The Riches Are in the Niches — with Jason S. Hamilton, MD

The Riches Are in the Niches — with Jason S. Hamilton, 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 the riches are in the niches with Jason S. Hamilton, MD. 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 guest is very special, it’s Jason S. Hamilton, MD, who will discuss with us about how the riches are in the niches.

He’s a director of facial plastic surgery at the Osborne Head & Neck Institute based at Cedar-Sinai Medical Towers in Beverly Hills. Now, Dr. Hamilton attended Duke University and did a fellowship through the AAFPRS. He’s also held several teaching appointments as an attending surgeon and clinical faculty member in the department of surgery at Cedar-Sinai, where he teaches facial plastic and reconstructive surgery.

Now, he’s also lectured internationally and he is published over 54 peer reviewed scientific articles and book chapters, and Dr. Hamilton specializes in primary and revision African American rhinoplasty, while pioneering new methods designed specifically for the black nose. Now, his goal is to give his patients a beautiful nose that will always look natural throughout their entire life.

That’s no easy feat for Jason S. Hamilton and how the riches are in the niches. Now, he’s been honored with numerous awards and is considered one of the top African American rhinoplasty surgeons in the country and probably the world. Now, he’s an academic mentor to high school students. He goes on missions he gives back by working with several humanitarian organizations such as Face to Face, the National Domestic Violence Program, and Faces of Honor.

Dr. Hamilton, welcome to Beauty and the Biz. It is a pleasure to have you.

Jason S. Hamilton, MD: Thank you, and thanks for that great introduction.

Catherine Maley, MBA: Well, there was a lot to go through with how you, Jason S. Hamilton, MD who’s discovered how the riches are in the niches. I mean, I had been researching you and I thought, Dear Lord, this guy’s been around. And you look a lot younger for all of your achievements, but congratulations for that.

Jason S. Hamilton, MD: Yeah. Well, you know, we’re, we’re definitely in the right business. Keep looking younger.

Catherine Maley, MBA: Right, Jason S. Hamilton, MD. So, you have to start me out with, how did you say, were you a little boy saying, I want to be a facial plastic surgeon and discover the riches in the niches, or how do you get.

Jason S. Hamilton, MD: Yeah, so initially I I’m originally from Jamaica. That’s where I was born.

So, we immigrated to Florida. And I had an interest in science and I like kids, you know, that those were my interests. So, I thought I wanted to be a pediatrician. No one in my family’s in medicine. And so, when I got to medical school, you know, you get introduced to the different specialties.

So, my passion very quickly was anatomy, and I loved the head and neck area. And I started spending time kind of playing hook in the days because our lectures were recorded. So, I, I would listen to them. And in the day, I would go hang out with the surgeons in the hospital and try to figure out what I want to do with my life.

And so, hanging out and spending time with some of the reconstructive head and neck surgeons where they were rebuilding jaw bones, rebuilding tongues pharynx cheeks doing trauma surgery. That’s where I really got my passion and interest in becoming a facial plastic surgeon. I didn’t know that.

You would go through e n T to, to get to that point. So that was a surprise. But e NT is where you learn about all the anatomy of the head and neck and obviously all of the cosmetic and plastic surgery procedures. So, I really got passionate about in my ENT training about sticking with plastics and I was really, really interested in the reconstructive side of things.

I had no cosmetic interests whatsoever. I. Thinking about being a quote unquote plastic surgeon. I only wanted to deal with reconstruction, and then that kind of morphed as time went by. Patients who I had done some reconstructive procedures would come back and ask for cosmetic procedures.

They in turn would bring family members who I would accept as patients because it was a direct referral. And then, you know, I became passionate about that. And then things just kind of took a natural course from.

Catherine Maley, MBA: So, Jason S. Hamilton, MD, were you ever in solo practice on your way to figuring out how the riches are in the niches, or did you go straight from the hospital and then join Osborne Head and Neck?

Jason S. Hamilton, MD: How did that transition happen? Yeah. I was never in a solo practice. I think our practice is kind of a hybrid, mm-hmm. because we, we published a lot. We have a foundation that does mission work, you know, throughout the world. We are involved with training of residents and even mentoring college and high school students.

So, when I. Was training in my residency. That’s where I actually met Dr. Osborne. He was a chief and then our attending. And I was a first-year general surgery resident coming into the program. That’s where we met and we kind of gained a lot of respect for one another. We started writing papers and presenting at that time.

And then when I was going to graduate and start my fellow. He was starting out here at Cedar Sinai, and at that time he was the, the first director of Head and neck cancer at Cedar Sinai. And so, when I was going to graduate, he, he kind of pulled me to the side and he was like, I know, I know you’re going to hear a lot of stuff, but I think we should work together.

Right? And, and I kind said, hey, you’re an oncologist, how are we going to work together? It’s never going to work. And, and we basically came to the conclusion that the most important thing, and I think it’s important for, for all docs or anyone business, is that if you have someone who is dedicated, enthusiastic, hardworking, intelligent…

And, and your friends then you can find common grounds to build something up, you know? And that might not be worth letting go to work with someone who just happens to be in your specialty, but you don’t have anything in common, you know? So, so we just made a decision that we’re going to figure out how we’re going to work together, right?

And I, we started doing that while I was a fellow. We started building websites figuring out how we were going to kind of take the world by storm, so to speak. And then as soon as I graduated, I came here and I’ve been here ever since.

Catherine Maley, MBA: No kidding, Jason S. Hamilton, MD. You know when I looked at your website, I was, whoever did your branding was kind of magnificent because it looks very hospital-accredited and benefits from how the riches are in the niches.

Like I, I thought, Jason S. Hamilton, MD, it was a hospital because of the way you have done it. And it wasn’t the, your usual, like there are no social media logos. It was, it’s very educational, straightforward serious. You know, you guys are not clowning around on this thing. And I thought, how interesting, because was that the point to look and also calling yourself institute, which can help with how the riches are in the niches.

But was that the point to not be the typical solo practice going after all the cosmetic? You don’t, you wanted to be a teaching institute? Yes. Training

Jason S. Hamilton, MD: was that, yeah. You hit the nail right on the head. So just coming out and getting started we figured that if we just do what everybody else does, right,

Yes. They’re going to be two problems. One, we’re in a big market, so we’re not in a smaller mid-size city. We’re in Los Angeles, you know, which is equivalent to New York or Dallas or Miami. So, we’re in a big. Everyone is already doing what you’re thinking about doing very well, right? And that’s why you have an interest in being there because that’s where the consumers are.

So, we quickly identified just from our training again. That we had interest and talent in areas that our colleagues probably didn’t have a big interest in, you know, or shied away from because the surgeries took a long time or at the time they didn’t reimburse well or They couldn’t figure out how to integrate it into their practice.

But we started in that place. We said, we’re not going after anything, or we’re not going to take any interest in things that everybody’s doing. Right. And so that’s a slow process, right? But it has a future, you know, in our minds it has a future. And that’s, that’s, that’s why our branding and our logo we wear white coats, you know, preferentially, we wear white coats.

We don’t wear suits. We, we have a, a kind of clinical looking office, like a hospital. We don’t have marble on the floors. Because that’s not what we’re, we’re conveying. And that’s not what we’re selling and that’s not what we’re giving patients. What we’re trying to convey is that we’re kind of super specialists.

We, we have a passion for what we do. If you are in need of our services, we’re going to approach this at the highest level. And you can be assured that we have training, we have research background, and that you’re going to be getting delivered the highest-level product. And that’s our focus. So, I’m glad to see that’s your, your impression of what our branding is and because that’s exactly what we want it to be.

Catherine Maley, MBA: Well, Jason S. Hamilton, MD, who’s discovered how the riches are in the niches, I think it’s working for you because if I’m not mistaken, you have eight surgeons now at this point. Yeah, yeah. Where, where are you going with this? And you’re probably doing a lot of reconstructive as well as cosmetic or how is that to up in your practice?

Jason S. Hamilton, MD: So, one of the things is that everyone coming into the practice is pretty much doing something different, you know?

And so, for myself, just organically I probably work with my partner doing reconstruction on all his cases. Oh. And then in my, in my in my practice, I’m mostly focused on rhinoplasty and some reconstructive things with the nose, like fixing supple perforations. So that’s one of my big things.

And then then the side, the side interest just because I love sports and we’ve actually treated a lot of athletes like Stephan Johnson. Yeah. We’re going to talk about that next. Yeah. Yeah. And, and so that, that’s kind of my passion. So, I, I, we have the professional sports athletes that take care of myself.

Then we do the reconstructive surgery, and then the rest has been kind of whittled down in focus to mostly rhinoplasty and reconstructive nasal surgery. And, and specifically for the, the African, you know, descent population or ethnic rhino.

Catherine Maley, MBA: So back to running a practice, Jason S. Hamilton, MD, who’s discovered how the riches are in the niches, it’s difficult enough for two surgeons to make a decision and have the same vision.

So, kudos to, you know, Hamilton and Osborne. Good job there. But when you bring on a bunch of others, how difficult is it for you to keep that brand intact? Make sure everyone has the same values, to have the same vision? Is that, is it, does it get more difficult as you add more surgeons?

Jason S. Hamilton, MD: I think actually it’s the opposite.

Oh, right. So, it actually has been easier as we’ve added more surgeons because we look more at the brand, you know, as, as we’ve become larger. Right. So, so what I mean by that is when it was just, when it’s the two of us we have an. We have an idea. When there’s six of us, we have a brand, you know, and this is kind of the way, these are the jerseys that, you know, the Rams wear, you know, yeah.

This is the locker room. These are the shoes we wear. We run this kind of offense and it’s easy to recruit and you know bring people in when you’re very organized. And so, we focus on being organized sticking to the brand, not deviating from that. And then, so when you’re bringing in new people, it just seems like this is how the organization is.

So, I liken it to, if you join the university of, you know, XYZ you wouldn’t think that you could change your badge to whatever you wanted. I’m going to park where I want to park. No, they’re going to tell you where you’re going to park. These are the coats you wear; these are the color scrubs. You’re not allowed to wear, you know, jackets with hoodies.

There’s all the rules. You’re going to get a flu vaccine or have a good reason. And so actually the, the, the more people we’ve added, the more solid the branding has been and easier it has been to get conformity. And then when we were interviewing people, you’re, you’re saying this is what we’re looking for this is what we’re all doing.

Are you interested in that? You know, and, and, and some people are not because as we were, you know, speaking before which we’ll, we’ll talk about. Everyone doesn’t want to super focus or pick something that, that they want to go after. Cause it’s scary. It, it’s scary to just say, I’m going to focus on like highlight surgery or osis surgery.

Because you, you really have to have an acumen for it to, to build that practice and, and kind of just let everything else go to the wayside. And that can be a scary.

Catherine Maley, MBA: So, how difficult has it been getting staff, Jason S. Hamilton, MD, who’s discovered how the riches are in the niches, I know all we’re talking about in today, this year, this year we’re, we’re, we’re still having major staff challenges.

Not just finding them, but finding the right people who have the right, I don’t know, discipline, whatever. Jason S. Hamilton, , who’s discovered how the riches are in the niches , are you also finding that, or has your branding done so well that you’re attracting really key patients?

Jason S. Hamilton, MD: I think we you know, knock wood we were extremely lucky because at the timing of Covid, which I think is where this great resignation and yeah.

I call it the great reconsideration as well. People are thinking about their lives and now they want to live it, right? Yeah. And, and work is a big part of that. I think that we had had some, I wouldn’t call them lifers, but we had, we had a, a critical number of people who had been here for at least 10 years already, right?

So, 90% of the people that were here when Covid hit had been here for 10 years, you know? So, we didn’t have a lot of turnover. And everyone is still here, so I don’t, we, we didn’t feel that, those effects of having to get new people and having staffing issues, et cetera because it pretty much held our core group.

Some people You know, decided to do different things you know, for various reasons. Like, well, I know you guys are still open. I don’t want to come into contact with Covid patients. So that’s legitimate, you know, But I think going forward, I think staffing as we continue to expand or grow, I think staffing will be an issue.

You know, I think that’s something that’s, that’s hard to resolve for most practices. However, I think we’ve all embraced technology just like how we’re talking right now. You know? Technology is really allowing you to have close communications with your patients that you, you, it wasn’t accepted or as easy, you know, as before.

And I think with technology, you can kind of automate some things and then kind of focus on getting great staff, you know? So instead of two good staff members that you add, you can add a great or an exceptional one, and technology can help that member. Do their job and facilitate communicating with patients?

In my opinion, that’s my for sure.

Catherine Maley, MBA: Well, Jason S. Hamilton, , who’s discovered how the riches are in the niches, one thing I have noticed with surgeons as they find the riches in the niches, they do, if given the choice, would rather hide out in the OR and never deal with staff or processes or KPIs or SOPs, they don’t know what that is. They don’t want to know what that is. Yeah. But in your practice, just the feel I get after doing a lot of research on you it feels like you guys just have this under control.

It feels you’re very mellow. I love that. Your website’s very organized. You just, it just feels very organized as you said. Do you have a management team behind the scenes that’s running all this and making this run like a, I’m always trying to help practices run a smooth, like a Swiss Army knife, you know, Jason S. Hamilton, MD of how the riches are in the niches?

Yeah. Like who, who’s, who’s in the back end?

Jason S. Hamilton, MD: Well, most, most of it I would say to the credit is my partner, Dr. Osborne. He’s very hands on and he’s, I would say in a, in a business sense, he’s slow to hire. Right. And, and quick to, to fire, you know?

Catherine Maley, MBA: Well, that’s what they always say, but we don’t do it that way, Jason S. Hamilton, MD of how the riches are in the niches.

Jason S. Hamilton, MD: Yeah. Most people don’t do it that way. And so, it’s really hard for you to get in here if not impossible. Right. And. And so it, it attracts people who have similar mindsets and are trying to kind of build a career and, and not just, you know, jump from job to job and people grow while they’re here.

So, I think that’s very attractive. So, he does have a good handle on it. And then, Behind the scenes. We also have great office manager who’s been with us since the beginning. And we have good business and, and patient coordinators really keep the three key positions. So, so office management, business, and patient coordination, those, those individuals have been with us for 15 years plus.

And so that has probably been the key to, to our success. I would love to hide in the or under blanket. Anytime I could. But Dr. Osborne and those key people have really made all of our lives, including their own lives better just by being so solid and present in the practice. So yeah, I think that’s really important.

Turnover. Turnover can, can kill a great practice, you know? And so, if you can hold on to great staff and make people feel like they can grow in your organization, then, then it, it really takes stress.

Catherine Maley, MBA: And it really is the secret, Jason S. Hamilton, MD, who’s found out how the riches are in the niches. The consistency, and the continuity of having staff that like working together and know how you can just feel it in an office.

You can feel how it’s all, it’s all working like clockwork. A few hiccups here and there, but that overall, when you’re, when you’re on your game, you know, when everyone’s on their game and they know their role, oh, there’s nothing more beautiful than that. Yeah. So, I want to ask you technically some of these questions.

What percentage of your practice is rhino versus face and neck cosmetic surgery, Jason S. Hamilton, MD, who’s found out how the riches are in the niches?

Jason S. Hamilton, MD: I would say 99% is Rhino. 99%?

Catherine Maley, MBA: Yeah. Of those rhinos, how many are cosmetic versus reconstructive, Jason S. Hamilton, MD, who’s found out how the riches are in the niches?

Jason S. Hamilton, MD: I would say 75% cosmetic and 25% reconstructive.

Catherine Maley, MBA: Gotcha. And then how many rhinos per year are you doing that adds up, Jason S. Hamilton, MD, who’s found out how the riches are in the niches?

Jason S. Hamilton, MD: I would say if I edited up, so about five, about 250,

Catherine Maley, MBA: That’s what I was going to say, right around two 50 or three.

Yeah. How many revision rhinos could you have picked a more difficult procedure? You, you know, you’re, most surgeons are very risk averse. You apparently came from another pool. I mean, you, you can’t do anything more risky doing rhinos, then doing rhinos that are great for a lifetime. Cause you know, they’re going to come back to haunt you, what, five or 10 years later at the time.

So, I’m sorry, I had to go off on that. What you to pick rhinoplasty of all, Jason S. Hamilton, MD, who’s found out how the riches are in the niches?

Jason S. Hamilton, MD: But I agree with you about those elements that it, it is a tough population. It’s a tough surgery. A lot of plastic surgeons consider it one of the toughest surgeries because it’s a singular unit, right? So, you have two eyes, you can be distracted left and right but the nose is right in the center.

But it’s just the challenge, you know? It’s very interesting. It does not become mundane. Everyone’s nose is different. It’s a combination of mom and dad to, to a different percentages. And so, and you’re creating a new, a unique product for each patient. It never gets boring. And so that’s, that’s the, the surgical challenge, right?

Then there’s also the challenge of trying to actually help the patient, right? I learned very early that the results don’t really matter, right? Because everyone’s nose looks different, so the results don’t matter as much. The results that the patient is looking for. Yeah. Right. So, we can all think it looks great.

Patient may have some small complaints about asymmetries that, that you may not even see that they really want to be addressed and, and they have a difficult time being happy with anything that you deliver to them or any surgeon delivers to them. And then you have patients who are looking for minor.

Where you as a surgeon are like, no, we can fix all of these things., right? Yeah. And they’re like, no, I just want this little bump that I never had before. You know, I got hit with the baseball. I just want you to take that down and I’ll be happy. And so, the, the outcome is, is in the eye of the patient for sure.

It’s not in your eye. And that is actually what’s brought more satisfaction to my practice is not worrying about the surgery as much, which I’ve worried about to, to, to no end. It’s about worrying about can I make this patient happy and if I can’t, it doesn’t matter what it looks like, right? If it’s the best nose on the base of the earth, if I can’t make them happy with that nose, then they’re not ready for surgery.

And that, that’s been the biggest thing that’s helped me. And if they can be happy with, with a nose that I can deliver or, or even any surgeon could deliver, then they may be at that time a good candidate to have a revision surgery or a primary surgery. And that’s, that’s really been the key is, is, is as you’re learning, you’re going to, you don’t know how to take Donna Hump.

You don’t know how to get the tip right. You don’t, so you are concerned about that as you should be. Yeah. But I’m telling you equally or, or that what trumps that is figuring out should I operate on this patient? You know? And when you’re getting started, you won’t operate on everyone because you don’t have any patience.

You know? So that’s what gets you in trouble, I think. But if you can resist that urge to, to just operate and really focus on is this a good candidate? And it can be very reward and then, if you’re, if you’re picking good candidates, then it’s the best surgery. So, most satisfying, you can, you can operate on patients from 16, 17 in, in female 17, 18, 19, and males until they’re, you know, I have seven-year-old patients that break their nose.

So, you have a wider range of feasible patients that you can operate on. Right. Who are healthy. Facelifts are older. Population fillers are, I mean, some people are getting fillers very young now, but fillers fat transfer, a blepharoplasty, that’s an older population. So, it’s actually a wider market, you know, and, and that’s also attractive from a business standpoint.

Catherine Maley, MBA: But getting back to the patient, Jason S. Hamilton, MD, who’s found out how the riches are in the niches, this, now, you had so much experience, you probably don’t remember, but were you trying to like to, to get into the emotional mindset of a patient is difficult at best? Yeah, so oftentimes I’ve asked the surgeon, you know, somebody who’s been sued, I said, what did you learn from that?

He said that I should have trusted my gut. I knew something was wrong. I knew I thought I could handle. And I couldn’t, or it came from left field. Like I don’t know what happened. I don’t know why this went so sideways. So, are there any pearls there that you learned? Do you have them take a test? Do you have them to go to a psychiatrist?

Are there any telltale signs to watch out for, Jason S. Hamilton, MD of how the riches are in the niches, that now you flag immediately and go, uh oh, this isn’t going to work out?

Jason S. Hamilton, MD: Yeah, so I think, I think it’s a little bit of each. So, one, your gut, if you don’t feel good, if it’s not a good you are not obligated to do the surgery because someone booked a consultation and you just have to be okay with that.

So, feelings will be hurt. You may have to part ways. You do it kindly professionally and give them back their consultation fee and give them back their feet. Yeah. And, and then just be clean. You give them back their feet and it’s clean. Right? No harm to foul. So that’s just the gut feeling. The second thing is the, that are, that are red flags are.

Speed. Right. Someone who wants a rhinoplasty they’ve had this nose their entire life, but they for some reason need to have surgery within three weeks or five days or a month, or it has to get done. Because my birthday’s coming up and I’ve been waiting my whole life for that. That speed is going to put the patient in position where they’re not processing all the steps that are coming with specifically rhinoplasty.

Rhinoplasty is getting a graduate or a master’s degree. It’s a two-year process. Right. You’re not going to be healed in a week. Right. And so, the, the speed, the rushing, no, I have to get in now. I’m in town, it just flew in. Yeah. And then I want to have the surgery before I fly out on my… That those are red flags.

That’s, that’s where problems are going to come from. It’s just, just speed, right? And then and then patients who aren’t really willing to kind of go through the process and not following directions before you even do the surgery, you know? If you say, can you submit your operating reports from your, your other case, it’s been four months.

They, they never get them in. They come in for surgery and say, oh, I just couldn’t I don’t know what’s going on. They, they can’t get pictures from before their surgery. That’s a red flag. Like you don’t have any pictures from before. You know? That can be a red flag for you. Just having difficulty getting information.

They, they don’t get their h and p, they’re, they’re having problems getting labs. All of those things are potentially little. Points where you can overlook it as just, you know, something minor. But those things are going to happen after the surgery as well, and then it becomes a big problem, you know?

So, I think your gut inpatients, you know, and then the patients that are not following your protocol that you set, or they want to modify your protocol. No, I want my sutures out in, in five days, you know, and you always do it in seven. I want my cast off the third day because I need to travel and that’s not going to be good for me.

They’re trying to modify everything that you’re doing. Then that’s going to continue after the surgery. So, some, when, when you look back, like, like how you asked your other clients, when you look back, there are red flags the whole time, you know, it didn’t, it didn’t really come out of left field. There are red flags now.

Sometimes a red flag may pop up. Right the day before surgery or the morning of surgery, and, and you may not have the courage to, to, you know, call it quits at that point, but, but you, but you should, you know, I’ve, I’ve canceled someone on the gurney rolling into the OR because they’ve changed what they, they keep changing what they want.

Oh, I want to take, no, I don’t want to take it down. No, I want to leave that. No, I don’t want to do it. I’m like, you’re not. You know, and I’m very polite. I just say it’s probably not a good time right now, you know? And the most patient, every time I’ve done that, those patients specifically have turned out to be like the best patients.

Oh, nice. Right? Because, because they, they will go back and thank you and say, I, I wasn’t happy about things, but then I processed what happened, and I think you were right. I wasn’t actually ready. Now I have clarity about what I want to achieve. I appreciate you doing that. And then you turn out to, you have a great relationship.

So even someone who seems like there are, there are potentially you know, a difficult patient for themselves or for you can turn. A good patient, they may need to say psychiatrist, they might need a therapist. You know I had a aha moment walking my dog one day. Right. And you know, we, we are all trained.

And you’ve probably advised, and you just mentioned it or alluded to it, like, how do you avoid difficult patients? How do you avoid patients that maybe have body dysmorphia that you, you just not going to be able to help them with a knife? Right. That’s not the problem. You’re not going to be able to help them with a knife or a laser or a procedure.

There are other things that they need to work on before they consider doing that. And so, these are the things you need to do. What are the red flags asked Dr. Other doctors what the red flags and, and I, my aha moment was, no, that’s actually not the right thing to do. When someone comes in and we do their labs and they, they look like they’re a diabetic.

We all. Stop and we send them to the endocrinologist. We don’t try to figure it out, right? We don’t, that’s not what we do. We’re not the expert. There’s a whole specialty for that, right? If someone comes in and I’ve had that and their HCG is positive, like they’re pregnant the week up, we stop. We send them to the OB/Gyn.

We said, figure out what’s going on. Congratulations. We’ll see you when you, when you’re, when you’re ready to have surgery. We don’t try to handle it, you know? If someone’s thyroid is high, you know, preoperatively, we send them to the endocrinologist. Again, if someone has a blood dysplasia, their, their coags are off.

We don’t try to figure it out. We send them to the hematologist, they get it worked up and, and then they come back. If, if they have tachycardia, send them to cardiologists, but if they’re. Or they’ve had too many surgeries, or you’re not sure that their goals can be met. We try to figure it out and that’s not what we should do.

We should send them to a therapist or a psychiatrist. Right. That was kind of my aha moment. So, I don’t try to figure it out. I’m, I’m not trying to manage anyone’s Body dysmorphia of myself just because I’m a plastic surgeon. That’s something that needs to be managed by a therapist or a psychiatrist.

And, and maybe they can have treatment just like people may have short times where they’re depressed. But maybe 50% of patients with true body dysmorphia can have procedures with therapy and, and, and setting the standard about what we’re going to do. We’re going to do one surgery, you know, we’re not going to go back and keep doing things and adjusting.

And, and I think that can be very helpful for practice. So, you shouldn’t try to figure out how to manage you know, difficult patients. Before if you sense it, you can ask them, Hey I’m not sure that you’re, you’re. Confident about what procedure goals you want to reach. And, and I think that I would like you to see our therapist or our counselor, you know to kind of help you manage those and make sure that we’re communicating effectively and that we, we.

At absolute minimum, we want to meet your goals. But we’d like to exceed them if the patient’s response is right, I’m offended. Absolutely not. Then the, you probably avoided something, right? If their response is okay, then that’s probably a good patient, even if they don’t need it, right? Or, or they just need one session.

You’re probably going to avoid some difficult patients like that. So, so you can use that to kind of you know, check, test the water, so to speak. If you, if you re, I’ve had patients who have cardiac issues and I’m like, I think I need you to see a cardiologist and, and they don’t want to do it, and it’s no problem.

We’re not doing surgery like we don’t even think anything of it. But if it’s so. With mental disease or, or something where someone has body dysmorphia, we feel a little bad internally about sending them away. Right. But we shouldn’t, you know, we actually should help them and, and get them the right services they, they need just like we would with a diabetic or, you know a thyroid patient or anyone else that’s preoperatively having surgery work up.

Catherine Maley, MBA: I have I know words matter, Jason S. Hamilton, MD, who’s found out how the riches are in the niches. I don’t know if you can do this, but maybe call them a cosmetic coach instead of a psychiatrist. Just not to offend people because especially women are really funny about being labeled certain things. Yeah. Especially everybody is probably but I have noticed just being in this industry as long as I have if you a, a woman, several women will not use the word facelift.

They can’t say it. They’ll say I just need a little something. You know, something, something down here. You’re like… Yeah. They cannot say facelift. And I think how interesting. So anyway, so then you try to figure out other words to say that’s more comfortable for them anyway. So, having said all of that, what do you do?

You have to have tips for the unhappy patient, the one that you have had, they’ve had surgery, you think they have a fantastic result, or maybe you don’t, I mean, maybe it wasn’t your best work, but any tips for how to make them happy because that can go down this long road of stuff. Jason S. Hamilton, MD, how does it relate to how the riches are in the niches?

Jason S. Hamilton, MD: Well, I think one, you want to be responsive, you know, you want to respond to their complaints or their desires to follow up with you or show you what’s going on.

If, if they’re, if the patient’s talking to you, then you still have the patient, right? So, you should avoid middle men, right, or middle person, right? Don’t put someone in between you and the patient. You should be talking to the patient yourself. That, that decreases their angst. If someone has a problem, they don’t want to feel like they can’t get to their doctor, right?

If you can bring them in, in person or look at them face to face, the video is better than a phone call, right? And then have them point out in detail It’s bothering them. If a, if the concern is really just a matter of time, you know, let’s see how things pan out, then you just keep close.

Follow up with them. If it’s something that you need to fix or you feel like, Yeah, I could’ve done that better, you just need to tell them, we need to fix that right away, you know, no hesitation. And then work. Now, you know, many surgeons may have a difficult situation as far as getting people back to the operating room or getting things taken care of.

I’m lucky that we can just take patients back to surgery pretty easily. But if you need to take someone back, Just, just take care of it. If you can do it without any costs, yeah. That’s preferable, you know? And then because that doesn’t become part of the, the, the problem, right. And then and then just continue close follow up and usually, usually you can resolve most issues that way.

Right. If. And, and when things actually need to be fixed, then you can fix them, right? Now if someone has slipped through the cracks, right? And it’s, it’s just a difficult patient and you can’t find what to fix, or you’re having communication breakdowns then you, you definitely want to just have a comp, let everything kind of cool off, and then you definitely want to have a face-to-face conversation with that patient that that’s your best bet.

And, and then at the end of the day, there’s going to be one patient every, you know, five to 10 years that it doesn’t matter what you do you’re, you’re not going to be able to satisfy, you know satisfy their needs. And if you come to that conclusion, you may, you may have to have an honest conversation about that too, you know, but that, that shouldn’t, if you, if you’re, if you’re being cautious, you’re doing what’s best for the patient.

You’re looking for red flags. You’re not rushing in to do surgery. It shouldn’t be more than one every 10 years, you know? But it’s impossible for you if you just look at the numbers. It’s impossible for you to avoid, avoid that in, you know, a restaurant is going to have a customer who’s upset, you know it’s impossible for you not to.

So, it’s impossible for you to deal with a specialty where it is medicine, but there’s nothing functionally wrong with the majority of the patients, right? So, nothing is actually wrong, right? They’re making a choice. They’re basically shopping and to think no one is going to have buyer’s remorse ever, right?

No one’s going to. You know, I did like that tv, but maybe I could’ve got it cheaper. You know, I want to take it back, you know, is there anything wrong with tv, sir? No. But with plastic surgery, you can’t take it back, you know, but those feelings are still inside human beings, right? And so, it’s impossible to avoid a hiccup with a patient.

But you should be doing everything you can to avoid, you know avoid having problems or conflicts with patients. You should be looking for red flags. You should take your time and slow down, right? Be more concerned with doing a good job. Trying to find out if you can make patients happy instead of just trying to do procedures and build your practice.

Cause you’ll build it up and it will, you’ll backslide, you know, if you have problems with, with too many patients. And so, it, it seems like it’s exciting and, and you know, you’re in the little fever. You have the fever, you know, the practice growth fever, but you don’t want to go faster than you can actually still be a doctor and take care of you.

Catherine Maley, MBA: For sure. And, and in your case, Jason S. Hamilton, MD, who’s found out how the riches are in the niches, I would think quality is better than quantity. Just to, just to keep things good because you know, who, who I think the worst patients the ones who develop their own websites to slam you. Oh yeah. They seem to always be the rhino patients, you know? And they go to great lengths to do that.

And I that’s just, that’s a funny patient. So, kudos to, I had a, a rhinoplasty at a much later age, and I didn’t even know I needed one until one of my plastic surgeon friends said, you should really get your nose fixed. You don’t need a facelift; you need a nose job. And I thought, oh, thank you, sir.

But I loved it. Like I loved it. It softened my look, but I was the easiest patient on the planet. I was like, Can I just get rid of this bump? Thank you. And we were done. Speaking of which, are you using computer imaging? Cause patients really like that? Jason S. Hamilton, MD, how does it relate to how the riches are in the niches?

Jason S. Hamilton, MD: Not, Yeah, they do. I use it but I’m not using it to sell surgery.

Okay. Use what I’m saying. I’m using it to communicate. Just like you take a patient’s picture and you’re both looking at it together at the same time. Yep. You’re also looking. The changes and the goals that the patient has together at the same time, so to speak. But I’m not trying to perfect anything on the computer screen, you know, and that’s also a red flag, you know, if you show someone, if someone has a big Roman nose and, and you make it pretty straight, And they’re like, It’s really good, but maybe a millimeter more, no, half a millimeter.

No. Okay, that’s perfect. Now I want to have the surgery. No one has that much control, you know, in, in a case. And that means they’re not going to be, they’re telling you I’m not going to be happy with a 99% improvement. Right. I’m only going to be happy with perfect. And we know perfect is not possible. So that’s a red flag.

So, I’m actually using it to actually interview the patient as well. Right? And, and I, and I like it in that, that some people take the, the photos that I’ve morphed and they reor them, you know, and make the nose tiny and pinched. And I’m like, I’m glad you did that because that shows me that I’m not going to be able to deliver what you want.

I’m not going to do that. And, and we’re not a good match. You know, we’re just not a good match. And so, I like to use it that way. Some, some colleagues are using it to sell the surgery. You know, they, they make a perfect nose. They print it out, the patient’s walking around with it like this, and they think that’s what they’re going to get.

And you, you, you’re not a 3D printing, you know, robot. So, I would be cautious about using it to cell surgery. I would do a little less than you think you can actually deliver. Right? And, and you’re using it to kind of interview the patient. From an aesthetic standpoint, you know, if you do something that looks really nice natural, and that you think you can achieve, the patient’s completely unsatisfied with it, or they’re like more, more and more than that, that’s telling you that you, you, you may be cautious, you should be cautious about moving forward with that patient.

Catherine Maley, MBA: All right, so let’s go on to the more fun stuff and positive, Jason S. Hamilton, MD, who’s found out how the riches are in the niches, and that’s marketing and you people have that big out. One of the reasons I wanted you on this podcast I talk about this, I blog about it, it all of it’s called extreme targeting. And most surgeons are appalled at the thought of only having a certain target market or a certain procedure, right.

Or a certain thing that that catapults them to be different, you know? Yeah. And you just jumped right in completely with that. And as too, you even have black nose job.com URL. You have an email called Ethnic Plastic [email protected]. If you look at social. You are called African American rhinoplasty, ethnic rhinoplasty before, after septal perforation surgery, Dr. Jason Hamilton, but you have absolutely bought into extreme targeting in regards to how the riches are in the niches. And just tell me what that was like and were you scared to death to do it, to be that targeted or you know, do you regret it or, or has it actually catapulted you to get out of the fray of everybody?

Jason S. Hamilton, MD: Yeah, I, I think I think what you alluded to I like the way you kind of categorized that like extreme, you know, focus, it’s an extreme focus.

Yeah. I, I think it’s catapulted me. It was always my interest anyway, but just kind of putting a stamp on it and saying, this is who I. And, and I’m okay with who I am and, and this is what I do anyway. Let me just put a stamp on it. I think that that’s catapulted me in, in that submarket to heights that I probably wouldn’t think were possible.

It’s catapulted me over just a regular practice too. I’m not the, the numbers are busier than a busy surgeon, you know, in, in my mind. And I couldn’t do most of, I don’t think I can do much more and not pull my hair up, you know? But it’s definitely been, been a positive force, but I’ll tell you where it came from.

One in a very competitive market, right? Yes. And so, if you’re just going to be another Botox injector, you know it’s, it’s just going to be a price war at that point, right? A lot of doctors love rhinoplasty, especially in Los Angeles, you know big seed. They love doing rhinoplasty. But I think the niche for me is that I’ve, I’ve always just as a student, a resident, and then, you know, practicing on my own I find I’ve found that specifically black patients weren’t getting great results on rhinoplasty.

You know Michael Jackson, you know, being a beat the poster child. Yeah, yeah. Poster child for that. And so, and then, and this is something that I, I was passionate about and I feel I was doing a, a really good job at, and so I, I just said, I’m going to put my stamp on it. I, I have some marketing advantages and, and I’m going to use.

I am of African descent. I’m black, so that helps. I’m a facial plastic surgeon. I love rhinoplasty and I’m okay putting my stamp on it. If you look at the numbers there were, there were probably about let’s just say 400,000 rhinoplasties last year in the us in 2020 in the us probably down from the normal numbers, but that it’s still the number one cosmetic surgery right now.

Only about 5% of those are, are African American or Africans, or described as African. So that does not seem like a good marketing strategy, right? If 95% of the patients have rhinoplasties are going to be represented by, by a different ethnicity or race. And so however 5% of 400,000 is a lot of patience.

You know, that’s more patience than I could do in my lifetime. And that’s every year. You understand what I mean? So, so if you, if you can actually have the courage, focus on anything because there’s more than enough patience for you, you, there’s more patience than you could ever operate on in your entire life.

So, so, being kind of hyper, super extreme focused has worked very well for me because you get attention you get immediate recognition for that if you’re doing a good job and taking care of your patients. And it’s harder the entrance point for anyone else coming in. It’s a little, it’s a little more difficult.

You can’t just jump in, you know, it doesn’t come out of a box as I like to say to, to my staff and stuff. But wrestling, I can just open a box. Botox, they can just open a box. Cool sculpting. You just open the paddles, stick them on, turn on the sensor. But for you, if you’re a surgeon, this is just my belief, if you’re a surgeon, you have a unique set of skills.

If you have a particular area of interest, developed you know, repeatable, great results. You should jump out. You should jump out, you know especially in a big market, which sounds like the opposite of what you’d want to do. If I was in a small market, I probably would just stick with everything.

Cause there’s not a lot of competition, you know? In, in a, in a middle size sound, there may only be a couple surgeons. They may be cordial to one another and they all do different things. You should probably keep the breath of your, your specialty. But if you, if you want to compete and you have a talent for something, I think it’s okay to just focus on that now when you let everything else.

Catherine Maley, MBA: You’re going to see a nose dive that nobody can survive, Jason S. Hamilton, MD, who’s found out how the riches are in the niches.

Jason S. Hamilton, MD: They can’t handle that. Right. You have to, you have to survive the phone not ringing. Right. You know, you have to survive the phone not ringing and, and your schedule going to you know, turning white basically, you know, like nothing’s on the schedule, nothing’s there.

You have to be willing to survive that. But then when you are building back up, it’s, it’s actually real, you know? It, it’s I like to say if you just have a, a Botox practice you know, someone can set up shop across the street and get a, have discounts and you may lose, you know, percentage of those patients overnight.

If you’re, if you’re super specialized, you’re probably going to be okay. You’re going to weather a lot of storms and we’ve weathered a lot of storms. You know, I, I trained when I was training, it was during Katrina. You know maybe two years after I was done practicing the market crashed. You know even doctors weren’t referring patients because no one had insurance or so they were holding onto their patients as long as they could.

I’m in la plastic surgeons aren’t going to refer patients to, you know. And then and then I’ve been through the pandemic. I, I’ve had a lot of, lot, I started out in the recession, so that kind of made me aware that things can change in your practice, you know, and, and you want to have good stability.

You want to build in something that can weather the storm. And I think extreme, you know, specialization is one of those things, you know, if people need those services. They, they will find you. And, and I’m diversified. I’m not just doing cosmetics. So, the reconstructive part of my practice you, you, if you, if you fracture your orbit, you know, you’re not going to be able to just walk around with that until you conveniently ready to take care of it.

So, I think all of those things are like, people let trauma, they let they let the reconstruction kind of slide away from their practice, where I think it’s a great a great part of, you know, plastic surgery. One of the most common. Perform procedures for all plastic surgeons, right? It almost trumps everything else.

Is, is reconstructive, like doing skin cancer work? You know there’s, there’s a lot of work there for, for surgeons and, and if you give it up, you’re basically giving up your diversity. You know, hey, you’re not diversifying your practice, but, but when things are going well, there’s a temptation to do that.

I’m just really lucky that when I came out, things were going bad for everybody, you know? So, if you, if you grew up in the Great Depression, you keep cans of peas, you know, in basement you know, just in case.

Catherine Maley, MBA: But back to extreme targeting, Jason S. Hamilton, MD, who’s found out how the riches are in the niches, that allows you to charge an awful lot more, which I hope you are, because you have put all your eggs in this particular basket or a lot of your eggs, and the patient now is be, is being attracted to your expert status.

Yes, your celebrity status, like you’re hanging with the big boys, Jason S. Hamilton, MD, who’s found out how the riches are in the niches. Now at that you’re also in Beverly Hills, so that hasn’t hurt, but you’ve gotten some really killer PR from this. Yeah. You were on the doctors. The way is the doctors, is it kind of like a pay to play thing or some you had pay somebody to do something to get on these shows, right?

Jason S. Hamilton, MD: No. Just from our branding and experience. Yeah. We were contacted by the show to see if we could help, you know, a particular patient. At least in our case. That’s how it’s always gone. We were on Dr. Pimple Popper, you know, recently, and again, you know, she contacted us just from my reputation to help her with, you know, a case.

So that’s how it’s gone for us. And, and what I’m saying is, that’s, that’s better than having to necessarily have a PR person if, if you’re just known as Okay. A lot of, a lot of practices can do this, but when you have a real. This is where you go, we’re those guys, you know?

Catherine Maley, MBA: And so, and that’s what, what everyone wants.

Like when, when you have a patient who wants something like a facelift, who do you go to? You want your name to pop up. And that doesn’t happen by accident. You have to focus on that and write about it and speak about it and do a lot of it and have a lot of people talking about it. How about the celebrity status you have though, because you are attracting can you just tell one story about the that football player?

I don’t know anything about football, but Sta Johnson Yeah. Did that kind of put you on the map and change your career a bit to help you, Jason S. Hamilton, MD, who’s found out how the riches are in the niches?

Jason S. Hamilton, MD: Yeah, I think so because you know, everyone’s aware of like orthopedic surgeons, right? Dealing with some shoulder injury on a football player, but there probably has never been an E N T or a facial plastics doctor that’s going to be on ESPN, you know?

And so, the Stefan Johnson had dropped, you know, 275-pound weight on his neck basically crushing his, his larynx and his ability to breathe. And we got the call to come to, to come help out and basically ended up saving his life and his career because he was able to get back out on the football field.

And that story through ESPN running, you know, almost every hour during the Christmas holiday, you know? Oh my God. We got a lot of notoriety wherever I. It, we were traveling to New York once, and it was on the jumbotron, you know, big screen in New York, Times Square, you know, so, so the, the, that definitely catapulted us and made people aware that we do also take care of athletes, which, you know, no one thinks that e t doctor or facial plastic, so you’re thinking orthopedics.

But these guys break their nose, boxers, break their jaws. And it just kind of put us on the map for that. And then we started getting contacted by athletes and sports teams and to take care of patients. And it really catapulted that part of my practice. And that, that also builds, builds credibility, you know?

Yep. And then that allows you to build other parts of your practice. So, we’re going to stick with our plan. Seems to be working, and that’s a great plan. It, it’s a slower, more methodical, meticulous road, but it pays dividends for a longer period of time, I think.

Catherine Maley, MBA: Right. So, what’s driving you, Jason S. Hamilton, MD, who’s found out how the riches are in the niches? I like to talk about mindset, like how did you get to thinking like this?

It doesn’t sound like you grew up with medicine, so that kind of came out of left field, but do you have a drive to help people? Ego gratification? Like what, what, like what’s driving you?

Jason S. Hamilton, MD: Basically, my drive is initially I wanted to get into medicine. Because I wanted to be able to take care of myself and my family.

Like you know, coming from Jamaica we don’t have access to this level of healthcare. When my grandmother, for example, had surgery, we had to buy the implant and take it, you know, to the doctor and hand it to them., you have to bring food to the hospital and you have to feed your family member, bathe them, and do all, you have to change the bedding.

You’re basically nursing and, and that you know, children process things differently. That seems a little scary to me., you know? And, and my fear was being a position where I can help my family or myself, you know? So that was my initial interest in saying, hey, I think medicine would be a good choice because you, you can help your family, you know, you can help, you can help people, and, and, and you don’t have to, you know, live in fear.

And so that, that was one of my drivers to get into medicine and just being. Individually passionate about being excellent at something. That’s, that’s really what I wanted to be excellent at something. And I think we all do we all have those dreams but we may not know how to do it. And I, I wanted to feel like I could grow in medicine, in an area where I could find an expertise and kind of really focus on that.

And that’s, that’s really my drive. Rhinoplasty gives you that you’ll never perfect it. You’ll never perfect it. You know, you’re really practicing medicine in the sense that you, you can become as, as good as you are. And even when you get to the, the stage where maybe even patients don’t know what you’re talking about, where you’re finding critiques on yourself but you’re finding them, you’re finding those critiques, right?

And you want to make them better. And, and the further you go in your career, and you follow your patients, you get to see those long-term results. You get to see 10-year results, 15-year results, and, and then you think back and you’re like, I’m not going to do that again. I’m going to, I’m going to change what I do, and then I want to see how that turns out in 10 years.

So, it’s, it’s very motivating and it’s inspiring and it’s you’re kind of like a tortured artist in that sense. Ok. Cause you’re, you’re, you’re picking yourself apart and it keeps you humble. So, I, there’s no ego involved in it. It actually keeps you humble because you’ll never perfect it. And, and agreeing to sign up for that challenge right.

Is very humbling. And, and it keeps the passion going for myself, you know, for myself.

Catherine Maley, MBA: Well, the payoff’s been fantastic, Jason S. Hamilton, MD, who’s discovered how the riches are in the niches. You have, you just have a lovely practice, lovely demeanor, lovely reputation great patients. I think you did Cardi B recently, or no? Or no. There’s, oh my God, you just, you have a lot of good things going on there and you, when you mentioned your dog, was it the dog? The therapy dog.

Jason S. Hamilton, MD: Oh yeah. Yeah, we have a well I have my own dog, but we, we do have a therapy dog that’s part of the practice, you know Laney and that, that kind of grew out of Covid and it’s called Pause for Patients. It’s part of our foundation. And Elany will go to different schools and help.

Children with maybe learning disabilities and the children will read to her. And just get to kind of have some comfort or the excitement. Who doesn’t love a dog? You know, it was really big during Covid because people were isolated. So, Laney was even doing video, you know, talks with kid’s classrooms and so it’s been really popular.

And it’s, you know, therapy dogs are well known. Most people probably don’t have one as part of their practice, but you know, it’s just, it’s, it’s very unique and We’re excited about her participation and she, she’s been able to, you know, Laney has been able to raise funds for us to do medical missions in other countries and health children and, you know, adults that have you know, maybe cancer diagnoses or tumors or deformities that they could never have taken care of because of resources in their country.

And that’s something I’m passionate about too, and that keeps me really humble because I have a good balance. I’m in Beverly Hills plastic surgery. And then and then I’m going to third world countries and seeing what real, you know, poverty or lack of hope looks like. And it really balances, balances things out for me.

My kids get to see me do that and I’ve brought my children with me on these trips, and so they get to see what the world looks like outside of our bubble. And, and I think that’s important too, and I recommend that to anyone is to you definitely. You definitely want to give back and you definitely want to see what the world looks like and what your gift is as a physician and what you can do outside of just your practice.

Catherine Maley, MBA: Huh. Excellent words of wisdom, Jason S. Hamilton, MD, who’s discovered how the riches are in the niches, I think. We’ll, we’ll leave it at that. Thank you so much for coming on. I really appreciate it. I’ll be watching you grow, although you probably don’t need any more growth. You’re doing just fine. But everybody if you did want to get ahold of Dr. Hamilton, you could go to www. BlackNoseJob.com.

Yeah. And then it’ll viral off onto different places. But he’s doing a heck of a job, so I would take a look at that.

Everybody that’s going to wrap it up for us today, a Beauty and the Biz and this episode on how the riches are in the niches with Jason S. Hamilton, MD.

A big thanks to Dr. Jason S. Hamilton for sharing his successes related to how the riches are in the niches.

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.

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

-End transcript for the “The Riches are in the Niches — with Jason S. Hamilton, MD.”