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Dr Elias Tam - EHA Clinic Shaw Centre in Singapore

Dr Elias Tam's interest in cosmetic medicine sparked because of his patients needs and is guided by a simple philosophy.

Name: Dr Elias Tam Dr Elias Tam - EHA Clinic Shaw Centre Singapore
Clinic: EHA Clinic
Location: Shaw Centre, Jurong West, and Toa Payoh

Brief Bio:

I am involved in several medical societies. This includes being a committee member of the Society of Men’s Health of Singapore, and in the International college of Surgeons(ICS). I am very humbled to be accepted as a Fellow of ICS being a non-surgeon, and even more overwhelmed to be elected the President for the Singapore Section. At the international level of ICS, I am also the Honorary Secretary of the Pacific Federation, Honorary Secretary of the Cosmetic-Aesthetic Specialty and member of the International Executive Committee. I have also started a Cadaveric workshop since 2010 and invite the best from different disciplines to teach our fellow doctors. The unique opportunity to refresh our anatomy through dissection and confirm that we are injecting into the correct depth/compartment cannot be over emphasized.

What made you interested in branching out to cosmetic medicine?

After starting my first clinic in 1998, there was constant request for treatment of skin problems such as acne, wrinkles, hair loss, pigmentation and tattoo. To take better care of my patients, I went to attend various trainings in laser treatment, filler injection, or surgical techniques such as hair transplant. The term Cosmetic Medicine or Aesthetic Medicine was unknown then. Legally speaking in Singapore today, we are classified as General Practitioners with a special interest in Aesthetic Medicine. Cosmetic/aesthetic medicine does not belong exclusively to...

Click to read more ...


Dr. Steven Ang - Steven Aesthetic and Laser Clinic, Orchard Road

From injecting earlobes for good luck to training other physicians, Singaporean Physician, Dr. Ang has a number of interesting stories to share.

Dr Steven Aesthetic and Laser Clinic, Orchard RoadName: Dr Steven Ang
Clinic: Dr. Steven Aesthetics and Laser Clinic
Location: Orchard Road, Singapore


Dr Steven Ang started his private cosmetic medicine practice in Singapore in 1998. The same year, he became a member of the International Union of Esthetic Medicine, and in the process, introduced the term and concept of esthetic medicine (cosmetic medicine) locally. He was one of the pioneer cosmetic doctors in laser medicine and surgery, intense pulsed light, botulinum toxin and dermal filler injections in Singapore. In the past, he had been a trainer in botulinum toxin injections. He had developed the course syllabus at a local beauty school. He was a member of the Beauty Task Force, a committee set up by the Consumers Association of Singapore to look into objectionable practices by beauty salons and consumer complaints in Singapore in 2002.

Which factors played in your journey to cosmetic medicine?

I was exposed to using lasers for skin treatment in 1991 while working at a clinic. In the process, I saw a big market potential for cosmetic medicine.

As a teenager, I suffered from severe acne. One of the nasty remarks made by a former classmate that stuck in my mind was: “Your face looked like excreta.” Later, I managed to treat myself and regain confidence. This motivated me to want to help others. My favorite tagline is “Sculpting Beauty, Creating Happiness”.

I graduated with Bachelor of Medicine and Surgery degrees from the National University of Singapore in 1987. I sought further training at the renowned St John’s Institute of Dermatology in London and obtained my Master of Science degree in Clinical Dermatology from the University of London in 1994.

In the early days, there was no formal training for cosmetic medicine. I enrolled at a local beauty college that offered diplomas from the United Kingdom and Switzerland. I learnt the practices of an esthetician. In 1998, I became a member of the International Union of Esthetic Medicine (IUEM), which was based in Europe.

I started my private cosmetic medicine practice in Singapore in 1998, and through my membership with IUEM, introduced the term and concept of esthetic medicine locally.

Slimming and body contouring are another aspect to cosmetic medicine. To learn more, I undertook the clinical and oral examinations conducted by the American Board of Barriatric Medicine (now renamed as the American Board of Obesity Medicine) in 2002.

I now practiced at two locations, in Orchard Road and Redhill. We offer a full range of esthetic services. Our staff strength is 13 personnel. We serve thousands of patients each year.

Every cosmetic physicians has stories. What stories can you share with us?

One thing I learnt about practicing cosmetic medicine is unpredictable situations can arise and you must learn to respond. Once, I have a Chinese patient who consulted about getting dermal filler in his earlobes. According to him, a bigger earlobe will attract fortune and ensure a long life. Being Chinese myself, I know that these ethnic physiognomy beliefs are real. Therefore I proceeded to treat him.

As an experienced physician, what can you advise your fellow doctors in cosmetic medicine?

Over the years, I have learned that there are several critical factors that can contribute to the success of a practice...

Click to read more ...


Dr. Mohiba Tareen - Tareen Dermatology, Minnesota

Dr. Mohiba Tareen - Tareen Dermatology, Minnesota

In our interview with Dr. Mohiba Tareen, she shares her views about staffing and running a successful dermatology and cosmetic practice.

Name: Dr. Mohiba Tareen
Clinic: Tareen Dermatology
Location: Minneapolis, Minnesota

Dr. Mohiba K. Tareen is a board certified dermatologist and dermatologic surgeon. She serves as medical director for Tareen Dermatology, a full service medical, surgical, and cosmetic dermatology practice located in Roseville, Minnesota. Dr. Tareen is proud to be the mother of 4 young and active sons.

About Tareen Dermatology:

Since its inception in 2011, Tareen Dermatology has provided high quality dermatologic care to thousands of patients in the Twin Cities and suburbs of Minneapolis and St. Paul. Dr Tareen trained at University of Michigan in Ann Arbor and Columbia University and also worked at a number of high profile New York City Dermatology practices prior to relocating to Minnesota. The Tareen Dermatology aesthetic practice began as a natural extension of the dermatology practice. It has now grown to employing 5 aestheticians in 2 different locations as well as a total of 4 physician assistants and 40 support staff members (clinic administrator, receptionists, clinical assistants, pharmacy staff, etc).

As a dermatologist, what sparked your interest in cosmetic medicine?

Dermatology and aesthetic medicine are complementary. I trained and worked in New York City for several years before moving to Minnesota. Patients in the midwest were surprised by the minimal and natural approach that I brought to toxins, fillers, lasers and skin care. The practice has grown tremendously as patients know that I will recommend simple and cost effective interventions that will enhance their youthfulness and beauty, while keeping them natural.

Tareen Dermatology prides itself as a comprehensive practice that cares for all aspects and ages of skin and health. I am proud to care for 3 and 4 generations of patients. From a cosmetic perspective, this may translate to chemical peels for a teenager with acne, filler/botox for a middle aged parent, and full face laser resurfacing for the grandmother to rejuvenate the skin. I also care for all of their medical needs.

As the physician, I form the center of the wheel. My four physician assistants work with me to provide excellent medical care. Our aestheticans perform procedures and consults. Our medical assistants make sure patients are comfortable and all their needs are taken care of. I surround myself with the best- a patient recently remarked that Tareen Dermatology is like "Dermatology Disneyland" as we really have such a happy office!

Can you tell us more about you think of and use your staff?

My rule is to always over-staff. My job is much less stressful if we have enough staff. When I enjoy my job, everything always runs more smoothly! Also, I have learned that, these days, most staff only work at any given place for a few years. I used to take it personally when staff left, but now I have changed my perspective and try to feel fortunate that I was able to have a skilled individual for a few years. Most of my staff keep in great touch and it is exciting to see the great things that they go on to do.

You've got a number of lasers, and in some cases more than one of the same kind. Can you give us a run-down of the technology you're using?

We have three Excimer lasers for Psoriasis, three vascular specific lasers, 2 Candela Gentlemax units for hair removal and deep vascular lesions, a fractional and non fractional CO2, 2 coolsculpting machines, and we just purchased an Enlighten laser for tattoo removal!

In general, I prefer specific lasers, not IPL modaliies, as I feel they deliver safer and more predictable results

Most of your marketing is word-of-mouth and based on your exisiting dermatology patients. Is that so?

Our marketing is almost completely internal. We are fortunate to have an audience of 150- 200 dermatology patients who trust us who come into our office every day as well as patients who spread the great work that we do.

My time is money- so the services that I do not have to perform directly- coolsculpting, vascular laser, laser skin tightening, and laser resurfacing- are the most profitable. I still do filler and toxin personally so I always struggle as I likely could make more money seeing medical patients during the time it takes me to do these procedures. However, I do enjoy the artistry and patients love my natural approach!

As a dermatologist whose practice is not entirely cosmetic, what have you learned about practicing cosmetic medicine?

In a medical and cosmetic dermatology office, often the lines can be blurred. Several years ago, we did a full face CO2 on a wonderful patient who had many medical and cosmetic procedures in the past. As she was checking out my assistant presented her with the $2,500 charge. She was confused and said, "Oh, I thought this was medical and we were doing it for my pre-cancer spots!" This taught me that I need to always draw a line between medical and cosmetic. Now, PRIOR to procedures, patients sign a form delineating their charges.

What advice can you impart to your fellow dermatologists or physicians?

Ironically, I was against the significant growth of my aesthetic practice. I thought that it would take away from the legitimacy of my very successful medical and surgical dermatology practice. I resisted the growth and purchase of expensive lasers. My husband, a urologist and my business manager, encouraged me. He said "Mohiba, people know you do good work. They are going to other places now and not getting the results they desire." My husband was correct, and our practice has grown exponentially. I think that if people know you do great work medically, aesthetics is a natural extension. I wish I would have grown my aesthetic practice sooner!

About Dr. Tareen

Dr. Tareen completed her dermatology residency at Columbia Presbyterian Medical Center in New York, New York. During this time, she also lectured extensively and had her work published in a number of prestigious medical journals, including The New England Journal of Medicine. In addition, she was awarded the Conrad Stritzler Award of the New York Dermatological Society while a second year resident.


Dr. Renier van Aardt - NS MediSpa and Vitality MediSpa in Truro and Halifax

Opening a medi-spa was a natural extension of Dr. Renier van Aardt’s passion for medicine, beauty and helping people. He began practicing family medicine in Canada in 1993, and now spends much of his time in the practice of cosmetic medicine.

Dr. Renier van Aardt - NS MediSpa and Vitality MediSpa Canada

Name: Dr Renier van Aardt MB,ChB,CCFP
Clinics: NS MediSpa, Vitality Medi-Spa
Locations: Truro and Halifax Nova Scotia Canada

Brief Bio:

Graduated with degrees in medicine and surgery in 1991 from the University of Stellenbosch, South Africa. Practiced Family Medicine and ER medicine in Canada from 1993 to 2004, Canadian Board Certified in FM. Started doing laser and cosmetic medical procedures in 2000 & transitioning full time in 2004. Now the Medical Director of 5 clinics in NS, NB & ON, President of the Canadian Association of Aesthetic Medicine and a fellow of the ASLMS, teaching and speaking nationally & internationally, authored 2 chapters for Elsevier and contributing to journal articles for Aesthetic Medicine, many TV and radio interviews.

When you were in South Africa you were a surgeon. What led to your switch to cosmetic medicine when you moved to Canada?

After leaving South Africa for Canada I was forced to abandon surgery and the many hands on procedures that I loved to do, so I was itching to specialize in a surgical area of practice. In 2000 I happened attended a presentation in Toronto on laser tattoo removal and laser skin treatments. Early that morning I met Dr Mark Lupin at the venue and he encouraged me to take the leap to offer cosmetic medical treatments in my practice. The rest is history.

You've got two clinics, one in Truro and one in Halifax. Could you tell us about your practice and where your focus is?

My practice is definitely unique and unlike most others. I have two main locations in Nova Scotia and three satellite clinics between NS, NB & Ontario. I have an amazing team that manage and operate these locations, while I focus on patient care and travel between them along with my nurse.

My focus is on injectables and minimally invasive medical cosmetic treatments with minimal to no downtime. The patient demographic ranges from teens to patients in their 80's, some medical, most with cosmetic concerns and we have noticed a shift from middle aged, to more patients in their 20's and 30's in the past 8 years. According to industry partners, my practice size ranks amongst the top 25 in Canada.

What have you learned about managing and motivating your staff? Do you work on commissions?

It has taken me many years to distill many employees into a cohesive and focusing team with a common goal of success. It is an ever evolving and constantly growing effort. Staff have to have initiative, be self motivated and have a spark of entrepreneurship in order to be a good fit for my practice. It requires a good sense of reading character and intuition to identify the individuals who will make up a winning team.

All of my staff work on some type of commission structure. I'm a firm believer in capitalism, the harder you work, the better you do. There is no one perfect compensating plan & I use at leasts 3 different types across my clinics and they all seem to work fine. All staff are subject to a 3 month trial period & If any red flags arise, we make a clean break right away.

Technology is always a critical decison for a clinic. Could you tell us more about the technologies you use and what you think of the tech you're familiar with?

I've learnt a lot of hard lessons with technology purchases over the years. The best approach that I can advise is to start your practice with low overhead procedures, build up equity to where you can make an outright purchase, or at least be in a very comfortable financial position in order to make an equipment purchase. It should never be a burden on you or your practice. Never make an emotional purchase!

In my practice, I have laser and IPL platforms that I have purchased outright that perform many functions, as well as niche treatments that we have identified as good additions for revenue and practice growth like CoolSculpting and the ThermiRF suite of treatments. These niche treatments are definitely for the more mature practice that is established and financially sound.

Most of our energy device treatments are delegated to well trained staff. As Medical Director, along with my board of directors, any device purchase is very carefully considered and the advantage vs cost and marketing efforts are considered. I'm no longer influenced by sales representative pressure and glamour and glitz presentations, but rather consider my practice goals, practicality and feasibility of an additional procedure at any given point in time. Some companies will actually partner with a physicians in a non threatening way to assess their needs and make realistic suggestions for optimizing the practice portfolio - be alert and take the time to think it over.

I don't believe that there is any "bad" technology in our industry, however I'm careful to select the best bang for the buck options that have at least some track record of performing well and providing patients with impressive results before I'd continue make a purchase. I'd also always discuss it with a colleague that has used it for a while before taking the plunge.

Any marketing strategies or tips you can share?

Marketing is challenging as we have to abide by College rules, but within the restrictions that apply, I tend to stick to the lowest cost options. My advice is to avoid costly advertising and rather spend your marketing dollars on a great website and gradually develop a solid social media following. Open houses and patient focused in-house events are also very beneficial. At the end of the day, word of mouth is the best way to build a practice. Slow but sure and consistent efforts will pay big dividends.

Botox and fillers are often cited as amont the most popular treatments in most medspas or clinics. What are the most popular treatments in your practice?

It is imperative to track every treatment's profitability and monitor what's working and what's not. We market the treatments that do best and axe those that don't perform, if possible. Injectables are our top earners, followed by body contouring, skin care and lastly laser treatments. Minor surgeries like resections, sclerotherapy and scar treatment have fallen by the wayside in my practice. One of the newest trends is vaginal rejuvenation and we have just begun promoting that treatment in our practice.

Could you tell us some stories in your career in cosmetic medicine?

There are so many anecdotes! My nurse and I have started filming little video clips of funny situations that we reenact to show at the next annual meeting of CAAM in Toronto next November. We definitely have fun and enjoy our work tremendously. Of course, like any area medicine, complications and side effects occur and we need to be ever vigilant. We've also come across scam artists that complain about their outcomes for the sole purpose of obtaining a refund and one woman wrote 2 horrible reviews of me on RateMD's because I refused to reimburse her. It's par for the course and I think if we practice ethically and honestly, then we should stand up for what we do and believe in. This particular woman screamed at the top of her lungs how we've ripper her off and stormed out of the office to the shock and dismay of all the other patients waiting. I called a few colleagues in the area and they all new her and had blacklisted her for the same reason.

Any advice for fellow physicians who are just starting out in cosmetic medicine?

Dream big. Believe in yourself. Be patient. Set goals and write them down. Have passion for what you do. Have a "no matter what" attitude. Learn from others, do preceptorships with physicians that are successful. Be open to teach and share ideas with your colleagues so that we can all grow together. Attend conferences regularly. Be a member of CAAM to network with peers and obtain good CME and have access to the complications hotline. Don't make big debts when you're just getting started. Never give up.

Believe in yourself!

About Dr. van Aardt

Dr. van Aardt has studied medical aesthetics extensively, and approaches his patients with a thorough understanding of the person as a whole. He appreciates the medical, psychological and aesthetic considerations that go into making someone feel better – even more beautiful.

Through years of experience, Dr van Aardt has perfected the art of providing medical cosmetic treatments with remarkable patient comfort. The results speak to his attention to detail and ability to reveal or enhance a patient’s natural beauty.


Cosmetic Clinic Embezzlement: Bank Deposits

The following is a story from the Medical Spa Embezzlement & Employee Theft Scams Report which contains information for physicians and medspa owners to understand these scams and find out how to protect your cosmetic clinic.

The complete report is available for free to all Medical Spa MD members.

Beware anyone taking complete control of the books and the bank deposits.

Our embezzlement story has some classic elements: a break down in financial control procedures, an employee (bookkeeper) showing behavior changes and a drug problem, and a manager and a boss not paying close enough attention.

I have a solo private practice of plastic surgery with skin care services. At the time, we readily accepted cash payments, even for surgical procedures.

My practice manager was responsible to review the daily close, checking the work of the full-time bookkeeper. The manager was to make the bank deposit daily and attach the deposit receipt to the daily close. I would normally check our financial statements at my meeting with the manager every other week. It turns out that we missed one of our meetings, (because of schedule conflicts, being “too busy,” or the usual excuses/reasons that we end up skipping an administrative meeting) and I didn’t ask to see all the reports, anyway.

I became concerned when I noticed some behavioral changes in my bookkeeper, including erratic hours, late for work, leaving the office during the day.

When I discussed this with my manager, she noted that some of the daily reports were coming inconsistently.  I asked if the manager was getting the daily close and making the bank deposit;  my manager (now “buddies” with the bookkeeper) explained that the bookkeeper had taken this over “to help, since she saw I was so busy.”

The short story: the bookkeeper was pocketing all the cash and depositing/ recording only the credit card and check deposits, “cooking the books” to try to hide the missing cash. Fortunately, we discovered the ploy within a short time; our audit showed a loss of less than $11,000.

I brought in an HR attorney for the termination of the bookkeeper and the manager and filed a report with the Sheriff.

We subsequently learned the bookkeeper had developed a Vicodin/codeine habit from a fairly recent injury.

When the bookkeeper left the state, without forwarding address, and “could not be found,” we did not invest in prosecuting, on the advice of the attorney.


  • Have secure financial/bookkeeping controls: Have a daily close. Make sure that the person who collects is different from the person who checks/records. Use a third person to make the deposit.
  • Verify compliance with these procedures (“Trust, but verify!”).
  •  No matter how “busy” you get, check the daily deposit.
  • Hold yourself accountable,as well!

Erratic behavior is a warning sign of something worse. Trust your gut. If something “doesn’t seem right,” check it out, sooner rather than later.


Tea & Muffins on-demand graphic design for cosmetic medical clinics

Unlimited, beautiful graphic design for your business. 72 hour delivery (or less). 100% happiness guarantee.

Tea & Muffins is a design and advertising resource that you should take a look at for your clincs marketing and advertising.

Cosmetic clinics are in constant need of design and advertising, from small tweeks to before and after images to sophisticated advertising campaings. Tea & Muffins fills a critical space that gives your clinic the flexibility and capability you need at a fixed monthly price no matter how much you use them. It's essentially a subscription service that can fundimentally change the way that you think of how you think of your design needs.

A simple one time job can be had for a flat fee of $129, and for $399 you get work that is essentially unlimited as long as you only have 2 tasks outstanding at a time.

It's a perfect solution for clinics and medical spas who want to have a read resource that knows what they're doing at a fixed price.

Check them out at


Dr. Shuba Dharmana - Le Jeune MedSpa, India

Trained as a GP in the UK, Dr Shuba Dharmana runs three clinics in India and has become well-known among a celebrity clientele.

In this interview, Dr. Dharmana discusses her cosmetic clincis, staffing, marketing and working on darker skin types with IPL and lasers.

Name: Dr. Shuba Dharmana MBBS, DFFP, DPD (UK) Associate member of ISHRS (International society of Hair Restoration Surgeons)
Clinic: Le Jeune MedSpa
Location: Hyderabad, Bangalore, and Visag India

Brief Bio: Dr. Shuba Dharmana - Le Jeune MedSpa, India

I trained and worked as a General Practitioner in the UK for several years for the NHS and in the private sector as an Aesthetic and a slimming specialist.

I worked for the National Slimming and Cosmetic Clinics in the UK in Northampton and Coventry and for several other aesthetic clinics as an injector for Botox and Fillers. I also ran my own clinic ‘Cosmesthetic’ in North London for 2 years before relocating to India. Whilst in the UK I trained under some eminent cosmetic surgeons and got certified to perform various basic and advanced procedures in cosmetology. In 2011, I undertook Hair Transplant training under one of Europe’s most eminent Hair Transplant Surgeons, Dr. Marwan Saifi, in Poland and also completed my post graduate diploma in Clinical dermatology from the university of Cardiff, UK.

I then relocated to India in June 2011 and after working briefly at a hospital heading a dermatology department, branched out on my own and set up my first clinic in Hyderabad. This clinic quickly became very popular with celebrities and socialites with operational break even from first month. Its been 2 years since that I further relocated to another city in India and quickly opened a second clinic in Bangalore and now the third in Vizag. I am an associate member of International Society of Hair Restoration Surgeons and also an ambassador for an NGO that aims to improve education levels in government schools called “Teach for Change’ in Bangalore.

Currently I am working on a unique style of liquid facelift that I call the V3 Lift with fillers that is popular with my celebrity clientele

What made you decide to pursue cosmetic medicine?

I suffered from eczema as a teenager and it prevented me from going into modelling which I had always wanted to do. I was selected as a finalist for Miss India competition but couldn’t compete because of medical exam commitments. I quickly saw how physical appearances matter a lot in this world. It gives you a world of confidence, grows your self esteem and opens up a lot of opportunities. My background in modelling and my skin problem made me realize the value of good skin and beauty.

Throughout my tenure as a GP also I gravitated and favoured to treat skin problems because I could relate to the psychological issues attached with them. When one of my GP colleagues told me about a Botox course I enrolled immediately and once there I realized just how quickly and amazingly medical technology had been advancing. For me there was no looking back since then. One after the other I did all the courses that were advertised in the UK in aesthetic medicine. All the money I kept earning through general practice went into funding my aesthetic training. I got my first job as an aesthetic doctor and slimming specialist at the NSCC and soon offers poured in from all around the country in UK.

Could you tell us more about your clinics?

I am running 3 clinics today in different parts of south India, in Bangalore, in Hyderabad and in Vizag. Since I live in Bangalore, its easier to manage here. The appointments are booked through a practice management software and I get to know about my appointments early in the morning. I have a digital marketing team that assist with Google adwords and social media marketing on twitter, instagram & facebook to get us leads, a PR team that help publish various news articles on latest trends, procedures, etc, a manager and counselor who follows up on the leads, makes appointments, mediates to negotiates payments and essentially helps to convert the lead. In my other centres I have employed doctors and dermatologists who are trained or are being trained by me. They consult all cases and do procedures such as Peels, Prp for hair loss and acne scars, lasers and other procedures they are competent at. Few skilled procedures such as botox, fillers and hair transplants are lined up for me once in 2 -3 weeks and they assist me with these procedures as well. 4-5 days before my arrival the clients are all informed about my dates and clients that particularly want to see me make their appointments with me during those dates.

The services we offer are : Peels, Dermaroller, Vampire facelifts, laser hair removal, Fractional CO2, Fractional RF, Skin brightening and toning with q switched ND Yag, Hydrafcial, O2 Intraceutical facial, RF refirme, Ultherapy, UltraLipo for body contouring, Cool Sculpting, Microdermabrasion, snake venom facial, sheep placenta facial, Scalp micropigmentation, PRP for Hair loss, eyebrow tattooing, Botox, Dermal Fillers, Lipodissolve PPC injections, weight loss programme with nutrition counseling and FUE hair Transplantation.

We see an affluent population as well as a middle class aspirational crowd for most procedures these days. Men want these procedures today as much as women do. Botox and Fillers are taken up quite a lot by the actresses followed by socialites and an expat crowd.

WE have grown into 3 clinics now, in Hyderabad, Bangalore and Vizag , all in the south of India

How do you manage your staff?

The manager who counsels and helps to convert a lead works on a salary and gets an incentive or a commission. If they demand a higher salary they do not get other incentives. We prefer they take a salary along with a commission on the sales so that they retain interest. If it’s a doctor we give them 3 different slabs of salaries with or without commissions. For eg: high salary with no more commissions and lower, basic salary slab with highest commission percentage and something in between with a lesser commission on treatments. I find this plan easiest to use as it gives the member the choice of how they want to work and when they choose to work for salary and commission they feel like this is their own business. The more work they put it the more they get out of it and it works best for everyone. They feel very involved in the business.

What available technologies do you use for your patients?

Most Indians have skin type IV so we invest in diodes. I have 2 of Syneron’s elase with elos technology that uses RF and diode energies. The diode is therefore kept low to avoid burns on dark skinned patients. Its is therefore very safe and very effective. The risk of burns is low but is mainly from the RF aspect when the handpiece is not kept in contact with the skin hence a little operator dependant. I am quite happy with the technology and results but cannot say anything positive about the service issues. You never get the support you are promised after purchasing the laser.

We have Soprano Accord from Alma Laser another diode system for laser hair removal. It is painless and quite effective like the elase but unlike elase’s RF component that can cause burns, this does not cause burns unless you are using grossly wrong settings. It is easier to train a technician on Alma Accord than Syneron’s elase. With regard to results I find Syneron’s superior because the RF component can be increased during the final sittings to target finer hair.

In the Fractional devices I have Fractional Co2 and Fractional RF. Fractional RF allows me to treat skin type IV and above with no risks but with fractional Co2 on skin type IV and above, esp if I want to use higher settings, I prep the skin with a demelanising cream for few weeks before treatment.

For Skin tightening I can try and compare my Ultherapy with RF Refirme. RF refirme does show results but several sittings are needed and then maintanence and results are nowhere as drastic as ultherapy. Ultherapy uses focused Ultrasound technology to lift and induce collagen and I have seen some amazing results. It requires only one sitting and hence Ultherapy treatment can be expensive. RF refirme on the other hand is not expensive and clients can easily afford several sessions. I have had the opportunity to work with Alma’s Clearlift also and I am quite impressed with the results. It falls somewhere in between RF Refirme and Ultherapy.

Alma promises to entice me with some upcoming great powerful lasers and user support but that is something I will have to wait and see. I like Ultherapy, the technology, the results and since they have been very supportive with marketing and training I would like to be associated with them forever. I am not happy with the support Syneron has given me despite buying several of their lasers including 2 elase and 1 e2 system and for this very reason I refuse to buy any more from them.

What are your marketing strategies?

We have a digital marketing team who are working on Google adwords, SEO and social media posts on facebook, twitter and instagram. In this digital age we live in digital marketing is extremely important, much more than traditional newspaper, radio or TV marketing. Everyone I know is hanging out on Instagram or facebook!

Our PR team helps with brand building activities, speaker opportunities, magazine and newspaper publications. I realize PR is very important but it helps in building your brand not in getting you immediate business. Do not expect leads or increase in business immediately from PR activities , it takes time and you should start this later if you cannot afford to do it right away.

Traditional marketing is not working for us anymore. There was a time newspaper advertising worked but not anymore. Radio marketing is also for brand building which did not get us any leads. TV marketing can get very expensive and depending on the area you live in, it may or may not work. If there is too much competition in your area and there are too many clinics advertising on a channel, it gets very expensive. If you are the only one of your kind and from a small town, then you have better chances of getting your audience’s attention.

I support causes that I am passionate about like education for kids in government schools through the NGO ‘Teach for Change’, and sporting and fitness events. Being a fitness enthusiast I get my clinic involved in fitness events like 8K, 10 run events, zumba or Yoga sessions with healthy breakfast, and also conduct beauty, nutrition and skin care workshops to educate groups of interested people. Involving yourself in such activities like charities, social events make people look upto you and notice you. It helps to pick an interest and develop it parallely. It helps to avoid a burn out and boredom. In the process you get to meet many potential clients.

Cconducting workshops, educating people, writing articles, writing books and speaking at events and on TV, radio etc helps people to recognize you as an expert in the field

What are the most sought after treatments or procedures in your clinics?

Hair Transplantation: The investment isn’t much and returns are good even thought t maybe labour extensive. Its also something that needs a lot of skill and hence the justification of profits. Its also highly satisfying to see their face transform. Its something that gives me a lot of joy.

Laser Hair Removal: Here in India dark hair on a darker skin tone makes one look even darker which isn’t liked by anyone. There is a big market for treatments for unwanted hair and this earns us our bread and butter. Ofcourse the investment in a laser is huge but because majority of the population seek this this can me something that is paying your rent and salaries.

PRP: PRP for hair loss is really picking pace. Hair loss issues are many in both women and men and PRP is showing excellent results. Investment is minimal and earns a good revenue

Peels: India has a big market for skin brightening and Peels really sell. Peels are for acne, for lifting Tan, spots, pigmentation, melasma, rejuvenation and they are used by one and all. Minimal investment and good returns

Botox and Fillers: can be good if you have a good celebrity /socialite clientele. In Bangalore I have an expat and socialite crowd that ask for it and in Hyderabad I have actresses, celebrities and socialites

Fractional Treatments: Investment is big in the machine and returns aren’t great. Most people do not want any downtime and they find the treatments expensive. If given a choice they choose dermaroller treatment

Hydrafacial: Good revenue can be generated by acne clientele. Has good scope for marketing with all existing clientele

O2 intraceutical : not really worth the investment but when it is clubbed with other treatments such as microdermabrasion or fractional it can be a luxury experience. So good to give some in a package

Ultherapy: cosumable cost is too high but there is a decent profit to be made if marketed well

Ultralipo: we haven’t done any marketing for it so its not really earning its money. I regret the purchase

E2 system: ematrix sublative fractional RF is good technology with good results but consumable cost is too high hence people find it expensive. We are not using the RF refirme as much as we’d have liked to. I regret the purchase

I am looking to add a Q switched ND yag . we are already working with Alma’s Clearlift and I like it. Investment is huge again but I am positive it will work for us because at large the population here suffers from pigmentation and colour issues and this should be a good source of revenue

Have you had any interesting episodes that you can share with us?

I have not had horrible situations in my clinic thankfully. The time I did have one not so horrible situation was because of a miscommunication as is usually what happens in these scenarios. What I clearly told her would happen and marked and showed was not understood and she expected something else. Although her tear trough area looked great after injecting she wanted it dissolved after few days because she felt it made her eyes look smaller. She was counseled for hyaluronidase injections and the hyaluronidase used that is known to cause allergic reactions caused a reaction. Throughout her treatment and post whilst she suffered the allergic reaction, I kept in touch with her to reassure and support. The reaction took 5 days to subside and she panicked initially but I was there for her. She told me after that how grateful she felt for everything and she even came back twice after that for further filler injections. She is still a good client of mine. When something goes wrong in cosmetic medicine , which maybe your fault or not but its important to not let communication be affected. If I have to put in extra work because of their misunderstanding I do it mostly even if its costing me additional money because for me its not about money. Its about giving them satisfaction and a good experience.

As an experienced physician, what can you share to your fellow physicians?

Good communication skills are key to set treatment goals and keep expectations in check. Showing them some of the before and after pics of treatments you have done allows them to see what they can expect. All concerns should be addressed before they sign a consent form. Get into the habit of taking before and after pictures for their own medical records. Document the procedure well and look for a history of mental health issues and depression. Document post care, hand them some post care instructions with clinic numbers to call in case of any concerns and do not ever neglect someone calling about a concern. The sooner the problem is dealt with the better their options to find a solution. An unhappy client is something you never want and an unhappy client landing in your competitor’s clinic is far worse. Writing bad reviews online and filing law suits are some others you don’t want to face.

About Dr. Dharmana

Dr. Shuba Dharmana is a renowned and experienced Cosmetic Dermatologist & Hair Transplant Surgeon with tremendous international exposure. In March 2012, she established her presence in India with Dr.Shuba Skin & Laser Clinic in Madhapur, Hyderabad.

'Dr. Shuba then founded LEJEUNE Medspa which in a short period of time' has gained tremendous popularity with locals and celebrities alike. Her celebrity clientele consists of several top socialites and famous personalities from the Tollywood and fashion industry.

She trained at several internationally famous cosmetic clinics in London and Ascot under the guidance of world renowned pioneers of Aesthetic medicine. She regularly and religiously attended various seminars, workshops and conferences conducted in UK like 'Faces' and in Monte Carlo 'Anti-Ageing Medicine World Congress'. She became a laser specialist after undergoing several laser training courses in London.

Whilst in United Kingdom, she established and successfully ran 2 clinics - 'The Ultimate Beauty' in Luton and 'Cosmesthetic' in West London. She worked for several private cosmetic clinics including NSCC (National Slimming and Cosmetic Clinics) in Northampton and Coventry for 4 years as a Cosmetic and weight Loss specialist and for 'Novo London' for over a year in Berkhamstead.

Dr. Shuba writes columns and articles regularly for leading magazines and newspapers such as - 'Aesthetic Life'- Pakistan's no.1 aesthetic magazine, 'You & I' magazine, 'Times of India', 'Postnoon', 'AndhraJyothi', 'Deccan Chronicle', 'Deccan Herald', 'Diabetic Living', 'Health India Portal' etc.


Dr. Ebtisam Elghblawi - Aesthetic Dermatologist in Tripoli, Libya

Libyan Dermatologist, Dr. Elghblawi, expresses her passion towards aesthetic medicine and continues to develop her skills in cosmetic medicine further.

Dr. Ebtisam Elghblawi - Aestethic Physician in Libya

Name: Dr Ebtisam Elghblawi. MD, MBBCh, MScRes, ADD, DRH and PGC skin cancer
Clinic: Tripoli, Libya
Specialties: Clinical, medical and aesthetic dermatology

Brief Bio:

I am based in the capital. (Tripoli)

I am not that big and I am not with the idea of having a busy crowded clinic as many do. I believe on quality rather than quantity and patient satisfaction would generate eventually loyal patients.

I am very keen passionate to master facial aesthetics. I always want to improve my current skills, scale them up and increase my knowledge in Aesthetic as it’s a dynamic medicine. It’s about the concept of “less is more" with minimally invasive procedures. So it’s about how to not guess the patient age and not to know if the patients had any work done already, just being looked refreshed and contented.

I developed passion about aesthetic dermatology and want to learn the art and the skills of it to tailor it accordingly. It’s delivering harmonious beautification and not overly done procedures with pleasing aesthetic results which will positively impact your patients’ lives. I personally want to create a pleasing reflection when my patients look into a mirror. Which would give them inner empowerment and which make a difference in peoples’ lives and create a self secure state. I am always eager to learn more and more.

Question: Can you tell us a little bit about you and how you got started in cosmetic medicine?

I started in 2012 embarking and learning about the aesthetic dermatology in great details to learn the basic knowledge, essence and the foundation. Plus learning the science behind emerging aesthetic medicine based products and devices. It’s a wide field and every time it keeps changing as I said up about medicine development. Even now I can speculate that the future in aesthetic for face lifts by facial threading as its emerging strongly in the market. It’s a huge market though and any one should be familiar and well oriented about its pros and cons in order to avoid fatal mistakes and patients disappointment. It is very vital to meet patient’s expectations at the first place, in order to gain their trust and develop a mutual rapport and understanding which I consider the backbone to any booming procedures. I started developing my own skills from reading extensively and attended some training workshops abroad plus subscribing to attending online webinars and sharing views, procedures and results.

I am inborn artistic as I do drawing as a hobby since I was young and I believe tasting beauty and performing it would help to achieve the desired subtle changes to enhance beauty in an acceptable and a comforting manner. I dislike extreme changes which would imply and reflect negatively.

A person per se is a piece of art, a sculpture, and herein we are creating a beauty. We have to look at each person face objectively. Moreover the market currently is looking at attraction and beauty the most and aesthetic work should improve the quality of people lives. Aged skin involves a lot of physical process, starting off with the photo-aging and the process of aging itself, where skin become thin, loss its elasticity, elastin and collage, fat, and with imminent bone resorption and become loose, redundant and sagging with gravity which would impact our wellbeing and self confidence.

The face should have divine measures. We have to look for artist for each client faces. Patients are exceptionally critique due to many brands across the market.

Moreover as I said, medicine is evolving speedily and constantly and a new lesson to gain and learn is essential. We learn over time and nowadays practicing medicine is uniform across the world as its all connected by the well developed technology, the ‘internet’, and is only culturally differs. Medicine after all is Nobel and risky profession. “The day we graduate medical school we say, “Doctor do no harm.” Thus taking care of the patients by listening to them wisely and addressing their worries, show empathy and compassion and meeting their expectation is a triumph to any doctor.

Any medical practitioner has to have the appropriate training; in-depth knowledge based learning, expertise and experience to perform the procedure and to deal with all routine aspects of care and any likely complications. It is very essential to be reacquainted with facial anatomy and should pay a careful attention to the dangerous zones of the face, where detrimental complications can happen, namely vascular obstruction, tissue necrosis and permanent blindness.

Nonetheless, in reality nowadays, many registered medical doctor has started performing non-cosmetic surgical operations without proper qualifications from an accredited training body at all. There should be some guidelines and appropriate regulations with licensing that would have had more force, and offer more protection to the public and for doctors towards having appropriate qualifications and proper training. Nonetheless, it stops short of mandating a minimum qualification. The decision as to the level of expertise or experience is left to the doctor.

In the least practicing doctors should have the required knowledge, expertise and experience. However, no one is immune as in fact many qualified surgeons also harm patients and generate complaints.

The public trust the level of training and supervision involved is some reassurance a minimum level of skill has been obtained. The problem is always, ‘oversimplified the procedures and overstated the results’, which would have a strong impact on patients’ attraction as many medical practitioners do. It is after all the integrity of the treatment which should be the main concern for any medical practitioners.

Moreover, additional local anaesthetic may be administered, and this could lead to an overdose, which is potentially fatal if was not used wisely.

Some cosmetic surgeons have a significant conflict of interest – putting patient interest ahead of profits. Also it’s mandatory that ethical obligations to patients supersede profits. This is an important first step, but it cannot be the last. Also subtle changes would help rather than looking like aliens.
Moreover, patient assessment and informed consent is mandatory for the medical practitioners to provide and convey clear information about risks and possible complications.

I myself offered some patients who wanted to have cosmetic for a change and cannot afford the high prices, and to feel confident by injecting them for free and paying only the price for medicine from the dealer. I am trying to help my patients to have the face that they want to feel better in and out, and I offer empathy that many doctors lack, and I know what I am doing. I constantly stop while performing the procedure and let the patient to look into the mirror to show and explain what I am doing. One patient I recall told me that these changes changed her life and made her feel good and even men complimented her at work. It is always good to not putting profit above the wellbeing of our customers.

Nowadays, there are procedures done by the girl who runs the tanning bed shop or a local hairdresser and it is atrocious.

I give myself top-ups with fillers and Botox. I know the human face better than many expensive surgeons, and I can even do procedures on myself proudly speaking. Many of my cosmetic colleagues just inject patients and did not try on themselves at all and wondering why not to have the feel of.

I take the say of “I wouldn’t perform a procedure I had not had done on myself, to experience the procedure myself. We need to protect anyone who has cosmetic procedures and I should know – I have been under the needle and behind it.

Conversely, women have long been held path to a higher aging standard than men, but it appears as though that gap may be closing, as now men are joining in women, and “They realize that they also want to look and feel their best, and to maintain a healthy and youthful appearance especially when older work in a younger men workforce environment. Botox for instance, helps turn the frown line upside down and sometimes as the say of ‘The person looking back in the mirror is not the person you feel like’. It’s called ‘Brotox’ for men.
Men nowadays are much more open and proactive about their appearance. And this can be explained to the reason of quick fix with no downtime for starters.

It has been found that youthful appearance can generate more revenue than their older looking peers, and the widespread accord that men require higher doses of Botox than their female counterparts.

Many men do secretly Botox ‘little and often’, where nothing is severe really. Vain middle aged men like to call it a ‘Brotox’ and like to give it a go. Botox is shameless vanity, an expensive, self indulgent secret.

The ‘English look’ is where a skillful needlework given to freshens up a face rather than creating a creepily smooth forehead. It is always better to address the face as a whole to look better and not necessarily different.
The general joking say is ‘the more fit men are, the worse they look, they look close to death’. As in fact heavy exercise causes fat to drain from a needy area and build up in parts of the face where it conveys an ugly look for men. Brotox is meant to just accentuate masculinity which means improving the jaw line rather frown freeze thing.

Men who have tried Botox look better, feel better, and believe it gives them a competitive frame. Furthermore there's also less of a stigma associated with cosmetic procedures nowadays and they don’t see it a taboo treatment as used to be and they believe on the importance of maintaining a youthful look. After all, skin treatments can improve their looks and self-confidence.

Lastly, it is always the ubiquitous search for eternal beauty and youth which won’t stop at all and always will be developing and evolving.

Question: Can you tell us more about your clinic?

I don’t have my own clinic. However I always suggest some changes and offer some ideas to make the clinical practice more appealing, charming and attracting. The aesthetic in Libya is still kind of primitive and I expect to grow more across the coming years. The clients can vary unexpectedly and both genders nowadays want to look their best, refreshed and alluring.

The services I do are mostly clinical and aesthetic dermatology, namely, Botox, filler, PRP, chemical peeling and laser technology.

Question: Staffing is always something that physicians are interested in. Can you give us some insight into how you hire and manage your staff and what you’ve learned?

Not applicable.

Question: What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

I have worked with Candela laser gentlelase for hair removal and was a good pleasing experience. I know IPL is not that effective as the laser itself and I have written a paper about it and hereby the link to it;

• Alex Laser Hair Removal with Candela GentleLASE®;

Question: How do you market your clinic?

Not applicable.

However, from what I am seeing recently that most uses the social media, face book to generate, advertise and promote about their works and I think it conveys the message strongly, however we have to be very careful about spreading and disseminating our work and it should be the truth and not just selling sparkling and dazzling words. We have to reflect precisely what we do to gain and keep patients trust.

Question: What treatments or services are most profitable for you?

I can’t comment precisely about this as I am not that kind of a doctor who likes to have a lot of patients to work on one go. I like to work in peaceful, calming and quite environment to create, innovate and deliver a quality appealing results that patients will like, and not a quantity results.

My patients come to me and most often, the first thing they say is, I don’t want to look done. In fact, some of my patients don’t tell anyone they have had work, not even their partners. They simply want to look refresher and good.

Question: What have you learned about practicing cosmetic medicine? What stories can you tell?

What I can add is that we have to listen to our patients sensibly and address their main concern and worries and don’t give unrealistic expectation to avoid misfortune and disappointment which would incur a lot of problems, plus will affect our reputation.

Addressing patients’ main expectations and checking out realistic outcomes are the main goal in any successful aesthetic practice. In many instances some patients do have body dysmorphia whereby they never appreciate nor see any positive outcomes even if it was subtle. It’s after all, patients own perception of their body and they could just make unnecessary troubles.

I happen to see lately a lady that I feel sorry for her. She did filler since few years that she is not aware of the kind injected and I think it was calcium hydroxylapatite (CaHA) and the issue caused her four big hard stony nodules in her smile lines and cheeks. I sought medical advice from abroad to try sorting her out and called her twice. However she responded but declined attendance, and I kept thinking of her I must say as its really a tragic misfortune that could happen to any injectors.

Also sometimes you keep explaining to the patients and it seems they are mute and cant digest it well. For example a lady with a facial and neck sagging skin came to me and I advised according to her budget to have her face done in stages to appreciate the subtle changes. So basically I told her we can do the forehead with Botox to relax it and improve a bit the two long deep vertical lines around the glabella and I explained that we might even need filler to smooth it out after filling it and for the neck I can start with short mono lift threads and I even didn’t charge my hands work. She only paid for the goods, and after that she came complaining that she just wasted her money and didn’t see nor appreciate that changes though it was obvious and clear. She kept saying that the forehead is only a skin over the bone and doesn’t have any muscle really and that I didn’t do anything really for that. And as far as for her sagging neck, I explained it needs time to see the subtle changes and might need more needles the cog ones or the silhouette soft lift. However she is not prepared to pay for them as they are costly. Moreover she declined me taking photos after where I can compare and show her the changes that she cant see really. Some patient can be so stubborn that won’t see nor appreciate and just give you a hard time and put blame whatsoever on you and accuse you with all sorts of reasoning. You explain and even tell them to read on the internet to have the basic feel, and the knowledge; however it is as you throwing words in the air. Nothing really would work and such patients should be declined at the first instance as they will only waste your time, create troubles and give you a hard time.

Another story a lady who has pigmentation on her face and came and demanded a clearing up for her face skin. I explained about the chemical peeling and what is expected and all can her brain process is having a baby pink skin and other drawbacks her brain couldn’t digest. So she kept coming and blaming me for that as its my own fault. They think all just can happen in a glimpse of time.

Another story that a lady who had a deep simle line and a big fatty face demanded filling up those lines and declared she wont pay for more than one syringe of one cc. I had managed to make her dream come true through that and was an amazing sublte correction that my colleague appreciated it well by that small amount. However she kept coming and complaining and said it wasn’t as she wished.

Another story a lady who had filler for her smile line and a tiny bit on the sides of her lip, kept complaining of angioedema and thought its due to the injected filler. Though her examination didn’t show any lumps and after a through investigations, found that she fancy taking red chili plus she had bad teeth hygiene and gums troubles.

Another story from a greedy colleague who wants to make profit on you. A patient I did since sometime and she was content and all went well. This colleague obviously has no morality. He didn’t pay my money and despite of that called the patient and told her if she has any problem that she can complain about me and took all that as an excuse to not pay my money for the lady I did. Anyhow after 8 months she shown up in another clinic that I work in and she knew me and was happy about my aesthetic services and told me that the greedy colleague wanted to use her for his own sickness and asked her to complain if she didn’t like my work which obviously she declined as in fact she is happy with the results she achieved by me. It seems sometimes that colleague can act badly and secretly and the sky is the limit.

Question: What advice would you give to other physicians based upon your experiences?

I always emphasize the foremost on is listening to our patients carefully and addressing their main concerns and needs in order to reach a good settlement that would give a pleasant experience which would mean keeping the work on even in the future once patients gained the physicians trust. It’s also vital to weigh things between patient needs versus patient wants.

Cosmetic involves and covers all phases from patient assessment through to aftercare. And a small wrong thing in patients is unforgettable. Plus it’s highly recommended to document every small thing because patients keep forgetting especially when it comes to cosmetic.

I always like to provide quality aesthetic procedures to my patients. It’s important always to learn how to develop and sharpen our aesthetic eyes, and keep up to date with the latest studies, researches and technology in the field of Aesthetic Medicine.

We all know that aging process is inevitable. Thus, it’s vital to understand the concept of the aging process and the proper aesthetic analysis in order to create and correct. I recently joined a course which addressed the 4 ‘R’, which stands for; rejuvenation modalities- (Resurface (skin care), Relaxation (Neurotoxins), Refill and replenishment (Dermal Fillers) and Re-suspend and boost (Face-lifting).

It is not the injectable but rather the injector who makes the difference after all once mastered the art. It’s also important to hear to the patient feedbacks in order to improve, master and innovate.

Lastly, it’s about safely enhancing the patients’ current beauty without altering their natural facial features. After all, People are now more conscious about their outlook and they scare the aging process and wish to defeat it.

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