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Ep.47: Private Practice COVID-19 Survival with David Sieber, MD

Private Practice COVID-19 Survival

Listen to the unique perspective of David A. Sieber, MD in relation to COVID-19 and his San Francisco practice. Learn what’s working for him as Catherine shares her sound advice on making the best of the pandemic situation.

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Beauty and the Biz

Ep.47: Private Practice COVID-19 Survival with David Sieber, MD

Catherine Maley, MBA: Hello and welcome to Beauty and the Biz, where we learn the business and marketing side of cosmetic practices. So, I’m Catherine Maley, your host and author of Your Aesthetic Practice: What Your Patients Are Saying. And today we have a really special guest, Dr. David Sieber, and he is an upcoming or certified plastic and reconstructive surgeon in San Francisco. And he’s been in practice now for over four years. And I’m really excited to get his perspective on things because he hasn’t been around for 20 years. He’s one of the new guys. So, he’s a graduate of Loyola University Stritch School of Medicine and he did a five-year residency in general surgery at Loyola University Medical Center. He then did a three-year residency in plastic and reconstructive surgery. And then he did a one-year stick surgery fellowship at University of Texas Southwestern program in Dallas. Now, Dr. Sieber received an award for best research paper in 2015 by the aesthetic surgery Journal editorial board, and that’s a really big deal because that’s a tough group. He serves on several ASAPs committees. And he’s also a peer reviewer for both the Journal of plastic and reconstructive surgery, as well as the aesthetic surgery journal. And what I really like is Dr.Sieber gives back. He has a special interest in treating underserved patients. And he’s provided medical care to patients in Nepal, Peru and Armenia. So welcome to the show, Dr. Sieber.

David Sieber, MD: Thank you. Thank you for having me.

Catherine Maley, MBA: You’re so welcome. So here are a couple things before we get started, when I was doing some research on you, I realized we have some things in common. And I didn’t realize you were from Chicago, and I’m from Chicago. Yeah. But why don’t you have the luckiest accent like I do?

David Sieber, MD: You should hear my mom is like, I’m you’re probably not going to Costco.

Catherine Maley, MBA: Yeah. My family says, and we’re going he said, god awful. That’s a long a that’s really, I can’t lose it. I’ve been gone for 50, 40 years or something. I’m still talking like big buckets. Actually, I can’t even say deep buckets anymore, because nobody even knows who he is. For all those who don’t know if he’s a very famous football player from dubare. Yeah, funny. Yeah. And you know, what else is really interesting? Your office is at 450 Sutter Street, right?

David Sieber, MD: Yep.

Catherine Maley, MBA: The top floor.

David Sieber, MD: Yep.

Catherine Maley, MBA: My very first client, when I became a consultant to plastic surgeons, my very first client was on the top floor, I believe in your face, or actually next door. And the first thing I did was I moved his coordinator to an office with that incredible, breathtaking view of the area. Because wherever the money is being discussed, and you have to have some on the on, the patients would walk in and they knew darwell what this isn’t going to be cheap. Like they it stopped them a lot from negotiating because we had it set up where this is a first class, first race. And we’re not here to discount so it’s a little small world. It’s a very small room. Here, Lord. Alright. So, like you from Chicago. I assume you moved out here for the weather.

David Sieber, MD: We have for the weather. Yeah. So, we were I trained in Chicago. And then in Minneapolis, it was freezing cold there. So, we wanted to go somewhere. That wasn’t in the south. So, we ended up in California and felt like the Bay Area was a better fit than somewhere like Los Angeles or somewhere else in California.

Catherine Maley, MBA: For sure. All right, so tell me I’m we’re here to talk about– actually, the title of this time is called private practice. COVID-19 survival. We have been longer. We’ve been under shelter in place longer than anybody else. I believe. We went under way early. I feel like I am so out of sorts. And it just never ends. I hear now it goes until June 1 if all goes well. So, what are you hearing and with what’s going on in urine? Because I’m in Sausalito, which is right outside the city. And so, is it any different where you are?

David Sieber, MD: No. So the mayor London breed made announcement yesterday basically saying that Southern place was gonna continue until she said through May. I am we’ll get into this later. But I was on the phone today with the Office of Public Health for San Francisco today. And the date that they gave me was May 31. And then but the thing both from London as well as from Gavin Newsom is neither one of them seems to have a finite end date to this

Catherine Maley, MBA: Isn’t it crazy?

David Sieber, MD: Yeah.

Catherine Maley, MBA: I have been through two recessions, an earthquake in San Francisco, two blackouts last summer. We were involved in those blackouts that was crazy. Luckily, we weren’t affected at all your Lord. And then I think, you know, we have this like, what the heck is going on. All right, and you know what else I realized even when we go back and you’re in a building, that’s not helping because I remember standing at those elevators with hundreds of people, you know, waiting for the bus. How are they going to handle that?

David Sieber, MD: I don’t even know. You know, if you go to summer to get food, they have those actors of marketing. apart, I went into the office on Saturday to pick up my mail. And it was, you know, the security guards there and the building was mostly empty, especially for a Saturday. So, I imagine they’re gonna have to put something to promote the social distancing until we can kind of loosen up on that.

Catherine Maley, MBA: And maybe like only two people in the elevator or something.

David Sieber, MD: Yeah, I don’t know. I mean, you could be waiting for an elevator sometimes for 1015 minutes, and then you can get in sometimes there’s literally nowhere to stand.

Catherine Maley, MBA: Dear, Lord. Okay, well, it’s another challenge. Um, so where are you at with all of this? Did you have to lay off staff what happened to you.

David Sieber, MD: So, I often share with another plastic surgeon. So, there’s the two of us, we have one shared employee, our front office person shared, and then we each have our own piece of care for neighbors. So, I really only have one of my own full-time employees and I she’s still working full time, she does a great job. And she’s worth, you know, paying the money here. In this time, I do have some friends who have huge practices that did have to lay some people off. But most of my friends around the country who have smallish, small to medium sized practices, if they like their employees, still kept them on paper.

Catherine Maley, MBA: I you know, now is the perfect time to keep your overhead down. So right. Good for you. I don’t know if you did that on purpose, or just because you’re still growing. But you know, a lot of these practices have med spas, because we all were surgeons had to open up med spas. And that created 20 to 30, more staff, right once a laser payment, and it just never ends. And I think oh my god, what are they going to do with all these people?

David Sieber, MD: Right before this happened, I was in the process of getting a loan from the bank, I was gonna expand my office, I’m going to move to a different space where I could have more, more space to have injectors and do more things. And then fortunate that this, you know, I hadn’t taken the money and this all kind of happened. And that can kind of, you know, wanting to sort out, I can go back and do it. But I didn’t have to make the payments on loans or anything through all this. For sure. So, you haven’t invested in lasers and I have one, one laser I make payments on. And that’s it. We have two devices. I have a cytomx laser and then I have a laser, which is the four it’s like– Yeah.

Catherine Maley, MBA: Are you doing high definition?

David Sieber, MD: I do. Yeah.

Catherine Maley, MBA: The other laser that you got, is it for facial rejuvenation, laser hair removal, what was it for?

David Sieber, MD: So, a full disclosure, I do some speaking for the company. So, do you know I love the laser even regardless of the fact that I’m probably a little bit biased. But the great thing about the site time is you have everything you need on a single platform. So, it’s a single platform, I have a full shield erbium for basically getting rid of any type of wrinkle. I have a fractionated erbium which is good for scars and some facial rejuvenation. I have bbl which is eight times random IPL which is really good for photo facials interest and damage rosacea, acne, hair removal with it, and treat acne with it. And then I also have their 1060 for laser two, which is good for some basketball feature.

Catherine Maley, MBA: Good for you for getting one multi-Purpose platform and it’s insane. Now isn’t saying all the lasers, I think I’ve consulted a lot on this. And what happens is somehow the doctor ends up at some kind of conference or God knows what. And he has now ordered like, one for laser hair removal one for Yeah. And I always say if you’re brand new, if you’re brand new, go for the biggest procedure possible that could cover like, what’s the biggest thing women especially women have a problem with. And it’s typically a skin rejuvenation kind of stuff, laser hair removal that everybody in the brother handle, and then don’t get the hair transplant thing either like, you know, something that most women have a problem with. And it’s usually spots and dots and you know, wrinkles.

David Sieber, MD: Yeah, and the interesting thing is my practice originally started in the rim. I was there for about a year in the city. And my practice, I was really able to build my practice using my site Time Machine. And the reason for that is because my wife and I don’t know anyone here but only family. We were only friends when we first moved here. So, I needed to be able to do a procedure that people didn’t really need to like trust me for, but they would still come in abilities and results. So, I bought the site on record, do Halo and BB ELLs on patients. Now one of downtime, great results. It’s a way that they can start getting this referral low. And so, Dr. Sieber had a good bedside manner. I love the treatment he did. And that’s really how I built my practice was within these non-surgical procedures. I did not realize you were over here. Where were you? I was in the Golden Age urgent care. Right off request in and out.

Catherine Maley, MBA: Oh, my God. You need to market more.

David Sieber, MD: Hold on, I’m doing now.

Catherine Maley, MBA: But I definitely have had a few halos and it’s good. You did good. Oh, God. That’s so interesting. I don’t know how we haven’t met before. We are like in the same circles.

David Sieber, MD: I know.

Catherine Maley, MBA: Yeah. Alright, so Let me see what else can we talk about? What’s your biggest concern? When it’s a restart? When we finally restart, what are you worried about?

David Sieber, MD: I don’t know that I have like one main concern because there’s really so many moving parts. So recently, the cellphone cases extended to the beginning of May, but at the same time, they’ve now like elective surgeries. But the problem is, is there’s not really any guidance from any of the societies. The American society has any guidance the American study, guide the government doesn’t have any guidance. The mayor hasn’t had any guidance. So today I called the Office of Public Health. And I asked to talk to the head of physician there for some guidance, because I said, you know what, there’s all these different rules, they seem to kind of like contradict each other. And I don’t really understand at this point, what I’m allowed to do and what I’m not allowed to do. And they said, Well, you can do elective surgeries, you that mandate, which is put into place, I think, on March 16, or 18th. until April 7, he said that expired April 7. So, after April 7, we should have been able to do like the surgeries, but I don’t think anyone realized that. And he says, but because of the shelter in place, you still need to shelter in place. Right? So, this doesn’t make any sense. Because one thing is sheltering in place, Elon says I can start doing surgery. So, like, which is it. And he said that the Office of Health is separate from the city and the mayor. So, they have different legislative boards, they make different rules. So, the health orders are the ones that really apply more to our practices. But as long as they’re still rooted in social distancing, if you’re, you know, an older patient, something with preexisting conditions, maybe should be out of the house, you probably shouldn’t be doing anything. But then the hoarding, well, can I start operating? Or is it okay to start seeing patients? So, I talked to all of my colleagues who occurred in the area and kind of see what people are doing. And it seems like most people are going to start operating but not going to offer non-surgical procedures, or they’re not going to see anyone for just a routine follow up who’s doing well, or might have a little thing that can wait until the self in places is that so I think I’m going to start operating because according to the laws, I can, but I’m not going to see anyone for non-surgical stuff yet.

Catherine Maley, MBA: Where are you going to operate?

David Sieber, MD: So, there’s two places I operate. The office that I’m an officer with has a surgery center attached to it. And they’re opening on the fourth the surgeon electric cases again, and then there’s another center in my building that also is going to open for like two cases.

Catherine Maley, MBA: And they are been open for elective cosmetic, because a lot of them are still saying you’re like the elected the cosmetic is on the bottom of the priority list. So what?

David Sieber, MD: Yeah, so the real issue is, and I talked to another past surgeon in the peninsula last night about it was he said, well, what’s the difference between someone who’s had a hernia for five years, it’s not causing any problems, we often have the lack of respect, versus a young woman who’s had kids and wants them breast augmentation. Because what you know, is there a difference between the two? And when I thought about it, I thought I didn’t know there probably isn’t much of a difference between the two. I mean, I was just making a person feel better once helping a hernia, but neither one of them is really virgin.

Catherine Maley, MBA: Do you use their staff, their surgical staff?

David Sieber, MD: Yeah.

Catherine Maley, MBA: I was just on a webinar right before this one. And they were saying even the CDC didn’t give really good guidance about how protective does everybody need to be?

David Sieber, MD: Nobody is. And I think that’s because no, no one knows. And, you know, I today I called the mayor’s office, I talked to the Office of Public Health two or three times, and it’s all the same thing. Like no one really knows how to advise people. It’s all just kind of, well, here’s what this person said, here’s what this person said, but you need to kind of like, figure out what works for you. And if you’re okay, doing that.

Catherine Maley, MBA: My biggest concern for surgeons is you guys have always been a target for the law, the law firm bla, bla, and I’m just cover your butt as much as humanly possible. I, I would be having that patient time. COVID-19 I’m aware of the problem. I’m aware I’m you are held not responsible for I think, I don’t know if it holds up or not. But at the moment, I just I can see that going sideways.

David Sieber, MD: Yeah, and the good news for me, that makes me feel a little bit better is I am antibodies to it. So, I must have had, I must have gotten it. Last month, sometime, I was at a large national meeting run ads and friends who tested positive. And I had some kind of symptoms I was I was really tired. I didn’t really have a profit, a little bit of a sore throat. And then I started spiking fevers. And then I lost my smell in my case, which I know is kind of a path and monic for having COVID. So, I went had my antibodies. I had to test for antibodies last week ago when I got results on Saturday saying that I was positive. So, which is good. I mean, we still don’t really know what that means. And I know a lot of the tests aren’t perfect yet. But based on what we know about the other coronaviruses that we’ve had in humans, it should I mean, it should have some sort of immunity for at least a year or two. So just great. Like get into she got tested but didn’t have the antibodies, which is kind of surprising, because we’ve been stuck in the same house for you know, two months now. So, I don’t know if it is an error in the past or if she just actually doesn’t have the antibodies.

Catherine Maley, MBA: That’s crazy. Is there anything you’re gonna start doing now when you go back?

David Sieber, MD: Yes, we’re gonna treat it just like we were if we were in a restaurant or getting food, I mean, everything I’ve masked on all the time, the surgery centers that I go to we do have a, like a waiver that we basically put together about folded in the wrist and all this other stuff. I mean, the truth behind it is it would be almost impossible to prove that you got it somewhere because we’re we interact with people everywhere. I mean, who’s to say that we could have gotten there on the elevator on the way down from surgery. And at one of the facilities, I work at the entire staff had to be tested to make sure that no one actually has the Buyers when they come back to work,

Catherine Maley, MBA: I’m not totally up on the testing. I’ve been listening to the White House and Como, and they have those new like chip slots. And yeah, they can test quickly? Or do we have an out here in California? I don’t know if we have that yet.

David Sieber, MD: Yeah, we do. So, the city of San Francisco has free testing for anyone who sent them. I don’t, I’m not sure where you go and get the testing. I haven’t looked into it. But we do have rapid testing for the actual active effector the antibody testing is, so it’s kind of new, it’s become more widely available in the last week or two. And that really is, we need a lot of information than that, because it’s gonna tell us who has immunity to it.

Catherine Maley, MBA: Oh, is there anything you’re gonna stop doing when you restart?

David Sieber, MD: Well, the statement said, I’m, like, kind of not concerned about but I’m confused about how I’m gonna do it, or like, a lot of the injectables people come in and they have masks on the whole time, are you gonna drop someone’s lips with the mask on? You know, and I think a lot of it is gonna vary just on patient comfort to what people are comfortable with. I mean, I’m pretty comfortable being around whoever, just because I know I have those antibodies. But, you know, everyone’s so different. I mean, even our people still want to come in and get stuff done. And they don’t seem to be bothered at all by any of this. Probably, because the number of cases and deaths here in San Francisco compared to somewhere like New York are so drastically different.

Catherine Maley, MBA: Do you feel like your patients that? You don’t know, but have you surveyed them at all? And do you have different demographics? I know you have a younger demographic, just because you’re young, you would attract a younger, a younger demographic may feel differently about COVID-19 than– patient, do you get a feel for the majority of your patients? Are they comfortable? Are they afraid?

David Sieber, MD: No, I think the majority of mine are comfortable. I mean, we’re a little [inaudible 16:39] with a lot of like young professionals in their late 20s, early 30s 40s, which is kind of the demographic of my patients. And people around here are still doing stuff and getting together and they don’t seem to really, I mean, they’re following the guidance to a degree, but I think it’s something that’s kind of an A, in the back of their mind, and not really something that they’re actively concerned about.

Catherine Maley, MBA: Well, if you want my two cents, I’ll just give it to you. And take it for what it’s worth everybody. But it seems to me, if there’s any chance, you could come up with some in house procedures that are local, you know, done under local, done in house, and you don’t have to deal with surgery centers. And all that if like I happen to know a surgeon just jumped at anecdotally, there was a surgeon and I won’t say who it was, but he was getting a divorce. And he had two very little kids that he needed to take care of. And he said, how am I going to be a plastic surgeon and take care of kids. So, he got a nanny, and he would go into his office, and he would do little eyelid removal. And he called it a cute name. It had a really cute name that I can’t remember now, but and he was making like, let’s say he was in the Midwest, it was low, like a 20 $500. Right here, we would probably 4000. And they were done very quickly and no risk, little downtime. No, you know, no scarring. It was and he said that stage his practice. So, we’re saying, if somebody thinks that’s a good idea, why not pick a couple procedures you could do in house and try to live off of that for right now? Is that possible?

David Sieber, MD: Yes. I kind of I mean, in with what I do, there’s a really limited number of procedures that can be done, like truly done well, under local, I see a lot of patients who come to me and they say, Oh, I saw this other doctor who can do my life inspection under local, or I had liposuction done under local, but it seems like they missed a bunch of the fat. There’s really limit in what you’re able to do with those types of procedures with eyelids, of course, you can do those under local, but like doing it, you know, I owe people to do breast augmentations that are local, I don’t think it’s a great idea.

Catherine Maley, MBA: Well, but then what are you going to do if you’re not going to do non-surgical, and you’re just going to do surgical, and you hope that everyone comes back. And I personally have a feeling that there’s a rush that’s going to come back, you know, like I’m the usual suspects, but I’ll just devalue and get some more of my Botox and filler like always, and maybe other laser stuff, you know, although even that’s kind of iffy right now, because it really wasn’t all that bad. So, but I don’t know how many will come back. And for real, like the masses, the masses come back.

David Sieber, MD: I had 27 patients scheduled on Monday to come see me. And they were confirmed and registered me and I reschedule them and I just couldn’t reschedule this would be the third time to reschedule them. And I think you know, I saw one quote that at the end of eight weeks, we’re going to lose 80% of the world’s blondes. You know, we’ve been in quarantine long enough now where if you had Botox to begin with, but it’s all worn off for now. So, I think people are really itching to get back in to get back in their beauty routine to do these things. So, one, going back to her talking about a second ago, the one procedure that does infer a little more risk of rhinoplasty because and I guess the rhinoplasty society’s been kind of discussing this a lot about how to handle that and talk to one of the members of Texas about like the intubation process. And basically, what they’re doing in his surgery center is it’s going to be only the anesthesiologist in the patient in the room during intubation. He has his own sort of special math; you need to be patient. And then all applicants circulate the air within a certain amount of time whether that’s 10 minutes or 20 minutes. So then basically no one can enter the room until all the airs that we circulated and then you can go the secret. So once patients intubated, I mean, it’s almost no risk of you getting anything.

Catherine Maley, MBA: Will there be a time limit on how long it takes to do a surgery?

David Sieber, MD: I don’t think so. I mean, the normal kind of safe window is less than six hours, there’s been a lot of studies showing that if you do cases over six hours, increase your risk of, you know, your temperature goes down. I mean, these are some complications. So, I always try to do cases that are sort of a mess. But I don’t think because of this new stuff, there’s gonna be new restrictions on time limits, per se.

Catherine Maley, MBA: Okay, so let’s go to my favorite topic marketing. So, you’ve done a really good job, and you’re one of the younger guys. So, you had to come in and market differently than the good old days. And when you did your fellowship, did you learn about business and marketing during your fellowship? or How did you figure out how you were going to enter this marketplace?

David Sieber, MD: That’s a good question. So, my dad is a CPA. So, he does a lot of accounting. He went his master’s in business. And he thinks it’s amazing that I went through all these years of training, like 13 years, and we didn’t get a single course on a single hour on business or marketing. Because I sit here now as a small business owner, yet I’ve never received any formal training on how to run a small business which is–

Catherine Maley, MBA: There are people like me, because yeah, while you were in that school, I was in Business School.

David Sieber, MD: So as far as marketing goes, what I’ve learned a lot of it’s just been research, I like to research things to kind of look into stuff. I’m very, like data driven. So, what I did is I did a lot of research. And not only do they do research locally, but I talk to a lot of my friends and colleagues, nationally. And what I found is that different in different markets, different things work better. So, for instance, here, a lot of people use Yelp in California, I have a friend in New York, and I asked him if Yelp is good for him out there. And he said, Yelp is where my bad reviews go to die, because no one looked at it. So, a lot of us just kind of trial and error when I first started as I would take some money $500 or $1,000 a month, and I would put it in something. And then I would kind of see how it did. And then because I’m a numbers person, I would track everything. So, I would say oh, you know, I put $1 into this. And I made $4 for $1, investment and $10. So, every patient that comes in, I want to know where they’re coming from, how did you hear about me? Oh, I heard you I find you on Google. So, then I can, I can, at the end of the month, look at all this stuff and say, Oh, I spent this much on Google ads, then this is this is the ROI of ROI gum investing.

Catherine Maley, MBA: Would you say Google Ads is your number one marketing channel?

David Sieber, MD: I know my number one has been my SEO, when I first started, I was kind of skeptical of SEO, because I would work with these companies that would you know, when you first start, you don’t need money. So, you have this little bit of money, you just finished fellowship or wherever you’re a bunch of debt. And then you start practice. And these people say, Oh, we want to, you know, we want to spend 2000 hours a month doing something that’s going to help getting you know, the tail is gonna help you grow, keep trying to do anything. And when I first started, I had my website made by this one company, and they said, Oh, you know, we are good at SEO, we’ll take care of this for you. So, they made this beautiful website. And then Time went by and by I wasn’t really I wasn’t seeing anything because like I said, I would ask all these patients, how did you hear about me? And they would say, Oh, I heard about you in Yelp, or I find you on you know, everybody through a friend. No one has ever seen anything like I found you on Google, you know, breast augmentation popped up. So, then I left that company and joined a new company. And they go well, we looked at all the backlinks and the other people made, there were some Russia and China and that was probably hurting you because of that. So, I was with the second company for a while. And I noticed things were like they grew a little bit and kind of stuff. So, I found this other individual who only does SEO through one of my friends. And he took over and since he’s done the SEO, I’m on the first one to respond to most of the search terms I want to do.

Catherine Maley, MBA: [inaudible 23:35] to all this SEO, it really is content is king, you have to– it’s not a one and done thing. Your website is a living organism. And it’s the it’s the gateway into you, you and that’s why I blog constantly do I don’t blog? No. Do I want to– like the podcast has been number one, the best thing I’ve done for the last two years and the content you get the links you get from it about the content creation is the result of podcasting once a week, blogging once a week, email list every week, like it’s every week, there’s I have a content machine. And that’s how it runs like anybody who says all fit your SEO. And then like if nothing happens, they don’t have an ID unless they’re coming back and saying to you any content, any content, or they’re great, because they understand you. But they should be asking you for videos and q&a. They should they need you. That’s the problem with marketing today. It needs you to market, right. And now you have to be a surgeon and a marketer and a business manager, which is I have but you don’t need to count because your father already is.

David Sieber, MD: That’s right, I’m very lucky. I gotta pass on now.

Catherine Maley, MBA: So, tell me about social media because I realized that if you weren’t on board before, which you are, but if you weren’t you better be now because social media that’s all people can hear about and talk about and just tell me your experience with social media. How much do you what do you do there? How much time you spend on it and what’s your ROI?

David Sieber, MD: So, that’s a good question. So, it’s almost impossible to grin on his face and media. The Tiger is basically done. I think was last November, I think was last November, maybe a little bit before that Instagram update all the policies and rules, which made organic growth nearly impossible. So, I’m up around 54,000 followers or something. And I grew up basically doing organic stuff on finding people interacting with their accounts, you really have to have good content. I think if you don’t have a social media account, now you need to make one. And the one thing I found, especially with my younger patients, who are the average age of my page, probably the same demographics they see on Instagram, which are that 25 to 45 years old, and like 73 to 80% female. And what patients do is if a patient is looking for breast augmentation that day, they’re going to go into Google, and they’re gonna say, breast augmentation, San Francisco, and then they’re going to go on, they’re gonna click on all these people’s pages, and they’re gonna, they’re gonna go to Google reviews, or go to Yelp, and those are all your Yelp reviews, and then they’re gonna check to see if you have a social media account. And the social media account can either hurt you or help you, it’s not really gonna, I mean, it’s not gonna make a huge difference. But if they look at this account, and it’s pictures of your family, it’s really disorganized, they’re really low quality pictures. That’s kind of a reflection of you and your practice. So, what you really want is you want your whole feed to be very polished, very professional looking, if you want any stories, that’s really kind of more of the behind-the-scenes type stuff. But what patients do is they say, Oh, I find you on Google that I like your Instagram. And Instagram is basically another place for you to have more before and after stuff you’re doing. And people will oftentimes come in and say, I saw this one person on Instagram, I thought that was always amazing. What did you do to them, and then you can tell them as far as ROI is around, it’s hard to say because I didn’t spend any money on it. It’s just time, as long as like, what is my time worth. But I get a fair number of people from Instagram. And again, Instagram, like any other marketing tool, and success is determined by geographic location, my friends in Miami, Los Angeles, Las Vegas, and get a ton more people than I do from social media. And I think the reason for that is, is here in the Bay Area, it’s and you can agree or disagree with me, I feel like it’s very much like Chicago and Midwest, where people are politically liberal, but still very personally conservative. So, a lot of my patients don’t want to share their pictures online, they don’t want me to use it before and afters on my on my website or on my social media. So, it’s very difficult for me to get patients who want me to use this stuff, someone like Beverly Hills, it’s a you know, a badge of honor to be on someone’s Instagram page. So, they’re much more willing to share these results. And then you get a lot more people because we’re always looking to these people.

David Sieber, MD: I will say that it could be a limiting belief on your part only because you might be uncomfortable with it. Because you do have a younger group. And the whole world does selfies constantly. And so that the group you’re going after, it’s not like a facelift patient, those those I agree can be a little tougher, but still, it’s just a numbers game, you just keep asking until you get some but it’s so important that I know you can’t bribe anybody. But if you have a really good relationship with that patient, and I just hope it’s part of your protocol, when they’re a static, and the timing is everything on that. Oh, yeah. When they’re static, too. Would you do me a favor? You know how important reviews are in today’s world? Because you know, what’s funny about you is you’ve got 75 Yelp reviews, so you’re not afraid to ask. So, I mean, I mean, that’s pretty amazing. yelp works for you. I’ve been to conferences where the Yelp booth, like they should be wearing armor, you know, material because they’re going to kill them. Because Yelp doesn’t work? Well, if you’re not good at what you’re doing. And especially if your demographic is the younger patient, Yelp is a viable channel for people to go to say, who is this guy who’s really this guy?

David Sieber, MD: Right.

Catherine Maley, MBA: So, you’ve done a great job there. So, I think you could do it. Maybe you’re just not asking on you, but not give you the photos, that’s unusual.

David Sieber, MD: It’s strange, like, with your 25 year old your breast augmentation, and then she comes back for her three month visit, which is kind of usually when I you know, they want to settle, they look more natural. They’re really happy three months. It’s kind of us you want to ask them, and I have you wouldn’t believe the number of my hand, right? I’ll ask them. Hey, you know, just like you found me using my website, look into my gallery and look at my reviews. It’s, it’s very helpful for you, if you’re able to tell others about your experience to review and they’re always like, Oh, yeah, I’d love direct review, no problem. And then I say, Okay, well, I’ll send you basically a link, you just need to click on the link, and I’ll take you right to the Google review page. It’s super easy. And they say, Oh, yeah, I’d love to fill it out. No problem. And then it never gets filled out. And then the other thing is with the photos is they just are embarrassed. I don’t think they want people to know that they did anything. I’ll even have some patients who I’ll ask them and they say, you know, I have this mole right here. I’m afraid someone’s gonna look in your gallery, and they’re going to be able to identify me like, well, I’ll Photoshop them allows me to be there. And they still don’t do it.

Catherine Maley, MBA: Okay. Well, I did go to your photo gallery. It’s very good. And I’m just interested, just keep working it. Keep asking. Yes. It’s a numbers game for sure. And the thing about Instagram And I’m sure you know this, you know, in Canada, they took out the number of followers who have, right. So, they’re going to do that here eventually, too. And you know that it’s very difficult to get any kind of organic reach with that everybody to pay to play. And the thing that doctors don’t understand is think about in the US, I hate to say before, let’s say TV, you would buy a TV ad that was super expensive, and you bought it because it would give you like a million person reach. Well think about that. And even then, how many calls did you get? A million people saw your ad. So how many calls? I get– went down to 1000. And from and it went down to you got a 50. You know, sales out of it is a big numbers game and an Instagram and Facebook, everyone thinks, well, I gave it $100. I mean, what do you want, you know, you they want money. They know, hey, to get that reach, and you just do and the content is everything. And I’m sorry that you guys now have to be content machines. But Gosh, that’s–

David Sieber, MD: That’s a whole another thing. I mean, I think a lot of people who are used to developing really good content, like they kind of get burned out with it. Like, I don’t know, if you know, Christian sumio, he’s working on the mind. He gets younger, and he, he makes this fabulous stuff. But it takes a lot, it’s a lot of effort to do. And after a while, he’ll just get kind of burned out from doing it. And then I’ll come back and do some more stuff. But it’s a lot of work to always be creating all this content unless you have a full-time marketing person that’s doing it for you.

Catherine Maley, MBA: Well, what I tell everybody else is because it needs to be you, I would get a videographer and get somebody walking around with you to kind of capture your day in the life of a plastic surgeon. And that is your content. It’s the everyday, you know, all day long, because you’re right. It never ends. The content never even so funny. I I think he’s hysterical. He’s a riot. However, you and I have discussed this. What you know, where’s the money? You know, he puts his like Steven Spielberg, for God’s sakes. I mean, the guy is amazing. Really, I think he should be a video, you know, production person or something. He’s really, really good. And he’s like an actor. He’s really good. But does it parlay into Oh, this is the surgeon that I want to do? Tell me, right? You have to be careful with that image, the fine line. It really is. And I know he’s a brilliant surgeon. He’s a very good surgeon, and he does know how to show his before and after photos. So, he Yeah, you just have to, you know, who’s your audience? And who’s going to appreciate it? You have to be okay. By the way, are you okay with the negative criticism? I don’t know if you get any, but some of the doctors just hold the minute they get one little criticism, they’re out.

David Sieber, MD: I’m really– and I don’t know why it is, I don’t get a lot of like trolls on my social media saying stuff. Every once in a while, someone will say something like, Oh, I can’t believe you did surgery, she looked fine before. Now she has this fake butt or something. And sometimes I’ll delete the comment and just block the person. Because it’s really my page and I can make it whatever I want. And I want it to be a positive place. There’s something about the before and after pictures, I mean, the patient trusts you to kind of look after them in a sense. So, I think if people are ridiculing the patient online, which, you know, is the most cowardly thing to do to do a thing behind your phone. I kind of feel responsible for the patient. And I just don’t think that’s appropriate and I try not to allow it.

Catherine Maley, MBA: Good for you. Yeah. Oh, by the way, are you doing virtual consultations?

David Sieber, MD: Yeah.

Catherine Maley, MBA: Has that been helpful?

David Sieber, MD: It’s been good. I’ve had– I mean, I’ve done some so long ago that I’ve already done the virtual preoperative patient.

Catherine Maley, MBA: Oh, wow. Okay. I mean, I don’t really have anything else do you? Is there anything else want to talk about?

David Sieber, MD: I mean, this, the whole COVID thing is very, very strange. The thing that I don’t understand is, if all this is going on now, and this is mostly going to come back again in the fall, it’s gonna be interesting to see what the government does then. Because, you know, I can’t see them shutting all the businesses down for another three months again, just kind of kind of strange.

Catherine Maley, MBA: It’s strange. I have a plastic surgeon friend in Korea. And because I used to, I used to speak all over the world. And now I don’t go anywhere. I just did in Sausalito doing nothing and I’m anxious to get back on a plane. And we were talking on an Instagram. No, I don’t know what LinkedIn last night or something. Yeah, he was saying in Korea, just if you think it’s competitive here, there are 300 plastic surgeons within, like, I can’t remember three kilometers or 30 kilometers. I’m not sure what a kilometer is. But needless to say, they’re in a very little place. So, he’s a very well known, international, big, big way over there. So, he goes to China, and he gets paid like 100-grand to do light bulbs with the Chinese they’re very upscale Chinese over there. So, he goes to China. Well, he says that gig is over. You guys. Right on. He has to stay two weeks 14 and get going in another two weeks going out. And he said now I’m stuck in Korea Where? Well, the 300 doctors you can imagine the price problem.

David Sieber, MD: Yeah, big discrepancy.

Catherine Maley, MBA: Can you imagine?

David Sieber, MD: No.

Catherine Maley, MBA: So just if that makes anybody feel better, we haven’t made over here. I’m glad you’re not [inaudible 34:59].

David Sieber, MD: You’re stuck in Sausalito, you could be in a worse place.

Catherine Maley, MBA: There are a few– Yeah, as a matter of fact, I think in the Bay Area, whatever, 80 something plastic surgeons?

David Sieber, MD: Well, there’s 27, or 29 just in my building.

Catherine Maley, MBA: Wow, that’s crazy. I have been around; this is my 20th anniversary. And when I first started, just so you know, in San Francisco, there were only two plastic surgeons that read it went to yet, I won’t say who they are now, but they had it made. But keep in mind, they also hadn’t lived. In those days, the wives were the PR people. And the wives took care of all the social life activities. So, they belong to all the fundraisers, they were the high society people because this was for high society. It wasn’t for the man. Yeah, we had this before. And that’s how they ran it. And you always knew whose facelift they got, because they were very distinctive differences in the face list. And, um, and then they anyway, so that’s what it used to be. And now it’s, of course, changed dramatically. But by the way, before we end, I also realized that, you know, in my research, I learned that you play the trumpet, or Yeah, and you used to see and do lacrosse, and you were also in Michigan for a while, and you have no fears, you have no fears other than white sharks. And so personally speaking, are you not afraid of anything?

David Sieber, MD: I like to plan ahead, but I kind of think that I’m gonna have fear, you need to like, you need to have like a thought of something and then acknowledged it, and then like, creating some scenario, and then like, played out in that scenario. And I don’t really like, encounter used to teach these classes on emotional intelligence. And, to me that, like doesn’t really make any sense. To kind of like think that way. Yeah. I mean, there’s, there’s things that I’m, you know, like, I don’t like spiders, I think there’s like a black widow, maybe in our backyard like he’ll the other day. But and this is my bed I don’t like but I don’t know that I have a specific, like a fear of dying or fear of whatever it is. I mean, that’s going to happens and you just have to, you can either, like, get depressed about things and worry, or you can just kind of deal with it and move on.

Catherine Maley, MBA: Great attitude. Do you meditate?

David Sieber, MD: No, I always stride on my mind races too much.

Catherine Maley, MBA: Well, that’s the whole point. You meditate. You– to have to sit still and not let it I mean, I have. I have definitely been doing it a lot this past year because I’m just to Taipei, I get too hyper and believe it or not, I don’t drink coffee. But I forced myself to sit there. It has been very, very helpful. I also, during this time that we’ve had because we’ve had a lot more downtime. I personally needed it. I think a lot of us needed to chill for a second and say what are we doing now? called up and you see all the memes on Instagram, you know? Yeah, all of that. And it’s so true, though. I you know, what’s important to us? Why? Why are we doing what we’re doing? But meditating. I Wow, I struggle with it every day. But I know it’s good for me.

David Sieber, MD: It’s super good. There was I think it was headspace. When I was when I was doing my oral boards like thing for plastic surgery. I would do some of the headspace meditation. They’re really good.

Catherine Maley, MBA: I do that, I do them every day about that guy with the English accent.

David Sieber, MD: Yeah.

Catherine Maley, MBA: That is my app, it’s $95 a year. Although he talks too much. I can’t meditate when he’s talking all the time. It’s like, dude, shut up, you know, so. Yeah, because now you’re just filling my head with your head. You know, you’re like, Hey, man, do you still play the trumpet or–?

David Sieber, MD: No.

Catherine Maley, MBA: Don’t you?

David Sieber, MD: Yeah, I could have said then. I didn’t play in college; it was only in high school.

Catherine Maley, MBA: I forgot to ask, is there anything you’re doing at home to learn or grow or prepare for the startup for the restart?

David Sieber, MD: So, there’s a lot of webinars going on, or like pretty much anything you can think of right now. So, I’ve been watching some of the webinars last Saturday, we had our like, surgeons had their annual meeting virtually, that was pretty neat to you know, continue that education. And then I have I filmed like a course. I think it’s a paid course on like breast augmentation mastopexy with Bill Adams. I think it’s going to be out this week or next week, I think, maybe next week. And then there’s another meeting the world, wasn’t it– it was out of Colombia, the world of plastic surgery is basically the first kind of global aesthetic meeting on fact surgery. And I find it just so interesting, how differently they do liposuction and some of the vital procedures in South America. And I really honestly think that they do the procedure. I mean, 20 times better than we do the United States, their training is so much better. So, it’s interesting to see them talk about my gluteal implants, which we don’t really do here. People here kind of poopoo those and talk about how dangerous they are. But the South Americans do everything modestly. It’s not ever overdone or exaggerated, kind of we’ve, we’ve come to notice on these procedures here. And it works out really well and with low complication rates.

Catherine Maley, MBA: No kidding. So, do you feel like you can learn just as well, virtually these new techniques, as you would? [inaudible 40:06] a human talking to everybody in the hall. I think that’s what conferences are about the hallway, part of it.

David Sieber, MD: Yeah.

Catherine Maley, MBA: You know they’re just as well virtually?

David Sieber, MD: I think, kind of, like most classical, and I don’t know, if this is true, maybe I’m gonna make a generalization, but like, I’m a visual learner. So, I can read a book, which is fine, I do really bad listening to stuff. So, I have a hard time actually listening to podcasts and things because I just can’t retain the information, I need to actually like, see things. So, I went on the Columbia to spend some time with Alfredo Hoyos. And to actually see the surgeon in our own space. Doing the operation, in my opinion, is the best way to actually learn something. When I was with Texas, I trained with this one face of surgeon Fritz Barton. And that’s what he always said, he always said that if you want to learn how to truly do a procedure, like the master, does it, you need to go see them in their own operating room?

Catherine Maley, MBA: That makes sense, though? And are you planning on doing more of that?

David Sieber, MD: Yeah. As I continue to kind of like focus my practice on different things. I do want to spend more time one is the more people I just think there’s, there’s so much to learn from people, even outside of the United States. We just are really, really fantastic versions.

Catherine Maley, MBA: For sure. All right. I am good to go. Do you have anything else? Any parting thoughts?

David Sieber, MD: No, I think I’m really excited to be here. This is super interesting. I’m maybe a little nervous, but excited to see how everything kind of progresses forward. But I think like myself, everyone’s looking forward to getting back into work, which I think most people never thought that they would be really excited and ready to get back to work.

Catherine Maley, MBA: For sure. And then how can they find you online?

David Sieber, MD: So, you can either go to my website, all the request contact information there, or you can send an email to with my kind of more personal email address.

Catherine Maley, MBA: Gotcha. And it’s spelled S I E B E R.

David Sieber, MD: That’s right.

Catherine Maley, MBA: I kept on spelling it — I had to fix that. All right. And that will do it for us. I really appreciate you. Thank you so much for coming on board. And do me a favor and give me a review at Beauty and the Biz, I’d really appreciate that. It helps me grow this to reach more surgeons. And then if you’ve got any feedback or comments for me, please, you can leave me a message on my website at or you can DM me at catherinemaleymba on Instagram. Thanks so much. 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.


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