Dr. Kouros Azar, Live at The Aesthetic Meeting 2023

Max Baybak

Hello, hello out there. Max here, co-founder and Chief Growth Officer at Influx Marketing, and today we're at the Aesthetic Society meeting here at the Miami Beach Convention Center. This is the annual meeting of the American Society for Aesthetic Plastic Surgery. Every year I walk the aisles and I end up spending most of my time chatting with industry peers and marketing-minded physicians, and I always walk away really feeling like I have my finger on the pulse of what's happening in our space.

So this year I thought it'd be fun to take it a step further and have those same discussions that I always find myself having, but do it in a podcast format so that I can bring them to you at home. So if you're like me and you want to be dialed in on what's happening within the world of patient acquisition and digital marketing for aesthetic practices, follow along, and I hope to bring you some valuable insights through these conversations that you can use to take your practice to the next level. Can't take myself seriously. All right, let's roll with it.

We're back, and I now have the pleasure of being joined by Dr. Kouros Azar, who happens to be an Influx client. He's based in the Los Angeles area — Thousand Oaks, specifically. Thank you, Dr. Azar, so much for joining us.

Dr. Kouros Azar

Thank you so much for having me.

Max Baybak

Yes, it's my pleasure, and I'm really looking forward to picking your brain. Well, actually, before I get to — let me, I'll just have you tell our audience a little bit about yourself, your practice, what you focus on.

Dr. Kouros Azar

Sure. I'm a board-certified plastic surgeon. I've been in the Thousand Oaks area for about 20 years, and our practice focuses primarily on aesthetic surgery, so we do a lot of facelifts, rhinoplasty, breast augmentation, revision breast augmentation, tummy tucks, et cetera. And we have a med spa and a surgery center as well, so I have nurse injectors, I have an esthetician, we have lots of lasers and sculpting and non-invasive technologies as well. So we're addressing the whole gamut of aesthetics.

Max Baybak

Excellent. Do you have a sense, right offhand, of sort of what percentage of your practice is non-surgical and surgical?

Dr. Kouros Azar

It's hard to measure, because some of my time is levered — so when I'm operating, my staff is doing some of the non-surgical stuff. But I would say, you know, I probably overall have about 40 percent of my practice would be non-surgical.

Max Baybak

And so it represents a significant portion.

Dr. Kouros Azar

Yes.

Max Baybak

When did you — when did you begin the med spa side of it and bring in the non-surgicals?

Dr. Kouros Azar

So I've had estheticians all along. Of course, there's always been a challenge with finding, like, the best ones that you really connect with and have the best ability to make the best treatments for your patients. So we've had really great estheticians for about six years now. I brought on nurse injectors about four years ago, and I've been gradually training them more and more, and so they typically are at the point now where they can do almost everything I can do, which is great. But it took a while to get there.

Max Baybak

I'm sure, I'm sure. I wanna — this show, as you know, is about marketing, so when I have a chance to sit down with a surgeon, a solo practitioner — or I guess you have a whole med spa component too — but when I get to sit down with the surgeon, I want to understand things from their insight. You know, whether marketing is your passion or background or not, you have a vantage point that we want, because we're sitting behind the screen or sitting remote. We always like to work locked in lockstep with our client, understand what they're seeing on the ground.

It's actually something we talk to our team about a lot: you want to tell the client what you're seeing in your marketing numbers, but also listen to what they're saying. Don't just say "this is what's happening," because you're not there, and you need to match the two things together, and then you can make pivots and adjustments to find the sweet spot. So I really want to pick your brain about marketing, and since you do have such a significant non-surgical portion, I'd love to talk about the difference in the marketing for the surgical and the non-surgical.

Dr. Kouros Azar

Sure.

Max Baybak

But for starters, if I could just go back to when you first started your practice — how were you first acquiring patients?

Dr. Kouros Azar

So I think early on, you know, 20 years ago was a very different game than it is now, and back then it was more about — the way we were trained is just show up, be affable, be available, be able. You know, just go around, meet people. Word of mouth, which is still of course very important — internal marketing. But in those days we could do some print advertising, we could have an article written about us at a local magazine, or we could have, you know, small events. You know, things were more organic.

And with digital now, it's just much more complex, just like life in general — the way that you get texts and emails all day long now. You know, that wasn't the case 20 years ago. So now we have to understand things like pay-per-click and organic and, you know, reviews and listings and rankings and all the stuff that we didn't have to know about 15 years ago.

Max Baybak

Yeah. Happened fast, actually. And now I feel like there's all kinds of new change coming with technology.

Dr. Kouros Azar

Absolutely, and we'll see what the next wave is.

Max Baybak

That's right. AI is already here.

Dr. Kouros Azar

Right — growing fast, and so that's all going to be part of what we do.

Max Baybak

Excellent. Yeah, I agree, I know it will be, and I have a good idea in some cases of how it will manifest, and in some ways I don't know yet. That's why we watch it closely.

Dr. Kouros Azar

One of the things you brought up is the difference between surgical and non-surgical marketing, and that's an interesting one, because I noticed as a plastic surgeon starting out doing a lot of big surgeries, you know, and med spas competing down the street, for example — you know, or even within my own practice, when I run some type of marketing campaign for non-surgical versus surgical, I think for the same amount of dollars, per se, you get bigger response on non-surgical treatments than you do with surgical, because it's less intimidating, right? So if people feel like they could just come in and hear about it, and they don't have to meet with a plastic surgeon, and they don't have to get dressed up to come into the office — there's all this sort of inhibition with coming in for surgery, right? So the med spa is having a bit of an advantage that way.

And within our own practice, our med spa has an advantage because people are more likely to just call and book an appointment or book a treatment. You know, they can call up and say, "I want to have hair removal," or "I want to have a BBL laser to get rid of my red, you know, red and brown sun damage." I don't necessarily need to put makeup on and sit in front of Dr. Azar for 30 minutes and feel intimidated, right? So I feel like the marketing efforts go a lot farther with non-surgical treatments than surgical treatments, because of that intimidation.

Max Baybak

I agree. And — tell me if you agree — but then by that very same token, it ends up sort of being a nice entry into maybe more surgical procedures. I know some will do non-surgical and maybe not ever consider surgical, but do you see a sort of translation of some percentage of people who maybe came in for something they were hoping could be remedied non-surgically, but ultimately they learn —

Dr. Kouros Azar

Absolutely — they're going to need a surgical. There's sort of two main portals where people can convert from non-surgical to surgical. One is if they just have trust, right? So they've tried microneedling, they've tried a facial with us, maybe they've had hair removal, and then they say, "Oh, this seems like a good office. I've had a good experience here. I've seen the doctor walking down the hall. He seems like a nice guy. Maybe I'll book a consult and talk to them about my breasts or something." So that's one way.

The other way is just when they feel like they need something but they don't know what they need, and then my staff looks at them and says, "You know, it'd be great if you could do a non-surgical facelift, but you're not really a candidate for it. You're not going to get a result. You're going to spend all this money and not get what you want. You need to see Dr. Azar for a facelift, because that's what you need." Because the public doesn't necessarily have the awareness of this arena enough to know — everybody doesn't know what they need, right?

So just having them in the office where somebody could look at them and say, "You know what, just to be honest, you're not going to get a result from X, Y, and Z treatment. You need to actually have surgery, I'm sorry to tell you" — or, you know, we have to sometimes break it to people lightly, because they didn't come there for that reason. But we also want to be honest — we're the experts in the field. So if they choose to do nothing, that's okay too, but the last thing we want to do is sell them on a treatment for X amount of dollars and they're not going to get the benefit that they were looking for.

Max Baybak

Exactly. How about the other way, and surgical to non-surgical? There's obviously quite a few entry points where you can transition someone.

Dr. Kouros Azar

Absolutely. So if somebody has, let's say, breast augmentation surgery with me and they're happy with the result, and then they can go have laser hair removal in my office, or they could have their facials. I see it as sort of a portal where they can sort of be deposited in the laser hair removal bank for a while and then come back to the practice for other things, so you don't lose them. You know, patient retention is very, very key, because as the biggest component of marketing, you want to do internal marketing first, because it's cheaper than external marketing, right?

So the big component of internal marketing is patient retention. So if you can keep your existing patients, you're going to have a lower customer acquisition cost than spending money on ads and so forth. So one good way to do that is to move them from surgery into hair removal or to facials or microneedling or something to maintain their skin, and they'll be back when it's time for their tummy tuck or whatever else.

Max Baybak

Yeah. And how about complementary procedures? So maybe they've had a facelift, and there's things — I'm just using that as an example — and there's things that you recommend that they follow up. I know that there are some skincare brands out there in the perioperative space, or periprocedural space, you know, but that's just one example. There's probably a lot of kind of adjunct or complementary non-surgical procedures you can recommend with a surgical.

Dr. Kouros Azar

Absolutely, and I think I look at that in two ways. I look at it as educational and reactivating, or maintaining, that patient. So when we do a facelift, we include laser resurfacing most of the time, unless their skin is not appropriate for it, but we also include professional-grade skin care. So we have five or six different lines in the office, so we include that with them, so hopefully they're learning a lot more about professional-grade skin care, which to me means, like, products that actually contain active ingredients, right? So if you go to Nordstrom or Sephora or wherever and you buy really great skincare products, they're not going to contain prescription-grade ingredients, whereas in my office they would, and also we have professional staff that can help you with those products.

So once you learn that, you can't unlearn it, right? So even though you've had your facelift, you're not going to go back to using products over the counter that don't work for $200 a pop, when you can spend the same amount or less and get a prescription-grade product that actually makes a difference, and have the staff to back you up. So once they learn that, it's helpful to just keep them on this product, both for patient retention and because they'll have better skin as a result.

Max Baybak

Absolutely, yeah. So internal marketing — I was going to go there, I was going to get to that — because on the non-surgical side specifically, I wanted to point out, or ask your opinion on, you know, increasing that lifetime value of a patient. In surgical, I've heard different studies that people will averagely have as many as three surgeries in a lifetime. That would start from, like, you know — theoretically the arc is a breast augmentation or some sort of breast surgery, and then tummy tuck after childbirth, and then maybe face stuff when you're — okay, that would be the natural progression.

Dr. Kouros Azar

That's the natural progression, and it made sense — if you're bought into doing aesthetic surgery at a young age, you're probably going to come back to it, and if you've got a good result.

Max Baybak

Yes. But okay, so maybe three surgeries, averagely, but the opportunity in non-surgical is obviously much higher volume. So the importance of winning back and retaining those clients through internal marketing — is that something that you focus on, or do you have any comment on that?

Dr. Kouros Azar

Yeah, that's huge for my practice, because one of the things I'm really big on is I want my practice, my office staff, and myself to appear like experts in our field, right? My dad was a heart surgeon, and he taught me — he said, if you're not going to be the best, you're wasting your time, right? And he used to cite people like Denton Cooley and Michael DeBakey, who were like the top heart surgeons in the world. He was like, if you're not going to be like them, you're wasting your time. So I always want my staff to understand that when a patient's there, they need to feel like we're the experts, you know. And I don't care if they're calling up for a new pediatrician or a new OB doctor or something — if they know that we are really smart at what we do and they see us as a resource for anything and everything in the medical field, you know, that makes me happy.

And so — just to give them such a good experience at the office, and also such a good knowledge base on the part of my staff, that they're not going to want to go anywhere else, right? Because there's a lot of stiff competition. They can certainly get, you know, toxin or filler down the street for less, but there has to be a compelling reason for them to not go anywhere else.

Max Baybak

Yeah, it makes sense, yeah. Is there anything you do, internal marketing-wise, in terms of patient loyalty, membership programs, on the non-surgical side?

Dr. Kouros Azar

Yes, we have a couple things. We have a pre-booking discount, so if they book their tox and filler appointment ahead of time for the next appointment, they get a savings. We also have a one percent back reward program. I have the patients carry a black card that has a chip on it, like your credit card, and it stores points, and it's also an excuse for them to carry my passport around for me.

Max Baybak

That's good.

Dr. Kouros Azar

And although those are some app-based loyalty programs now, I don't like those as much, because I really like them having my business cards in their purse. Because it's like, if the patient — if a friend asks them, you know, "Who do you go to?" — they've got my info right there.

Max Baybak

Yeah, that's neat.

Dr. Kouros Azar

And then sometimes, if we were to have a month where I wanted a little bit more volume, we could send out an email — hey, double your points this month, right? So if somebody, let's say they spent — you know, start them out on a breast augmentation, now they have $200 credit on their loyalty card. I can turn that $200 into $400 spontaneously by sending out an email — hey, come in this month to get double points, right? So those are little tricks that we've used.

Max Baybak

Yeah, good. And it's good you're doing those kind of things. So we were talking earlier about your experience in marketing, and I'm curious, just in, you know, having been in practice for the years that you have been, what advice you would give to other surgeons, and your takeaways from your different marketing trials and tribulations.

Dr. Kouros Azar

Absolutely. Well, I think number one, as I already said, is internal marketing is also most important, because if you're not doing that, there's a lot of waste happening. The second is to really measure your results — really work with a team, like an outside company. Like, Influx has done a great job for me, just filling in the gaps that we're not good at, right? We're not good at everything. We can't possibly run our own pay-per-click campaigns; we can't possibly maintain a measurement of all of our organic rankings day in and day out. So working with a good company and a good team like Influx has been really valuable to us.

But also utilizing the ability to measure that. So if you're running ads, or you're really hoping to be the facelift guy on the block, or, you know, the expert on abdominal etching, or whatever you want to do — make sure you're measuring, you know, what you're getting for the dollars that you're spending and the time you're spending, because your time is also valuable, right? So if you're not measuring it, you're really just kind of barking up random trees and wasting time, which is not good for any of us.

Max Baybak

I couldn't agree more. The more insights we can have — and it does take participation on the practice. We provide what we can, but we need some input, and kind of work together with them to make sure they're implementing systems that help us to track things and put that data together and match it up, so you can really see what's not working, where to double down, right? And you can make data-driven decisions.

Dr. Kouros Azar

Exactly. Another thing I noticed is there's a magazine out there called Fast Company. I don't know if you've ever seen that.

Max Baybak

Yeah.

Dr. Kouros Azar

You know, it's like Entrepreneur magazine or Forbes, but I wonder, what does that mean, Fast Company? You know, and because I'm not a business person, so I started reading it, and I realize it's — time is really money, right? So if you look at a new business that opens up — like, I remember in our neighborhood there was a Red Lobster restaurant that went up, like, in two months, and I was trying to make a few changes in my office during that time, and I'm like, well, certainly if they can build a whole new Red Lobster in two months, we can make these changes as well. So time is money, and I think when you're measuring marketing, you have to have a time limit for yourself — like, I'm gonna run a certain campaign for two months, and at the end of that two months, I'm either gonna double that campaign — double down on it — or I'm gonna kill it. And if we don't make those kind of time-related decisions in our practice, we just won't make progress.

Max Baybak

I agree, but I'll also say that there's an important flip side of that, which is that if you don't set a time frame for a given experiment or campaign —

Dr. Kouros Azar

That's right.

Max Baybak

— on the other side of it, where you go, "I'm going to do this for this long before I make a decision," because sometimes people need your — you know, at a week into a campaign or something. So also having a little bit of a vision and so forth.

Dr. Kouros Azar

That's right, and that's where we rely on you guys, because, you know, you're the experts in marketing, so I defer to your experts on how long to weigh it and how much to put into it.

Max Baybak

Well, excellent. Well, thank you so much, Dr. Azar, for joining us here today. Is there anything else you would want to share with kind of the surgical community or peers? And it doesn't even have to be about marketing — if there's anything, here while you're on this platform.

Dr. Kouros Azar

I would just say, you know, follow us on Instagram — it's Azar Plastic Surgery. We're doing some great new videos. I'm also an engineer, so I love medical device development, so I'm also inventing new things and love to get people's perspective on stuff I'm doing. So shoot me messages if I can help you with anything you're up to.

Max Baybak

Excellent. Thank you so much, Dr. Azar. Appreciate your time.

Dr. Kouros Azar

Thank you for your time.