7 Biggest Mistakes Made by New Plastic Surgeons in Private Practice

What are the Seven Biggest Mistakes Made by Plastic Surgeons?

Starting out in private practice as a plastic surgeon is both exciting and daunting. Many new plastic surgeons underestimate the challenges beyond the O.R. or operating theatre – the business, leadership, and patient care systems that underpin a safe and successful practice. Without the basics and right foundations, a promising new practice can quickly unravel.
Here are the seven most common mistakes I see new plastic surgeons make when starting their own private practice – and how to avoid them.

AAA – Offering “Anything for Anyone at Any Price”

A classic early mistake is trying to please everyone. New surgeons, keen to fill their diary, often accept any case that walks in the door in ANY location. This leads to:

Poor patient selection and mismatched expectations
Taking higher-risk or unsuitable cases leading to complications or potential patient litigation
Discounting surgeon fees – undermining profitability and credibility
Travelling to too many distant clinics and being unable to adequately support patients in those locations

Successful practices focus on clear positioning – choosing the right procedures, the right patients, and setting fair, sustainable pricing. Saying “no” early often protects both the surgeon and the patient.

BBB – Basics Before Brand Advertising

Many new practices spend up big on advertising and Google Ads before they have the fundamentals in place. Running ads without proper systems leads to wasting a lot of money – typically hundreds of dollars per patient enquiry.
Common problems include:

Calls and enquiries are going unanswered or poorly handled
No structured lead conversion and follow-up process in place
A practice brand built on marketing hype with a poor patient experience

The rule is simple: master the basics before chasing visibility. Hire & train the front desk team, implement talk tracks & phone scripts, and measure your enquiry conversion rates. Only then should you scale up your advertising and branding efforts.

CCC – Checklists & Consents reduce Complications

Many new surgeon practices are missing good processes and documentation. Inadequate Documentation and Records can cause problems
Medical-legal risk is highest in the early years, yet documentation is often neglected. Missing or inconsistent records expose new surgeons to serious risk. Key gaps include:

Incomplete or poorly explained consent forms
Missing complication logs or follow-up records
No systematic checklists for surgery preparation or aftercare

Strong documentation is not optional – it’s a protective shield for both surgeon and patient. Establish systems for consent, complications tracking, and audit from day one.
Read the Book – Growing a Medical Practice 2nd Edition by Sarah Bartholomeusz for an excellent summary of the risk & legal aspects of setting up and running a private medical practice.

FFF – Family, Fools & Friends – The Pain of Poor Recruiting Efforts

Early hiring decisions shape the culture of the practice. Unfortunately, many new surgeons fall into “Warm Body Recruiting” (WBR) – desperate hiring of whoever is available, often family, friends, or fools (untrained staff). This results in:

Inconsistent patient experiences and results
Risky Gaps in critical practice skills
Frustration for the surgeon, leading to staff turnover and retraining costs

Instead, recruit deliberately. Define the roles needed, start with experienced practice staff, and invest in good onboarding, systems and training. The right team will multiply the surgeon’s effectiveness; the wrong team will drain it.

PPP – Poor Patient Photography

Before-and-after photography is the backbone of surgical marketing and patient communication for plastic surgeons. Yet many new practices cut corners with poor lighting, inconsistent angles, or unsuitable equipment. The consequences include:

Weak case documentation for medicolegal defence
Missed marketing opportunities for the website and social media
Disappointed patients when the results look underwhelming in photos

Professional-grade photography, with ASPS standardised lighting and positioning, is one of the highest-ROI investments a new surgeon can make.
You may never get a second chance to take the BEFORE photos – especially when you get an outstanding surgical result.

RRR – Reviews, Referrers and Repeat Patients

Your Reputation is everything in private practice. Many new surgeons neglect their most powerful growth drivers:

Online patient reviews that build trust and credibility with new patients – the surgeon has to ASK for reviews
Building solid relationships with medical and non-medical referrers – Thank them, be grateful and keep them updated
Ongoing patient care that fosters word-of-mouth

Instead of chasing new leads with advertising, new surgeons should actively cultivate patient reviews, build local referrer relationships, and nurture their past patients through events and enewsletters. Reputation compounds over time – but only if you start early.

TTT – Team Too Timepoor

In many new practices, both the surgeon and the small support team are stretched too thin or work part-time hours. Enquiries are missed, follow-up is inconsistent, and potential patients slip away. Warning signs include:

Consults not being responded to quickly and followed up within 24–48 hours – “Speed to Lead” wins
No time for proper enquiry handling or patient education
The surgeon is feeling burnt out and stressed from micromanaging both business and clinical tasks

A time-poor team limits growth. Investing in efficient systems, automation, and sufficiently trained staff ensures no patient is left behind.

Combining a New Surgeon with a New Nurse or Practice Manager – A Big Risk

One of the riskiest setups is when both the surgeon and the practice manager are brand new to private practice. Neither has the experience nor the knowledge to anticipate pitfalls, leaving patients exposed to inconsistent systems, poor communication, and unmet expectations. Mentorship, external consulting, or structured training can bridge this gap. You don’t know what you don’t know. An OR nurse is NOT a trained practice manager.

Other Overlooked Pitfalls in New Practices

Beyond the “7 Biggest,” here are a few other traps that commonly catch new plastic surgeons:

All Eggs in ONE Basket – relying on one hospital, one anaesthetist, or one income stream creates vulnerability. Remember: a choice of one is no choice. Always have a Plan B (or C)
Delaying accreditation, regulatory compliance – startup practices may run without proper frameworks, but this can backfire legally and reputationally.
Failing to plan work–life balance – without boundaries, burnout comes fast.
Not building a personal online brand early in their career – a simple website, LinkedIn, Youtube video and social media following

Final Thoughts about the Biggest Mistakes Made by Plastic Surgeons

Launching a private practice is more than hanging a shingle. It’s about building safe systems, a capable team, and a sustainable business model – not just surgical skills. By avoiding these seven mistakes, new plastic surgeons give themselves the best chance of creating a respected practice that thrives for decades to come.

Avoiding these mistakes takes foresight, discipline, and the humility to seek guidance early. Private practice can be immensely rewarding, but only when the right foundations are in place – from patient selection and systems to staffing and reputation management. Every successful surgeon eventually learns these lessons, but the wisest learn them quickly and with the least cost.

If you’re a newer plastic surgeon or practice manager, take the time now to build strong processes, recruit the right people, and protect both your patients and your future. With clarity, planning, and the right support, your practice can grow into a trusted, respected, and profitable centre of excellence.

FAQs about the Biggest Mistakes made by Plastic Surgeons in Private Practice

Q: Why is saying “yes” to every patient one of the biggest mistakes new plastic surgeons make?

New surgeons often feel pressure to fill their schedule and accept every case, but this can backfire quickly. Poor patient selection leads to mismatched expectations, higher complication risks, and unhappy patients who may damage the surgeon’s reputation. Learning to say “no” and focusing on the right patients for your skillset helps protect both the surgeon and the practice.

Q: What happens if a plastic surgeon discounts their fees too heavily in private practice?

Discounting may attract patients in the short term, but it undermines the surgeon’s credibility and profitability. Patients who only choose based on price often have unrealistic expectations and are less loyal. Setting fair, sustainable fees communicates value, supports business growth, and ensures the practice can reinvest in staff, systems, and patient care.

Q: How can poor patient selection damage a surgeon’s reputation early in their career?

Taking on unsuitable patients can lead to complications, dissatisfaction, and even litigation. Negative experiences spread quickly through word-of-mouth and online reviews, making it harder to build trust with future patients. Establishing clear selection criteria early helps protect outcomes, safety, and long-term reputation.

Q: What systems should a practice put in place before running advertising campaigns?

Before spending on ads, a practice needs strong enquiry-handling systems, trained front desk staff, and a consistent conversion process. Without these basics, enquiries are lost or poorly managed, wasting marketing spend. Practices that prepare in advance convert more leads, deliver a better patient experience, and get a far higher return on advertising.

Q: How do front desk scripts and talk tracks improve conversion rates in a surgery practice?

Scripts give the front desk team confidence, consistency, and professionalism when handling patient calls and emails. They ensure important details are captured, objections are handled gracefully, and patients feel cared for from the very first contact. Over time, this builds trust, increases consultation bookings, and directly improves conversion rates.

Q: What are the risks of running a private practice without proper documentation or consent processes?

Incomplete consent forms, missing complication logs, or poorly kept records expose surgeons to serious medicolegal risk. If a dispute arises, weak documentation makes it harder to defend clinical decisions. Good systems for checklists, consent, and follow-up not only protect the surgeon legally but also improve safety and patient trust.

Q: What is “Warm Body Recruiting” and why does it fail in healthcare practices?

Warm Body Recruiting means hiring whoever is available rather than carefully selecting the right candidate. Many new surgeons hire family, friends, or untrained staff, only to find big gaps in skills, professionalism, and patient care. Poor recruitment slows growth, increases turnover, and creates stress. A deliberate, structured hiring process with good training and onboarding is essential.

Q: Why is professional before-and-after photography critical for plastic surgeons?

High-quality photography is vital for documenting results, managing patient expectations, and showcasing work online. Poor lighting or inconsistent angles can make excellent surgical results look underwhelming, frustrating patients and harming marketing. Standardised, professional-grade photos are one of the best long-term investments a practice can make.

Q: What happens if a surgeon misses the opportunity to take proper “before” photos?

If baseline ‘before surgery’ patient photos are not taken, the chance is gone forever. Even with outstanding surgical results, the surgeon cannot show the improvement accurately or defend outcomes in the case of a complaint. Proper “before” photos should always be taken as part of the intake process, even for seemingly routine cases.

Q: How do online patient reviews affect the growth of a plastic surgery practice?

Research shows reviews and photos are often the first things potential patients check before booking a consult with a plastic surgeon. A strong collection of positive, authentic online reviews builds trust and credibility faster than advertising alone. Without reviews, even excellent surgeons struggle to compete against more established practices with visible reputations. Google Reviews, Realself and Local Directory patient reviews are the most useful.

Q: What is the best way for surgeons to ask patients for reviews without being pushy?

The key is to ask at the right time, when the patient is happiest with their care or outcome. Surgeons can build review requests into their follow-up process, making it simple and stress-free for the patient. Ask for a small favour. Thanking patients for their feedback reinforces trust and encourages more positive responses.

Q: Why are medical referrers more valuable than paid ads for new surgeons?

Referrers provide pre-qualified patients who already trust the surgeon because of the referring doctor’s endorsement. These referred patients are much more likely to book (70%+ conversion rate compared to 30% from website), more likely to follow through, and often more satisfied. Building solid relationships with good referrers provides steady, high-quality patient flow without the ongoing high cost of advertising.

Q: What is the biggest risk when both the surgeon and practice manager are new to private practice?

When both are inexperienced, the practice lacks the foresight to anticipate problems with systems, patient management, and compliance. Patients may face inconsistent communication, disorganisation, or poor follow-up. Pairing a new surgeon with an experienced practice manager—or seeking external mentoring—reduces these risks dramatically.

Q: Why is it dangerous to assume a nurse can run a plastic surgery practice as a manager?

While skilled in clinical care, most nurses are not usually trained in the financial, legal, and marketing aspects of managing a business. This mismatch can create gaps in compliance, patient communication, and profitability. A dedicated, trained practice manager brings the business knowledge required to support a growing practice.

Q: What does “a choice of one is no choice” mean in medical practice management?

Relying on one hospital, one anaesthetist, or one revenue source makes a practice highly vulnerable. If that single option becomes unavailable, the surgeon is left without alternatives. Building multiple partnerships, locations, or service streams creates resilience and long-term stability.

Q: How does poor planning for work–life balance lead to surgeon burnout?

New surgeons often underestimate the demands of running a business alongside surgery. Without clear boundaries, long hours and constant stress quickly erode energy, focus, and family life. Planning time for rest, delegation, and personal health ensures sustainable success and prevents early burnout.

Q: Why is “speed to lead” so critical in converting patient enquiries?

Studies show that patients who receive fast first response to their enquiry are far more likely to book consultations. If enquiries sit unanswered for hours or days, patients often move on to competitors. A structured follow-up system with automated quality instant responses maximises conversion and gives patients confidence in the practice’s professionalism.

Q: How can automation tools like GHL and Podium help a small plastic surgery team handle enquiries better?

Automation streamlines routine tasks like appointment reminders, email follow-ups, and enquiry tracking. This frees up staff time to focus on building relationships with patients. Small practices that use automation appear more responsive, consistent, and patient-focused—without overwhelming their limited team.

Q: Why do some new plastic surgeons fail despite excellent surgical skills?

Surgical expertise alone is not enough to run a thriving private practice. Without strong systems for marketing, patient management, and team leadership, even highly skilled surgeons can struggle to attract and retain patients. Success in private practice comes from combining clinical excellence with business and leadership skills.