28 JANUARY/FEBRUARY 2014 | MedEsthetics
By Janine Ferguson
Photography by Cory Sorensen
Dermatologist Anna D. Guanche, MD,
finds success by choosing and pursuing
the right patients for her practice.
DERMATOLOGIST AND DERMATOLOGIC SURGEON Anna D. Guanche, MD, entered medical
school with her sights set on becoming an orthopedic surgeon in the fi eld of hand microsurgery, until
a friend persuaded her to do a two-week rotation in dermatology. “T e morning of my very fi rst day of
rotation we did laser resurfacing, a lip fi ller and a large skin cancer surgery on the abdomen,” she recalls.
“I was dumb-founded. I could not believe that we could do all these procedures in dermatology.” At
lunchtime, she called her husband to tell him she would be changing her specialty. “I knew I would never
be bored. I love detail work—that’s why hand microsurgery appealed to me—but this allowed me to do
more than one area of the body,” says Dr. Guanche. “I can make people feel good, and it’s artistic, which
was something I wanted from the very beginning.”
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Customized CareAfter obtaining her medical degree at Louisiana State Medi-
cal School and completing her residency at the University
of Minnesota Medical Center, Dr. Guanche worked in a
dermatology offi ce in Thousand Oaks, California, for three
years. The desire for more freedom and a location closer
to her home and two children led Dr. Guanche to launch
her own practice in Calabasas, California. “It’s sort of like
growing up,” she says. “You go through a bit of being a kid,
and then you get growing pains and decide you have to do
your own thing.”
Ten years later, she is the owner of the Bella Skin
Institute, a dermatology practice that specializes in medical
dermatology, noninvasive cosmetic procedures and es-
thetic facial treatments. She credits the practice’s success to
its focus on creating customized treatment options. “Each
face is different and each person’s goals and budgets are
different. I have a lot of different devices so I can create the
right treatment for each person,” says Dr. Guanche.
Some of her most popular noninvasive procedures
include IPL, CoolSculpting (Zeltiq, coolsculpting.com),
Velashape cellulite treatments (Syneron, syneron.com),
Fraxel skin resurfacing (Solta Medical, fraxel.com), laser
hair removal, the VBeam laser for vascular concerns
(Syneron-Candela, syneron-candela.com), Thermage
radiofrequency skin tightening (Solta Medical, thermage.
com), and Ultherapy ultrasound-based skin tightening
(Ulthera, ultherapy.com).
“Eyelid surgery, blepharoplasty and mini-facelifts, along
with skin cancer surgery are the most invasive procedures
we do,” says Dr. Guanche. “We have celebrity clients,
moms, families and kids. It’s a varied patient population, so
we try to have a procedure for everyone. My favorites are
fi llers and Botox because they have minimal down time,
are high yield, and the patients look so much different
afterwards, they are so excited about it.”
Building a BusinessDr. Guanche describes her current staff as her “dream
team,” but points out that mastering practice management
did entail acquiring a new skill set. While doctors spend
many years learning how to care for patients, starting your
own practice requires an entirely different type of training
to address topics such as: How will you set up your busi-
ness; how will you market it; how will you put protocols
in place; and how will you hire and train the right people
who will treat patients the way you want them to be
treated?
“I think, in general, the staff follows the leader,” says
Dr. Guanche. “If the leader is good to her patients, then
that fl ows through the staff.” She based many of her busi-
ness strategies on the book Book Yourself Solid, which she
discovered early on in her career. “It helped me realize
that you must implement policies with clients, and stick to
them,” she says. “It also helped me to garner my and my
staff’s efforts in pleasing and pampering the clients. Clients
need your best efforts, and they will bring their friends.”
The book also helped Dr. Guanche fi ne-tune her
practice-building strategies. Rather than casting a wide net,
she focused on building the patient base that she wanted.
“It’s a directed way of working,” she says. “You focus your
efforts on the clients you want to attract. I shifted my
practice, and now we’re there. The people I see every
day are people I would hang out with. Coming to work
feels like fun.”
Dr. Guanche believes that taking this type of a per-
sonal approach with patients is the best way to build and
maintain a healthy business. “I always make a connection
with my patients. I am interested in them because they
are interesting people,” she says. “I want to know about
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“I always make a
connection with my
patients. I want to know
them, and they feel it.”
30 JANUARY/FEBRUARY 2014 | MedEsthetics
ake a
Dr. Guanche prides herself
on providing customized
treatment options.
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32 JANUARY/FEBRUARY 2014 | MedEsthetics
them, and they feel it. It’s not just a business where you
come in and get your procedures done. I know entire
families—the little ones for warts, the older ones for skin
cancer, and the ones in the middle are coming in for fi llers
and Botox.”
Building these types of long-term relationships starts by
focusing on patient satisfaction. Dr. Guanche schedules
every patient for a follow-up within one to two weeks of
treatment. “I like patients to come back for a follow-up,
because once everything settles down, they may want a
little adjustment,” she says. “I almost always do touch-ups
at no charge. My goal at the end of the day is to have a
happy patient who looks beautiful. I always proactively
schedule patients instead of waiting for them to call,
because I fi nd that sometimes people are shy and don’t
call back. They may not want to complain but those are
exactly the patients that I want to keep.”
Although a large percentage of her cosmetic clients are
acquired through word of mouth, Dr. Guanche maintains
an active marketing program that includes Google ad
words, an SEO-optimized website and print ads in local
magazines. She also writes for a local magazine, which
increases people’s familiarity with her business, and
purchases space in backlits—which are similar to small
billboards—in the local commons shopping area.
“I have done more national advertising, but I fi nd
that local marketing is more effective. Some clips of me
were on Oprah and, interestingly, when that happened I
told my receptionist to be ready for a lot of phone calls,
but that exposure generated less phone calls than my
appearances on the local KTLA news,” says Dr. Guanche.
“When you are in a local magazine, people think you
are more accessible and actually call and come in. So I
changed my marketing strategy based on experience.
I would say, focus on your community fi rst, and then
slowly branch out. If you have a limited budget, market
to your core audience and get a reputation going. It can
branch out from there.”
Dr. Guanche uses a reminder program called Solu-
tionReach (solutionreach.com) that sends reminders a
minimum of once a year to patients in her database. It also
sends email, text and phone reminders to alert the patient
to upcoming appointments. “Working to get a new patient
is a lot harder than retaining and keeping patients happy, so
we reward the big spenders every quarter by giving them
a discount for the following quarter,” says Dr. Guanche. “It
helps us show our appreciation and garners loyalty.”
“If you have a limited
budget, market to your
core audience and get a
reputation going. It can
branch out from there.”
The Bella Skin Institute offers an
array of cosmetic and medical
dermatology treatments.
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Utilizing DowntimeAs with any business, there are slow days. Dr. Guanche
has learned over the years not to panic and instead
to channel her downtime into creative endeavors,
like networking in the community, developing a new
marketing strategy or improving work fl ow. “Every time I
have downtime, I am trying to make my fl ow better, fi nd
a better way of charting, of reaching out to patients or
develop new marketing,” she says.
Key to staying booked in the highly competitive LA
market is keeping up-to-date on the latest advances.
Dr. Guanche achieves this by staying active in the
dermatology community through dermatologic
societies and academia. She is a clinical professor at the
UCLA David Geffen School of Medicine and volunteers
at UCLA Olive View. “I love to be around the
residents,” she says. “They are young and vibrant, and
they teach me as much as I teach them. I have been
in practice for over 10 years, so I teach them clinically
through my experience with patterns and conditions in
the skin and how to approach them, and they teach me
a lot about the newest drugs and regimens. It keeps me
connected with the academic community, and it’s a way
of giving back.”
Though medical aesthetics has become increasingly
competitive, Dr. Guanche advises new private practice
physicians to think about the type of practice they want
to be running in the long-term, rather than grabbing any
business that is available. “You are going to be stressed,
because you have a fi nancial commitment you have to
meet,” she says. “But keep in mind that you should be
spending time and putting effort and energy into the
clients that you want to be around and that you want to
work with.”
Janine Ferguson is a Los Angeles-based freelance writer.
Dr. Anna Guanche with
her “Dream Team.”
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