A Niche Social Site That's More Than Skin Deep

"I am nervous. I have read more than 100 reviews on this site from the good, to the bad, to the absolute unthinkable. I am hoping to get into a bikini by maybe July or August. I want better confidence, a fresher more youthful appearance. I want to be able to sit in a chair without pulling my shirt down to cover my flab/folds."

So begins one woman's four-month diary of a tummy tuck. It is personal, painful, emotional and an often brutally honest chronicle. It also generates dozens of responses, both sympathetic and critical. It is accompanied by expert advice, before and after photos as well as video journals of others who had the surgery.  Though the writer admits to many days of doubt and fear along the journey, her last posting reads: "It's been a happy trail." 

Welcome to RealSelf, a social-media website that offers detailed, first-hand reviews and comments by real people who've undergone a cosmetic treatment or procedure, or who are thinking about it. Treatments are rated on how much it cost, the pain involved and whether it was worth it or not worth it--one of the most popular and unique sections of the site. Medical responses are provided by a community of board-certified plastic surgeons, as well as by specialists in everything from Botox to braces, and all are done on a voluntary, unpaid basis. RealSelf doesn't sell leads to doctors, either.

The aim, according to Tom Seery, the affable, laid-back founder and president of the Seattle-based site, is "to build a rich and credible content environment which would prove irresistible to the right advertisers."

Mirror, Mirror The desire for invasive plastic surgery procedures, many of which require substantial recovery time, suggests people want big changes, not just minor nips and tucks. Of those who would get cosmetic work done, if money were no object: almost one in three (29 percent) would choose a tummy tuck, 23 percent would want liposuction, and 13 percent would opt for a facelift. Source: Harris Interactive, 2010 Survey

Seery's timing couldn't be better. RealSelf, launched only four years ago, is now at the heart of a growing web startup category, where a specialized niche rather than generalized social connectivity is king. These are sites that solve problems for consumers who are trying to make a buying decision with the help of expert advice.  "And where else but in healthcare are people faced with big decisions, even life-changing decisions, especially where the information out there is opaque?" asks Seery. "Health in general is one of those areas that none of us have much insight about, particularly when it comes to the consumer voice and experience."

Like most entrepreneurs, Seery, who has an MBA from the University of Washington, an MS from Drexel University as well as what he calls "an old-fashioned liberal arts degree" from Connecticut College, says, "Going back to childhood, I've always been sort of an entrepreneurial spirit--whether it was creating my own lawn service, running the clichéd lemonade stand or hawking my baseball card collection."

Clearly, that spirit carried through to adulthood. In fact, he attributes this early passion for enterprise with his ability to first recognize the opportunity he has now. "I vividly recall the moment the light bulb went off in my head," he says with the relish of an inventor reminiscing about a laboratory discovery. As he tells it, about four years ago his wife, Krista, was doing research online for a simple laser treatment. In exploring her options about skin care, she became perplexed that she couldn't get the same kind of quality information about laser procedures that she could readily obtain about a hotel's towels or its spa facilities. "And this was something that affected her face, her body, her personal appearance," says Seery. "I had already been delving into the whole healthcare morass and trying to figure out where in that information area there was an opening. I knew this was it."

He combined this insight with his experience working at Bellevue, WA-based Expedia, where he says he learned about the power of consumer contributions to websites by watching the success of TripAdvisor, a company which Expedia eventually acquired.  "This was an incredible business and it was all based on content that wasn't written by editors but a community of regular people," he says. "I think it is the most compelling and under-told story in social media. We all talk about Facebook and LinkedIn and all the others, but I think TripAdvisor is the most successful model because it's designed around consumers swapping opinions and information and also involves a monetary transaction."

"This was a perfect concept to apply to another market," he says. And he believed that the cosmetic surgery segment was the smart way to go. So in 2006, Seery put up $100,000 of his own money and created a prototype. "Actually," he quickly clarifies, "half the money was my wife's," adding that she was instrumental in the launch. He ran this for about a year and found it a low-cost way to test his assumptions, collect data and validate that RealSelf was indeed worthy of taking on more risk and time.

And the numbers looked good. Seery estimated that the total elective cosmetic surgery business was a $20 to $30 billion category, including dentistry, cosmetic products and ancillary services. His initial research also showed that 41 percent of Americans were using the web to search for health-related information. That figure is now up to 61 percent, according to a Pew Internet study.

"Obviously, there was--and is--a huge opportunity here," he says. To further confirm his thinking, RealSelf recently commissioned a survey with Harris Interactive in which 2,148 adults were asked if they would choose to have cosmetic alterations done. Sixty-nine percent said yes, up from 54 percent who said the same thing in November 2009, deflecting any concerns that the recession has affected the vanity market.

The initial prototype period also turned out to be beneficial when it came to luring investors. "It helped that they could see the data I'd gathered, so that they understood I wasn't smoking something when building the financial model," he recalls. Seery was soon able to raise a second and then a third round of seed money with the support of Rich Barton, the co-founder of Expedia and Seattle-based Second Avenue Partners. Seery estimates that the total funding amounted to about $2 million. He retains a majority stake.

Because it is privately held, RealSelf does not disclose specific financial information, but Seery did share that its revenues have increased 125 percent in the last three years and he projects to accelerate that growth by another 75 percent in 2010. In the past the company has made most of its money through Google's AdSense, though it recently has started to do direct ad sales, too. "We could make changes now to reach a certain level of profitability," he explains, "but we've decided not to do that. I had a board meeting recently and one of the key members went so far as to say, 'Don't even think about breaking even now for God's sake.' You don't normally hear that from an investor. His point is that there is so much potential in this category and so much room to grow the audience that it's crazy to squeeze quick profits out of the business now."

Seery also notes that the site now gets more than one million unique visitors each month. So promising are the prospects that RealSelf plans to double its staff to 14 full-time employees by the end of the first quarter of 2011. "I'm now hiring people who don't remember who Jimmy Carter is," says Seery, who is 41.

The site has partnered with every major medical organization in the country, including the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery and the American Society for Dermatologic Surgery. "We let consumers know what those organizations stand for and why it matters," Seery says. "We indicate in the doctors' profiles their credentials and detail their specific affiliations. The organizations, in turn, are happy to promote us to their members as a reliable source on the web. It also gives these doctors an opportunity to become more social-media savvy and to be more competitive when it comes to getting in front of a large group of consumers." RealSelf now has more than 1,000 board certified doctors participating on the site, offering consumers virtual consultations. And consumers have access to over 85,000 answers submitted by a wide-range of medical experts.

But he does not see partnerships--either with organizations or individual doctors--as another revenue stream. "Our model is predicated on the assumption that we are not a paid directory. We've approached the business as a pure consumer service. If you're a doctor with specialized expertise you should be sharing that information with the world," he said.

Doctors seem to like the proposition, too.

Dr. Michael Law, a board-certified plastic surgeon and RealSelf contributor for two years, believes that "the big danger on the web is that people will say anything, assuring maximum results with minimum effort and risk. Real life isn't like that." Dr. Law, who practices in Raleigh-Durham, N.C., says Seery's site is "a good way to get the message out about what is likely to be worthwhile and what is likely not to be worthwhile."

Others find the site singular in its approach to marketing and community involvement. Memphis-based Dr. Mickey Bernstein, past president of the American Academy of Cosmetic Dentistry, says it is particularly attractive "because the demographic I hope to attract is already visiting the site in large numbers. I have been active for just a month, but have already had visits to our website from the RealSelf links."

Adds Dr. David Shafer, a board certified plastic surgeon in New York City, who has been a frequent voice on RealSelf since 2008: "While there are dozens or perhaps hundreds of cosmetic surgery sites and blogs these days, I've yet to see one quite like this one, which is so totally consumer-centric and patient oriented."  Dr. Shafer also reports many referrals have resulted from his involvement.

Asked about some of those other sites, like WebMD, Seery explains that consumers have two sets of needs when it comes to elective, aesthetic medical procedures--functional and emotional. Other sites, he says, approach the consumer mainly from the functional and clinical stance--here's how you solve your problem. They leave out the emotional part. "A lot of people--most people, in fact--are looking for affirmation or reassurance, the sense that they are not crazy to have this thought or fear or whatever," he explains. "The differentiation of our site is that it fills this other set of needs. That's the heart and soul of RealSelf."

But knowing all he knows, would Seery ever consider plastic surgery for himself? "Not currently. But startup life seems to be aging me faster than my peers," he admits.

Build it Right and They Will Come
What does Tom Seery recommend as key steps for starting a web business?

Begin by asking yourself some tough questions: Are you solving a real problem for the consumer. Will your product or service fill a genuine need in an otherwise under-served market? Do you have a sustainable revenue model? Do you have a realistic business plan?

Test and validate those assumptions. Create a prototype. Run it for a year. Have no expectations of making money.

Stretch your capital to the max. You need significant runway in any startup. Think more in terms of years than quarters or months.

Embrace your constraints. Accept that limitations are opportunities in disguise. Be super creative about problem solving. Be judicious about deciding what's important and what's not. You can't overcome every obstacle by throwing money at it.

Hire carefully and slowly. Start off with a small, core group of smart, driven, passionate people who share your mission. Be sure they're clear about their roles. Be sure you're clear about their roles. Manage those expectations daily.

Get backing from investors who buy into your vision, not just the business. Those who are looking mainly to make a fast buck can sink a company faster than any competitor.