Plastic Surgery Practice and Growth

Speaker 1 0:31

My name is Timothy Mountcastle. I'm a double board certified plastic surgeon and general surgeon. I serve my clients in multiple different facets as I have two different practices. I have my plastic surgery practice and I have my medical spa as well. They're two totally separate entities in two different locations and obviously a med spa does what a med spa does. You know they. We have injector, we have four injectors, we have three estheticians, we have a whole huge team that promotes, you know, health and wellness of the skin and beauty. Um, in my medical, in my medical practice, I mainly, from a plastic surgery perspective, do breast and tummy. I do breast augmentation, breast lift, breast reduction, breast cancer reconstruction, tummy tucks and liposuction of the abdomen and other body parts. But I also do a lot of medical plastic surgery as well. I do cancer reconstructions as breast cancers, melanoma skin cancers, mohs reconstruction, reconstructions as breast cancers, melanoma skin cancers, mohs reconstruction. And I also do a lot of Dr Pimple Popper dermatology as well as some vein surgery.

Speaker 2 1:42

Wow, you guys certainly cover a lot of those practices. Yes, how did you get into the medical field and specifically plastic surgery route?

Speaker 1 1:51

Sure, tell me a little bit about your path.

Speaker 1 1:54

Well, the medical field, I mean it started all the way back at James Madison University where I went to college and I started off an accounting major. My brother's an accountant. He's actually now he's the CFO of Privia Health. He's in healthcare too. That kind of was a roundabout route for him as well. But yeah, I off as an accounting major didn't really like it, started taking biology classes. It was something my mom always thought she might want to do when she was growing up be a doctor. So that kind of got me interested in it as well and then I just pursued it further, started taking anatomy and physiology and all these different classes at JMU and I loved them all. So that was kind of when I determined I wanted to be a doctor.

Speaker 1 2:37

Once I got into medical school I pretty much instantly knew or almost knew before I think that I wanted to be a surgeon. You know, anatomy was always one of my favorite classes at James Madison and on into medical school and I just always liked working with my hands and fixing things. So you know, surgery was the route that I knew I wanted to take. I had no plans at any point on becoming a plastic surgeon. That kind of just happened. It was fate, as you can say.

Speaker 1 3:06

My friend who was the chief of plastic surgery at the time, dr Summer Black, she came to me about two months before the start of that residency year and she told me the previous the person that had accepted that position almost a year and a half before you have to apply, like two years in advance decided they were going to back out and they didn't want to come. So there was a spot open and she offered it to me. So there was a spot open and she offered it to me. I initially said I wasn't really interested, but within a week I changed my mind and I went and did an extra residency in plastic surgery.

Speaker 2 3:43

What made you change your?

Speaker 1 3:45

mind. I just always like learning and you know it's a totally different field. And I was like I really actually didn't even have a job yet. I hadn't even so I was just like, oh yeah.

Speaker 2 3:53

Maybe this is meant to be, this is meant to be, this is meant to be. This is fate, and I have loved it ever since.

Speaker 1 4:02

So, wow, what do you find most rewarding about what you do? Most rewarding is you know helping out patients. That's that's why I became a doctor in the first place. You know being able to figure out a problem, fix the problem and help out that patient you patient, you know to the path of healing.

Speaker 2 4:21

Yeah, and looking better and feeling better.

Speaker 1 4:24

Looking better and feeling better as well in the medical spa, that's, you know, as well as in my medical practice as well. Those are two huge things.

Speaker 2 4:32

What's it like working? You mentioned some of the cancer patients that are coming in and reconstructive surgery.

Speaker 1 4:37

Sure.

Speaker 1 4:39

What is it like working with those patients? I mean, those patients have always, when they come to me, they've been through a lot. You know, breast cancer patients end up seeing countless numbers of doctors and breast cancer coordinators, cancer coordinators, and they've seen hematologists and oncologists and radiation doctors and breast cancer surgeons and breast cancer nurses and when they come to me they are just exhausted. They're exhausted, you know. So it's a challenge from that, you know. And we are also doing a big surgery.

Speaker 1 5:12

I mean, when I first started doing breast cancer surgery it used to be three surgeries where we do the mastectomy, do a little bit of the reconstruction, then then we'd have to follow it up down the road with the completion plastic surgeries. Now we cram all that into one surgery. So they're doing a much bigger surgery with a lot more risk involved and skin tissue healing and so on and so forth. But you know, those patients who are anxiety levels are high. So you're dealing with that aspect of the patient as well. It's not just the cancer, it's the anxiety and the worry about having cancer. And that's the same thing with my melanoma patients as well. Those are two of the patients that are the most challenging from that aspect.

Speaker 2 5:53

Sure yeah, and making them feel good about themselves again after going through that is traumatizing. I'm sure you probably have a little holding on to a bit of that when they come in to see you, right? Tell me a little bit about what it was like starting your own practice and how you've grown your practice and opened up your second location, sure, and how you've grown your practice and opened up your second location, sure.

Medical Spa Marketing Trends and Challenges

Speaker 1 6:15

Yeah, I mean that's. You know, it was always something that I none of this was just kind of organically grew. But in 2006, I started a practice with a group of surgeons at Loudoun Hospital. We were in the physician office building adjacent to Inova Loudoun Hospital and the practice just got bigger and bigger and bigger, to the point that I had to leave because I was taking up too much space in the office. I moved down the street and then eventually to my current location in Ashburn where I have initially started the medical practice and the medical spa together. But that once again grew and grew and grew, to the point I had to move the medical spa to a different office and eventually even to a bigger office. You know, it just kind of just organically grew over time.

Speaker 2 7:11

What do you think contributed to that growth?

Speaker 1 7:13

I mean it's obviously you become more well-known in the community I've operated I feel like almost every person in Loudoun County at this point, or I've met with every person.

Speaker 2 7:24

I definitely heard your name in some social settings. I know I've met with every person.

Speaker 1 7:28

I go to the grocery store and run into my patients. I go to Tuskegee's. I run into my patients, I go anywhere and run into my patients. You know, organically grew over time. There was no master plan. I want to do this X, Y and Z. It just kind of kept getting bigger and bigger and to the point, you know, there is a point where I don't want to get any bigger.

Speaker 2 7:48

I kind of don't want to get any bigger right now because it's just, it's a lot more to you know to handle, yeah, so yeah, and more staff and patients and systems and all of the things.

Speaker 1 8:00

Yeah.

Speaker 2 8:01

So I know you do a lot of word of mouth. What else are you doing as far as marketing and advertising to get people in the door?

Speaker 1 8:09

I mean, word of mouth is the biggest one, but we also we do Instagram and Facebook and TikTok and YouTube and Google advertising. So we do a little bit of all those things. We don't do a ton of it. It's just enough to kind of, I guess, stay relevant, I guess, so to speak, and let the patients know, Because I still have tons of patients in the medical spa and in the both practices have gone to other places and didn't get the best care, and they finally find us, you know, after having X, Y and Z procedure done, some of which they didn't really need to have done, you know. So I'm just trying to make sure patients get taken care of correctly.

Speaker 2 8:52

Yeah, in regards to word of mouth, do you feel that it's with your patients? And, given what you do, do you feel like people are pretty transparent about saying, oh, I've had this done. Oh, yeah, I think so yeah.

Speaker 1 9:05

When they meet the doctor, we have the history and physicals and I rarely, occasionally, I might find somebody who doesn't mention a surgery that they had. But then in general I'd say most of the patients are pretty honest about it and it's important too. I mean, for example, now when we, when I do major surgeries um, a big thing right now is Ozempic and you know Skinny Shot, ozempic and Wagovi and all those different things Patients we have we cancel patients. If they've been taking that medicine up to the time of surgery, they must stop it two weeks prior, that's a great question.

Speaker 1 9:41

Because you're. Usually you can't eat or drink anything for eight hours before the surgery. Now, with that it slows down the time. So you're not. You have to stop that two weeks before, so your stomach's empty when you go to sleep. So that's important for those, especially for that type of medicine, or we?

Speaker 2 9:59

have to cancel your surgery, or you to get it out of your system, or you put yourself at risk. Yeah.

Speaker 1 10:03

Do you?

Speaker 2 10:04

find an upswing in certain surgeries because of those weight loss medications that are out.

Speaker 1 10:09

Yeah, that's an interesting point.

Speaker 2 10:11

They've got loose skin. Well, I've seen a downtick and an uptick. Okay.

Speaker 1 10:15

So the downtick is I'm almost doing very few to zero liposuctions this year. I usually do probably 50 to 100 lipos a year.

Speaker 2 10:24

Okay, that's interesting.

Speaker 1 10:32

This year I'm doing maybe 10 or 15. So there's a lot less patients getting liposuction because they're just taking a pill.

Speaker 1 10:36

I mean, obviously that's a lot easier than having surgery. On the flip side, from those patients who lost a lot of weight, I'm seeing an uptick in tummy tucks. I'm seeing a lot more tummy tucks because now they've lost all this weight, they have this hanging skin, they have this stretch marks with hanging skin and no fat underneath of it that they're coming in for tummy tucks, so that we're seeing an uptick, whereas the liposuction we're seeing a downturn.

Speaker 2 10:58

Yeah, that's interesting how that medical trend is dictating it's the same thing in the medical spa we're seeing lots more patients.

Speaker 1 11:08

They've lost all the weight in their face. They're now having to come in to get Sculptra, where they can refill their whole face with Sculptra or with fillers or with other things as well, because you can almost tell they look, they call it the ozempic face, where it's all silken. They look gaunt, they look very gaunt, exactly.

Speaker 2 11:26

And they need to gain that fullness back.

Speaker 1 11:27

They need to gain that fullness back, especially in the cheeks, where that sculpture really comes in handy.

Speaker 2 11:31

Yeah, tell me a little bit about what services you offer in your med spa.

Speaker 1 11:43

The services we offer. I mean we offer pretty much every service out there. I mean laser-wise, we offer Morpheus 8, which is a skin tightening procedure. It really works great on the neck and face. It's a radiofrequency microneedling device which actually the little tiny microneedles penetrate skin and delivers heat to the skin to tighten it. We offer CoolSculpting, which is a fat reduction method via freezing the fatty tissue. We offer CO2 fractionated laser, otherwise we call it cool peel for laser resurfacing.

Speaker 1 12:08

But that has different levels from ablative to non-ablative. The ablative is a little bit more involved and need to use laughing gas for that which we have in the office. Then we also do IPL and BBL, which are intermittent pulse light and broadband light, which are things that really target colors, light, reds and browns to kind of get rid of some of the different skin you know, like rosacea and and so on and so forth. We also have a what we call fraxel, which is another type of laser which also targets browns, can also do some skin tightening as well. We have a Clear and Brilliant which is more for a younger patient for skin maintenance. That's a laser for that. We have another machine called VaneGo which we can zap little tiny, the little spider veins around the nose. That from the esthetician perspective. We also do facials and skin care management and all that kind of stuff as well. From the injector perspective we do all the typical. We use Restylane products, volumo, valvella products.

Speaker 2 13:15

We use.

Speaker 1 13:16

Sculptra. And then from the toxs we use Dysport Botox, xeomin. We're actually starting to use Daxify as the newest one.

Speaker 2 13:27

Because not every med spa offers that, as far as I know, right Not every med spa offers it.

Speaker 1 13:33

Obviously, Botox and Dysport are probably our top two. Those are the ones that have been around. Obviously, Botox has been around the longest and Dysport is probably the second. Some people, I think, call it Dysport as well.

Speaker 2 13:44

I think that's what I said Dysport, yeah, dysport, dysport, dysport, yeah, I don't know, it could be either. I don't know, tomato, tomato, tomato tomato.

Speaker 1 13:50

Yeah, but there's a new one, Daxify, which was supposed to have a little bit longer than the Botox and Dysport. That's a newer one that we've been using and patients seem to like it as well. And Sculptra is basically more of a biostimulator where you inject it. It's not filler but it stimulates tissue growth in that area as you inject it and it's a series of injections and that's really for kind of full facial balancing and volume loss gives you a lot more volume than the fillers do.

Speaker 2 14:25

Yeah, and the fillers are dissolvable, right?

Speaker 1 14:33

Everything is dissolvable. You know some. Most of them last about six months.

Speaker 2 14:35

Some of them might last a little bit longer nine months and do they guide you through kind of the process of like evaluating how much you might need, or I see so many people that kind of get too excited and overdo it. Well, that's the thing is you should start low.

Speaker 1 14:49

I mean lips, for example, are one place that we've had people call and say I want two vials. We don't do two vials, you get one vial. That's the safety thing. If you want to get a second vial, you can come back in a few weeks later after you do the first vial and see how you like it and see how you react, and then we might give you a second vial. So that's one area that we you know. But most areas, yeah, you can always add more.

Speaker 1 15:13

It's hard to you know, you don't want to add all this stuff and then have to, you know, use all this collagenase product to dissolve it, and all that because it's overdone.

Speaker 2 15:23

Right, okay, yeah, what challenges are you facing these days in the medical field, specifically in the plastic surgery field?

Navigating Business and Plastic Surgery

Speaker 1 15:34

I don't know if it's necessarily in the plastic surgery field or the you know. But you know, I think the biggest challenge in just medicine is just the amount of bureaucracy that's involved, especially in my more medical practice insurance companies and hospitals and all these different you know, you know, you know entities that we deal with. It's just's just more and more bureaucracies. There's more. I was just last night doing another thing for my American Society of Plastic Surgery test taking, and this test taking and all these different courses that you have to take to maintain your licensure. Now, some of it's great, but some of it can be a little bit excessive, I think.

Speaker 2 16:26

Yeah, so trying to weed out what's necessary and what's not.

Speaker 1 16:30

Correct, I mean, but yeah, it's just, you know, most of it's just a bureaucracy of being a doctor, and that's not alone. I don't think to plastic surgery, that's across the spectrum. I think there's a lot of burnout with family practice doctors, pediatricians, a lot of these other doctors are just kind of getting burned out by the private equity firms taking over and so on and so forth.

Speaker 2 16:51

Yeah, and you've got to do all of that insurance and billing for cancer patients, melanoma patients, when you deal with insurance companies in terms of the billing.

Speaker 1 17:00

That's a another whole nightmare in of itself. I was just talking to my insurance person the other day and she was, like you know, x insurance company denied all the bills for a month. Ended up being a problem on their behalf. But you have to go back through and look at all the stuff and talk to people and send it over and read. Now you got to resubmit all the claims and I mean we just had and I mean we just had a bill paid from the insurance company.

Speaker 1 17:24

It was like five years ago. It took five years to get paid. It's crazy.

Speaker 2 17:29

It's crazy. I mean I'm dealing with that in my own personal. We just got another bill.

Speaker 1 17:34

Why do we need to pay?

Speaker 2 17:35

that yeah. So you said you're not looking to grow now. You're kind of good where you are as far as your private practice and the med spa, but where do you see things going?

Speaker 1 17:49

I mean you know things going, just taking care of our patients. I mean there's always room for a little growth. I mean we have a good 3,000 square foot office. So you know, and there will be, you know, staff coming and going, as you know. You know we have vacation time in the summer and so on and so forth, but you know, mainly just taking care of the patients that we have, you know, and bringing in a few more patients here and there and just being able to offer good, you know, sound, you know healthcare to those patients that we're taking care of.

Speaker 2 18:26

What would you say for someone that's maybe hesitant about coming in? What advice would you have for someone that maybe wants to have some things done? They're scared. You know they've had a few kids. They want a little. People call it mommy makeover. I call it mommy reconstructing.

Speaker 1 18:43

Yeah, I mean the surgery aspect. A lot of people come with a lot of anxiety and a lot of and some people will book and cancel book because they're just too scared to come in. You know, most of the surgeries that we're doing nowadays are much easier than you. For example, when I first started doing it breast reduction we keep the patient in the hospital for two days and then they'd go home. Now it's all outpatient.

Speaker 1 19:06

We have a drug called Expiril which is a five-day acting numbing agent I inject in all my breast patients, all my tummy tuck patients. Some of them come in the day after surgery looking like they almost didn't even have surgery. I mean these are wonderful new procedures and numbing techniques and numbing medicines and medicines that we offer that make the surgery so much easier on the patient. The same is in the medical spot. We have different techniques to make the recovery quicker, the bruising less. We have different drugs like Arnica that we give patients a cut down on bruising and swelling, and just the techniques have improved. You know we use cannulas instead of needles. We use all these different devices that have cut down on the recovery time from that aspect as well and improve the patient satisfaction.

Speaker 2 19:53

Is there an ideal time for? I mean? I know it's different for case-by-case basis, but you know, wait until you've lost the weight that you want, or wait for like? What kind of milestones do you give people as far as like timing From surgery yeah, for recovery?

Speaker 1 20:12

You don't want to have a lot of weight gain and weight loss around the time of surgery. I mean, 5 or 10 pounds is fine, but you don't want to have surgery. Then lose 30, 40 pounds, right, because then you might have needed a little bit more taking off yeah than lose 30, 40 pounds, you know, because then you might have needed a little bit more taking off. So you know. So that's, you know. Always want to kind of be at a stable, weight-ish kind of time period for anything.

Speaker 2 20:31

Yeah, as far as business-wise, what business advice would you have for a young professional getting out of college or getting out of med school that wants to go into plastics or even open up their own private practice?

Speaker 1 20:44

I mean, that's the interesting thing too is about plastic surgery training and doctor training for doctors is none of that prepares you to run a business. That's the hardest aspect of being a doctor is running the business. Hr hiring. Being a doctor is running the business HR hiring your front desk employees, hiring your clinical staff, hiring all of your staff and having to deal with staff being sick or maternity leave or this I'm going out of town for three months, I'm going to this country.

Speaker 1 21:27

The HR aspect is probably the hardest aspect of running the business, but just running a business in general it's a lot more to it than just hanging up a shingle. I mean, you've got to have an accountant, I have to have ads, I have to have social media people. You said you have a whole have to have social media people. There's all this stuff going on behind the scenes that takes a lot of time and effort in it, you know, and it took years and years and years to get to this point. It wasn't just, you know, an overnight thing. I mean, for years and years and years our medical spot was there was no one there, you know know, it was maybe 10 people a month and that just grew organically and bigger and bigger.

Speaker 2 22:07

And and now it's people telling we got four different injectors, yeah, yeah, saying come in and I love this place, the same as with my practice.

Speaker 1 22:15

I mean I would say almost. I mean I don't do any advertising for my medical practice. All of it is through word of mouth or doctor referrals. 100, 100% of it.

Speaker 2 22:25

That's a good place to be. Yeah, it's a good place to be. That's great.

Speaker 1 22:28

Yeah, you're well-known and well-respected in the community for sure, are there any last, the number one Google search term is Mountcastle, on both the medical spa and the medical practice.

Speaker 2 22:37

Oh, is it yeah? Yeah, like I said, I've definitely heard your name multiple times.

Speaker 1 22:43

It's good to have a unique name.

Speaker 2 22:44

Yeah, I like it. Do people call you Dr Mountcastle or Dr Castle?

Speaker 1 22:48

They call me all White Castle Mountcastle. I did anything with a castle, so yeah.

Speaker 2 22:58

Are there any last parting words you'd like to leave us with?

Speaker 1 23:03

This can be in regards to a life mantra that you live by. Business advice, um, I mean, the biggest thing is just key is finding a good work life balance. I mean you know you can work hard and build a wonderful practice, but you gotta have time for your family and spend time. You know, I mean I, I, I'd like to take a lot of vacations, I like to do a lot of traveling. So that's critically important, I think, to maintaining a good business is maintaining your good work-life balance.

Speaker 2 23:31

Yeah, and making that time to get out and be with the family and experience life a bit right yeah.

Speaker 1 23:37

Got my daughter's graduation from fifth grade coming up here in a week.

Speaker 2 23:42

Oh, that's exciting, yeah, yeah. What do you like to do outside of work? For fun travel, for fun travel.

Speaker 1 23:49

Yeah, I mean I went to the World Cup in Qatar last. I guess it was two years ago. I've been to three World Cups. I've traveled all over the world. I love doing that. It's a little bit harder with two young girls, but we also go to New Orleans a lot, where I trained. I did my training at LSU.

Speaker 2 24:05

So we travel there.

Speaker 1 24:06

We try to go there at least two times a year. We also go to Wilmington, north Carolina, wrightsville Beach, where my wife's parents were tired too. So we try to go to the beach in the summer and New Orleans in the fall and winter kind of thing. So we try to get around.

Speaker 2 24:22

Try to get around? And how old are the girls, if you said fifth grade Nine and 11.

Speaker 1 24:26

Nine and 11.

Speaker 2 24:27

Well, shout out to them.

Speaker 1 24:28

Absolutely.

Speaker 2 24:29

Well, thank you for being here today.

Speaker 1 24:31

Thank you so much Loved hearing your story. Thanks for having me.

Speaker 2 24:33

Pleasure to have you.