion industry that employs over a hundred thousand people.

(18:26)
So the industry in itself is growing, and I think people see this or people that want to get into the game see it as being lucrative. Now that's the point where for physicians like myself where we get a little uneasy because this isn't just something to make money on, there's so much training involved in what we do. In fact, if an injector joins our practice, there are months before they're allowed to touch a patient and levels that they have to do of education, just learning about it, learning about anatomy, learning about all those things because you can really harm someone with a lot of these things that med spas are doing. And then the other thing is if you look at who's running these med spas, they're not people in the big four, which that also drives me crazy because I always tell patients, if you ever have anything done, make sure there's a medical director that could be able to fix it.

(19:25)
So I mean, we all hear the stories. Someone wants to get in the game, they have a friend who's an ER doc or a family practice who has no background but just needs an MD or a DO, they raise capital either by themselves, take a loan out or a bunch of people put money together and they jump right in, and what do they have to do? They have to start making money, so you have to start injecting fast. So I'm not sure the education levels there, so that's what worries me regarding that. But again, we are seeing the numbers go up and it's something that's not going to stop.

No, I mean I think I was looking at the med spa report and it was up by 10%. So the growth is there.

More than surgery.

Exactly. Exactly. Well, you've got all the different generations that are entering into this market. Nonsurgical is fast, it leans into the other thing to note about this industry, which is budget conscious. And so people are thinking about what can I do that's going to give me the boost?

(20:21)
It's going to give me close to where I want to be, but maybe not necessarily where I ultimately want to be. It's a non-surgical can do that, it can help with that contrary and redefining. But I also think that at the end of this, it's still goes back to the thing that you said I want to talk about a little bit more is the education. And you do a heavy amount of it within your practice. When you think about educating your coordinators or your staff or even the people doing the injections, you do a fair amount of that. Let's talk a little bit more about what your expectation is from them and then where does that transition over into what the patients understand? I think that's a big loss is people don't understand the level of education of what should be.

And I think you brought up a great point is that if you don't educate all of your staff, who's answering the phones, the first touch with a patient, right?

(21:16)
And so that person has to be as educated as possible to at least have a good conversation about what the patient might be asking and start to build expectation. Now, if it gets more than that, we definitely kind of switch them to a provider or a patient care coordinator or something like that so they can get a little bit more in depth. But you have to know what we do first off. And the big thing is people talk about pricing. Do you talk about pricing over the phone? Do you not talk about pricing? Again, you want to build expectation. You're not helping yourself if you fill your schedule up with people that have no idea how much this stuff costs and come in and they're like, they take a spot and then they're like, oh, I can't afford that.

Well, people like to self-diagnosis and they decide what they need, how much they need, versus understanding where you think about full correction or you want to achieve X, well, you're not going to get there with just this.

And I think that's the other thing, full correction, talking about treating a patient as a whole. I think one of the most important things we do when people come in is it's about education. So we make sure that we have enough time allotted to have that conversation so that we can have a treatment that's both going to fulfill expectations and have a good outcome. So we follow a mantra, the right procedure on the right patient at the right time. And you have to follow that, cuz if you do, you'll have success. If you don't, you're just trying to, and this is the other thing I think with some med spas, it's all about revenue or numbers, and they give their injectors levels that they have to hit. So now they're taking it from something that's more like a medical type thing, to something that's like a commodity and it's like salesy. And so what happens? People might be not getting exactly what they need or under treated too, and then they might be unhappy. We certainly say no to patients where it's just like, oh, I just want one unit of Botox here and here and that's it. Or I only want to do one filler for my whole face. It's like, you're probably not, you know worth it.

So let's go back to what you just said, cuz I've been thinking about this. No, telling the patient no. And I know that that's probably in a practice that's medical, especially a plastic surgery practice, you understand the concept of no. What do you think that that really equivalents to within the med spa space?

Well, I think one of the biggest things is getting a good history on the patient. And I don't think everybody does that. Again, sometimes people go to med spas and it's almost like going to a restaurant and ordering off a menu and alright, I want 50 units of Botox, three syringes of filler. And then the practitioner comes in, they have the list, it's already drawn up, they do this and they don't have that talk, right? So yeah, the ability to say no, and I think a lot of it does come with getting a history. What have you had done? When have you had it done? Who does your normal injections? Maybe this was the fifth med spa or practice they've been to in the week. Everybody else has said no and someone's going to take their money. So I think it's important because again, to identify risky patients.

Yes, for sure.

And it could be risky for medical reasons. I know places that don't even ask what meds they're on, and then they'll have all these hematomas and stuff because patients are on blood thinners and it's just like, just ask.

Then when you spend time having those conversations with the patients, other things can come to light that you may not even have understood about that patient. That would be considered a risk because you didn't take the time to actually talk to them because everybody's rushing to get, we focus on volume. I want you to see X number of patients in a day. You need to push this number through so that you can hit this quota so that you can hit this level. And when we do that, then we take away what is really, this is a medical procedure and that is what's being forgotten, I think. Yes, it's a med spa, but first and foremost it's a medical spa, which means that you really need to be focused on this is truly a medical treatment. Are we taking the time to actually assess and only treat based upon what should be done for that patient?

Yes. And that means you have to have good protocols in place, you have to have leadership from the top, should be from the medical director having a very strong presence there for reviewing things with the providers with concerns they might have. But again, that comes with education of the providers as well. If they don't know, then they don't know what to ask. If they don't know, then they don't know what to look for.

Well, you're in Florida. So in Florida, a med spa cannot allow an aesthetician or a nurse to do any injections even in a practice. So it has to be a PA or an NP or a physician. So we know that, but that's also a big problem because throughout the country, that's not the same in every country. There's different regulations around that. There's states that allow aestheticians to inject, albeit that's not what we're here to kind of judge or understand. But what I do think is interesting is that, I'm in Georgia and nurses can inject, but what most people don't understand about that is that while a nurse can inject, they first have to have clearance by a physician or a PA or an NP that has actually done a history on that patient, or a good faith exam is what they might be calling it.

(26:58)
But having that true understanding, their history has been reviewed, we know that they're a candidate and we think that they've got, from our assessment, we can go forward, and standing orders are not going to be acceptable. That is overlooked a lot of times in practices. Now that would be helpful if that was understood and also adhered to because I think that that gives us a level up as far as making sure we're first and foremost looking at the patient and taking care of them, but treating them as a patient.

Yeah, I think from a safety standpoint, that's great because it's really going to make sure that boxes that need to be checked are going unchecked, things are going to fall through the cracks or the right questions aren't going to be asked. So from a safety standpoint, I think it's awesome. You just have to look from a practitioner standpoint, are injectors merely technicians or the true facial artists who have an understanding of the anatomy?

So let's circle all the way back to where we started, which is the ballet body. You could almost call it the ballet body is the head to toe. So injectables are generally in the face and it goes back to do they understand the art of what they should be doing and achieving and are they providing balance?

Well, if you take the time to educate like that, then absolutely they do.

For sure.

And this might be a change for some patients who have been treated somewhere else. And it's more of, again, pulling through a drive-through and being like, I know what I want, I know what I get, I get a syringe in each cheek and 50 units across the board. And they're like, it's a different experience sometimes with our practice where patients are like, wow, no one's ever really talked to me about that and really take the time to do the why.

Well, they don't educate, and I think that that's a big miss. We don't take the time to educate. And so people have assumptions that this is normal, and then that's where the risk comes into play.

Well it's risk and also let's look at it from a business standpoint. If you take the time to educate somebody and they have a better understanding of what you're trying to do and how you're going to do that, I think they're much more likely to invest more in their treatment because it takes it to a different level. It takes it from that drive-through, to almost being at a Michelin rated restaurant. They come in and they have the experience of, let's tell you what's on the menu today, let's talk about that.

We think about patient experience, but one of the things that we don't tend to include in our entourage or list of things for patient experience is education, because it takes time and people don't always remember everything, but it's a component to take into consideration because to your point, it provides you a patient that's a happier patient because they're educated and probably a more loyal patient. Even if they spend more or invest in more in your practice, it's probably loyalty that you'll have for life because they recognize that you're truly looking out for their best interest.

Absolutely. And again, going back to where we started, which is where we've seen success in our practice, not just in surgery, but in non-surgical side, is providing that experience of education and then they talk about it. And so when you talk about being able to weather changes in the economy or things like that, if there's a fixed number of people who are going to be seeking something and you're the place to go, you're going to be busy, the place to go.

(30:41)
And so that's the goal. But overall, I mean from the very beginning, and I think this might be very different than some of the med spas, is my goal wasn't to make the most amount of money possible. My goal was to provide the best experience possible. And that may have meant that it took a while for us to get where we needed to be from a financial revenue standpoint, but that, putting those roots down will not only help you grow incredibly long-term, but it'll help you weather those changes in the economy, then you will be the place to go.

I think that you've said it so well, and again, kudos to you and what you've done with your practice and how you've invested in that patient experience, and I think that that's going to win all day long every day. I appreciate you being on the show today, and I think this has been a great episode for us.

Thank you for having us.

I welcome you back anytime.

Absolutely. Thank you.

Thanks for listening to Aesthetically Speaking, the podcast where beauty meets business, presented by Nextech. Follow and subscribe on Apple, Spotify, YouTube, or wherever you like to listen to podcasts. Links to the resources mentioned on this podcast or available in your show notes. For more information about Nextech, visit nextech.com or to learn more about TouchMD, go to touchmd.com. Aesthetically Speaking is a production of The Axis, theaxis.io.