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Ep.108: Michael T. Somenek MD and Troy A. Pittman MD FACS

Beauty and the Biz with special guests, Michael T. Somenek MD and Troy A. Pittman MD FACS of S+P Advanced Plastic Surgery in Washington, D.C., where they’ve founded a premier and fully-accredited surgical suite and med spa.

Welcome to “Beauty and the Biz”, where we talk about the business and marketing side of plastic surgery.

I’m your host, Catherine Maley, author of “Your aesthetic practice – What your patients are saying”, and consultant to plastic surgeons to get them more patients and profits.

My guests today are the founders of Somenek & Pittman Advanced Plastic Surgery, offering “concierge care” in Washington, D.C.

Michael Somenek, MD is a double-board certified facial plastic surgeon specializing in rhinoplasty and facelifts, while Troy Pittman is a board-certified plastic & reconstructive surgeon focusing on the breast and body.

So, it’s 2 specialists under one roof. They recently opened a fully-accredited, all-private surgical suite which happens to be steps away from the Fairmont hotel for those patients who choose to recover in luxury.

And, not only are they partners in business but also in life so we’ll learn more about that.

Drs. Somenek and Pittman, welcome to “Beauty and the Biz”. It’s a pleasure to speak with you.

✔️Want to learn more about S+P Advanced Plastic Surgery? Visit their website at

Visit S+P Advanced Plastic Surgery


Click here for all the strategies for Plastic Surgery Marketing: What’s Working Now.

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​➡️ Robert Singer, MD FACS – Former President, The Aesthetic Society
​➡️ Grant Stevens, MD FACS – Former President, ASAPS
➡️ E. Gaylon McCollough, MD FACS – Former President, AAFPRS, ABFPRS, AACS

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Ep.108: Michael T. Somenek MD and Troy A. Pittman MD FACS

By Catherine Maley

July 27, 2021

Welcome to beauty and the biz discover how to grow your practice with effective cosmetic patient attraction, conversion and retention advice from author, speaker, trainer, and cosmetic practice, business and marketing coach Catherine Maley MBA.

Catherine Maley, MBA

Hello, and welcome to beauty in the minutes where we talk about the business and marketing side of plastic surgery. I’m your host, Catherine Maley, author of Your Aesthetic Practice, What your patients are saying, and consultant to plastic surgeons to get them more patients and more profits? Now, I have really great and interesting guests today. They are the founders of Somenek and Pittman Advanced Plastic Surgery offering concierge care in Washington, DC. Now Michael Somenek, MD is a double board-certified facial plastic surgeon.

Specializing in rhinoplasty and facellifts while Troy Pittman MD is a board-certified plastic and reconstructive surgeon focusing on the breast and body. So, it’s two specialists under one roof. Now they’ve recently opened a fully accredited all private surgical suite, which happens to be steps away from the Fairmont hotel for those patients who choose to recover there.

That sounds great to me. And not only are they partners in business, but also in life. So, we’ll learn more about that. Drs. Somenek and Pittman. Welcome to beauty and the biz. I really am excited to talk to you.

Michael T. Somenek, MD

Thank you. Thank you for having us.

Catherine Maley, MBA

Oh, lovely. So, let’s do a quick recap and I know, I know your journey is probably longer, but a long journey, but how did you get from, how did you get to where you are right now? Practicing together in Washington.

Michael T. Somenek, MD

Yeah, it’s been a little bit of a journey for us. We have. Now been together 15 years, I was doing my medical school training in Chicago at rush. And I’m started residency there in ENT where I met Troy, who was training in general surgery. And we kind of developed our own passions for facial plastic surgery and respective plastic surgery.

And, um, we ended up coming to the east coast. Now he continued to do a fellowship, but. I knew I wasn’t going to go into academics. And so, I’d found a private practice that I joined, which I did kind of partial ENT in partial facial plastic surgery. And we were there. I was there for a couple of years and, um, we decided to kind of collectively, we wanted to get back to DC and Troy was offered a job at Georgetown.

So, I made a transition at that point, too. An exclusive plastic surgery practice, uh, where I would focus all of my efforts on facial plastic surgery. And, you know, I think as with most people, when they’re in a group practice either works or it doesn’t. And for me, it just wasn’t working. I wanted to go out on my own, which is when I started my own practice in 2017.

So, I’ll let Troy kind of take over and explain how he got to joining me. And we collectively created our branding.

Catherine Maley, MBA

Who’s from Washington DC. Like what was the point? They’re going to tell us why you ended up in Washington.

Troy A. Pittman, MD, FACS

Yeah, so I’m from DC, but we didn’t really come back to DC for that reason. When I was finished with my plastic surgery residency, um, I came to Georgetown to do my fellowship with Scott and, um, so really came back to Georgetown, to train with Scott.

And when I was done with my fellowship, I actually joined the faculty at Johns Hopkins. And so, we kind of moved from DC to Baltimore. Where Mike has his practice in Baltimore and, um, kind of through a twist of feet. I ended up coming back to Georgetown, um, really to, uh, to Phil Scott’s practice when he left Georgetown.

So, I, we were kind of going up and down 95 and I joined the faculty at Georgetown, became the director of breast reconstruction at Georgetown. And, um, really kind of, uh, lived the academic life and, um, really wanted to change for myself. I really wanted to focus a lot more on cosmetic surgery, which most university programs there isn’t really a big emphasis on cosmetics.

It’s not really something that faculty is encouraged to do. And so, I knew the only way to really. Um, get into a cosmetic practice and to, to have a 100% cosmetic practice and be in charge of my own branding. And my own name was to, to leave the university and to start a practice. Mike had started his practice and I kind of hijacked his practice.

Um, he had started this solo, private practice. And I, and I said, I’m going to join your practice and we’ll have a practice together. And I think he, um, he begrudgingly at first said, oh, well, okay. You can’t really say no to your husband when they say we’re going to join practices. So that’s really how we, how it all.

Catherine Maley, MBA

Wow. That’s a lot. That’s, that’s a, that’s a bumpy journey, you know, and, and starting and stopping practices. And, um, and hopefully the patients are following you, but can’t because of distance. That’s a lot going on there. Um, so tell me this, because nothing’s simple about partners in it, especially partners, date, there’s some emotions called as well.

Who’s managing. What, how did you guys figure it out? Like who’s got the right skills for managing the surgery center or the staff or the accounting or the marketing. How did you do the data?

Troy A. Pittman, MD, FACS

Well, I think we both have strengths and weaknesses as in any partnership. And, um, you know, I was much more interested in kind of the admin side.

Um, Mike is very good at the creative side and, um, dealing with vendors, he’s kind of like the, the best PR person for the practice. And it was really, I wanted to manage the staff. I wanted to we’ll work on the numbers and, and the surgery center was really my passion project. And when I said to, and I said to Mike w we should open a surgery center, he was like, I think that’s a great idea.

You will run it. Um, so I think that it’s really about finding, um, who is good at what and capitalizing on it.

Michael T. Somenek, MD

Troy kind of summarize that. I mean, he, he definitely loves the HR aspect of the practice. I don’t, and, but we work together and you kind of figure out your strengths and weaknesses. And, um, we have a small family at the office and we have a, now I think we have what, 11 employees.

And so, we’ve certainly grown in the past couple of years. Yeah. You start to see even more of what your strengths and weaknesses are as it grows into from this like small little, two employee practice to 11 employees.

Catherine Maley, MBA

The question that comes up a lot lately is this surgery center due to COVID. A lot of you got bumped from hospitals and the patients weren’t excited about going to hospitals or public places.

When did you decide to open your own surgical center? And what was that process like? And how long did it take and how over budget did it go?

Troy A. Pittman, MD, FACS

When we, when we decided to open, um, no one even knew what the word COVID was. So, it takes really about a year from looking at a feasibility study to, to starting to really build.

There is a year of work that goes into that. And that was a manifestation of, we needed to get the space. We needed to figure out how we were going to utilize the space. Um, and so we really planned for a year or so to give, to give a brief timeline. It was April of. 2019 when we said, okay, we’re going to open a surgery center.

And we started planning and the construction was slated to start in February of 2020. And so that’s 10 months later, um, we were starting construction and they had just started demoing the space. All the contractors were in place. The plans were there, the consultants were there. The McKesson account was opened and, and COVID happens.

And we had to shut down the office for six weeks, right. When things were getting really crazy, we were, we shut down the hospitals basically shut us down. Um, we shut down our practice for April and half of may or what was it? April, basically half of March and how, and the whole month of April. But during that time, we were building.

Um, and the irony of that is there was a day when there were two anesthesia machines in the waiting room of our office. And I thought we would never be able to be open while we’re doing this. Um, but, but they kept building while COVID was happening. And the scariest thing about that was. Here. We were slated to do our first operation.

On June 3rd, we were worried that the mayor of DC wasn’t going to allow us to do elective surgery. And we were also thinking is any we’ve now spent all of this money. Um, we did not go over budget. I’m happy to say. Um, but I think COVID had a lot to do with that. You know, the, the, the marble counter that you’re going to have ends up being quartzite, because you don’t know what the budget’s going to do.

So, I think we really knew that we needed to be, we couldn’t be extravagant with spending because we didn’t know what was going to happen in June. So, so it was scary. I mean, it, it was six months of we’re building. This is anyone gonna really come.

Catherine Maley, MBA

All right. So, while you’re fielding this, are you still, are you also practicing in that same office?

So, is your surgery center attached to your practice and attached to your med spa? Is it all in one location or were you shuffling back and forth?

Michael T. Somenek, MD

Yeah, we were, we were fortunate enough to have adjacent spaces that we were able to acquire. And I mean, we’re in a, we’re in a medical office building. And so, the likelihood of two spaces next to us opening up or becoming available was, um, quite extraordinary to say the least.

And one that was large enough to accommodate a surgery center. So, they were able to. Sequester the building of the surgery center, where we were able to move on with normal out daily operations and not be totally affected by it. I mean, there obviously were some weekends and some Fridays and Mondays where, uh, they would be working on things where we’d see overflow of the construction in the waiting room, but all of our patients were very understanding and we put a sign on the door that said, We are undergoing a facelift, excuse the construction dust to kind of make a little joke of it.

And, and people really understood.

Catherine Maley, MBA

Are you loving it? Are you loving the convenience of it? Um, what are the pros and cons? Let’s put it that way. What are the pros and cons of having your own surgical?

Troy A. Pittman, MD, FACS

Well, you know, it is, it is like operating out of your house, um, because it’s all there for you. Uh, all of the scheduling issues that we would, uh, fight at the hospital about block time.

I can’t even remember what block time even is anymore because. When we need to schedule something, we just put it on the schedule. So, you’re completely in control of your own schedule. The hospitals don’t want us. And I think plastic surgeons need to realize that in, in cosmetic, um, cosmetic surgery is a money loser for hospitals.

It is a moneymaker for doctors. Um, and I used to say to surgeons all the time, you’re not going to get rich with an office-based surgical suite. You can open a store. Room or, and have orthopedics come in and get a certificate of need and make it, make it huge. But if you want to have a surgical suite that is for you and your practice, you’re not going to make a ton of money on it.

What you’re going to make money on is what you’re able to offer. The patients. Patients don’t want to go to the hospital. They want to fly private. They want to be taken care of and being able to, when Mrs. Smith comes in and says, I want to have my breast lift next Friday at two o’clock there’s no one to call.

If the Omar’s available, you put her on Friday at two o’clock time. Kills all deals. Especially with cosmetic surgery. And so that at time of going back and forth with the hospital where you’re calling the hospital to see if that’s available, you’re calling the patient back to say, that’s not okay.

Available pick day. Number two, as all of that goes back and forth, the patient is starting to second guess their decision. And so, we’re able to streamline things from a time perspective. Definitely helps convert.

Catherine Maley, MBA

Did you have any also that your surgeries are faster now because you’ve gotta be more efficient.

You have the same player, same tool. They’re all in the same place. Um, do you find them?

Troy A. Pittman, MD, FACS


Michael T. Somenek, MD

Yeah, there’s so much more predictability with it, for those exact reasons. I mean, we have the same surgical assistant, the same nursing team. They know which instruments may want. Everything is ready. No, let me go look for it.

Oh, we don’t have that today. So, we just really have a very streamlined process.

Troy A. Pittman, MD, FACS

Yeah, and it comes back to that whole thing of control. Plastic surgeons want to be in control. We wanted to control the patient experience. And so having patients come to our office and they, you know, they see this beautiful office they’re taking very good care of by the staff.

Once we went to the hospital, we lost all of that control. It wasn’t our brand; it was the hospital. And so now we’re in control of that entire patient experience.

Catherine Maley, MBA

Yeah, I couldn’t agree more. Uh, so regarding the business side of plastic surgery and the AR what’s the most frustrating part about managing this whole operation?

Michael T. Somenek, MD

I would say managing it. It’s, you know, it’s definitely, you are in charge when something breaks, you are in charge. So, um, thankfully Troy has really taken on that role. We kind of joke sometimes. Cause sometimes we’re like, uh, this machine isn’t acting and he comes in and he’s sort of the in-house mechanics sometimes for us because our technician, because he really understands how to do it.

But you, somebody has to know how to do that on site. If you’re going to plan on having your own surgery center,

Catherine Maley, MBA

what do you think about when you’re, when it’s time to scale? Troy cannot be the manager of the service. The repair man. I mean, eventually you’re gonna want to get out of that. If you read any of the leadership folks, they will tell you you’ve got to do what you do only and delegate the rest.

Do you feel like that’s where you’re heading down the road or, oh, do you have an office manager by the way or a surgical?

Troy A. Pittman, MD, FACS

Yeah, we have both. Um, and our surgical ORM manager really does, um, more she’s in charge of ordering. She does kind of day-to-day logistics things, but, um, you know, there isn’t, we don’t have an in-house anesthesia.

And so, um, you know, there are days when something is going on with the medical gases. And one of us has to know how to do that. I don’t think that, um, when you’re running a small organization like this, I don’t think it’s practical to have one single person. Running with each cog. You know, I do think that the, the beauty and the burden of being in this type of surgery situation surgery suite is everywhere.

One is doing every job or at least can do every day. There are times when the nurses are taking care of a patient in recovery and room turnover needs to happen. It’s not like the hospital where there’s a janitorial staff sitting there waiting to mop the room. If the room needs to be cleaned and the nurses are taking care of a patient, I’m mopping the room.

Um, I don’t like mopping there. I don’t choose that, but those are things I don’t think it’s realistic to think you’re going to have a single person in every role and still be able to run fiscally responsible.

Catherine Maley, MBA

I understand that. Yeah. Uh, so tell me, what would the most surgeons have said to me? Their biggest frustration is staffing people, human beings.

We are beings with emotions and corks and all of that. Any tips on how you’ve managed to hire fire motivate and keep staff happy?

Michael T. Somenek, MD

I think we’ve come a long way. We’ve learned a lot along the way. And early on, we didn’t have a lot of turnover, but we had more than we wanted. You know, there was like two or three staff members that ended up leaving, um, for, for various reasons.

And we have now over the past, probably six to eight months developed an extremely strong cohesive staff. And, and employee base. And I think a lot of that we’ve always valued our employees. That’s nothing new that we just started to improve, but it sort of fulfills it, you know, when you start showing them that you really appreciate them, which is various tiny things.

Incentivize them like, Hey, we got some skincare samples. Does anybody want these, take them out to happy hour? Just do some really nice group activities with them to let them know, like we are all a family and every staff meeting that we have, we let them know, like, they all mean something to us. This isn’t just like, Hey, you’re disposable.

And we never want anyone to think like that. So, I think having that attitude on a daily basis, And having a good attitude coming into work and not having this like sour puss on, on your face because we are the ones that really set the tone for the rest of the day. I think kind of bringing all of that in creates a very happy, um, office staff, basically.

Catherine Maley, MBA

For sure they want to switch to marketing now because I love talking about, I love talking about business, but I also love talking about marketing and you two are very good marketers. Um, everyone should go check out some of their magazine ads. They’re very creative and they’re real eye catching. They’re very good.

Was that you, Dr. Somenek? Was that your 2 cents on those?

Michael T. Somenek, MD

You know, what’s so funny is that a lot of those ideas are Troy’s because he sits in the evening. And I think he thinks of these things, watching various TV shows and commercials, and we kind of talk it out loud. And then all of a sudden, the next morning he’s got some tagline and it’s really worked out beautifully, but we do work together creatively to come up with these ads to make sure that they come out the way they do.

Catherine Maley, MBA

Hmm. So, what’s your, do you have a marketing plan or you’re winging it? Are you very good at, um, like repurposing content? What’s your, what’s your marketing?

Troy A. Pittman, MD, FACS

Yeah. I mean, we really try to, um, I mean, our marketing campaigns are planned out basically for the year and we kind of know what we want to say. I cannot take all of this credit.

I think one of the biggest resources was, um, a book called creating your brand story. And it was written by a guy who was a film writer. And it was basically about telling a story and making the patient the hero of the story and the plastic surgeon, the, um, the best friend of the hero that gets them, where they want to go at the end.

But through that process, you ask yourself a lot of questions is what are we, what are we trying to say to the patient? I think people really go awry with marketing when they make it, um, when they make the plastic surgeon, the hero of the story, it’s a turnoff to people. It really needs to be how are we going to help the patient get to where they’re going and how are we going to make that an interesting story.

So, so much of our marketing, um, I think you have to know who you are as a brand. Um, and you, we had marketing companies that we worked with that we continued to fire because everybody wanted to make us into something that we were at and they were trying to deviate away from our brand. And so, at the beginning of any marketing idea, when we’re brainstorming.

It all starts in, is this story worth telling in an ad or a campaign? And is this something that is going to resonate with potential patients? And is it on brand?

Catherine Maley, MBA

Which marketing channels are you using? And I asked that because if you’re, you’re doing like, um, Thiess breast body rhino. So that means you’re covering every gender age group.

Um, and you know, from what I’m a director, Copywriter person. So, I don’t talk to everybody because then you’re talking to nobody. How are you working at out? You know, how are you, how are you doing that? Because that takes some money and creativity. If you’re gonna, you know, it’s all about message marketing channel.

And, uh, what’s the other one message I can’t remember, but you’ve got to talk to the only that one target market or your neck, your, because they only hear what they’re interested in. So how are you making that?

Michael T. Somenek, MD

Yeah, that’s a really interesting question. Cause it’s, it’s certainly thought out on our part.

And I think, uh, the thing that Troy said earlier is brand and, you know, we base everything off of our brand. So, we, I, we interestingly spend a reasonable amount of money on print and local print, and that has worked out extremely well because we’ve positioned ourselves. In the, the higher end, more popular well-read magazines that are respected in the Washington DC area.

And so, because of that, I think we get a lot of traction with that, and we’re not directing our marketing at any specific demographic in those ads. Um, we’re just trying to, um, really demonstrate our brand, which is luxury concierge care when you come to our office. And, uh, I think that resonates with a lot of people.

So, it’s been an organic buildup and it’s very different than what traditional marketers will try and advertise or tell you, you need to do, which is you need to target this market or this age group. And we’ve kind of gone against that and it’s worked out very well. Well for us.

Troy A. Pittman, MD, FACS

Well, I think one of the things really also is.

Is the concept of brand awareness. And knowing that in that there is all of this noise, whether it’s social media, print, marketing, internet marketing, there is a YouTube, there’s so much noise and people are constantly being bombarded with different things. And we have so many patients who will call one of our biggest ROIs is Washingtonian magazine.

Which is kind of our, our cities magazine, which traditionally, everyone said, you’re wasting your money going into print. No one reads that magazine. I would say that for five of our Washington, it’s five to one, five Washingtonian leads to one lead coming from somewhere else. But a lot of it is I was on Facebook and I wanted to know who is the rhinoplasty guy to go to.

And Sominex name came up three times. Then I opened Washingtonian magazine. There was some INEC boom. So, it’s about positioning yourself where you’re visible in the right places. You’re not, you don’t want to be visible in the little throwaway neighborhood magazine, unless you’re really targeting that neighborhood.

Catherine Maley, MBA

For sure. I must say though, you’re going against the grain in today’s world. Print magazines are just unheard of because you can’t track the darn thing unless you’re willing to put in, you know, your free report all today, and then you would choose a fallen tracking number, but you guys are. I see why it’s working for you because you’re so intent on your luxury brand.

That’s attracting luxury patients. So, you’re probably the only people who see you are the ones you want, you know, you, you want, um, you know, you want somebody reading the Washingtonian who wants to, you know, recover it, the fear that the Fairmont. So, um, but would you say, are you sure you’re able to track everything?

Like if I were to ask you, where do you think most of your patients come from? What would be your answer? What are the top three marketing channels working the best?

Troy A. Pittman, MD, FACS

Word of mouth is number one. Washingtonian is number two. Um, and we do that. We do work with a marketing company called blue shark, or they’re blue sharks, the parent company they’re called med shark.

Um, and they designed our website. They, um, they, and they’re our marketing people. They, we go to them with marketing ideas, but they track everything. So, we do have a phone number for every single, um, print ad that we do. The website, phone number changes every day. Um, and, and then there’s a program called call rail that we use.

And so, I can tell you with a click of a button, how many patients called in the month of May from Washingtonian, not even from Washingtonian, but from that one ad in Washingtonian, because we use a different phone number for every single touch point. Instagram has its own phone number. Facebook has its own phone number.

So, we know where those leads are coming from. Other than the people who dial our main published number, which most of those are kind of word of mouth.

Catherine Maley, MBA

Um, I think for anybody who’s not tracking, like you’re doing, you’re such a disservice in today’s world, you can’t afford to be Willy nilly about these leads.

You’ve got to know who’s calling from where and what happens to them after they call, did they book, did they show up the day of surgery? Did anyone follow up with them afterwards to, you know, get them back in again. Um, do you, do you have all that cover? Because I really think that’s going to be the leverage in today’s world.

It’s too. It’s too crazy busy out there to just do the burn and churn kind of thing, I think.

Michael T. Somenek, MD

Yeah, no. Over the past couple of years, we have developed many systems to track, basically everything. And it’s not, it’s not one program. You know, we have our coordinators that created very detailed Excel sheets, which tracks our conversions.

What’s happened to the patient when they’re thinking, et cetera, we have our front office that. Tracks the leads as well. How many? I booked an appointment; how many have booked treatment when they come in? So, everyone is sort of doing their own task and it, it collectively comes together into one big tracking document, but it’s not just one person tracking everything.

Catherine Maley, MBA

Right. Um, by the way, do you ever track the revenues by procedures? So, do you know the difference between your surgical versus nonsurgical revenues?

Troy A. Pittman, MD, FACS

We do, but it’s not a, it’s not an exact, uh, I wish I could tell you it’s this percentage, this percentage, one of the things, what advice that I would give someone who’s looking into surgery center.

Is, you have to keep those budgets separate. You need to know what’s happening in the surgery center. You can’t have the med spa coming in and stealing surgical supplies to bring back to the med spa. Um, we do keep everything separate. Um, we obviously know what the revenue into the surgical suite is and the med spa.

We know what the, what the costs of doing business for each of those organizations are. Then we kind of know our whole. Our big number and we keep those cost centers very separate. So, we know what percentage is surgery center. What percentage has med spa? What percentage is non-invasive office injectables?

Um, laser treatments, things like that.

Catherine Maley, MBA

Good for you because I think you have such an opportunity to, you’ve already built the umbrella. Aesthetic needs of a patient. So today they come for a tummy tuck. Tomorrow is the facelift. Then they’re back to the med spa for laser skin treatments. Um, art, have you been good about cross promoting to the various profit centers?

Like arrows? Keep going back to another one when they’re done with that one. Are you good? Are you good at that? Because I think there’s so much leverage there.

Michael T. Somenek, MD

Oh, yeah, I agree. A ton. I, 100% with that, because with all my patients, they may come in for injectables, but they know you kind of learned throughout the process of your consultation or whatever you’re coming in for what we offer within the practice.

We have, you know, TVs that aren’t just selling. They’re more educational. They’re showing some of our before and after’s. They’re educating you on some of the treatments. We have our staff really onboarded to. What we offer, understanding the treatments, being able to explain it almost like we can at some times.

And so, whether they’re sitting in the waiting room or sitting in a room when we leave, whoever is with us, whatever clinical assistant is with us, we’ll say, Hey, here’s a menu of services to our med spa. If you’re interested in exploring that, and everyone knows that not to be salesy because we’re not like that.

We’re both of us, our personalities are just very matter of fact, when someone comes in to see us, I tell you what I think you need. I don’t try and say, Hey, we could do this or that. Sure. There’s an upsell, but in a very non sell-y way, if that makes any sense.

Troy A. Pittman, MD, FACS

Yeah. You know, I think I learned this really from Mike because coming from the university, I can remember the first six months sitting in my office going, I’m a surgeon I want to operate.

I want this patient to come in. I want them to have their operation. I want them to go. And that’s very much how it is in the university. And, and Mike really opened my eyes to how to run a comprehensive, um, aesthetic practice, which is surgery is one-third of that. And there are two thirds of other things, unless you want to hit these patients one time and never see them again.

Um, you have to be able to offer something more comprehensive and, um, and, and that’s really what we have built the practice around.

Michael T. Somenek, MD

I will note that he did say I was right at one point during that time,

Catherine Maley, MBA

I’m going to edit that for you individually. You’ll always stand for lifestyle. So on. So back to marketing, I noticed that you each have your own Instagram.

Um, so how is, so regarding your branding slash marketing, um, you have the same website, you share a website. Do you also have separate websites that I didn’t see or do you have one? Okay. One website, but, but Instagram is your own, right?

Troy A. Pittman, MD, FACS

We pretty much have our own Inns. We have our own Instagram and we have a, we have a DC dynamic duo is our combined Instagram.

Um, but you know, it’s, I think that there has to be a way to reach out to patients. Um, Patients who want to have their breasts done. Um, we w you know, I really focus on that and it’s worked very well. It didn’t when we were trying to combine things, because we started out with separate everything, and it was very confusing to patients.

And so, um, we were able to combine everything, but social media, we could never find a way to make that authentic and have both of our individual voices.

Catherine Maley, MBA

Yeah, it comes across in your Instagram. I can see your two different personalities. And I liked that a lot because I, I want to know you as a person, each of you also, I want to know you as a practice and a brand, but I also want to know his personality.

So, I think that was a good move on your part. Um, what would you say, uh, you know, looking at what you’ve done so far, what would be your advice to others who want to? Open up their own practice, open up their own, or run a bunch of staff, you know, that they’ve never done before. Um, well, I actually, I should have said, did you study this?

How did you figure this out? Did you read books? Did you go to courses? You know how to run a practice, how to run a business, um, leadership, any of that? How did you get there?

Troy A. Pittman, MD, FACS

A lot of it was intuition. Um, we were not afraid to ask for advice. Um, you know, I have a little advice. We each have our own little advisory board of other surgeons that we, that we see at meetings that we call for advice.

Um, what would you say, Mike?

Michael T. Somenek, MD

Well, I was just thinking when I, when I first started the practice in 2017, it was funny because I was like, okay, I’m going to do this. And I’m going to find a space. And so, I marched myself to PNC bank and I met with like, you know, two of their loan officers. And I said, I want to.

A business. Well, do you have a business plan? I said, uh, what? And they said, you need a business plan before you apply for a loan. So, I marched my butt back home. I got to reading on a ton of things and I wrote a 20-page business plan over the course of about a week. And in writing that business plan. I became acquainted with what it means to run a business, what the consumables, what the expenditures are, how much money I could expect to make within the first couple of months.

And I kind of learned that portion just on my own by doing research and everything else heard of came by trial and error. And occasionally I tend to a lot of conferences as well. So, I would go to some of the practice management things and listen to a few lectures and pick up some girls. But. You know, that’s the one thing I would say for someone that’s starting out a practice is starts small.

I wouldn’t buy an empire to start off with and gradually build from there and really have a business plan in mind. What do you, where are you going to be in one year, two year, five years? And it will become much clearer to you and much more attainable to you. If you follow that type of algorithm, rather than going and spending all of your money, looking at an empty office and going where all my patients, I have 20 staff members.

What did I do to myself?

Troy A. Pittman, MD, FACS

Hm. And that’s really one of the, one of the things with when we come out of training, um, particularly, so you spend your whole residency with patients, just magically coming out of the woodwork. They just are there because you’re a resident and you’re operating on your attendings patients.

And for me, going into academics the first day that I opened my office doors at Johns Hopkins, I was at Johns Hopkins. So, there was a line of patients out the door. And I think that. In private practice, you have to, you have to have the fortitude to know the patients are not lining up outside the door, but you have to take those moments.

It is a time in practice when you’re first starting, where you can do a one-hour breast augmentation consult. You can spend time. Really honing your craft. Do you have a, you have a lot of free time where there are no patients where you need to answer these questions? Who do you want to be? Who are you?

You have to be authentic in, in this, particularly with marketing, because if you’re phony, people will see right through it. Um, and there’s, we, we built the practice because there were times, you know, for me, I did a lot of the marketing and a lot of the admin things, because when I first started, I didn’t have any patients for the first six months.

I was, I was seeing two patients a day and I’ll have nothing on my, uh, I had nothing but time on my hands. And, um, you need to be able to have patience and that comes with not overextending yourself fiscally and knowing that you don’t need to build a palette. Patients want a nice clean office. They don’t really care that it has a babbling Brook in the middle of it.

Um, so, you know, for people starting out, I would say you, you have to have a lot more patients than you have in the university or coming out of residency because there’s gonna be those times where. You really have to sit there with your toes curled in your shoes, but plastic surgeons are not, these are not failing businesses.

I don’t know a lot of starving plastic surgeons and perseverance will bring success. It sounds a little, you know, a little cliche, but I do believe that, well,

Catherine Maley, MBA

I will tell you from experience, um, because I’ve been around a long time, it was a lot easier before, a lot easier. And you guys didn’t set up shop in the middle of.

Nowhere. I mean, you went to one of the most competitive areas in the country. And you have some pretty big, heavy hitters there. So, you had the confidence to go somewhere where you’ve got to carve out your niche or niche, as they say. And, um, were you at all worried about that? Because it used to take, you know, it used to take 10 years to build a practice, and now you have about 10 months to do the same thing and their expectations are ridiculous.

Um, the patients are so different now than before. Um, did you, were you that confident that things were going to work out great and in such a competitive arena?

Michael T. Somenek, MD

Well, before I had started the practice, I was with a plastic surgeon within the area for two years prior. So, there was not, not that I was this huge name in DC by any means, but there were some name recognition.

I had some patients. So, I knew that when I opened the office, some patients will be calling. I didn’t know, it would be. Two patients or 10 patients a day that would be calling to get an appointment, but patients did follow me and I am forever grateful to them because that they trusted me, you know, to seek me out, Google me, be like, where is he?

I need to find him. And that really just built on itself. So, I think for that reason, I was never really scared starting the practice. I was sometimes confused and wondering what’s the next step, but I wasn’t really scared. That’s not something that.

Troy A. Pittman, MD, FACS

I got scared.

And not talking personalities, you know, I always joke that there could be a hole in the bottom of the boat and I’m shoveling water and Mike’s like, it’s going to work out. Something’s going to plug the hole in the boat. But yes, you know, one of the things I want to say, Catherine, because this is something that you write about.

And I think it, it really resonated when I read it, is this, you know, you said we’re attracting the patients that we want to attract. Um, We, we had consultants when we started practice, started the practice who we were coming up with a fee schedule, and we came up with kind of a rudimentary fee schedule, but we realized very quickly that you cannot compete on price.

And this is something, you know, you wrote about in the spring was you have to really compete on, on quality. And we knew very quickly that we weren’t going to be the, the cheapest in town. Um, but we were going to take the best care of the patients and we wanted to provide a great patient experience. And with, with training the staff, You have to have the staff.

We believe in the staff, it’s much harder to get the staff to believe in you. And that is about how you treat the staff. Um, and because our practices, our name, they ha they kept it. Because they won’t promote you and the patients will see through that. And so, we needed the patients to fall in love with, we need the staff to fall in love with the brand before the patients could.

And so, it is about providing that concierge, that quality to the patients, patients know coming into the office that it’s going to be, it’s going to be pricey, um, when they’re shopping around. But we consistently have patients say, This is the best practice. The F the way the phone is answered, the way the staff treated me the way the coordinators treated me and, and it’s worth it.

Um, and I think that that whole statement of compete on quality don’t compete on price. If there’s anything, anyone takes away from things it’s truly that.

Catherine Maley, MBA

Well, you know, it’s funny, I assume. Um, when I consult, you know, throughout the United States, uh, actually, uh, I’ve been to Australia as well, consulting, um, I always say to the staff, make sure your doctor takes you to the Ritz or, or in your case, the Fairmont, because that’s what we’re striving for.

We don’t if, well, it depends. If you’re going for quality, the staff has to know what quality is. And a lot of them haven’t been to a rich or a Four Seasons or a Fairmont. Um, they, I really, I’m all about role modeling, you know, I mean, role model, what you want to see, but show them what that means in real life.

What does that mean? Because the Ritz is so much different than the holiday Inn. It’s just a night and day. And I don’t know if a lot of staff get that, you know, without seeing experiences. Um, so let’s talk about how in the world do you two work together and live together? I can’t imagine all of that together time.

I haven’t, I don’t have that kind of a personality, but it seems to work for you. You’ve been at it forever, but what’s that like, how do you figure all that out?

Michael T. Somenek, MD

Well, I mean, for us, the transition wasn’t as, um, I would say black and white as like, you know, all of a sudden, we start working together. We trained together for a while in Chicago.

So, we did have that functionality of. Um, operating together and seeing each other in the hospital on a daily basis. So that was kind of familiar to us. Even with that, we know plenty of couples that were in the same predicament as us and they cannot work together. So that does not mean just because you trained in the same hospital that you can go into practice together.

You know, we share, uh, the collective goal, uh, within our practice of success and the brand and all of that stuff. And I think that that makes it much easier for us to show up together at the office. We drive separately, by the way.

Troy A. Pittman, MD, FACS

Um, not just like me, that’s the thing that see, that’s the thing that saved us.

Michael T. Somenek, MD

Yeah, it saved me.

It saved. Yeah, because I like my radio. I like my coffee, but you know, um, it’s also about setting boundaries and expectations. And when we first started together, we all too commonly got in the habit of coming home and talking about work even into the hours where I would normally have a glass of wine and watch TV and decompress.

And it got to the point where I said, This isn’t working for me. I think we need to shut it off at some point and just enjoy each other aside from work. And we started doing that very early on. We didn’t let it go on for very long, but since we started doing that, I think it does create this nice reprieve for when we do come home, it is separate from work and we aren’t always working around the clock.

Sure. There are some evenings that both of us are working on separate things related to the office, but we’re not sitting there talking to each other about work constantly. And I think that is extremely important and a make or break for so many people that want to do what we do.

Catherine Maley, MBA

Dr. Pittman. Any comments on that?

Troy A. Pittman, MD, FACS

I mean, I think, you know, as I’m hearing this, one of the takeaway points. Is in practice. When I talk to people who are either leaving their current practice, or there are these practice breakups. So many times, it’s due to poor communication and due to people being really afraid to have a difficult conversation.

And so, you start harboring this internal resentment to the senior partner because you can’t really call them and say, Hey, I think your idea stinks. And I do the thing, one of the nice things about being in practice with your spouse is we, we like, we know how to have a hard conversation with each other and, you know, he, Michael will say to me, um, I think that idea is absolutely preposterous or what you did today at work was completely, um, was completely off.

And so, you kind of, you can’t have that conversation a lot of times with your partners that you’re not intimately involved with, however, we should be able to. And I think if there’s any takeaway from that, it’s, don’t be afraid to have hard conversations, um, because we have them all the time and we’re not afraid of that.

Catherine Maley, MBA

Uh, I wish people talk more real. I mean, I, I, I would cherish if somebody would tell me you’re acting like an idiot right now, you know, because you know, when you’re in practice by yourself or you run your own show, um, I just feel like half the time you’re just surrounded by yes. People that they know.

Tell me that, tell me, is this the stupidest idea? Uh, one of the stupidest things. I really appreciate that myself. Um, so where are the dogs right now? Because you have two adorable dogs that I saw on Instagram and I first thought they were chihuahuas, but they’re not what are they?

Michael T. Somenek, MD

Oh, I got their Chihuahua Yorkie sisters that we rescued, um, about two years ago from a foster home.

See, we’re about to send their DNA away probably next week. So, we may have an update for you if they, our Yorkies or there’s something totally different.

All right. Now I see the Yorkie in there and I, because I saw the two and, oh my God, they’re adorable. And what are their names?

Sophie and Piper. And they couldn’t be different from each other, which is the funniest thing.

One’s like a little skinny Minnie and the others like a little bit fuller figured we’ll call it.

Well, it’s funny you say, because they’re down there in the kitchen right now and I have my headphones on, so you can’t really hear them, but they have barked occasionally. Cause you know, they have their view of the backyard. So, they’re yelling at all the neighbors and the neighbors’ dogs.

Catherine Maley, MBA

Oh my god. I love dogs.

I like dogs a lot. I can get along with dogs. They’re great. They let me talk. Don’t you love when they look at you and they tilt their headlights. What do you say? Um, any, any last words of wisdom for any other surgeons out there thinking about doing what you’ve done, any of that?

Troy A. Pittman, MD, FACS

Just do it. Um, stop talking about it, stop thinking about it.

Um, take that first step and, and do it. Uh, it’s not it isn’t rocket science. We all know how to do surgery. Um, running a business is, is so challenging, but it’s so rewarding. And, you know, I just taught a course at the aesthetic society meeting on building your own surgery center. And the, the, the biggest thing was talking to people who just can’t, they can’t get past the feasibility study because they’re like, I just can’t do it.

I can’t do it. It’s too expensive. And it is totally attainable. And it is the future of where we’re going with a set of medicine. And so, stop talking about it and do it. That’s my advice.

Michael T. Somenek, MD

Yeah. I would say, just believe in yourself and none of this builds itself over. Particularly people will, I don’t want someone to take from this, like, oh, I’m going to put a really killer ad in a print magazine that really doesn’t work.

It really, your brand specifically takes time. You really have to water it and nurture it and be consistent about it. And before, you know, It will just be building on itself, but we’re not talking 30 days later, we’re talking 30 months later, you know, in some cases that you start seeing the fruits of your labor, but, but it will come just believe in yourself.

Catherine Maley, MBA

My new, my new tagline is be patient getting patients. Like, it’s not happening overnight. Everybody. I don’t care how much money you throw at anything TPC, any of it. It takes, it takes a minute, you know, for patients to get you and you get them and you figure you out and who you want in there with you. Oh, it’s a lot to do, but good for you.

I agree. Just doing, I don’t think I’ve ever heard of a practice that folded because of like the DOR, you know, there were other reasons it folded, but typically. Um, it’s obvious why, but, um, no, I think you, you figure it out, especially when you do have a lot of money on the table and you figure it out, you don’t get some help.

So, thank you so much for being on beauty and the business. I really appreciate it.

Troy A. Pittman, MD, FACS

Thank you, Catherine,

Michael T. Somenek, MD

Catherine. So good seeing you. Thank you.

Catherine Maley, MBA

You too. I hope to see everybody again. I’m finally, I haven’t been out yet, so, um, I am willing to, um, be at the global meeting in Miami, in November and there was another one coming up that I can’t remember.

So, I’m going to be out so you know this year, for sure. All right. Well, thanks. Bye. Bye everybody. Thank you so much for joining us. I hope you appreciated that. And please, if you would head over to iTunes and go to beauty and the business and subscribe, and if you care to give us a five-star hotel, five-star review, um, also if you’ve got any questions or feedback for the doctors, what’s your website.

If you want them, if somebody wants to get ahold of you, how would they do so?

Troy A. Pittman, MD, FACS

You’re going to have to spell your last name.

Michael T. Somenek, MD

Oh my God. I know nobody can ever spell my name even though it’s not that complicated. It’s actually, so are my email. I think email is probably the best way to do it, which is D R Somenek, [email protected].

I’m sure they do. Do that three times in a row.

Catherine Maley, MBA

I’ll put that in the notes. Okay. And how about you? Dr. Pittman?

Troy A. Pittman, MD, FACS

And mine is doctor Dr. Pittman. [email protected]. Or if you go to DCDynamicDuo on Instagram, you can find everything you need to know from that. And it’s easier to remember DC dynamic duo.

Catherine Maley, MBA

Love that. All right. And mine is Or you can find me, you can DM me on Instagram at CatherineMaleyMBA. With that. Thanks so much. And we’ll talk again.


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Catherine Maley

Catherine is a business/marketing consultant to plastic surgeons. She speaks at medical conferences all over the world on practice building, marketing and the business side of plastic surgery. Get a Free Copy of her popular book, Your Aesthetic Practice: What Your Patients Are Saying View Author Profile.


Beauty and the Biz is for Plastic Surgeons who know they don’t know everything and are open to discovering the pearls to grow and scale a sellable asset when they’re ready to exit.

Listen in as Catherine interviews surgeons who talk about the business and marketing side of plastic surgery and listen to Catherine’s pearls from consulting with plastic surgeons since Year 2000.



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