Everything is Negotiable — with Giancarlo Zuliani, MD

Everything is Negotiable — with Giancarlo Zuliani, MD

Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and how everything is negotiable, with Dr. Zuliani.

I’m your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients and more profits. Now, today’s episode is called “Everything is Negotiable — with Giancarlo Zuliani, MD”.

Our industry has evolved so much when it comes to facial rejuvenation.

There is so much advanced technology that has entered the marketplace that can delay the inevitable surgical facelift.

Personally, I thought back over all the past two decades on what I had spent just on Botox, fillers, microdermabrasion, lasers and skincare and was surprised.

When I added up my “face fund” expenses, it came to $125,000!

⬇️ Click below to watch “Everything is Negotiable — with Giancarlo Zuliani, MD”

So, in this week’s video, I interviewed Dr. Giancarlo Zuliani, a facial plastic surgeon in private practice in Bloomfield Hills, MI.

Dr. Zuliani focuses on rejuvenating, restoring and reconstructing the face through surgical and non-surgical procedures, so I asked him about his thoughts on offering surgical as well as non-surgical services to his patients.

He believes offering patients both options is crucial to his success in growing his cosmetic practice for the long run.

We even talked about lasers and how to decide which is best and how to negotiate the best price, since Dr. Zuliani believes everything is negotiable.


Everything is Negotiable — with Giancarlo Zuliani, MD

Catherine Maley, MBA: Hello and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery, and how everything is negotiable. I’m your host, Catherine Maley, author of Your Aesthetic Practice — What your patients are saying, as well as consultant to plastic surgeons to get them more patients and more profits.

Now today’s special guest is Giancarlo Zuliani, MD on how everything is negotiable. He’s a facial plastic surgeon in private practice in Bloomfield Hills, Michigan. Now, he focuses on rejuvenating, restoring, and reconstructing the face through surgical as well as nonsurgical procedures. Now, Dr. Zuliani completed his general surgery, residency and chief residency at Wayne State University in Detroit, Michigan, and he completed a fellowship through the AAFPRS

Now, he’s a speaker at other medical conferences as well as a member of several medical societies, not to mention having a lot to say on how everything is negotiable.

So, Dr. Zuliani, welcome to Beauty and the Biz. It’s a pleasure to have you.

Giancarlo Zuliani, MD: Thank you for having me.

Catherine Maley, MBA: Absolutely. So, you have a pretty fancy name. Um, did you get that name in Detroit, Michigan? Are you?

Giancarlo Zuliani, MD: Yeah, so my dad’s an actual immigrant from Italy. Right. And so, he came over at the age of eight and my mom’s not Italian. And so, you know, they’re trying to decide on names and, you know, Steve didn’t work really well with Zuliani, so, you know, they, they made it a little bit more Italian singsong.

Catherine Maley, MBA: Now, do you speak Italian?

Giancarlo Zuliani, MD: I do, I do.

Catherine Maley, MBA: Is that, is that helpful to have in Detroit, Michigan while figuring out how everything is negotiable

Giancarlo Zuliani, MD: Not really.

Catherine Maley, MBA: Ok. All right. So, I know you were in the hospital setting for a long time, and one thing the audience loves to hear is the journey from hospital insurance, et cetera, versus private practice cosmetic and how that relates to how everything is negotiable. So, could you just quickly go through how, what was that like for you to jump from one to the other?

Giancarlo Zuliani, MD: Sure. What coming out of fellowship, you know, everybody’s. Unsure of what’s going to happen and lot, a lot of people don’t want to take on that big financial burden right off the bat, so you’ll enter in some sort of agreement with the hospital. Myself, I went in with an academic practice, which was a multi-specialty group based out of multiple hospitals, not just one hospital.

Initially I was given a lot of leeway in terms of doing what I wanted to do so I can. Aesthetic work with insurance cases. The majority early in my career obviously were insurance cases. And it came to a point of probably about four to five years in where my cosmetic practice was picking up.

However, the mindset behind the academic group. Was not one of a private practice mindset. It was not business oriented. It wasn’t patient oriented per se. And so, at that point, along with other hiccups that happened along the road, which are many and don’t need to be explained here, but. Ed me that I needed to do this on my own.

And really, you know, once you get that mindset of doing it on your own, you just have to make that decision to get off the couch and do it. And so that happened about six to seven years in and took about two years of planning probably To get to a place where I wanted to be, you know, starting with where I wanted to open up shop who, how I wanted to construct a practice, you know, how to build it the way I envisioned to build it.

And so, it took a lot of planning. It took a lot of investment with my wife and I in terms of seeking out people around the country as well as around in my backyard to see how their experience went. Opening up their own practice, you know, securing financial backing for it. And working with established relationships in the community as well as with my vendors to support the practice.

And since that time, it’s been you know, it’s, it’s the most work you ever put in, but we’ve come to a point where it’s booming and obviously aided. The covid surge and things like that, but it’s, it’s been very humbling to know that it’s been so success.

Catherine Maley, MBA: So back to the multi-specialty practice, what I find is when everyone else is in insurance, you become like this, not even a prima donna, you become like, I’m not helping him (which is counter-intuitive to learning how everything is negotiable). You know?

So, a lot of times you join thinking, oh well this is my legion. You know, this is where the leads are going to come from. And, and then you’re sorely mistaken because a lot of your colleagues who don’t appreciate the aesthetic side for whatever reason they turn out not to be your legion source. After all, you have to grow it on your own.

But what, like, psychologically and how it relates to how everything is negotiable, how much courage? Cause I think it takes a ton of courage, but the keyword there was decide, right? Once you decide, you can now make. Decisions with a plan until you decide you’re still waffling. How long did you waffle before learning how everything is negotiable

Giancarlo Zuliani, MD: Well, at, at the, there there’s a couple incidents that happened that made me convince or convinced me to, to do this.

They have to, It takes that. Yeah. So, and you know, one was an incident of A patient’s information being stolen by a front desk member. You know, you know, things like that actually happen. So that, that was, you know, around the age of, think I was 40 or so, and then made my decision like at 40 I’m up my own doors.

I, I’m, I made a promise myself. And so that happened and you know, you are right in terms. You know, initially they, you know, the, the, the practice and the plastics practice within our division was, was going well. However, it takes a certain amount of money to sustain it, and you have to pay people and, you know, purchase a laser or any sort of other medical equipment as well as the on costs or recurring costs of injectables and neurotoxins.

And the other members didn’t understand like why the overhead had to increase. So, But they had no problem taking, you know, 60% of what I brought in plus a Dean’s tax of what I brought in. And what I brought in was more than most any other person, and I couldn’t, and they judge people by VUS and I, you know, my VUS are, it’s dollars.

You know, it’s not, it’s not a, it’s not an indication of work. It’s an indication of what people think I’m worth. And so, it became sort of, You know, a headbutting, you know, like should we support them or should we not support them? And you know, a lot of people try to convince me, even the head of the practice said, Oh, you, you know, you can’t do this on your own.

You’ll never succeed. And so that’s all I know when people, and they said that to me and I kept that in the back of me. That’s all the motivation you need.

Catherine Maley, MBA: That’s exactly When there’s none left, you fall back on that and learning how everything is negotiable.

Giancarlo Zuliani, MD: Exactly. Exactly. So, it’s but you, you, you have to, you have to get up off the couch. You have to just decide and do it.

Catherine Maley, MBA: When you did learn how everything is negotiable, and thankfully you have a wife that supported you doing this, because that can also be a very big challenge, right? If the wife is not behind your decision to do this, it just, you know, it, it triples the, the, the stress of it. Exactly. So how, how in the world do you go about finding a location and then do you decide, I’m just going to rent, I’m just going to rent from the hospital.

No, I’m going to get away from the hospital. I’m going to go into a, like a consumer setting. Right. How do you decide? Cause lo is location as important as it is in real estate in the realm of how everything is negotiable

Giancarlo Zuliani, MD: To a degree, but it was more important in terms of my lifestyle, to tell you the truth. So, I wanted to pick a place where, you know, I have young kids and I could be close to my home and close to the school that they attend.

And you know, I, my office is literally a quarter a mile away from my house. So, it, that was a, a big plus the area. It just happens that this area also has a lot of plastic surgeons around. I wasn’t scared by, you know, having six, you know, competitors quote unquote around the, around the around the street or around the block from me.

So, it was more convenience to tell you the truth. But now we’re in a, in a spot where I’m growing out of this facility and I’m looking to purchase my own building, which is really a struggle because things are just overpriced. These.

Catherine Maley, MBA: But I would think there’s a lot more commercial space now. Didn’t that, when the demand of that decreased, did that help you on your journey in figuring out how everything is negotiable

Giancarlo Zuliani, MD: Yeah, to a degree, except for things that are zoned medicals, things that are zoned medical are still at a premium. People who are, you know, you know, corporations, you know, which may not be using them, we’re big into auto around here, which may be pulling out, The only thing that’s really hot still is medical because people need to go see their doctor.

So, it is it’s been a challenge and so, you know, we’re tackling that one. So, I’ve got my goal on that one for two years. And we’re, we’re cranking ahead.

Catherine Maley, MBA: But in the meantime, you have to work with these hospitals. Are you having trouble booking? I know you did during covid. Has that settled down is all in relation to how everything is negotiable

Giancarlo Zuliani, MD: Thankfully my, my relationship with my, you know, outpatient surgical center and hospitals has been very, very good and I’ve been loyal to them since the beginning.

And so, I’ve had built in block time and they’ve really, Around helping me get all my cases in. You know, there was, you know, staff shortages everywhere and nursing shortages everywhere, and they had to pull back on rooms and amounts of cases you can board. But thankfully they, you know, worked with me where I didn’t really have to pull back a lot.

So that’s been, thankfully I’ve heard horror stories otherwise, but thankfully that’s been the case for.

Catherine Maley, MBA: I literally have had calls from surgeons who had to cancel surgery the next day because the, they didn’t have staff (or how everything is negotiable). They just, Yeah. It was like, what happened to our industry? When did all of this go sideways?

Giancarlo Zuliani, MD: I mean, that along with the shortages of lidocaine and saline in the, in the country, it’s sort of like, what else can go on? The supply chain issues are just, Plentiful and so complex, it’s hard to, it’s hard to run your own surgery center. It’s hard to go to the hospital. It’s just, there’s just not enough supplies nor there enough, you know, manpower to, to meet the demand.

Catherine Maley, MBA: Right. You touched on the car, the auto industry. I know Detroit, I’m actually originally from Chicago. Ok. I still have the accent. So, I’m hearing yours as well, but so how big of a deal is it? How big a deal are how everything is negotiable in the auto industry? Does that ruin you if they walk away? If they leave or, or what, What’s your situation about that?

Giancarlo Zuliani, MD: Not necessarily. They’re still the biggest provider of jobs I believe in, in the city with all the other ancillaries like the, the different tier. You know, suppliers and, and supply chains like that. But I think Detroit’s be, become a little bit more of, a little bit of a renaissance.

Recently, the, the restaurant scene has been booming, the real estate market, and well as two huge real estate corporations, mortgage companies, Quicken and United Wholesale Mortgage have been really fueling. Sort of a, a comeback in this area, so it’s not just strictly related to auto anymore. And now that the big three are getting involved in more electric cars and more technology I think they’re diversified enough where they, they’re not going to hit another 2008 where they need a an out.

Let’s hope. Back then it was bad back then it was, it was pretty.

Catherine Maley, MBA: You also have an incredible mall called the Summerset Mall.

Giancarlo Zuliani, MD: That is, that is a half mile away from my office.

Catherine Maley, MBA: They literally, like Google will call it a, an attraction, you know? Right. towards attraction. So, is that where you all hang out or not really? How does that relate to how everything is negotiable

Giancarlo Zuliani, MD: I mean, so Michigan is more of a, you know, it’s a four-season state. You know, spending time outside and doing boating and, you know, golfing and tennis and or going up skiing to up north northern Michigan. But it’s really more of an all-seasons type stage, you know? So, I don’t, I don’t really hang out at the mall, but hanging out outside for sure.

Yeah. I mean, it’s, but it’s a beautiful, it’s a beautiful mall. I, Oh, I mean, it’s, it’s, you know, it rivals, you know, the, the country, right?

Catherine Maley, MBA: And it’s under a, that’s just spectacular. I must, Your mom was very impressed. So, are you completely cosmetic in learning how everything is negotiable

Giancarlo Zuliani, MD: Yeah, so when I opened up my practice, I still would see some MOS reconstruction, things like that, but one year in, we stopped.

It was just too busy cosmetic wise, and so we gave up all insurance carriers at that point, and my cases are purely cosmetic now.

Catherine Maley, MBA: All right, so now this is what happens when you are a facial plastic surgeon. Typically, you can live off of, you know, from the neck up. There’s plenty of business there normally, but a lot of you also want to keep that patient for a lifetime.

And you, you bring on the nonsurgical as well, and I believe you have done that as well. So how important has it been? To do surgical as well as nonsurgical, and do they complement each other and build a practice of people who return and refer. How does that relate to how everything is negotiable

Giancarlo Zuliani, MD: Right. It’s, I think it’s essential. So, we have, you know multiple providers in the office doing, you know, energy-based treatments and injectables.

Full body injectables, full, full body treat. And so, you know, I can’t scale me, but I can scale that, type, that business, and we brought on more aestheticians and more injectors to, to help with that. So, it’s a, it’s essential. And the, and the play between the two is, is seamless. So, you know, I’ll say hello to their patients, even if I’ve not met them before when they’re in the med spa.

And I’ll, I’ll peek my head in and, you know, it’ll be, you know, I think it’s time for surgery, so they’ll schedule a consult with me, or I think you need to go see the aestheticians for X, Y, and Z, or go see the nurse injector. Perhaps you’re not of the best. Facelift can, but if you want something to tide you over, maybe have a consult for sculpture or threads or, or things like that.

And, you know, it’s, I think it’s important to have a varied menu of services to offer people, which, which have each of their own separate downtime in each of their own separate price point. And it’s our, it’s not our business to tell people where to spend their money, but it is our business to tell them and educate them what each procedure, non-surgical or surgical, Can do and what their expectations should be.

And so, we want to build a, a treatment sort of pathway for them and allow them to sort of choose where they go. And it’s sort of like a, a branch on a tree. If I do this, then I’ll do this and I’ll do, then I’ll do, I’m lucky. I mean, I still have patients who found me from my original practice who still come and see me all the time.

So, building those lifelong relationships and then, you know, their friends and their friends, it’s been more of a word of. Type of thing for me than anything.

Catherine Maley, MBA: Well, I know just coming from that, the patient perspective, most patients, I will say, generally speaking, don’t jump into a facelift, regardless if that helps one learn how everything is negotiable.

Giancarlo Zuliani, MD: Correct.

Catherine Maley, MBA: They tick little bit steps, little steps to get to that facelift, but it starts easy. And typically, that’s where your aesthetic comes in. Then your nurse injector, then the laser tech and all arrows point to surgery. It’s just let them have surgery when they’re emotionally ready for it. And in the mean, Develop that relationship that helps them learn how everything is negotiable.

I just think that’s really smart business in today’s world. Starting over every single surgery would be exhausting. Oh, for, you know, some say, You know what, I’m just a surgical practice, and I think, Okay. Then you’ll find a bunch of surgery surgical patients, you know?

Giancarlo Zuliani, MD: You know, everybody who comes in, there’s something to offer them later.

Now, once somebody has surgery, doesn’t necessarily they, they’re done, right? It’s, you know, you want to keep them in your practice and keep their results up. And that requires further techniques and further procedures. You know, you know, you want to keep things tight and you want to keep looking good and you don’t want to just go run out and bake on your boat and, you know, burn.

Catherine Maley, MBA: Right. That’s not the way, but that’s the American way, but not exactly in reference to how everything is negotiable. We destroy, then we destroy ourselves for decades and we say, Could you fix this thing?

Giancarlo Zuliani, MD: You’ve heard it all. Yeah. And, and the flex.

Catherine Maley, MBA: So, hurry up. So, I know you have lot of lasers. Do you have any words of wisdom or pearls about how to go about buying a laser and how that can help one discover how everything is negotiable

I’m just hearing so many stories about them. What, what do you think?

Giancarlo Zuliani, MD: Well, it’s. You know, I, I’m, I’m won’t be the, I won’t be the first to jump into anything that’s really new and they’re saying that it’s hot and it comes with, you know, a lot of flashing lights are there. I mean, the flashing lights are there to draw you like a moth to a flame.

You know, it’s, so you have to do your own research and talk to your colleagues around the country to see what is really the most bang for the buck. That doesn’t necessarily mean you have to go out and spend. $350,000 on a huge platform. But perhaps you start with something smaller. And the other thing is everything is negotiable.

Don’t feel like that is the price that they give you, is the price that it’s going to be. The, these companies, for the most part, want to keep you as a lifelong. Purchaser as well. So, they realize that you know, we’ll make calls to certain people suggesting certain things here and there. But you really got to b stand behind the technology and the company as well.

You know, it’s, it’s, it’s a huge investment to begin with, but it reaps its benefits for sure. Mostly because the patients are recurring, the, the price ticket on them is not super expensive, and depending on the type of laser, the downtime isn’t the worst. But working with a good company, which is, which puts their sort of.

Heart behind your practice and really wants to support your practice is valuable. I’ve, I’ve seen other companies where, you know, the last you see of the, you know, the salesman is the second they deliver it, and then they’re gone. But you, you know, I’ve worked with some companies where that’s not the case.

Catherine Maley, MBA: Well, I think the better companies they, well, they should be helping you market the darn thing for sure. Because a solo practitioner does not have the time, money, or wherewithal to do patient education. That’s not your job. Correct. Isn’t their job to drum up the consumer demand? And it’s your job to be the supplier of that demand while learning how everything is negotiable.

So, I want a company that backs you up like that. Like we kind of practice building tools and strategies and budget. Do they give you, to make sure this thing hits the ground running? Because a lot of times I have to say the practice when it doesn’t go well, they do blame it on the laser company a lot of times.

It’s not magic. I mean, somebody’s got to market the thing. Either you do or they do, but somebody’s got to have a plan in place to make that work. Have you, have you noticed that when you bring a new laser on board, do they? How does that help you learn how everything is negotiable

Giancarlo Zuliani, MD: Oh, yeah. Well, so we have, luckily, I have my own in-house social media people, so I think that’s exceptionally important for.

Transitioning because it’s a way that you can market on sort of a, a low budget without having to put up major ads on radio, print, or television. And you just have to, you have to grow it organically. It’s a, it’s a slow thing, but once you get the appropriate patient base and then using sort of, you know, click bait for Facebook or things like that, or on Google, Google ads, you can attract new people in for your, for your new.

Your new platform that you’re going to be bringing on, and then you have to do a lot of education about it too. You have to get on the, you got to get on the camera, you got to talk about it. So how excited you are. Treat the staff, have the staff tell them, you know, what it feels like, what expected results are.

But it’s, it’s a lot about just marketing and internal marketing obviously is the best, right? So, you. Keep talking to your existing client base who already trusts you for, you know, trusting their face in you and you want to keep telling them what’s coming up, what’s, what’s new, what’s coming up, And, and, and it, and it’ll be successful, but you can’t just buy and expect it to sell itself.

It’s not the way, that’s not the way it works. You have to invest time and you need the company to help you too. Whether it’s they’re doing direct to consumer ads or they’re giving you a certain allowance to. Pay for putting these ads out. It needs to be sold.

Catherine Maley, MBA: For sure. Here’s my pearl on that. If they’re paying for it, then sure they can use their name.

Otherwise, if you’re paying for it, I would get away from the name of the treatment or the laser and I would only talk about pain solution. You have sun damage. We wipe it out. You know, you, you give me, you, there was this ad before. You give me five days; I’ll give you five. Right. So brilliant. Nobody needs to know how, right now they’re in advertising.

They just need to know the what. You know, they have a problem. You’re, you have a solution. The details come in later. So that’s what I would do, especially while discovering how everything is negotiable.

Giancarlo Zuliani, MD: You know, just, Right. That’s the, that’s good. Websites are built like that. You know what, what’s your problem? And this is the treatment, you know, like. Brown spots Mala, you know, then, then you can go into what you can do for it.

Rather than say I have XYZ laser or XYZ radiofrequency micro kneeler, you know?

Catherine Maley, MBA: Yeah. They can pay for that. The vendor can pay for that problem. So, let’s just talk about staff is always the biggest challenge. I’m assuming you look like you have a lovely staff. You took them water skiing. I mean, everyone should have been happy with that

So, what pearls do you have, in reference to how everything is negotiable Just bring in the right staff on board, surrounding yourself with a good team.

Giancarlo Zuliani, MD: Right? Obviously, that, that is, that is the, the hardest thing for sure to get people to buy in. And from early on, we have, we had a really good core group that is still with me today, so a lot of it is, Giving them the reins to be creative and to have a certain amount of graduated responsibility, having their see a path of growth.

Meeting with them regularly, meeting with the team regularly, going over individuals well as corporate goals and then having fun together as well. It’s, I think it’s important to, to go out as a team and try and connect with people on a, a personal level. You know, and getting to know about their families and about their background and, you know, their inspirations, rather than just having it be a pure check in, check out where, you know, everybody’s sort of living in their own silo and nobody really cares about the sort of common goal.

And that’s what we’re all, you know, we want a team, right? It’s not. Necessarily a family, but it’s definitely a team that you want to build and have some people rely on each other and it takes work. It’s not easy. It’s actually the finding people and retaining people is hard. And it, but it’s a lot cheaper than recruiting, I’ll tell you that.

So, you know, it’s, it’s important and, you know, with inflation, you know, people need to be paid too. And so, if you. If you have an employee that is just so stellar, make them feel that way because it, you know, without them, if you’re going to be hurting, pay them accordingly and treat them according.

Catherine Maley, MBA: But how did you get it right from the beginning as you learned how everything is negotiable

Like you hired some really killer people.

Giancarlo Zuliani, MD: Well, I had a, I had a consultant and I, my wife’s background is in HR, so she knows hello. So, she an HR, she’s an HR director at one of the big three, and so she knew sort of the ins and outs of how to do this. She wrote my employee handbook, I mean, without her. You know, it would’ve been too much work for myself.

Catherine Maley, MBA: Well, I hope she got a, a stipend out of that while she helped you to learn how everything is negotiable.

Giancarlo Zuliani, MD: Yeah., she got a couple nice bags., she but you know, with that, it, it was. Continuous work, but we found the right people and it’s work now that have there been hiccups with other employees for sure, and Covid did not help that. So, you know, it’s a constant process.

Trying to find people, but I think right now we’ve, we’ve, we’re, we’re hit a groove where we we’re really getting along as a, as a team, and attitudes are great. So, but you’ll go through ups and downs and ins and outs and you just have to weather the storm and be able to be positive about it and take your time to, to hire the right.

Catherine Maley, MBA: Well, I know I’m prejudice, but I’m from the Midwest and I think the best working minds come from the Midwest, the work ethic, the blue collar, whatever you want to call that. Mm-hmm. I moved from; I couldn’t get out of Chicago fast enough, quite frankly. I, I couldn’t do the weather, I just couldn’t. So, I wanted to go to San Francisco and also learn how everything is negotiable.

And that, Wow. Talk about culture shock. another story. But out here, nobody did anything like, compared to Chicago. I mean, I was so disciplined and I didn’t even know it. I worked so hard and I didn’t even know it, but I thought, Oh my God, I’m going to be a big hit out here because I’m actually willing to get to, to the office by eight when nobody else was showing up till nine 30.

And I, I was just so surprised. Frankly, I think, well, the wife being an HR killer, killer strategy, And the next one is youre definitely in the middle of the Midwest where they have, they think differently or they used to anyway. How do you think that relates to how everything is negotiable

Giancarlo Zuliani, MD: So, well, I mean, I, there’s some, there’s some grit, you know, there’s some grit involved in Detroit’s, you know, sort of a roll up your sleeves and let’s get it done.

You know, even the, the, the basketball team is’, Going to work was their motto. You know, the, it’s, it’s a blue-collar town, but people definitely put the work in and if you, the work in you’ll reaps to get started and get the inertia going when it. You know, you don’t have to push as hard. You can just sort of nudge the rock along.

You got, you constantly have to do it, but you’re not going to be bearing, you know, the huge, you know, 3000-pound weight trying to roll the stone up the, up the mountain. Eventually it becomes a little bit easier, but you, but you gain people with you to help push it, right? So, you’re getting a team to help push it everything along and, and, and help progress the.

Corporate goals and the practice goals, but you already said it.

Catherine Maley, MBA: You meet with them regularly, everyone chipping in. You work together as a team (which also a way to learn how everything is negotiable). You’re not best friends. I don’t, I’m that can go sideways sometimes. Right. But but definitely just knowing that you care about your staff makes them work harder for you.

That I know. For a fact. For sure. And then for sure. And then, but sometimes they’ll some of, some of the surgeons, like they’ll have a Christmas party at their house and their house. Unbelievable. And sometimes I think that can backfire on you if you haven’t learned how everything is negotiable.

Giancarlo Zuliani, MD: Yeah. I mean, we’ve always done it elsewhere. Parties and like that, you know, we were, I mean, my and I just to London, we got everybody a.

You know, Union Jack, like little card carrier thing, you know, it’s just, it’s not nothing crazy expensive, but it’s the thought. And, you know, you would’ve thought, you know, we’d have bought people Berger eggs, you know, everybody was like, so excited, But it’s just, it’s the thought and, you know, recognizing that you’re on, you know, they’re on your mind and that makes people feel.

Catherine Maley, MBA: Oh, that’s fantastic to help master understanding of how everything is negotiable. Most surgeons would not even think to bring their staff back something, It just doesn’t occur to them. And that’s because they treat their staff like overhead and not an asset. And I think you watch them on my videos cause you and I are thinking the same way about you have to hang on them and when you have a great staff, there’s nothing better.

Been a well-oiled machine, right? There’s nothing better when everyone’s doing their thing and you’re all working together for the good of the practice, not for yourselves, nothing. It’s just, you know, that’s how to do it if you can. And then of course, as soon as it all works out, then somebody has sudden I have to move to Alaska.

Cause if their husband was transferred and it all falls apart, which doesn’t help with understanding how everything is negotiable.

Giancarlo Zuliani, MD: But that’s happened. I mean, we’ve had people like that. They’ve had to be transferred and so, You go through periods of like, Am I ever going to get out of this rut? Am I going to find somebody? And then it happens and you know, you know, the sun shines another day. It’ll be okay.

Catherine Maley, MBA: It all works out in the realm of how everything is negotiable. I my motto, especially when you get older, you’re like, You know what? This can’t. Drama all the time, you know? Right. Like, all right, it, But it does seem to happen in in clunk clusters. It does. You know, like it all falls apart at the same time. It’s like really? Like really?

Giancarlo Zuliani, MD: What? And my staff will say no. Mercury’s in retrograde watch out. So, they’ll you have three or four problems happening, like is going on. Like, know.

Catherine Maley, MBA: That’s funny. So, let’s talk about marketing  and how it relates to how everything is negotiable, because you’re doing something that I have been talking about for two decades now. Make a signature treatment with your initial on it, so Sure.

You have the Z lightning lift. That’s right. Can you talk about that?

Giancarlo Zuliani, MD: Oh yeah. It’s a, it’s a minimal access Facelift procedure, sort of hybrid using radiofrequency as well as sort of deeper plain tissue techniques that is done under local anesthesia only. We call it lightning lift because it’s done quicker.

The recovery is quicker. We’re using radiofrequency plasma, which is what lightning is. And so, We use the specific modality. I didn’t call it by its name. I just created my own little thing. It’s an own little niche surgery. Is it for everybody? No, but there are certain people who are, you know, in between.

Fillers and a formal facelift that just want something that’s minimal but gives them the refresher that they want. And we came up with that like year one and it’s been a boom. People will search it up and say, Am I a candidate for this? I’m a candidate. Unfortunately, a lot of people aren’t there.

They’re a little, a little bit older, and a lot of people can’t handle just plain locally anesthesia, but in the right person. It, it works really well, and they appreciate not, not having to go to the surgical center, not having to go under, not having to pay those additional costs and having, you know, great results without all that downtime.

Catherine Maley, MBA: I think that’s just genius. A lot of women cannot admit they need a facelift, but they need a little something, something. Right. That’s why they’re attracted to that, if I’m not mistaken. Did the lifestyle lift come from Michigan? How does that tie-in with how everything is negotiable

Giancarlo Zuliani, MD: It did. It did. It came right through three miles down the road in Troy, Michigan.

Catherine Maley, MBA: Okay. Because I’ll tell you, I don’t care what you say about them. They were talking right at the consumer. Right. No stars. It’s a band aid, not a band. You know, like round your head? No. Down. Minimal downtime, minimal scarring, minimal everything local. I mean, it, they were, that was music to women’s ears. You know, I can, an awful lot of result for a lot less, less money, less time, less hassle, less pain, less scarring.

And so, I’m assuming there’s some of that came from that. That’s also great to help with knowing how everything is negotiable.

Giancarlo Zuliani, MD: Yeah. Yes. A lot of it was trying to find that sort of, that niche and that where people, you know, were in between. And so that’s what we, we aimed to, to capture there.

Catherine Maley, MBA: So how do you use that in your, because frankly you could use it in all sorts of different ways.

There are women. Have you noticed the women are getting younger and younger who watch faceless? How has that affected your understanding of how everything is negotiable

Giancarlo Zuliani, MD: Oh, I mean, it’s, it’s extraordinary. I mean, we’re getting into late thirties, mid-thirties. A lot of people are like, I don’t want. To be burned out on filler, I’m just going to, or, you know, threads or whatever it may be.

I’m just going to invest in it now. And so, we did one on a 36-year-old a few weeks ago. And that’s where the lightning lift comes out. Like, Okay, let’s offer you this. That doesn’t mean you’re not going to have a secondary lift 15 years from now, but this will tide you over. Right. So yeah. But younger, young, I just, you know, I was just, Saying hi to a patient who was receiving an energy-based treatment, and she was like, Is it right for my facelift yet?

She’s, you know, she’s, and I’m like, she’s like, I just want to get it over with. I’m like, I understand. It’s, it’s, it’s happening younger and younger and younger, and I think a lot of it’s due to, you know, people are seeing, they’re not scared of surgery anymore. They’re seeing it more on social media and seeing sort of the results that surgical intervention can provide, and they’re drawn.

Catherine Maley, MBA: Well, especially when they’re watching the celebrities doing it at a younger age as well. Right. I just think though, psychologically, if they’re already struggling now at 33, wait until they’re in their forties and fifties and sixties, that’s me. It’s going to be way, I mean, I don’t know. They’re shoot themselves; You know that. I wonder how that goes with knowing how everything is negotiable

It’s not like you’re going to have a facelift at 35 and you’re good to go, you know? Right. There’s a lot more that happens after that called, you know?

Giancarlo Zuliani, MD: Exactly. Exactly. No.

Catherine Maley, MBA: So is there, I know you, you have a lot of competitors around there. Is there any other way or strategies you’re using to differentiate yourself from the others, and master understanding of how everything is negotiable

Giancarlo Zuliani, MD: The, the sort of the patented surgical procedure was a great one that, that did it. The I’m in an area where it’s a very highly sort of ethnic area where there’s a lot of rhinoplasties going on and not too many people doing rhinoplasty in my area. Good point. So, you know that I never even needed to.

Advertise for, and we’re doing, you know, 220 rhinoplasties a year, and I’m not, I’m not doing. Any sort of advertising for it. Where I am spending a little bit of advertising dollars is my aging face population, because it seems that everybody fights over that. You know, the full body plastic surgeons, the facial plastic surgeon, even dermatologists are fighting over, you know, lifts and, and things of that nature.

So, we, we do spend a little bit of money there, but nothing to even write home about. And it’s worked, It’s been consistent advertising towards that patient, consistent, putting information out there, consistently, having Facebook lives or Instagram lives doing q and as you know, from my own office, whether it’s, you know, whether people are here or not, and.

Putting out, you know, the “before and after’s” and it’s, it’s working or, or it’s up to, you know, 40% over last year just being consistent with it. And it’s great. And that, along with the, the zoom boom, people not wanting to look at their necks, it’s sort of just coincided that, you know, you can, and that that practice has.

Catherine Maley, MBA: I was watching one of your Facebook Lives and I was thinking, okay, for social media, you have somebody on board, which I think you have to have in today’s world. Not just like the roving reporter in the office, but you also need somebody who knows how to video edit because they can make you look great, which also helps with understanding how everything is negotiable.

You know, especially if you’re not into it and you’re not like, You know, you’ve never wanted to be an actor. They can, they can really add some music, some highlights. You can get by almost without talking because they can put in the quotes, you know, or just things. So, I think that’s going to be imperative for everybody in today’s world.

Google’s take, Google’s not letting anyone get to your website anymore. I’m just watching how brutal that’s gotten. They, I, I guess they just want to own the homepage for themselves and you don’t even have to leave the homepage cause all the answers are right there and. What the heck are you guys going to do to find new patients if they keep like, closing all those doors? That must affect mastering understanding of how everything is negotiable.

Giancarlo Zuliani, MD: Yeah, it’s all, it’s all those algorithms. And I have, you know, you know, I keep asking my, my college roommates back in the day, they, you know, most of them went to work, go work for Meta or Facebook or Google. They don’t really have an answer for it. I don’t, I, I, they’re just trying to keep things proprietary, I guess.

I don’t, I have no clue, but. Going back to having somebody in your office, it’s, it’s very important that you invest in them and allow them to take classes on how to market on the internet. And so, we’re constantly doing that with our, my, my patient care coordinators doubles as my social media manager and then, you know, farms the work out to every, you know, other people in the office.

She’s constantly taking classes and constantly knowing how to, you know, beat the algorithms and things like that. So, it’s important to invest in, definitely important to some, Invest in somebody like that.

Catherine Maley, MBA: Oh, in today’s world I, I mean, I have an MBA, I have a BS and an MBA, and quite frankly, I’ve learned more on buying courses at night that I watch online than I ever did in school.

That took years and years to learn, right? Marketing nowadays, You’re not learning a full-on foundation of things. You’re learning one thing. How do you do a Facebook ad boom. How do you do a LinkedIn ad, boom? Like, that’s so easy. Just go to YouTube. I mean, don’t tell everything you wanted know. You have to want to put the effort in, you know, is that’s the, the secret to it.

You know, you have to do that. If you’ve got staff who like to do that, they want to grow. It’s more fun for them. And I’ve noticed, have you noticed social media is, Look, it’s coming. Like it’s becoming a team player event. Like it, it builds. Have you? How does that help with understanding how everything is negotiable

Giancarlo Zuliani, MD: Well, everybody wants to get involved because it’s, it’s fun and it’s, you know, you can do, you know, I’m not, I’m never going to be the dancing guy or anything like that, but I’ll sure if the you know, if the other staff want to do that and have fun with it, I’ve got no problem.

You know, let your, let your personality show through. People want to know that you’re a real person, not a robot, you know, So you have to incorporate, you know, not just your treatments, but you know, things that are going on in the office. You. We, you know, post about our outings and, you know, whatever it may be.

You know, you have to let people know that there’s real humans here who are, who are doing the work. But it is, it’s, it’s, it’s fun. You know, Most people, most everybody wants, I don’t have a single. Not one that doesn’t, one, one that doesn’t like being one in front of the, you know, camera. You know, I’m, I’m not crazy about it, but I do it because I know it served a purpose.

But most people do want to, you know, help out in that regard.

Catherine Maley, MBA: Would you say social media is like one of those marketing channels that you’re focused on, or is something else working better than that? How does that tie-in with how everything is negotiable

Giancarlo Zuliani, MD: Well, you know, social media for one. But what really works for me is that I’ve, I’ve done surgeries on people who are in, in this area who are in a very tight knit community.

There’s, there’s a few. And it’s both mostly word of mouth between them. They have like these; these communities have Facebook groups on their own asking about who’s the best rhinoplasty surgeon. Who do you see for this? I had no clue that this was happening until mom showed me. And I was like, Oh my God, I, I have no clue.

It’s like an underground network of, of questions and answers for plastic surgery, but that hap if this is happening here, it’s happening everywhere. And so, you break into one of those communities and become the go-to guy. I mean, it sort of just spreads like wildfire.

Catherine Maley, MBA: It’s like your own little real self, you know? Certainly helps with understanding how everything is negotiable!

Giancarlo Zuliani, MD: Exactly, Exactly. And I don’t have to pay!

Catherine Maley, MBA: If you can get one, you can get that ho darn group, you know? Right. They all are connected; They hang around together. If you could give them that one procedure that they want like, like get known for that one. Like the rhino boy, you.

Giancarlo Zuliani, MD: Exactly. Yeah. Yeah.

Catherine Maley, MBA: All right, good for you.

Is there is there anything that you used to do for marketing that now just does not work and hinders mastering understanding of how everything is negotiable

Giancarlo Zuliani, MD: Well, I never put anything into print per se. And you know, we, we, we used to do more stuff on like sponsored links or sponsored stuff on RealSelf, and I’ve quit all that. I quit all that maybe four years ago.

I wasn’t seeing any real from that platform. Any real leads coming through that were really good. So, the, the advertisement on RealSelf, I’ve. Shied away from, I still have a, I keep a real self-link and things like that. But we’ve been doing our own, sort of reaching out to our patients through our social media and encouraging reviews, encouraging testimonials, encouraging video testimonials, encouraging patients to, you know, post about their journey with me and things like, And they’ll do it on TikTok and then they’ll share it with us.

So, they’re going Reddit. I don’t even know there is a plastic Reddit plastic surgery. That was amazed. You know, you know your patients and your perspective patients are, are reaching out on every platform known to man, looking for some looking for answers, looking for a real-life sort of experiences with you.

And so, you know, you want to encourage your patients to. Post on those so you can organically grow and it costs you no money other than asking them to do so. And a lot of people are scared to, to say that. But I encourage you say, please tell us about your experience, because I know we’re striving to provide, you know, a world class experience here.

Catherine Maley, MBA: For sure. For the Facebook Lives. Has that been helpful to you? Profitable? Has it helped in the realm of how everything is negotiable

Giancarlo Zuliani, MD: Yes, very much so. You know, so we’ll, we’ll, we’ll go back and we’ll analyze to see, you know, how many consults, you know, if 200 people books, you know, sign up, how many are actually showing up and watching it, How many are booking a consult from there.

But it’s been a good, it’s been a. You know, sort of pass through and thoroughfare of reaching more people. You know, some people are just sort of scared to come in the office. Some people are very hesitant to even make a consult. You know, you’re just trying to maybe tip somebody in the right direction and let your personality come through and let them see who you are as a person and what, what maybe your surgical beliefs are and that, you know, that’s, is its weight and gold.

I mean, that will get people in the.

Catherine Maley, MBA: Well, you know how I can tell when I look at your Instagram and you know, you can see the likes, they like dramatically increase. The more interactive you are being with that audience and those aren’t easy to do those Facebook lives. If you’re not used to sitting in front of a camera.

That can be very unnerving. You guys are doing a great job of that. But often I say to the surgeons, practice at home, get in front of your cell phone and just get used to talking to a screen. Right. You know, just so to lighten up, you know. The whole point is they need to see you as a caring, funny, nice, kind, compassionate person, human being. Also traits needed to master understanding of how everything is negotiable.

And however, you can get that to come across because you can’t when you’re so stiff.

Giancarlo Zuliani, MD: Yeah, right, right. I mean, long gone are the days of the sort of the patriarch doctor who sits there and is like, I’m going to do this and I’m going to do that. And that’s what we’re doing. And that’s gone. I mean, it’s, it’s. The way of the dodo bird, you have, you have to be engaged and you have to be, you have to come out of your comfort zone.

You have, you have to do things that you have to get in front of the camera or else it’s everybody else is going to be doing. You’re going to be left on the side of the road if you don’t.

Catherine Maley, MBA: That’s, you know what, That’s frankly your words of wisdom. If you don’t adapt to this new way of nurturing, educating, attracting patients, you are going to be left on the wayside because they’re, they’re not going to tolerate less than that, right?

Boy, the more uncomfortable you are, the happier. The patient is so just you off. So, what would be, do any like last of wisdom for anybody who let’s say is trying to make that jump that you made years ago to get into cosmetic? Anything you could tell them and how that can impact them learning how everything is negotiable

Giancarlo Zuliani, MD: You know, it, it takes, it takes belief in yourself, but you know the best person to bet on.

The best thing to bet on is yourself because you can control that. You can put the work in so bet on yourself. And if you do and you put the work in and you surround yourself with great people around you, you will succeed. Yeah.

Catherine Maley, MBA: And my last fun question is, tell us something we don’t know about you, and unrelated to how everything is negotiable.

Giancarlo Zuliani, MD: When about let’s see, how long ago was?

This was 20 years ago, so I ran with the bulls in Pamplona.

Catherine Maley, MBA: Oh, congratulations.. That’s a…

Giancarlo Zuliani, MD: Yeah, I was scared.

Catherine Maley, MBA: Was of the, But did, were you a runner?

Giancarlo Zuliani, MD: Yeah.

Catherine Maley, MBA: I mean, like are you good at running?

Giancarlo Zuliani, MD: Oh Well not so much anymore. My knees aren’t that great, but I’ve have run a couple half marathons and triathlons.

Catherine Maley, MBA: Right. Because you know, few beers and you’re going to go along with it.

Giancarlo Zuliani, MD: I, I did have a few. And that’s why I was at the front of the line.

Catherine Maley, MBA: Okay. Forget that. Yeah. Well, I’m glad you survived that. That is very interesting. I’ve never heard that one before. All right. Well, thank you so much, Dr. Zuliani for coming to Beauty and the Biz and discussing how everything is negotiable. I really appreciate it.

I hope to see you soon at one of our conferences coming up and everybody if you want to talk to Dr. Zuliani for whatever reason, his website is

Giancarlo Zuliani, MD: www.ZulianiMD.com.

Catherine Maley, MBA: Everybody that’s going to wrap it up for us today, a Beauty and the Biz and this episode on how everything is negotiable with Dr. Zuliani.

If you’ve got any questions or feedback for Dr. Zuliani, you can reach out to his website at, www.ZulianiMD.com.

A big thanks to Dr. Zuliani for sharing his experiences on how everything is negotiable.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you’ve enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don’t miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

-End transcript for the “Everything is Negotiable— with Giancarlo Zuliani, MD.”


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