It seems that practitioners and their marketers are constantly evaluating what really drives patients into cosmetic clinics. If you were asked which factors rate highest among patients, how would you rank the following: costs, location and travel time, the surgeon’s experience, clinic size, method of referral, media exposure, and online presence?

According to an interesting new study published in the January 2014 issue of Plastic and Reconstructive Surgery® 1, the official journal of the American Society of Plastic Surgery (ASPS), above all, patients value experience and personal recommendations when choosing a cosmetic surgeon.

Using a market research method called ‘conjoint analysis’ to determine what is perceived to be most valuable to consumers, Drs Marsidi, van den Bergh and Luijendijk of Berman Clinics, Bilthoven, in the Netherlands assessed the key factors affecting choice of surgeons in a group of 150 Dutch patients expressing an interest in cosmetic plastic surgery. Patients were presented with 18 different scenarios to rank their preferences in terms of cost, travel time, surgeon experience, clinic size, method of referral, and online presentation. The results showed that patients rated surgeon experience as the most influential attribute, with an importance of approximately 36%. Surgeons with at least 10 years of experience were preferred over less experienced surgeons. The method of referral was rated as having an importance of 21.5%. Surprisingly, however, referrals from television, radio, magazines, and Internet forums actually had a negative effect.

Travel time ranked with an importance factor of 14%, with patients preferring travel times of less than 1 hour. The cost of the procedure had an importance of 13%. Although patients preferred physicians who demonstrated a more extensive online presentation, this factor had an overall importance of less than 9%. Clinic size was the least important attribute — just 6% — with local clinics preferred over clinics with nationwide locations.

The study authors concluded that the most preferred clinic overall would look like this: A specialist with over 10 years of experience, is recommended by the patient’s general practitioner, offers fees that are approximately 15% less than average, the clinic has travel time between 0 and 30 minutes, is a local clinic rather than one with multiple locations, and has an extensive online presence.

Surgeon’s experience

This study is enlightening in a number of ways. While it is reassuring that, at least in the Netherlands, the surgeon’s level of experience holds the greatest importance to prospective patients, I question whether this translates in the same way in other regions. The researchers themselves acknowledged some limitations of their conjoint analysis technique, including the limited number of scenarios evaluated in the study. There are also a relatively small number of plastic surgeons in the Netherlands when compared with other EU markets, including the UK, France, Spain and Italy, and patients have fewer choices in terms of clinics. Therefore, it is to be expected that patients would be more inclined to choose the surgeons who have the most experience. In my observation, the Netherlands and Northern Europe in general tend to be more conservative than Southern and Eastern Europe, as well as North and South America.

In the US, for example, the average consumer is highly educated and informed about cosmetic procedures, and therefore the mere number of years a surgeon has been in practice is not always the overriding factor that influences their decision. Rather, savvy and sophisticated cosmetic patients will do a deeper dive into the surgeon’s background and expertise. A key question they will ask a surgeon is how many times he/she performs a given procedure, or how many of these procedures they have done in the past month, year, etc. They will also read up about surgeons and research the surgeon’s reputation online, reading over extensive reviews on multiple sites like,, They will see multiple cosmetic surgeons in consultation before making a decision. This number may be as little as three and as many as 10 or more. They are also more inclined to ask their friends and people they know who may have had the procedure they are considering, or who have been to the surgeon they have shortlisted.

Method of referral

It is interesting to note that the authors of the aforementioned study also concluded that how the patient was referred to the surgeon ranked second among patients’ criteria. For example, being referred by a GP was seen as having greater value. In these cases, patients clearly felt more confident having a referral from a trusted medical professional.

In particularly competitive markets, we also see that patients seek out referrals from other relevant healthcare providers, including dentists, gynaecologists, ophthalmologists, dermatologists, oncologists, as well as therapists, psychiatrists, psychologists, nutritionists and more. Other beauty experts also account for a large number of referrals to cosmetic surgeons, including aestheticians, hair stylists, manicurists, massage therapists, and personal trainers. These relationships are also intimate ones and may have been developed over many years. Hair salons, in particular, are known to be avid referral sources for cosmetic surgeons, often because they are compensated in some way for their referrals, a practice which is commonplace in many Latin countries and considered highly unethical or even fee splitting in countries like the US.

The missing part of this equation is the referrals that come from personal friends, family, and acquaintances that are such an important factor. The greatest compliment a cosmetic surgeon can receive is a referral from a happy and satisfied patient. Word of mouth is still the best way to grow a cosmetic practice, although it is perhaps the slowest. There was a time when positive word of mouth was all that was needed to have a busy clinic. However, in the current competitive market, relying on the kindness of colleagues and your community may not get you where you want to be alone.