Putting the Best Face on Cosmetic Surgeons

DR. GUS GALANTE, a board-certified plastic surgeon, would have been the first to admit he needed a makeover in 2006. If a local woman in the market for a tummy tuck had searched for plastic surgeon and northwest Indiana, his Web site came up so low among Google searches that he might have had better luck attracting patients by screaming from a mountaintop.

What’s more, there are 145 board-certified plastic surgeons within 60 miles of his offices in Schererville and Valparaiso, Ind., and twice as many doctors offering face-lifts and nose jobs.

His old site had before-and-after pictures and a laundry list of his impressive credentials, but nothing close to the online theatrics it takes for a plastic surgeon to make a sale today. Heart-to-heart videos in which doctors reveal why they got into this field, or why a patient should choose them over others, have a way of enticing patients.

In March 2006, Dr. Galante hired Etna Interactive, a medical marketing company in San Luis Obispo, Calif., to help raise his profile. He worked with an Etna copywriter to create pages for each procedure he offers, including information about how breast augmentation or liposuction is performed and what recovery entails.

Etna advised him to pay for listings on directories like smartplasticsurgery.com and yourplasticsurgeryguide.com, which are frequently visited by potential patients. Last year, his marketing costs came to roughly $20,000, but Dr. Galante, who joined eight directories in total and is happy with his Web site, galantemd.com, said he’s “definitely gotten more patients through the Web.”

Dr. Galante’s site has four times the traffic it did in 2006 and consultation requests have doubled, said Ryan Miller, founder of Etna.

“Being the one that gets picked out of hundreds and thousands is the challenge for the plastic surgeon,” said Mr. Miller, who said that Etna works with 165 cosmetic doctors, up from five in 2003.

Patients have plenty of options today. Roughly 5,700 plastic surgeons are certified with the American Board of Plastic Surgery, but that doesn’t include gynecologists, dentists and dermatologists, who can also nip and tuck. And some patients bat nary a droopy eyelid at boarding a plane to see a doctor.

Sundie Palmer, on Maui in Hawaii, found online two cosmetic surgeons in California that she liked and confirmed that they were board-certified by calling the American Board. After flying to Los Angeles to consult with each doctor in person, she chose Dr. Grant Stevens in Marina del Rey for her tummy tuck and breast lift. “I was impressed with his Web site,” she said, “but you still have to do your homework.”

But for less-shrewd patients, a boastful Web site is all they need to pencil in surgery. Roughly 113 million Americans have used the Internet to get health care information, according to the 2006 Pew Internet & American Life Project. But three-quarters of them do not consistently check the source and date of the health information they find online, the report said.

Granted, the study encompassed all kinds of physicians. But cosmetic doctors seem to be exceptionally adroit at promoting themselves online.

“Cosmetic doctors do all of the heavy advertising because they’re not controlled by health insurance company fee structures, and a lot of the surgery is done in private offices and clinics, not in hospitals,” said John Connolly, chief executive of Castle Connolly Medical, a health care research firm that has published seven editions of “America’s Top Doctors.” Plastic surgeons still advertise in high-end glossy magazines, he said, but “online is the least expensive, and they get the opportunity to show a lot more with real before-and-after photos and videos.”

That is not to say that doctors don’t have to pay hefty fees to play. Plastic Surgery Specialists, for example, a group of five plastic surgeons with five offices in the Baltimore area, spends $350,000 a year for the Cyphers Agency to promote them offline as well as to conceive, design, and write copy for their site. It’s necessary, said Ajia Coolbaugh, the office administrator who handles marketing. The competition in greater Baltimore “is fierce,” she said.

“Surgeons aren’t just able to put up a site and forget it,” said Steve Schadt, the director of marketing for Einstein Medical, a health care company in San Diego that has seen its work with plastic surgeons grow about 50 percent in the last four years.

To become a contender, a Web site loaded with key words (breast implants, rhinoplasty, 90210) highlights a plastic surgeon’s brand, whether they positioned themselves as a “mommy makeover” specialist with an endearing bedside manner or a family man who is sure that pinning your big ears will give you the confidence boost you deserve.

But there’s plenty that these sites don’t reveal. Namely, all those links to good news media coverage about the doctors? They may have paid for it, and need not disclose that fact. And patients shouldn’t necessarily be swayed by the prominent pictures of scantily-clad bodies, either. All too often those curves and taut stomachs aren’t the handiwork of said doctor, but a model who has been treated by Dr. Photoshop.

Doctors can advertise and market themselves to their hearts’ content. “As long as it’s not false, fraudulent, deceptive, or misleading, it’s allowed,” said Robert H. Aicher, a lawyer for the American Society for Aesthetic Plastic Surgery, a trade association of 2,400 board-certified plastic surgeons.

But who checks the facts on doctor sites? Too often no one. Doctors who belong to trade organizations like the society for aesthetic plastic surgery can’t pass off models as former patients online. Instead, they must identify models, Mr. Aicher said. (Looking closely at the biggest pictures on Dr. Galante’s site, a watermark tagging certain bodies as models is visible.)

But many doctors practicing cosmetic medicine don’t belong to such trade groups and are exempt from rules. For instance, Dr. Jan Adams, who performed a tummy tuck and breast reduction on Kanye West’s mother, Donda, was not board-certified. Ms. West died of complications after surgery.

Too few patients surfing the Web for a nose job realize that doctors do not have to disclose whether they paid to be listed on a directory like LocateADoc.com or docshop.com. Doctors also are not heavily vetted before being listed. They need only be board-certified.What’s more, patients don’t know that sites like certifiedplasticsurgeons.com book appointments for patients and receive a commission each time they virtually escort a patient to a doctor’s door regardless of whether the person books a procedure.

Some medical marketers are all too aware that patients aren’t terribly savvy. “To the layman, whoever has the biggest billboard or Web site that’s the best guy in town,” said Mr. Schadt of Einstein Medical.

Wendy Lewis, a cosmetic-surgery consultant in Manhattan, wants patients to better inform themselves. She runs an independent reference service for patients, so she doesn’t get paid by doctors for her referrals, but she does charge $400 an hour for an office consultation ($300 for a phone consultation). “My clients come in with pages and pages of information they printed off the Web,” Ms. Lewis said. “They’ll say, ‘What do you think of this doctor? I really liked his before and afters.’ ”

Mary Carr, 24, the manager of a towing company who lives near Dallas, was so taken with before-and-after photographs on drwallace.com, that she booked a breast augmentation sight unseen. She liked the fact that Dr. Charles A. Wallace of Dallas, who is board-certified, had done “multiple surgeries from head to toe,” and was impressed by the “articles” on his site. She didn’t realize those pieces are ad copy.

Not all cosmetic doctors think online marketing is the best thing since Restylane. “There’s this cheesiness factor associated with all of this self promotion,” said Dr. C. Coleman Brown, a board-certified plastic surgeon in Chevy Chase, Md. He and his partner, Dr. James R. Bruno, spent years relying on word of mouth, but in 2005, they paid $6,000 to LocateADoc.com to get clients. The response was “lukewarm,” Dr. Brown said. “We mainly broke even.”

Last year, they left the service and joined another, breastimplants411.com, for $11,000. It has brought in more clients, but Dr. Brown doesn’t think he should have to brag that he’s the most skilled plastic surgeon east of the Mississippi. “We’re a little more old school,” he said. “And it costs a lot of money.”

By ABBY ELLIN

NY TIMES