First Republic is proud to support medical professionals and their practices. In this Client Spotlight, one of our clients offers its insights into starting and growing a private practice.
How did two renowned, double board–certified facial plastic surgeons transition from sharing a humble space to owning a bustling plastic surgery and medical spa practice in Palo Alto, California? For Drs. David Lieberman and Sachin Parikh, it took a commitment to quality, innovation and charity. In 2011, they teamed up to launch L&P Aesthetics, a business that fits seamlessly into the technology-obsessed population of Silicon Valley, serving patients seeking a refreshed, healthy and natural appearance.
To learn more about how these doctors went from a most modest beginning to creating a beautiful, state-of-the-art center, we stopped by for a tour and a talk. David and Sachin shared their insights about their prudent, goal-driven approach for success in a ferociously competitive industry.
What were your early days like?
They were interesting! We shared a space with another surgeon in Palo Alto, and we didn't have any patients yet. Outside of a folding table from Costco, we just had an empty room. So we put our brains together and figured out how to get people in the door. We wrote down our goals and thought about the different ways to accomplish them.
We spent a lot of time introducing ourselves to the community, showing our results. Many colleagues also just starting their practices said we’d stare at the paint drying on the walls, but it was quite the opposite. We’d visit doctors’ offices, in a car from our training days that had logged 185,000 miles, and would park several blocks away to hide it. We would bring a bottle of wine, a box of chocolates and an iPad that showed our before-and-after pictures, and we’d sit in waiting rooms until we were called in. It was humbling, but it didn’t take long before we were busy.
What role did your First Republic banker, Steve Rochlin, play in the business development process?
We approached several financial institutions for funding, but Steve was the only person who actually interviewed us in person. He wanted to get to know us, so he asked about our families and value systems, then role-played various scenarios, such as what we’d do if the partnership dissolved. It was such a high level of service. He answered our questions even when we’d call at midnight, and has always given us good advice. In fact, Steve has been more like a business mentor than just a banker, and he has definitely helped us grow the practice.
We wanted to focus on our surgical results, what our hands can do, so we started with a very small loan. Then we began to invest in capital-intensive equipment so we could offer more services. The other philosophy to starting a practice is to take out large loans, buy an array of devices, then try to get patients in the door. However, when you purchase everything at once, you end up with a high amount in loan payments. Steve has seen it done both ways and recommended the former approach, which is what we preferred because it helped us minimize debt and run a lean business to start.
Let’s discuss Silicon Valley. What are the advantages to being headquartered in this area, and what do your patients tend to expect?
Being here is beneficial since we’re exposed to so much emerging technology. In fact, some of our lasers were developed in the Bay Area. But these machines are expensive, so we wait until we feel it's the absolute right thing for our practice and fills a niche for our patients. We'd rather let time pass without having something until we know it’s great. Neither of us will purchase a piece of capital equipment or new technology until we can look our patients in the eyes and say it’s the best.
Silicon Valley is a melting pot of tech and financial industries from all around the world, and many clients are very young. Hiring managers and executives are often in their mid-20s. Incredibly smart people who are 35 and above can feel an age pressure they wouldn't necessarily experience elsewhere.
Our patient population is constantly pushing the envelope and wondering what's better, what's out there. It forces us to always be knowledgeable. We offer surgical and nonsurgical services that make people feel empowered. Facial cosmetic surgery can be a frightening concept, but once you gain a reputation for producing natural outcomes, the patients are much more at ease. They’re the kind of transformative outcomes where it becomes hard to figure out if something has been done. The focus is highlighting natural beauty. Changes may be imperceptible to outside observers. This isn't Hollywood; people aren’t trying to look like the next Angelina Jolie. Everybody should look very much like themselves, but healthy and youthful, as if they’ve been on a relaxing vacation.
L&P Aesthetics is also a teaching center, and you both are fellowship directors, which is unique. Why did you make that choice?
It was one of our initial goals. We were fortunate that there was another facial plastic surgeon in the area who's had a fellowship for 30 years. He asked us to become faculty and sent a trainee to spend time with us. That person’s feedback was so positive that the surgeon invited us to become co–fellowship directors. It's an honor and a great way to pass down what we've learned to the next generation of surgeons.
Teaching also helps us stay on our toes. Young minds question everything, and you've got to substantiate why you're doing something. But they share knowledge with us as well. These doctors come from training centers from all over the country and have had their own mentors in residency, so they pass ideas to us. It's a symbiotic relationship.
Giving back to the community by doing charitable work is also important to you, isn't it?
Yes, we go overseas to volunteer for the HUGS Foundation, a nonprofit organization. We provide free surgeries to kids who were born without ears or have cleft lips and palates, or who need facial reconstruction. It’s an awesome organization.
Domestically we partner with Next Door Solutions to Domestic Violence, providing pro bono surgical procedures such as scar revisions. We have a skill set that we can offer to people who have been in difficult relationships. Scars can be reminders of a terrible time in their lives, and removing the evidence can help them overcome a mental block or forget about that relationship. When we threw our grand-opening party, all the proceeds of the raffles and auctions went to Next Door Solutions, and we raised about $10,000 for them that evening alone.
Still, many businesses don’t make it. How have you managed to grow and thrive?
There is no magic recipe to succeeding in our line of work; you just have to treat people well and deliver excellent, consistent outcomes. If you do that year after year, you're going to build a successful practice. Hiring the right staff and mentoring them helped us grow, too, because they became passionate about our brand. The two-physician model can often be unsuccessful, but we stuck to our vision and didn’t let money or egos get in the way.
After a couple of years of sharing spaces and building the business, we were bursting at the seams. We needed the right physical structure for the way we envisioned our practice to run, which took nearly three years. Steve was instrumental in the final decision because he wanted us to wait until we found the perfect match. When we designed our new center in the heart of downtown Palo Alto, we kept our patients in mind, making sure the space was luxurious, modern and also comfortable. Each treatment room has a different color scheme, and there are black-and-white portraits of our patients on the walls. We were also able to build in our own fully accredited operating room right on site. Finally, we included a little fun in areas such as the restroom, which is wallpapered in artistic watercolor images of lips — perfect for selfies!
Now that your center is up and running, what does the future hold?
Our goals are to continue to break boundaries in terms of surgical innovations and outcomes, patient care, being an educational center and doing community outreach. We’ve got a hunger to keep moving forward, to keep growing. This vision is reflected in how we choose technologies and continue to perfect our surgical techniques. Everything must meet our standards, and we are really discerning.
We also want to expand the number of physicians that come through here, educating them so they can build their own practice in other parts of the country. Our hope is that they represent the brand we've cultivated here.