Lessons learned from over 1500 rhinoplasty

Lessons Learned From 1,500 Rhinoplasties with Beauty and the Biz

This was originally published on catherinemaley.com.

I had the pleasure of joining Catherine Maley on her podcast, Beauty and the Biz! On episode 164, we talked all about the business and marketing side of plastic surgery, and the lessons I’ve learned from performing over 1,500 rhinoplasties.

Lessons Learned From 1,500 Rhinoplasties

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Surgeons and Social Media

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Transcript below:

LESSONS LEARNED FROM 1,500 RHINOPLASTIES – WITH DIANA PONSKY, MD

Catherine Maley, MBA: Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, as well as lessons learned from 1,500 rhinoplasties.

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 profits.

So, today’s guest is Dr. Diana Ponsky, who will be discussing lessons learned from rhinoplasties. She’s a board certified facial and reconstructive surgeon. With a private practice in Beachwood, Ohio for the past six years.

Surgeon and rhinoplasties’ star, Dr. Ponsky is also an assistant professor for the department of otolaryngology at university hospitals, and she’s performed more than 1500 rhinoplasty. And if that weren’t enough, she managed to find time to get married to a very funny surgeon and they’re raising three daughters.

Oh my gosh. And by the way, Your family is doing such a good job on your Instagram account with your lessons learned from rhinoplasties. I hope your husband is as hilarious as he looks. He looks like the nicest dad. Like the dad. I always wanted that I didn’t have. Is, is he like that?

Diana Ponsky, MD: Oh, he’s super funny. I, I. I tell him I don’t have a funny bone in my body and he, like, he makes he more than makes up for it.

Catherine Maley, MBA: So, I don’t know if you need two funny people in your family when it comes to lessons learned from rhinoplasties. Yeah. So, Dr. Ponsky welcome to Beauty and the Biz podcast. It’s a pleasure to have you.

Diana Ponsky, MD: It’s my pleasure to be here. Thank you, Catherine. I’ve admired your lectures from afar. So, I’m excited to be here with you today.

Catherine Maley, MBA: Terrific. Well, let’s, let’s learn what’s going on in your world with lessons learned from rhinoplasties in regards to surgeons.

The first thing I do like to ask is, especially for women, how do you grow up to be a facial plastic surgeon? Like I never, you even heard of that. And did it come to your family? Did how, how did that?

Diana Ponsky, MD: Right. So, I grew up in a very, you know simple family. I say I have a mom and a dad who are both blue collar workers, and I kind of happened upon the medical field by accident and each path along the way has been purely by I credit to the mentors.

I was lucky to, you know, meet during that course. And so, when I was in college, I worked with a chemist and he inspired me to go into the sciences. So I went to the sciences, but then I needed to work. And so, I worked for a dermatology. As her front office, you know, receptionist. And I just loved the medical field through her also because she was sick.

She, she had a heart condition and I would often help her with certain things where she didn’t have anybody. And so, so I, I knew her for over eight years and so that. You know, put me on that trajectory. And when I got into medical school, I was so super excited. Went through the rotations, found T fell in love with it for the intricacies of a head and neck cancer surgery.

But then worked for the VA for a couple, for two years while my husband was doing his fellowship and then fell in. Even more with the rhinoplasty. So that’s how it came about.

So, I, I, I think my field’s amazing and I love mentoring young women to, you know, to kind of check it out and, and look into it.

Catherine Maley, MBA: And you ended up in private practice, like well, almost six years ago. So, are you still in the university setting or how is that working out in regards to lessons learned from rhinoplasties?

Diana Ponsky, MD: No. So I was very lucky to have a hybrid practice for many years. I because of the support of my chair, man, and then chairwoman, and then in August of 2020, I left completely and, and just focused on private practice.

So, it was a, a gradual transition mainly because I think. You know, kind of nervous about taking that big, bold step out from academia.

Catherine Maley, MBA: And, and so why did you, like, what were the pros and cons of being in academia and then going into private practice. Like what was that decision making? Because I know a lot of surgeons are just on the fence, you know, they’re just not sure what to do, especially when it comes to lessons learned from rhinoplasties.

Diana Ponsky, MD: Yes. So, for me, I loved working within a team. I, I loved that. I had colleagues that I could ask questions of, that we could all get together and do cases together. I. Being able to teach residents and having an input in that it was difficult from a family standpoint because my husband’s also a surgeon and he travels a lot lectures a lot.

And as the university became tougher in terms of. Having one person work with you. They would have a lot of people who would do different things so that they can delegate and work with 10 different surgeons. They’re scheduling conflicts and, and issues with that. A lot of my colleagues ended up leaving and so I was.

Probably the last one standing. So that was the tough part. It was mainly bureaucracy because the camaraderie of working in academia is one thing. The other frustration came out when the billing practices were an issue. And so, my patients would get mad at me because the hospital couldn’t figure out good system for.

Functional nasal surgery with cosmetic nasal surgery. And I always felt like I, I was put in the middle and I couldn’t explain it any better, nor could I have any influence over the numbers or the people who sent them bills. And so, all those frustrations kind of came together and, you know, six months after COVID I was just kind of ready.

Catherine Maley, MBA: Good for you. And you did it in, in the middle of COVID? How did that affect your lessons learned from rhinoplasties?

Diana Ponsky, MD: Yes.

Catherine Maley, MBA: Well, what were you thinking, in regards to lessons learned from rhinoplasties?

Diana Ponsky, MD: Yeah, I was just it was, I, I, we worked all throughout COVID at least to cover call and help. The pulmonary system, you know, people out, we try to protect our faculty by taking like shifts for a whole week.

And then when things came back, it wasn’t fully back. There were still issues with seeing patients and, and telemedicine and all that. And I thought it was just a good point. I promised my chairwoman, I find my replacement for me at the university, and it was a good time to make an exit. So yeah, so I did.

Catherine Maley, MBA: Well, kudos to you regarding functional versus cosmetic rhinoplasty. I know I had one years ago and everybody I know says the same thing while you are at it in regards to lessons learned from rhinoplasties. Could you also take care of this, this bump on my nose? Like everybody wants to start out with insurance and just throw the role that cosmetic in, and you’ve got to have a, a script and a structure response to that, because that doesn’t, that come up like nine out of 10 times in regards to rhinoplasties and lessons learned?

Diana Ponsky, MD: Definitely. Yes. In my practice, there are certain numbers of, there are, there are about three insurances that I work with and the rest are all cosmetic. So, we I feel like we do our best to guide patients through it, but there is And most of our patients are reasonable. So that difficulty comes in when I’m trying to explain that if you’re having trouble with breathing and you have a, a passageway that’s, you know, so big and you’re trying to make it even smaller, then, then the fact that it’s.

Partly functional comes into play. So, so I explain it in terms of that. And a lot of people understand it where, when I participate with their insurance, we definitely try to get that part of it covered by their insurance to help them out. And if it doesn’t work out, we still give them credit for it because in the end, I don’t want that to be the single factor that turns a patient away because I’m, I’m more into building.

Like building a, you know, rapport, like building a good relationship with patients. And honestly, I think that if you’re going to take someone for surgery, I’d rather they not, not do something because of a few dollars. Right. So, you want to give them the best of both worlds, so cosmetic and the functional aspect.

And it that’s usually my goal. So, it’s, it’s one of those things that like one of those surgeries that I absolutely love because it’s such a marriage of the two things So, so, so I don’t know if I can answer your question, but it’s very tough to explain. Yes.

Catherine Maley, MBA: When the patients know that you accept insurance, that’s all they hear.

Oh, she takes insurance. That’s fantastic. I’ll get this taken care of the minute. That conversation changes to, well, not so fast, you know, I’ll, some of this is insurance and some is, is out of pocket and, and the minute that credit card gets involved the. All, all bets are off and it changes the relationship often and are big lessons learned from rhinoplasties.

So, if you can straddle that good for you eventually down the road, you might say cash only because yeah. And just leave that word insurance out completely. Although I think you really enjoy doing the insurance side. So, like what percentages insurance versus cosmetic in your practice? How does that effect lessons learned from rhinoplasties?

Diana Ponsky, MD: So right now, I would say 80% are cosmetics and 20% and has a functional insurance issue.

Catherine Maley, MBA: Good for you.

Diana Ponsky, MD: Yeah. Very little. Oh, good for you. Like you did that early on, because you’ve only been at this for like six years. Right. But I know it well from the university. Right. And then for the numbers. So even though it’s been six years for the hybrid model, like there’s been a lot of learning along the way with managing both sides of.

Catherine Maley, MBA: So, so where is a lot of your time spent in regards to lessons learned from rhinoplasties? Is it, are your kind of like the rhino surgeon or are there a lot of faceless left? I looked on your website and it does, it definitely looks more rhino centric, you know? Yes. But where, where are you going with that? Do you want to, do you want to be known as that or do you want to spread out or what’s your plan with lessons learned from rhinoplasties?

Diana Ponsky, MD: Sure. So that’s a very good question, Catherine, because I spent most of my early years at the university doing mainly that that’s, that brings on another answer to one of the questions you asked earlier, part of how the, the, the department of otolaryngology slash facial plastics advertised me was purely in the nasal arena, right?

Because plastic surgery took over everything. And their marketing wasn’t in that. And so, I saw mainly noses at the university, a lot of reconstructive faces for you know, facial palsy issues and some eyes for functional reasons. But I was trained in all of that. I did my fellowship with bomb and Geron and I’m trained in all of it.

I love all of. And so, part of my reason for exiting also is that I get to do all those things. So, you know outside, without with control over my advertising and my marketing. And so, I, I do love all of those surgeries for sure. I, I would say about 75% of my surgeries are rhinoplasty now with about 20.

15 to 20% facelifts and the rest in in lefts and brow lifts. And so that’s of the surgical numbers. I spend my time between non nonsurgical and surgical days. And so, it’s pretty evenly split. So.

Catherine Maley, MBA: Isn’t that amazing how you almost have to have nonsurgical parallel to your surgical because you’re going to catch those who are never going to do surgery.

You’ve got an option for them. Now. We never had that before this technology has changed everything. So, you can turn off block nowadays without it. So is one of your philosophies, in regards to lessons learned from rhinoplasties, is to offer nonsurgical and surgical to keep that patient with?

Diana Ponsky, MD: Yeah. So, I feel that the younger generation are more likely to try things that are non-surgical early on.

Right. And it’s a, it’s an educational process too. You take care of your skin. Now, do you take care of, you know, preventing or. Rejuvenation take care of preventing the wrinkles. Now you’ll have less that we have to fix in the future or a longer process until we have to, you know, do something more invasive with it.

So, I, I know a lot of my plus. My better, more established plastic surgeons in the community will not do Botox or fillers. They’ll send to derm and they’ll just do the surgical cases. And I guess at this point I could probably make the transition, but I actually like the relationship building up to the point where.

they may need you for surgery or the relationship building of after surgery, maintaining things. So, it’s, it’s one of the, you know, more gratifying portions of what I do.

Catherine Maley, MBA: Here’s what I’ve noticed with other surgeon’s practices who only focus on surgical and advertise only that on social media. That is a very old school kind of way of thinking when it comes to lessons learned from rhinoplasties especially.

You’re. Or you’re. So just so darn sure that you’re going to have surgery forever and ever that, you know, you, you hang your hat on it in today’s world. I’m not sure most surgeons can plan on that. I think you’ve got to have that non-surgical aspect to your practice. You may not be the one doing the non-surgical treatments, but keeping that patient in your practice versus wandering around (lessons learned from rhinoplasties) and hoping they end up with you again, the next time they need surgery.

I, I think that’s. Dreaming, you know, I’m, I’m just my opinion on that. So, when you were going to go out on your own, how, how did you know what to do in regards to lessons learned from rhinoplasties? Did you decide, okay, I’m just going to rent some space or I’m going to get, go rent some space from somebody else, or I’m going to go in a big building or I’m going to buy my own building.

Like what, what did you end up doing to get you from the hospital to private? How did this effect you in regards to lessons learned from rhinoplasties?

Diana Ponsky, MD: Yes. So probably by now you’ve learned that I’m very cautious and I take little steps instead of big ones. I was very lucky that my chairman really supported me and I had shared with him some of my frustrations with the ho you know, the university system and how it was tough to get cases that I wanted.

Blasts and facelifts because of plastic surgery, how it was difficult to get the business office, to kind of talk to patients and explain the process of, of billing a little bit better. So, to keep me there, he allowed me to rent space from them in the plastic surgery building. So, for two days a week, I had a time share there and so little steps.

They rented it to me for two years and then they switched plastic surgery with urology. So that was a good time for me. Exit and find my own space to lease, but I stayed with them in that hybrid model for a few more years before completely going private.

Catherine Maley, MBA: So, and then how, and then where did you end up, physically, and in regards to learning lessons from rhinoplasties?

So now you’re leasing space. Is it in a big medical building or a consumer? Place or mall?

Diana Ponsky, MD: So, it’s in a, a big business building that has both offices as well as medical offices. So, I’m on the same floor as the gastroenterologist who have a surgical suite. And I am on the same floor as the dental and oral surgery offices.

So, and then above us, there’s, you know, equity firms. Office leasing firms. So, it’s a mixture a digital internet company. So yeah, different offices. And I was there for, I had a five-year lease. I just renewed on it. I it’s a small boutique office and I kind of just figured it out by, you know, going through some, going through notes of the academy, furnished us probably from your lectures in the past.

And. Picking up books and podcasts and, you know, things along the way and checking with friends who had done it in other cities and states and yeah.

Catherine Maley, MBA: So, I think that’s your best bet. See what everyone else is doing outside of your area, especially when it comes to learning lessons from rhinoplasties. Like, just so nobody’s all competitive. Boy, I mean, there’s no need for you to go through half the mistakes that others made, you know?

Is there a saying about that? The, the, the smart surgeons learn from other surgeon’s mistakes and don’t make (especially in lessons learned from rhinoplasties). Themselves and so true. So, when you went out on your own, now you have to, you don’t have the university behind you now, it’s you? So how did you go about presenting yourself to the marketplace and how were you going to position yourself from the lessons learned from rhinoplasties?

So, what did you do in regards to lessons learned from rhinoplasties to get your name out there?

Diana Ponsky, MD: Right. Gosh I was, so I learned a lot about marketing Instagram, you know the Google ads and how to build your website twice. And there, there was a, a steep learning curve for sure. In that regard. I luckily. Stayed in the same area where, you know, I worked previously.

And so, I had a lot of referrals already from the internists, the Pete’s offices for broken noses of kids. The dermatology practice in town who worked with me with, you know, cancer or most patients before. So, I was lucky that I had a chance to kind of build my name in the community first and. It was a little bit of an easier transition coming out there, but gosh, Kathryn, I couldn’t tell you, like the first time I heard about like, oh, you got to do this on Instagram or put this out on Facebook or like really in this, you know, just, yeah.

It’s a, it’s a whole new world in advertising. Yeah.

Catherine Maley, MBA: Is there any other marketing channel you’re using other than your surgeon’s social media accounts? Have you tried anything else related to lessons learned from rhinoplasties?

Diana Ponsky, MD: So, I have a, a girl who runs her own social media company and she manages all of that for me, we would meet once a week so that we can go over ideas, how to, you know, be different, but also deliver the right message all the time in a consistent way every week.

I have a guy who does my website and I actually use BSMS, you know, the elegant brands people, and they connected me with a guy who is a digital marketing expert. And so, he comes into our social media meetings every week also. And oh, and I think my best thing. So, my husband’s very funny, and he does a lot of these internet educational, you know, webinars and.

He’s on every single platform educating the world. And so, he, so he shares, you know, has helped me with little tips along the way with, in this regard. But along with him, my most valuable resources a who’s my employee now. He, I call him my marketing strategist. He has no formal education in it, but because he worked for a number of years at, in the museum of art and he’s very creative.

We come up with finding funny ideas. And so, they’re kind of like slightly off, you know, and different. But it really. So, he, he brings the creativity into it. So BSM my creative director my social media person. Sometimes I use my kids for TikTok cause they can do it better than, you know than I can and faster.

Catherine Maley, MBA: Well, especially now all of a sudden everything has to be a rhinoplasties video and, you know, I was just getting used to. Doing my picture, you know, my portal. And it’s like, really now everything’s got to be video. Like I’m not that creative. But as long as your family’s backing you up, they’re doing a great job with the reels, you know, so, oh, thank has a great surgeon’s social media Instagram account.

Like he, a pediatric surgeon. Is that right?

Diana Ponsky, MD: Yes, that’s correct. Yeah,

Catherine Maley, MBA: Maybe that’s why, because he’s pediatric that he he’s kept his youthfulness about him, you know? Yeah. Yeah. Really funny surgeon on social media, funny, when you were critiquing his looks like now that he’s turning 50. Oh, this is not going to go well. Is, is open for cosmetic rejuvenation tips from you?

Diana Ponsky, MD: He’s much better now that I’ve pointed it out. But yeah, before he wasn’t, he would let me like, make fun of him every now and then. I had to bribe him to even treat him to Botox elevens there, but yeah, he’s, he’s coming around. He’s coming around.

Catherine Maley, MBA: All right. So, let’s talk about the surgeon’s staff for a minute, as it relates to lessons learned from rhinoplasties, because if you haven’t been used to running a practice and at the hospital, everyone’s, that’s the wild, wild west, you know, is, you’ve got a lot of managers there.

A lot of people telling you what to do in person and on social media. But in your own private surgeon’s practice, it’s your show and, and all arrows point to you. If things are going well, It’s you, things are not going well. It’s you. How have you, how were you with this? Like, like managing people, leading them did that come naturally for you?

Or what kind of challenges have you had in regards to lessons learned from rhinoplasties?

Diana Ponsky, MD: No, I, I find that to be the most you know, challenging portion of going out on your own. I love the part where you get to, you know, Determine what you do. You get to decide who you hire. And early on, it was all about experiences, because I really didn’t know how to navigate that ship all so I people with experience, but as they came on board, it, it turned out that not every.

Personality would mesh well together. And so, HR is definitely the toughest part of what I do. Now I pick for personality and right now I’m actually without an office manager, which will soon change. I have someone that’s been with me for five years. She’s great. I have an RN who is soon to be an NP that I’ve trained for over a year.

And she’s terrific. I’ve Michael, my creative director. Who’s also terrific. And my front desk gal is also great. So, so, you know, it’s, I it’s, I’m, I’m learning along the way, but definitely it’s been the biggest challenge because I, I actually don’t find out that I don’t know how to manage people. I didn’t go to, you know, I’m, I’m not good at that.

And, It’s tough when there are working together and you have to have the personal. Be, you know, symbiotic with each other too.

So, try on error. That’s what I say of navigating.

Catherine Maley, MBA: And just so you know, no surgeon is a born manager when it comes to people or lessons learned from rhinoplasties, just like nobody was a born good surgeon or anything else. It really is. Some people, a little major, a little minority, 2% were like just.

Really brilliant at it. Like they just innately are really good with people and have great people. Skills surgeons are not notoriously known for people skills. You were very busy doing something else. You know, you were not supervising, you were studying. So, you’re not, you’re already up against, against the odds.

There are being a good surgeon with their rhinoplasties and a good manager. It’s a taught skill though, like anything else, even in regards to lessons learned from rhinoplasties. And you have to get out of your own head and talk to other people and be patient with them and listen to them. And. There is nothing easy about, you know, right. Especially when you have your own vision of how you want things, in regards to learning lessons from rhinoplasties.

And typically, surgeons are pretty perfectionistic (especially when it comes to lessons learned from rhinoplasties), which we want, you know, as a surgeon, we want that as a manager, we don’t, or as a wife or something or spouse, we don’t either. Or as it’s just, that’ll always be just a, a learning curve, like forever, probably.

Diana Ponsky, MD: Yeah. Yeah. It’s a good, I mean, luckily, I have friends who’ve helped with the process.

So, when I started, they’re like, okay, well, here’s the handbook. Here are some things you have to define up front. You know, here are the things like to just make sure that you like. Always have meetings, you know, with your staff. So, you’re all on the same page. Always let them know how grateful you are and how great that you, you know, the team is.

And so, I’ve been lucky. I, yeah, to have friends that have, have, you know, guide me through the process.

Catherine Maley, MBA: Very good advice. Meet with the team regularly. Tell them your vision with the practice and lessons learned from rhinoplasties. Let them know what your rhinoplasties and lesson-learning standards are, what you expect, what your values are hold them accountable. And that’s what the meetings are about.

And, and then, you know, appreciate them and acknowledge them, especially in today’s world. You know, they people, boy, they need a lot of, you know, Yeah. And I know I did not come from that world. It does not come naturally me for me to constantly, but I’ve noticed like when I’m talking to my staff on every email, I always say, thanks.

And it’s like, this is exhausting, but I know it’s important, you know, so right. It’s just, it’s just a learned skill. So just gimme one. So, so far you haven’t been at this for, for 20 years, you’ve been at it a lot less, but gimme one big mistake you made that you wish you had avoided, or at least that you learned something.

Diana Ponsky, MD: Sure. So, I went into business with one, with a family member in the beginning. We were at different levels and it was, you know, I, I was an attending when he was a resident there. And it, it didn’t work out. I was. I feel like, you know, that’s one thing that I wish I could kind of not, you know, repeat or have people go into it.

Like you think you hear it all the time. Don’t do business with family, you know, leave like as much as you love your family, leave them in that position. It’s. It’s hard to, to mesh the two because things, you know, personalities come out and decision-making things become a little bit, you know, tougher.

So, so, you know, somehow, I thought I could be like Lieberman Andry or, you know or my friends in, in North Carolina, but it didn’t work out. We are both better off for it. You know, I think each of us felt like now we have the latitude to do what we want to do. And so, I would say that’s probably one of the, you know, biggest.

Business mistakes I made; I don’t think many people are attempted to go into business with their family members. So, I don’t think others are going to yeah. Have that same issue, but would say was a family member a cousin. So, it’s my husband’s family. So yeah, it was your husband’s family.

Catherine Maley, MBA: Oh, that’s more complicated in regards to lessons learned from rhinoplasties.

Oh, OK. I was thinking maybe it was your brother. Cause at least you two.

Like fighting and then break up, but then be okay. Oh, that a tricky one. Yeah. I would’ve, I would’ve probably consulted you on that one.

Diana Ponsky, MD: You would’ve been, yeah, I was badly in need of your –

Catherine Maley, MBA: I mean, what are the chances, seriously? What are the chances when you’re in private practice and all the risk is on.

And you have a surgeon’s vision for lessons learned from rhinoplasties, for what you want and what you stand for in your brand. And what are the chances somebody else has that same darn vision and you both, you know, and one of you wants to do the marketing and one of you wants to do the HR, so your boundaries are perfect and like, That’s really slim to none.

For those and the egos get involved, like there is nothing easy about two strong headed surgeons getting together and trying to build one vision there, nothing easy about that. Yeah. So, would, is there, like, do you have high hopes for down the road to, to add partners or associates? Are you pretty happy being a boutique practice?

Diana Ponsky, MD: Right. So that’s the question right now? Nurse practitioner, nurse practitioner. Who will, you know contribute to the practice and she’ll start building her own practice. And my, my plan is to, to maybe hire one or two more but still right now, I’m trying to keep it more of a boutique practice.

And the question is I went into this because I, I love being able to help people I love to, to operate. And I do feel like I have a knack for recognizing what is natural and how to deliver it in a really eh, You know quality way with, with integrity. And so, I kind of want to keep to that vision, which is why I’m not sure that I want to grow it.

The other part of why I went into private practice is I want to be around for my kids until they don’t want me anymore. And they’re off to college, you know? Type of thing. So, so I am at a crossroads a little bit because I do need more staff. I need to grow this space, but once you do that, then you’re going to have to add more, you know, nurse practitioners or an associate or so, so, so I’m, I’m at the point where I can’t tell you definitively, I’d like to probably add another nurse practitioner and figure it out from there, I guess.

Catherine Maley, MBA: Is there some reason you’re adding nurse practitioners versus an RN?

Diana Ponsky, MD: Right. So, I can also add an RN. I just feel that I, I would like someone who can run solo. So, in Ohio my nurse injector can inject with me and the proximity, but it’s, it’s sort of like, Still grayish. Right. But if I ever leave town, it’s a little bit harder to regulate, whereas an NP has more latitude to do things on their own and, you know, I just have to be in collaborating or overseeing physicians.

So, I don’t know how, yeah. Are you in California or in, okay. So, so that’s my thinking is that I’d like someone who has a little bit more independence too. Gotcha.

Catherine Maley, MBA: It’s just they’re they can be more expensive. They’re not as easy to find and especially in today’s climate. I would think that it’s like a needle in the haystack trying to find a cosmetic NP who wants to work on somebody, you know?

Diana Ponsky, MD: Right, right. And, and I don’t mind training. This young girl that I have, she’s terrific. And I’ve trained to her for over a year. And I, you know, that’s part of what I did at the university was teach. And so, I, I don’t mind that part. I think it’s great. I’d rather, they. Learn from me and know the anatomy, because I took her into the, or showed her things and I’d like that rather than send it to a course to learn from, you know, whoever it may be teaching, who’s never seen the deeper portions of where they inject.

Catherine Maley, MBA: Another thing that happens is they start gaining confidence and their experienced and now they think they have a following and they don’t see you make it. Look. You know, right?

And they don’t see what it’s like to run a practice, learn lessons from rhinoplasties, and pay the bills and have all that risk on your shoulders and always worrying about the overhead and all of that.

So yeah, my advice would be, just make sure all of their work is watermarked with your logo, like their name and your name always stay together, you know?

Diana Ponsky, MD: Okay. That’s a very good piece of advice. I –

Catherine Maley, MBA: Yeah, you don’t want them to get too, you know, big for their pitches, you know, and they’re not running the show by themselves.

They’re under your name. And so anyway, that would be my 2 cents on that.

So, I think to your area, I have this funny story. I was in Cleveland for a conference and. I’m from California. So, Uber is a big deal out here. It never dawned on me that there wasn’t Uber in that neighborhood. So, I have to leave the conference at night and go meet one of my classic surgeons in your neighborhood whom I know, you know, so the front desk says, oh, we don’t have Uber, but here’s a card.

And they literally hand me this card that. A taxi of and a husband. And so, I said, what? And so literally the taxi driver is the, the wife and they’re probably in their fifties or sixties, he’s sitting in the he’s sitting shotgun and.

And she I’m in this big van. They bring me to the restaurant; they wait for me and then they bring me back to the hotel.

Cause I going to be screwed. If I got that, that restaurant, how was I going to get home? I paid yearly for it, but it was the thing, literally she’s advertising. And my husband’s going to be here too. And I thought entertainment, entertainment committee.

Diana Ponsky, MD: Oh my gosh. That’s hilarious. I bet you so. In Ohio, it’s probably the, be my designated dryer. Like be my DD. They travel want to in.

Limit it. So, you could be waiting like 20 minutes for over where, whereas like in California, I’m sure. Like every few there’s another one.

Catherine Maley, MBA: What do you mean they don’t have?

How are you going to differentiate in regards to lessons learned from rhinoplasties? Because the, let me ask about rhinoplasty because you have picked the toughest procedure on the planet. You, you you’ve got the younger child, you know, the younger kid that you have somehow relate to, or you have to relate to their mother, or you have the older, more maturing patient who’s nose, you know, like it’s all falling down.

So now you have like, you know, the more mature patient who wants to get their nose back where it was. How’s that going? And how’s your unhappy patient factor? Any, any tips in, because actually I had a podcast interview with, I can’t remember his name. He’s in New Hampshire. He’s. Hey God, you wrote the book on the unhappy patient.

Diana Ponsky, MD: Oh yes. Constant –

Catherine Maley, MBA: Constantine. Yes, yes, yes. This whole philosophy was, oh my God. I fixed their nose and they still weren’t happy. Like, what do you mean how I did like a perfect job and you’re still unhappy? So, I was wondering like, do you have any tips and tricks? How to make that unhappy rhino patient happy.

Diana Ponsky, MD: Right. I, you know, unfortunately I wish I did. I think, you know, Mark’s, Mark’s closest to the, of, of that arena, you know? Cause I couldn’t have, I couldn’t possibly write a book about that subject because I’m still learning about that. I. We all have unhappy patients for me, it’s, you know, I rely on multiple discussions with them.

Then you get a sense of their, their motivation, their personality. And I can tell you I’m I, that, that part I’m pretty good about picking out, but it usually takes me two or three meetings. And so, I structure it as a consultation, a pre you know, a more. Discussion. And then a pre-op discussion too, with my nurse.

You know, starting the conversation I’ll come in any last-minute questions, that type of thing. And so, I had to turn away two patients because they showed up with things that are suspect between the second and the third, you know, where you get the feeling that you can’t possibly achieve all their goals.

And no matter how many times you tell them the human nose is not an animat subject. It’s not like a car door that you can out and just, you know, get the right color. So, so, so now I’m much better about picking out those patients. I feel like the morph is the biggest. Leveling field. It’s so helpful.

It’s a tool that not a lot of my mentors had, they would just draw it out or draw an overlay over it. And now I have the power of Adobe and the power of all these like morphing programs. And so that’s very helpful. And then just showing patients examples of other patients where, you know, I’ve had to take someone back because I didn’t reduce their nose enough to their liking, or they had a soft tissue.

You know, poly beak that we had to inject and follow over time. So, I always start my conversations with that, that I like to follow my noses for my rhinoplasty patients for up to about a year. We’re building a long-lasting relationship and you’re going to be in my office at least five times during that journey.

And if you feel like you need to come in more often to ask questions, you know, I’m. I can definitely do that. So, so one of my patients didn’t tell me that she had a chin implant in and wanted a rhinoplasty. And we talked about that a little bit. And then it came out in her second discussion. When, you know, we were talking about morphs and things like that.

So she was, you know, she’s like, well, I’m going to enlarge the size of this. Eventually. I’m like, oh, well that would’ve factored into the whole morph discussion too beforehand. And then. So, so things come out, the more you meet with people. But I don’t, I wish I had a magic potion. It’s just sort of getting to know their personality through, you know, just talking a, a little bit more with them.

Catherine Maley, MBA: Well, what happens when they bring the celebrity photos with them or show you on social media or they, are they going to tell you exactly how this is going to go? I, I think some of. Like they’re giving you yellow flags often. Yes. And some of the surgeons ignore that saying, oh, please, I’ve been through this a million times. I, I can handle this and then they make fires on them.

But are there any big yellow flags like that? Or does your staff ever jump in and say something doesn’t feel right here? How does that effect lessons learned from rhinoplasties?

Diana Ponsky, MD: Right. So, I always get the input of my staff because everybody has different interactions and that’s very helpful. The one red flag, one patient, she, she made eight more for me of what her nose would look like.

And she’s like, okay, can you look at it with this? I like this, but I don’t like this. I want a little bit more of a slope. And not as much of this slope. I like it was, it was one. So, one such patient, another one you know, they’re little things and sometimes it’s just anxiety. But I would say nowadays, interestingly, I don’t get the celebrity photos as much anymore.

And I think it’s because we tell the patient that we’ll create a more of you based on your features, your likeness and not, you know, someone else’s like. You know, Kim Kardashians nose is not going to look good on someone with a round face, you know? And we talk about how this is important because you don’t want to be like Michael Jackson, someone who like pursues surgery or after surgery, after surgery, because we didn’t narrow down the essence of what you’re looking for.

So, so I think that’s helped a lot. The giving patients a, a more rendition of what their nose could look. And then using patient examples of other patients, who’ve been through the journey where sometimes it’s just perfect. And sometimes it’s not, sometimes you need a, you know, chin implant, and sometimes you’re on the cusp and you can use fillers for a minute until you decide So, yeah, no magic solution.

When you find it, you let me know right. Cause I’ll come to that course and I’ll take that.

Catherine Maley, MBA: All right. I’ll keep watching and listening. But I have noticed though, the rhinoplasties patients are the happiest, most emotional patients. Yeah. They’re the ones that they’re, they’re always crying on surgeon’s social media Instagram accounts on their rhinoplasties.

It’s such a transformation for them. I’m thinking that’s half of why you like it so much. It’s so transformational. Have you noticed that? Yeah, like aren’t the most satisfied when they’re…

Diana Ponsky, MD: Yes, definitely. And I, I, my favorite thing to tell a patient is you’re so focused on your nose. It has to be so perfect, but when it’s balanced in your face, you don’t notice it.

And no one else notices it after a while because it’s not, no, it’s no longer your leading feature for whatever reason. It’s too big. It’s too narrow. It’s. Do page, it’s a little off it’s like once it’s balanced, no one notices it anymore. And they always come back and say, you’re absolutely right. I spent so much time fixate on it.

And now no one who says single thing about it. They say my eyes look better or something else, you know?

Catherine Maley, MBA: I think that’s the biggest issue in regards to lessons learned from rhinoplasties. You, all of us are standing in the mirror, staring at the things we don’t like about ourselves and it just compounds it every morning, just staring at you.

So, anyway so what, so now that you’ve been in practice, what, what words of wisdom in regards to lessons learned from rhinoplasties surgeons would you give to somebody else?

That’s a little behind you to jump into the private arena.

Diana Ponsky, MD: I, you know, found that I liked managing that part of my world a little bit more than I expected when I went in, I didn’t think, you know, well, I don’t know anything about business. I didn’t don’t have any formal training in it. I don’t know the single first thing about marketing and I enjoyed learning about it.

I enjoyed, you know, hearing, going to lectures and hearing about. The things we should do and the things we should look out for. So, to a younger colleague, I would say, you know, if you love the surgery and it is hard for you to do in the university, or if you want to make it your own and be your own boss, control your schedule better.

Then, then it’s a good time to go out and start your own practice. I do feel on another level that private practice is going to swing the other way. So, with all the restrictions that we’re seeing and all the hospitals showing more acute care patients that. That more physicians more are going to go out on their own.

And in fact, the AMA is starting a sub-sector of education on returning to private practice. What’s going to work. What’s not the, the, the group multi, you know, specialty groups. Are also not so popular now just because they are almost an institution. Right. And so, I, I think that more and more people to, to have control over their lives are going to think about it a little bit more.

So, I would just say, if you think this is what you want to do and the, and the, and the university or the academic arena is a little more challenging, look into it. I, I think people end up liking it more. So, well, I know when

Catherine Maley, MBA: I started this 22 years ago, I do have an MBA. So, when I was consulting, I would give you like an MBA education within a month, you know, like I have a 60-day program.

So, I mean, you could get you, I would fast track you and tell you what you need just specifically for this. You know, private practice as a plastic surgeon. And now everybody’s doing that. Like, I mean, every, and even the doctors want to do what I do. Like, like everyone has jumped into, oh, let me teach you the business side and the marketing side of plastic surgery, because, well, frankly, You have to know it in today’s world.

Yeah. You, you do need all of that. The best surgeon on the planet will get trumped by the best marketer on the planet, at least in the short run.

Diana Ponsky, MD: Right.

Catherine Maley, MBA: And if you’re, if you’re with one of those, if you have one of those in your area, they can reach have on you. And you’re like, how dare they? They’re not anything like me.

I’m way better surgeon than them, but they’re way better at branding and marketing. So, oh boy, it’s so interesting watching. Huh?

Diana Ponsky, MD: It, it definitely is. I mean, I you’re the, you were the one that started out on this track before anybody else, and now there. I guess there’s like yellow telescope, but not companies like that, that kind of gray are in that arena.

Catherine Maley, MBA: Yeah. Oh. And quite a few of the surgeons now are very entrepreneurial and great at rhinoplasties as well, and they’re getting into, let’s say their own skincare lines or their own signs. I that too. Yeah. Signature procedure. And then some of them are you know doing like a franchise where they have built their prototype practice and now, they’re going to franchise it out.

So, it’s just been so interesting watching. How everyone’s like finding their, you know, and there’s no one answer when it comes to lessons learned from rhinoplasties. Yeah. Right. So, alright. So that’s like all the questions I have for you. I just, I’m dying to talk about your family because I, when you said you had kids, I’m thinking, well, she looks so young.

She must have really little kids. And I thought, how is she doing all of this? And looks like she even taller than you. So how old are you?

Diana Ponsky, MD: She’s yeah. She’s 16. She is an inch taller than me. She likes to remind me every day. And then I have a 12-year-old and a 10-year-old too. So, all three girls and yeah.

Catherine Maley, MBA: Is anyone showing any promise of following you in your footsteps?

Diana Ponsky, MD: I don’t think so. They all claim they don’t. Well, so they’re interested in the sciences, but they want to be vets rather than doctors right now. Oh, me too. Or artists. Yeah. So, or my oldest is very artistic. But I think she’s, she’s not, you know, interested in this field.

We’ll see where it develops later, but she’s saying she just wants to, you know, draw and travel the world and design things and paint on them. My middle child may end up here. She’s like, She, she loves learning. She’s super. Yeah. She picks up things real fast. So, we’ll see. We’ll see. We’ll let them decide, you know, as long as they’re happy, that’s all we yeah.

Want. And as long as they work hard at what they want to do, that’s all I’m asking of them.

Catherine Maley, MBA: Well, I mean, of course we all want to do what the, the first one’s doing. She wants to do our art and travel the world. I mean, that, that sounds good to me too, but you got to have to have a plan to do that.

Diana Ponsky, MD: Right. So, I read about you.

You’re one of seven. I don’t you’ve made your own path though. You didn’t, you didn’t follow the yeah.

Catherine Maley, MBA: Yeah, I know I’m still, I’m still, I’m traumatized by my childhood. I’m still getting over it. I was not meant to be in, I mean, the cliche, Irish family, seven kids. Yeah. Father drank too much the whole thing and I couldn’t get out fast enough.

I thought this is way too noisy for me. It’s way too chaotic. I, I am not meant to be here, so I will see you all later. And I came out to California. I’m from Chicago.

I’m sure you’ve heard a lot about Chicago. And I mean, I was destined to be married with seven kids and, and a husband who watches 10 hours of football every Sunday, and I thought, shoot me, you know, it’s just not right.

I think that’s what you just have to know that self, if that’s not where, what you want. And so many people. Caught up in that, like they were told to be a doctor, they, or they were told to be a housewife like me and I, and you can say, okay, I’ll, I’ll do your program.

And then that’s why you have a, a midlife crisis probably. Or you, you realize, wait a second, that’s not where I’m heading.

So, and then you follow your own heart, but you have to work for it. You know? I mean, there’s challenges to both roads, but anyways.

Diana Ponsky, MD: So, so you weren’t kidding. You really were traumatized in your childhood.

Catherine Maley, MBA: Oh, wasn’t I wanted to be the only child. I wanted to be a princess. I wanted all focus on me. right. And nobody, I don’t even think anyone learned my name. Like there were so many people there it’s like, it just wasn’t my, my style.

Diana Ponsky, MD: Yeah. yeah, I got it. I’m one of five. Girls. Okay. So, all girls? Yeah. All girls.

And I was like, do my girls. Yeah. I’m surrounded by girls. I can’t escape it.

Catherine Maley, MBA: But do you all get along?

Diana Ponsky, MD: We do actually, interestingly enough, I mean, I’m sure we had our, our share of fights when we were younger as the oldest. I don’t remember all the fights because I probably, you know, like, yeah, I. So, but now we’re all super close, so that’s the best part.

Catherine Maley, MBA: Like I, my, my sister, my one sister that I just love, she’s my best friend. I just love her. I see her every week and, and that’s all I needed. I just. I just need one sister. Okay.

Yeah. Anyway, you know, I wanted to give out your website in case anybody wanted to, you know, to get ahold of you.

It’s www.DrDianaPonsky.com. Yeah?

Diana Ponsky, MD: Yes, yes.

Catherine Maley, MBA: Okay. And then you’re also a rhinoplasties surgeon who’s on Instagram and other social media channels. And is that, what is your handle on Instagram?

Diana Ponsky, MD: It’s @Dr.DianaPonsky. So, yeah, same thing with Twitter and also Facebook’s a little bit different. Facebook’s @DianaPonskyFacialPlasticSurgery.

Catherine Maley, MBA: Okay. So, all right, well thank you so much.

It has been a pleasure talking to you. I’ll see you again in another meeting eventually. Yeah?

Diana Ponsky, MD: Yeah. I’ll definitely, I would love to talk to you again.

Catherine Maley, MBA: Thank you. Okay. Thanks everybody. We are going to wrap it up now for Beauty and the Biz with Diana Ponsky, MD and her amazing discussion on lessons learned from rhinoplasties.

-End transcript for the “Lessons Learned From 1,500 Rhinoplasties – with Diana Ponsky, MD” Podcast.

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