Interview: Tom Seery, founder/chairman RealSelf, Part 2


My guest today is Tom Seery, founder and current Executive Chairman of RealSelf, the leading review site and marketplace for cosmetic surgery. This is Part 2 of the interview where Tom explains the tools he used to build and grow the RealSelf business into the largest site of its kind in the world. Subscribers also have access to yesterday’s interview where we explored Tom’s career path that set him up to found RealSelf.

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Edward: This is Marketing BS. This is part two of my interview with Tom Seery. Today we’re going to explore how he grew RealSelf from scratch into the leading cosmetic surgery marketplaces in the world. Tom, can you start by describing what RealSelf is.

Tom: RealSelf is obviously a website. Maybe it’s not obvious— It is a resource that enables people to find information that is related to cosmetic procedures. Cosmetic treatments ranging from botox to cosmetic surgery, and to find bulk information about what those treatments are like and to find a doctor or a clinic near them or relevant to them and map that up to booking an appointment.

Edward: You came from Expedia immediately before that. Was RealSelf pitched as a TripAdvisor for cosmetic surgery?

Tom: Did you hear that from me before? Because that’s pretty good. In my original pitch, I actually looked at the deck recently and I literally said it's a TripAdvisor for your body, face, and smile. That just seems to really help people get quickly to oh, okay, what does that mean? Then, it will lead to describing what you mean: body, face, and smile.

What I mean by that, by the way, is millions of people in the US and hundreds of millions globally have explored, continued to be interested in whether they should move forward with a cosmetic procedure. Thankfully, they’re very thoughtfully considered purchases because while the return policy stings in some of these things. It’s pretty permanent in many cases. It’s modifying your body, your appearances, it’s taking some risks, and it’s financially a big deal. I know you’ve had a background in big purchase decisions. This is up there with home buying, getting married, and having kids. It’s that level of thought and consideration.

Edward: The fact that it’s a high priced point, permanent, and rare, is what makes it different from the hotel space and what TripAdvisor is doing? For many people, travel and hotels are also very expensive, but it’s not as permanent or life altering. How is RealSelf different from TripAdvisor?

Tom: TripAdvisor, travel is still a very important intimate experience. Where you go with your family or you personally where you stay, where you sleep, where you take off your clothes, where you take a shower, where you spend your limited time off or time away is a big deal. That’s the magic of what TripAdvisor tapped into, is that people actually want to dispense of all the risks that go to making the wrong decisions associated with that.

But it’s still ephemeral. It’s a transaction that you get over. You get a bad hotel experience, you can laugh about it. But when it comes to a cosmetic procedure, that’s just not a really acceptable outcome. You don’t want to be in a place where you’ve made a wrong decision and suddenly now, you’re facing a consequence of looking “botched” or just an outcome that you just hadn’t expected. You want your expectations delivered on.

Edward: I guess it’s much more risk averse when you go into cosmetic surgery than when you’re booking a vacation. How does that risk aversion play into the design of the actual website and product?

Tom: Yeah. It is absolutely. Risk aversion is a good way of thinking of it. Or wanting to have not just 5 answers to questions, but 500. When we talk to people who routinely use RealSelf and what our value proposition is, is that we want to have answers to all of your questions. The best way to get you answers is not just Q & A, in which we have millions of answers from doctors, but actually learning from others who’ve had these experiences in an authentic way.

We have hundreds of thousands of stories told by real people with photos, with video of what it’s like from start to finish. Including people who’ve decided not to do things. It’s that kind of level of authenticity and trusted exchange of information that enables a person to make an informed decision.

Edward: So it’s very important for RealSelf then to collect not just reviews, but detailed intensive reviews that go into far more detail than a book review in Amazon.

Tom: Yeah. The star rating is not the point. It’s the story. Story telling associated with these procedures is what differentiates RealSelf from Google, Yelp, and others and that. People tell their stories overtime, updates, and like I mentioned, imagery and photos that shape the journey. The entire journey a person goes through from start, to recovery, to living their life, and what it’s like afterwards.

That created the concept of having people not just tell their story, but say, was it worth it or not? We created the Worth It index. That’s people yes, it was worth it, or no, or I’m not sure. We count those up and now we have rankings of every procedure by its Worth It rating. That’s become, in our industry, a very powerful vehicle for identifying patient’s satisfaction and customer satisfaction.

Edward: How do you get users to do that? How do you get a user to invest the time and effort to go and do that whole tracking process?

Tom: The motivation for a person on a platform is perhaps different than others. When we’ve dug into that and listened to our audience, members, and community members, why are you doing this? Are you trying to get back at your doctor? What’s the reason? You have extra time on your hand? The motivation in our audience is typically women who are posting. Women have this tendency to want the world to be a better place and help, have more of a community view.

They said, because this person was doing it before me and helped me so much, I wanted to also contribute and make it easier for the next person. There’s a lot of negativity in the internet and things like RealSelf and that motivation point to the beauty of the internet and just how incredible people can be in terms of trying to make the world a better place and its own place.

Edward: How much time and effort are you guys spending internally to go and facilitate that, or do you make it possible then just let it flow in?

Tom: Yeah. The [...] problem is a real issue when you’re starting a community. Bill Gurley from Benchmark visited my office—and I say office because it’s a room with three of us in it—when it first started. And he said what you’re doing here to start a community is something that larger companies would never do. It’s like building a fire when you’re camping, he described it as. It takes a lot of discipline. You don’t just throw a log on and say, okay, then pour some gas on and hope it just catches fire. You have to actually start with kindling and you get the right conditions. It has to be dry enough. You just have to be nurturing.

In the early days, getting that early kindling required things like convincing people to share their stories on the platform. The way I found them was things like YouTube, and like who’s willing to share already about their procedures and experiences on YouTube and say, hey, would you come over here and also post. That worked. But what moved from there and captivated more conversions and postings was controversy.

That’s why I created the word that writing is a binary yes or no. I don’t know how to say this in a way that hopefully doesn’t sound manipulative, but it does force people to pick a side. When you have two sides and when you have two sides and something it does usually create conversations. It was not worth it, it was worth it, and then people debating that led to more and more engagement.

Edward: And then once it gets going, do you have to do very much at all? The team today, now that you’re 14 years into the business, did you worry about other things and just let that part run?

Tom: It certainly is not as intensive of effort. I don’t know, flywheel. I know you’re very science based in marketing. I hate to use the term flywheel. It certainly has some elements of network effect where you’re saying more begets more and it self serves. But it does require nurturing and a lot of community guideline renforcement. There’s no shortage of actors out there who want to post things or trolls who want to take away from whatever it is otherwise are great experiences online.

Edward: That’s the consumer side. What about the doctors? How do you build the marketplace on the doctor’s side to get them engaged?

Tom: Doctors are a really interesting group of professionals. I really didn’t know how they thought and what was important to them until I started the company and started learning and talking to them. They’re very much, as you would hope from your physician. You walk into your doctor, you don’t want them to say, hey, I just got this new thing in yesterday, can I inject you with it? What do you think? You want to try it? You’re like, woah, wait.

They’re cautious by nature, they’re scientists. They want to see proof points, data, and research around something. As well as they are very much intrigued by their peer size. They tend to have what are called key opinion leaders who they look to whether it's a journal writer, people have written journal articles and authors or speakers at conferences. I centered on that. In the initial days, I really focused on getting myself on the podium as a starting point and also forging relationships with those key opinion leaders was another part of my strategy.

Edward: Has that changed over time then too? At the beginning, you had to do those things the same way you needed to go and use the kindling on the fire on the user side. Now that you’re 14 years into the business, has recruiting doctors changed? Or is it somewhat kicking into more podiums?

Tom: Yeah, with the pandemic, definitely the podium has been collapsed to a digital experience and the digital conferences really aren’t working for reaching to audiences. I would say that the environment whether I like it or not has changed and maybe forever changed, we don’t know yet as of this recording. But it certainly comes to fruition where you realize that your target customer, they don’t necessarily follow the same dynamics as the way the industry is structured.

We find that we’re most relevant to practices that are in growth mode, for instance. They really do want incremental patient acquisition in value that they tend to be a little bit more youthful, doctors who grow up with technology tend to adopt it more readily. Other factors like making it a typical customer acquisition where it’s maybe not that individual is who is on the podium at the top of their career.

Edward: Tom, how does RealSelf monetize? How does it actually take that two sides of traffic and turn it into cash?

Tom: We sell advertising to our doctors and the subscription add product. We’ve tried to keep it as simple as possible after listening to doctors and realizing they have no time. One thing that doctors can say over and over no matter what specialty you speak to is they are time starved. They didn’t go to school to learn how to be marketers. They want something that’s simple. This idea of bidding on platforms like Google AdWords or Facebook, yeah they could outsource it. But generally, they needed something simple.

So we created a pretty simple ad product that they could be for instance, featured for a procedure like say, surgeon here in Seattle could be featured on the platform for setting the number of impressions for rhinoplasty. And they would pay a flat monthly amount for that no matter what it did for performance. Though I think guarantee is the number of impressions. That model has been around with us for many years and we’re looking at the next stage of the model moving to a more performance driven approach.

Edward: It’s interesting. There are some marketplaces out there like hotels, like Expedia, that monetize so well, where the aggregators monetize so well that the providers are basically pushed out on the search. Have you searched for hotels in Seattle? The paid results are Expedia,,, followed by tiny little marketplaces you have never even heard of. Marriott and Westin aren’t listed there at all.

But if I searched for cosmetic surgery in Seattle, the results are all individual doctors. I don’t see RealSelf or the paid results at all. Why the difference?

Tom: We do some paid work in targeted ways. But there are certainly not inherently built transaction models that the industry doesn’t have like a model by which, oh, if you deliver a patient to me, I will pay you X. In fact, in many cases, in many states, that’s against the law. This idea of your doctor getting paid for referring you to a specialist would be seen as quite concerning.

There’s a lot of regulatory reasons for that and just an industry that’s very cottage-y. We have individual practices that we work with small practices, small businesses and they just don’t have a common standard way to either aggregate their supply of spaces of their schedule nor a common understanding of how to “sell” that or fill it. This idea of inventory is something that just doesn’t exist in the market as well. It’s a very challenging space to monetize because of both technology and limitations as well as a lack of precedence on how transactions should be monetized.

Edward: Tom, what do you think is driving that? Because it’s not just RealSelf. If I look at Avvo in the lawyers space or Yelp with restaurants, we see similar patterns where the restaurants or the lawyers or the cosmetic surgeons are fine paying a lot of money to Google. But then the individual websites aren’t set up with the paper click model, aren’t set up with these auction models. Why are these doctors willing to do the auction model on Google but not on RealSelf? Why is it too complicated on RealSelf, but simple enough on Google?

Tom: Yeah. I think I’d take exception with your observation in that. Let’s say if you’ve talked to most of our customers, very few of them actually advertise on Google and if they do it’s through their web vendor and it’s just a couple thousand dollars thrown at it. There’s no sophistication put around it. Web vendors, it’s easier for them because they can make a little bit of money with the markup and they can self manage the campaigns.

In some ways, inadvertently, we have cut out their technology team, their web vendor, and they don’t have an easy way to work with us and they do have an easy plugin for these other platforms. That may be an oversight on my part. I don’t quite know over time, I’ll maybe reflect and understand that. But generally, our customers don’t, I say this without any disparagement because it’s more from a place of empathy. They don’t really know how to measure ROI and the customer's journey to them is a very convoluted one.

If you want to look at complex purchase paths, boy, our space would probably be up there on the top 10. We would use real estate easily in terms of how many touch points it takes and information where it comes from and how long a person considers and what influences them. This idea of simply ranking better in a directory is pretty attractive to doctors. Okay, I want to be number one on Google. Why? Because I think a lot of people use Google. That’s about as simple as it gets in terms of how those models appeal to doctors.

Ours is more influence driven and influencing consumers with content and also rankings. But it’s just more nuanced and requires them to pay more attention and take more time.

Edward: What gets RealSelf to grow more? Do you need to sign up more doctors and get them more interested in advertising or do you need to get more consumers interested using RealSelf to make their decision?

Tom: Yeah. We need people like you to help sell for that. No, it’s a two side marketplace. You need a network to grow on the supply side and in our place, it’s served like a three side marketplace. We need brands to help facilitate these brands. They are the ones who have most of the margin, like botoxes of the world who need to help support the ecosystem of consumer education and conversion. Certainly, a growing, engaged audience, and high quality intent.

Getting marketplaces is a work as you have experience is really tricky because you got to get those all right. I think the most important strategy for us is where you and I have talked about years ago, so you'd probably shake your head like you’re still doing this? It’s like, we still need to think of how over time RealSelf moves what I would describe as a passive model where it’s impressions driven to direct driven which is performance oriented. Where we’re getting paid when something happens. Something closer to the transaction. That can be regulatorily supported and approved.

Edward: It’s tough though. As you described, when you’re in a business where so much of the influence happens so early in the funnel, it’s so the value you’re creating as early in the funnel to get credit for the revenue it’s generated at the end of the funnel.

Tom: 49% of our audience members who found a doctor in our platform go to the doctor’s website to book. According to our last survey. I mean, if that’s not leakage, I don’t know what it is.

Edward: Tom, thank you so much for being here today. Before you go, tell me about your quake book and how it changed the way you think about the world.

Tom: I really appreciate you having me on your show and I’m a huge fan of your postings and way of thinking, of course. It’s kind of in line with your BS, of like let’s look at things closer and let’s look at it from a data driven view. Mine is not a book. I read many years ago, I should probably get a date on this, but it was probably ‘92 or something like that. I was very fearful of what was happening, at that time, the biggest health concern was HIV AIDS. It was very much seen as unknown, anybody could get it no matter what you did. I was very concerned, as I was single, college graduate, dating, very fearful of contracting AIDS. It wasn’t until I read an article in the Wall Street Journal, it laid out in really clear terms the probabilities and the real data around the risk levels of a sexual male to contract HIV AIDS.

It just really helped me understand, you have to go beyond the headlines, you have to dig into hype and really dig into the math to understand something as important as your own health and safety. Just like you do with your show here and your writings. I think I had an early experience with that that helped shape my approach to lots of things in life and business.

Edward: Tom, thank you so much. I really appreciate your time today.

Tom: It’s fun to leave the show talking about AIDS.

Edward: On that note.

Tom: Thanks for letting me end with that.