Medical Spa MD

Dealing With Anonymous Patient Reviews As A Physician

2012-05-30T21:00:00Z

The internet is a double edged sword to the Plastic Surgeon.

Patients from near and far can read about and research our skill and services but at the same time a handful of malicious people can significantly tarnish a great reputation which we have strived to achieve and maintain.

As a surgeon and as a human I have always strived to maintain the highest ethical and moral pathway. Most of us went into medicine to help people. What we do as cosmetic surgeons may not save lives but it does save quality of life and that is evident in our patients' smiles and behavior after successful cosmetic surgery. As doctors we strive to achieve and maintain a pristine reputation but as in anything else in life, it is impossible to please all the people all the time.

The internet has given a voice to everyone but it seems like angry, bitter, malicious people take advantage of this soap box and platform much more often than normal happy folks. You can see this on comments on YouTube or blogs or chat rooms of all kinds - not just medical or plastic surgery related.

But in our field, we depend on our reputation and while you may have thousands of happy patients, a small handful of unhappy ones can affect your reputation. Personally I have seen that the vast majority of my negative online anonymous patient reviews or ratings are from people who I have either never seen in my office or have seen but refused to operate on as patients. I recently had a "1 star negative review" on YELP from a person who has never even come to my office nor met me but decided that she did not want to pay $100 for an hour of my time for a consult and felt obligated to give me a negative rating for not offering free consults! We have all had such occurrences. But how do you deal with it?

My method has always been dealing straight forward with any and all comments. If it is out there then it begs clarification and a reply from my staff or office managers or even myself. There has to be accountability. In the restaurant industry, restaurants can actually review and rate their patrons, not just vice versa! As physicians, we have to respect patient confidentiality and HIPAA but that does not mean we must be silent and let any anonymous person's comments go without a reply or clarification especially when most of us work so hard to do the right thing and practice with skill, ethics and integrity.

Resources for physicians:

How Does A Plastic Surgeon Incorporate Lasers Into A Primarily Surgical Practice?

2012-05-28T17:00:00Z

One of the most common questions that other physicians ask me is “how do I incorporate lasers into my surgical practice?”

I am often called by a plastic surgeon, specializing in cosmetic surgery, who wants to know how he or she can begin to use lasers in their practice. It can seem exciting yet daunting to bring in a new procedure because of the level of knowledge and training required to properly treat patients and produce excellent results. And many times, physicians have limited time for further training once a busy practice has been established. In addition, lasers are expensive and most surgeons are not used to having to purchase expensive equipment beyond the initial investment in supplies to start a surgical practice. That being said, the laser procedures can help surgeons offer a much wider range of treatments that will benefit both the patient who has had surgery and the one who is not yet ready for surgery. I tell physicians and patients that laser procedures can be “insurance for your surgical procedure” in many ways. Laser procedures can help add to the result of surgical tightening by treating dyschromia, discoloration, texture, pore size, vascular lesions, and providing overall better skin health and appearance. One can pull the skin tighter with surgery, but the skin often needs surface treatment with laser procedures. Don’t just focus on achieving tighter skin, focus on overall better looking skin also. This may sound like a sales pitch, but you will hear me often say, “don’t put cheap tires on a Rolls Royce!” Surgical results will greatly benefit from maintenance laser procedures and good medical skincare. Finally, a laser procedure can often help a plastic surgeon treat a patient who does not really need surgery yet, so that the patient does not have to be referred elsewhere.

My advice always starts with telling fellow surgeons that they need to obtain proper training in the type of laser they are going to incorporate into their practice. Understanding the theory and physics of each different laser device is the key to fully utilizing the device in treating patients, not just in safety measures but in achieving great results (remembering that you can undertreat just as much as you can over treat). Although I unfortunately see burns and other complications from other practices, it is much more common for me to see a patient who has had a treatment somewhere else who is unhappy because they were “undertreated” or treated with the wrong device. This commonly occurs when a physician delegates a “lesser laser” procedure to someone who is not properly trained. Laser hair removal and IPL (intense pulsed light) are probably the two most common procedures that patients have had somewhere else before coming to see me and are unhappy with lack of desired result. A thorough consultation, informed consent, expectation discussion, and proper patient selection are also necessary for success.

There are basically two ways for a surgeon to begin to incorporate lasers. I call it “top down” or “bottom up.” “Top down” simply means that the surgeons first laser is one that provides the highest grade result for skin tightening that a laser can provide. The “top” is actually a surgical result, but the top laser is, in my opinion, a CO2 resurfacing laser. As the laser practice grows, the surgeon can begin to incorporate other lasers “down” from the CO2 laser including fractional lasers (both ablative and non-ablative), IPL, vascular lasers, and laser hair removal lasers. That way, the surgeon first adds what compliments surgery the most (my favorite is fractional ablative and fully ablative CO2) and then adds other as the need arises. This is the best way to develop a laser practice, but it necessitates a lot of involvement by the surgeon (which is the way it should be!).

The “bottom up” approach allows the surgeon to start with a more common and simpler procedure like laser hair removal. Delegating this procedure to a non-physician can be done carefully with proper training of the practitioner and proper continued involvement of the physician (after he or she is well-trained and individually comfortable with all aspects of the laser procedure). Then, as the “laser side” develops, other devices can comfortably be purchased as the practice wants to incorporate a wider variety. If you’ve ever read my material or heard me train or lecture, then you have heard me warn you against becoming the “jack of all trades, master of none.” So be careful to master each procedure before spreading you or your staff too thin.

So how do you get trained?

Ideally the physician received proper training as a resident and was exposed to a wide range and number of procedures. Residency programs such as dermatology and plastic surgery are increasing requirements for cosmetic laser and procedures, but the majority of physicians reading this may not have had much experience with lasers as a resident. Regardless, the physician must become familiar with what each laser can and cannot treat, the range of treatment parameters, the risks and complications, and what type of patient will benefit from a procedure. Typical “weekend courses” are very expensive and usually only cover the basics of different procedures (and are often “company specific” so that you would need further training if you bought another brand of the same type of laser). These courses are good for the beginner without much experience. Once the basics of theory and physics are learned and specific laser training is obtained, the physician usually can begin to conservatively treat staff members, family, friends, and trusted patients. This is a common way to start treating because a lot can be learned from conservative treatments that become more aggressive with comfort. Proper disclosure to those treated about the complication risk but especially the chance of under treatment will allow the physician to carefully treat and learn how he or she can begin to treat more aggressively. Once the physician has performed a number of basic treatments, then further training can be obtained at a practice like mine in which someone can come and spend a few days getting advanced training. Practice makes perfect, and that’s why they call it practice! Remember that the enemy of good is better!

Another great question is how to choose a laser in a certain category of procedures. It is overwhelming even for someone with experience to consider all of the different companies that make a laser that treats the same condition. A procedure like laser hair removal, IPL, or fractional CO2 may be offered by five to ten companies or more. I am a practitioner, not a “techy”, but I know my laser physics and theory, so when I consider a new device, I want to be shown the science.

Any new sales rep that calls on me will be met with an initial question from me of “show me the science.” Don’t let them show you a bunch of procedures and pictures and say “it really works,” find out why! This is the most common mistake practitioners make in buying the wrong device. One will rarely find a “cheaper laser” that does what its more expensive competitor does. You get what you pay for. You need to research a number of different options and companies, discuss with trusted colleagues, understand the device and conditions it treats, and “try it before you buy it.” I will typically research a device for months, let others try it first and publish studies, demo it, and wait for results before even considering cost and purchase. I personally offer training services, so please feel free to contact me for more information or leave a comment below.

Knowing what each laser can and cannot treat is also very important. “If all you have is a hammer, then everything looks like a nail.” This is true for any device, especially those that have a wide range of conditions that are FDA approved for the laser to treat. Usually, each condition is only best treated with one or two devices. Practitioners will have complications if they try it for something else to see if it works. Although this philosophy can cause complications, it more often simply leads to an unhappy patient. Stick to what you know the laser can do and use this when you consider buying a device. If it’s hard to believe that it can really do that, it probably doesn’t do it as successfully as the pictures show.

Physicians will often delegate laser procedures to non-physician practitioners. If done correctly, this can be very financially beneficial to the practice and very cosmetically beneficial to the patient. You must always know the state medical board’s policy regarding delegation, and this information can be found on the state board’s website or by simply calling the board itself. My best advice in this situation is to first become very comfortable with the procedure yourself and build a history of achieving great results. Then have the practitioner spend ample time observing you perform the procedure and eventually you observing them perform. This is the most important thing to remember for success: that practitioner must be able to perform the procedure just as well as you! This can be achieved by the well-qualified practitioner acting under you if you stay involved. You should always see the patient for the initial consult and consent. I believe that it works best if the physician does the initial consult with the practitioner along with you. If this is not possible (in some practices this may be difficult), then this can be done time efficiently by having the practitioner who will be performing the procedure do the bulk of the consult and the physician can give a “final blessing” and consent. However, it works best if the physician can also see the patient each time a treatment is to be performed so that past treatment and result and future settings can be discussed. This will give the patient the utmost confidence that they are not receiving a lesser treatment than they would if the physician was performing the treatment. I actually had a patient recently come to see me for solar damage treatment. I recommended IPL (which I perform myself). She was hesitant to agree and informed me that she had had it done somewhere else and "it didn't work." She was also told by the person who performed it that, since it didn't work, she could get it done with the "other IPL" which the physician supposedly performed and "that might work better!" I don't think I need to comment further!

One last word of advice concerns medical skin care. I have trained many physicians and am always concerned if a practice is beginning to use lasers without including a good medical skin care line. Pre- and post-procedure skin care is extremely important. Aestheticians or a skin care consultant staff member can be a key part of this in that they will be able to help you train the patient in using the proper skin care. Each of my laser procedures has a very detailed required skin care regimen for before and after the procedure. Although I know everything there is to know about the skin care lines we carry, I believe that having another specialist to separately help the patient is ideal. It will also save you a lot of time if, although you will direct the product selection, the specialist can set a full skin care plan for the patient. I see all too often that a very well-trained surgeon will begin performing laser procedures without also focusing on skin care. You never want to perform a great laser procedure and put the patient on non-medical over the counter junk! Finally, I always recommend further training in skin care and the organ of skin itself!

In summary, I believe that incorporating laser procedures into a cosmetic surgery practice can be very beneficial to both the practice and the patients. My best advice is to start slow! Don’t take on too many lasers and not properly learn what needs to be known about each one. Start with one or two devices and master them. Then you will have started to build the “laser side” of the practice with good devices and good results. The biggest mistake that I see physicians all too make is to buy one or a number of lasers and hand them off to another practitioner without the physician or the practitioner obtaining the proper training and comfort with the procedure. Every day, I see a patient who came in from another office where they were burned or more often just undertreated with little to no result. And, that patient just as frequently comes from one of the big practices in town as from one of the corner “medspas.” A patient wouldn’t want a surgical procedure from you if you don’t have experience any more than they would want a laser procedure from an undertrained physician or practitioner!

Learn the theory and physics of lasers in general and of each device.
Take your time in choosing a laser after a lot of research, asking questions, and demonstrations.
Ask someone you trust who has experience with the device you are considering.

Take your time and get trained! Patients will love you for it when they love the result. Remember that you will be lucky if one happy patient gains you one more patient, and luckier if one unhappy patient doesn’t lose you more than 20 potential patients!

Hospital Administrators Are Not Always Honest

2012-05-28T16:00:00Z

Hospital administrators have an agenda that's not always aligned with yours.

I used to do emergency work at a hospital in a large chain. It was hardy profitable and became less so over time. When I moved an hour away I sought to limit my emergency exposure for obvious reasons. The hospital administration cited sections of the Bylaws and Rules and Regulations that mandated that surgical specialists take call. This was specified for Plastic Surgery and Orthopedics.

Later and entirely by accident, I found out that the Orthopedists were being paid to take this emergency call by the same administration that was citing those hospital documents. Essentially they were being paid to take call from 15 minutes away whereas I was required to take call for free from four times the distance. Needless to say I dropped that hospital after briefly entertaining legal action. So soon after my divorce I hardly wanted to enrich another attorney. They are much smarter about getting paid than physicians are. I did inform a contact at the local newspaper who passed on the story stating that the public doesn't really care if a doctor gets screwed over. I found that a bit amusing.

As the story evolved I extended my practice up the street not so far away and something similar almost happened again. This time the administration in my new acute care hospital sought to get into an arrangement with me to take call. They were very quick to stipulate that this arrangement was to be secret. It was to involve some kind of payment from the hospital. The thought left a bad taste in my mouth. Emergency call is a loser. I just stopped taking it.

The moral of this story is that you should not expect hospital administrators to be honorable people. Entering into any kind of business arrangement with them especially a secret one is liable to be unfair, unjust or just plain illegal. You might want to avoid that.

Laser Liposuction & Skin Tightening - Emperor's New Clothes?

2012-05-26T20:00:00Z

Does laser assisted liposuction really provide all of the skin tightening benefits that the manufacturers claim?

We are in pursuit of many Holy Grails in plastic surgery, from scarless post-surgical healing, non-invasive liposuction and implant-free breast augmentation to non-invasive skin tightening. With the advent of laser-assisted liposuction (LAL) came the promise from the manufacturers that we have finally achieved a way of combining "minimally invasive" fat removal with skin tightening, sensationally treating two maladies with one procedure.

I been involved with LAL for many years, and it has been the primary revenue driver in my practice for nearly five years running. I began to perform the procedure when the machines became powerful enough to actually generate enough subdermal heat in a timely fashion to potentially create significant collagen remodeling and hopefully result in skin tightening. My case load quickly became large enough that I was asked to be a national speaker for one of the dominant laser companies educating other physicians on the use of LAL. As such, I delved into every published paper even remotely relating to heat-generated skin tightening and laser assisted liposuction. Over the years, I have been able to merge a huge surgical experience with the science behind the procedure and draw some fairly clear and simple conclusions on the issue of skin tightening.

Setting up a patient for potential skin tightening is fully dependent on generating ample subdermal heat to initiate collagen denaturation and subsequent remodelling. Generally, this temperature is felt to be between 40 to 45 degrees celsius. At around 47 degrees celsius, skin blistering and burns occur. With proper time, temperature-monitoring devices, and careful technique, adequate temperatures can be achieved. Getting the skin to this temperature range takes time and significantly prolongs the procedure. Additionally, the risk of seroma escalates the longer you spend with the tissues in this temperature range in my experience.

In about 15% of cases, I see clinically visible skin tightening which I don't feel I would have seen using other techniques. This skin tightening is not the equivalent of excision techniques, but typically limited and subtle. This is obviously purely my subjective opinion to be clear, and I cannot say that these same results may not have occured witht the same frequency had I used other liposuction techniques.

The science of LAL and skin tightening is clear that some tightening does occur and is quantifiable. But this does not predictably translate into clinical relevance. I have now performed nearly 1000 LAL's and no longer educate my patients that LAL is a good method of tightening skin. The limited degree of tightening I credit LAL for is not enough to call it a clinically relevant skin tightening procedure. The majority of new LAL consults in my practice present with the impression that LAL is going to tighten up their loose skin while removing fat. The notion is dominant on the internet and even in print ads. I politely educate them that although there may indeed by some skin tightening, this will be subtle at best. In my opinion, the advantages of LAL lie elsewhere, particularly in a somewhat easier recovery.

I continue to hear from colleagues who also use LAL that they believe in the skin tightening. I don't know if this is a case of "The Emporers New Clothes" or not. I have pushed the envelope in terms of thoroughly heating up the skin to appropriate temperatures and length of time, but only see minimal tightening and an increase number of seromas. I continue to use LAL heavily but no longer tout skin tightening as being an expected end point.

Samuel Lam, MD, FACS: Plastic Surgeon, Artist & Entrepreneur In Dallas, Texas

2012-05-22T14:00:00Z

Double board certified in facial plastic surgery and hair restoration, Dr. Samuel Lam keeps himself busy with his Ova skin care line and lecturing worldwide.

Dr. Sam Lam is a triple board-certified facial plastic surgeon who is world renowned for his pioneering work in facial rejuvenation and hair restoration. He is the owner of the 27,000 sq.ft. Willow Bend Wellness Center. He has authored five major medical textbooks, Comprehensive Facial Rejuvenation, Cosmetic Surgery of the Asian Face, Complementary Fat Grafting, Simplified Facial Rejuvenation, and Hair Transplant 360 along with over 150 book chapters and scientific papers. He lectures monthly nationally and internationally with well over 100 lectures to date. He is the 2002 winner of the John Orlando Roe Research Prize for his research on skin rejuvenation.

Name: Dr. Samuel M. Lam
Clinic: Lam Facial Plastic Surgery Center
Location: Dallas, TX
Website: lamfacialplastics.com, hairtx.com, ova-skin.com

That's interesting: After 2 years of research and development, Dr. Lam launched his new skin care line, OVA, that features plant-derived stem cells for skin rejuvenation, that is simple to use with only one morning product and one evening product.

He is an accomplished artist having completed all of the illustrations for three of his medical textbooks along with many drawings for his scientific articles and book chapters. He enjoys painting during his free time and has on display over 150 of his original paintings in the new wellness center. He's also a certified PADI divemaster.

Can you tell us about how you ended up as a plastic surgeon, researcher, and entrepreneur with your own skin care line?

Part of it was planned determination and part of it was what Steve Jobs calls “connecting the dots backwards”. Jobs mentioned that he loved calligraphy when he was at Reed College. He never knew that it would be so influential years later when he introduced to the world the concept of the font with the release of the first Macintosh in 1984. I was a history major in college and because of that background, I have been able to write prolifically without much difficulty and also be an engaging public speaker throughout the year. I started my residency in head and neck surgery at Columbia University and when I heard Gene Tardy, a very patrician facial plastic surgeon, speak about rhinoplasty, I realized that I could integrate my passion for art and science. I believe what motivates me every day is being able to perform my art. That creativity inspires me.

The idea of the skin care line started 2 years ago when I realized that most products out there were bunk. Too many steps, too complicated, too many chemicals, and little performance. I was blown away with the final formulation of my product OVA when we integrated plant stem cells. I saw a difference in my skin within 2 days. I have never seen that with any other product. This skin care line involves a single step besides the cleanser and there are no eye and neck creams or hand creams. It is all in a single morning and a single night product. As a guy, I have no time for putting creams on, and this product is profoundly simple to use. When I asked my biochemist, “Do we really need 10 products in this line?” She responded, “No, all of that is just marketing.” That is why I felt comfortable that we could put 10 active ingredients into a single bottle and blow away the market with this. I was also able to express my passion for design by designing every element of this product including the box, logo, name, bottle, colors, lines, practically everything.

Finally, the skin care line allows me to give back to our community. 5% of all profits go to support Off the Mat, an organization that is helping to eradicate sex slavery in India where underage girls are sold against their will into sex slavery, impregnated and then their children are forcibly placed into the same trade. Part of the effort is to retrain them in a legitimate, non-sex trade so that they can survive. The thing that riles me the most is human rights violations and stopping man’s inhumanity to man. That is what I am passionate about.

You're a winner of the John Orlando Roe Research Prize for research on skin rejuvenation. Can you tell us about your research background and how that's helped (or hindered) your career?

Even though I lecture throughout the year and write a lot of articles and books, I really do not perform active research today. It is just not my cup of tea. We all have to know what we love and what we don’t. The award was for best clinical research during my fellowship in facial plastic surgery. It involved evaluating whether certain non-invasive lasers would be beneficial for the skin. The biggest thing I learned is that sometimes basic science research that shows improvement in skin may not translate into real-life clinical scenarios. That was the point of the study. I am very proud of it but it is something that has little impact on my life as a surgeon today.

You're pretty involved with the 'fat transfer' procedures. Tell us where you think that fat transfer fits in your practice and where you think fat transfer procedures are going in the future?

I think fat transfer is the single most important advance in the last decade in facial rejuvenation.

I remember 2 years into my practice sitting in a lecture hall hearing my world shatter. I looked at photos and philosophy that forced me to do a hard-nosed evaluation of my practice and I realized that what I was doing was not right. Browlifts in people that did not need them and facelifts that were done too prematurely. Fat transfer if done well (and that is a big caveat) can make someone tremendously more youthful, attractive, and feminine (for women that is), all without any cutting. Unfortunately today, I think very unartistic overfilled faces is more the norm. You see this in celebrities today. We have gone from overlifted to overfilled results. I hate them. Fat grafting can truly be a wonderful artistic endeavor, and it certainly has been for me. I think my work does not look like anyone else’s, as it reflects my aesthetic sensibility. The beautiful thing is that if done well it is safe, permanent (minus ongoing aging), and natural.

You've written five major medical textbooks including Comprehensive Facial Rejuvenation and Cosmetic Surgery of the Asian Face, you're regularly publishing and speaking, and you're running your own clinic. Where have you made conscious decisions to try and focus your career and where has serendipity come in to play?

I think as I mentioned both are always in action. But I like the expression that chance favors the prepared mind. I will never take credit for all my success. It is the hard work of all my wonderful staff who are imbued with the same passion, integrity, and work ethic that I have. In short, they share the same culture I espouse. I love going to and lecturing at conferences. I think by going to so many meetings each year I not only build up a network of colleagues and friends but I learn so much new information that I think my colleagues who only go to one a year or fewer than that simply don’t get. For example, I have been using platelet rich plasma (PRP) in my hair restoration work that has simply revolutionized my practice. The consistency, speed, and quality of growth now is unmatched. I have been blown away. I learned that in Anchorage, Alaska last year at the International Society of Hair Restoration Surgery’s Annual Meeting. That is only one of so many advances that I have incorporated into my practice in the past year alone.

Running a 27,000sq ft wellness center must come with some notable experiences. What have you learned about about staffing and operations that other physicians could benefit from?

I think the best thing I have done is join the chapter of the Entrepreneur’s Organization in Dallas 6 years ago. As a physician, I do not have real business experience and way too many years in school, I really benefit from the education, experience, and collegiality of my peers in EO and have found it to be like a mini-MBA for me. When I moderated my forum group 2 years ago, I was able to really learn how to lead leaders, something very hard to do. Also, running now 5 businesses (my plastic surgery practice, my salon, my spa, my skin care line, and my building) has taught me a lot about business that I think I would never have gotten just running my own practice. I also learned a lot from my mentor Ed Williams, who was my fellowship director, and who really inspired me as a business leader. Fortunately, I was able to get him excited to get into EO, which he says is one of the best things he has done.

What IPL and laser technologies are you using and why did you choose these particular platforms?

I use Alma lasers and the Soprano XL for laser hair removal. I rely on plasma skin resurfacing for the skin at a deeper level. I was impressed with these technologies for two reasons: safety and efficacy. Regarding safety, I have anecdotally heard too many problems with fat loss and other issues with other types of very strong IPLs. I have never heard of or encountered that with these technologies. I also like the fact that they provide wonderful skin rejuvenation without the egregious downtime and risk of loss of pigment associated with traditional CO2 resurfacing. In short, I am very happy with the technologies that I am using today.

Where do you think that 'plastic surgery' will be replaced by technology in the future?

Obviously, the trend today is toward less and less invasive procedures. People simply do not want big surgeries. However, sometimes technology may not work as well as we would think. I performed a suture based lifting procedure for the neck in the past that has not lived up to my expectations. Going back to perform a facelift albeit with small incisions is still the way to go in my practice. I like the expression that one should not be the first person on the block to do something or be the last. One of the biggest technological advances is the use of disposable microcannulas to perform injections in the face with fillers. The ability to contour complex areas is unlike anything ever that I have encountered. I am able to perform a “fat transfer” type look without doing fat. Of course, these are with temporary fillers and therefore it can be quite expensive (even more expensive than fat grafting) if someone needs a lot of fillers. Every time I go to a major conference I pick up an amazing pearl that completely changes my practice in a good way. I think technology will continue to evolve and be powerful adjuncts to plastic surgery. I don’t think it will replace it anytime soon. But who knows?

What advice would you give to other plastic surgeons about the new cosmetic technologies?

I think what I stated above is a good maxim: don’t be the first or last person on the block performing a procedure. We all remember the Contour threadlift that really did zero good for patients. The hurt that can cause a young surgeon without an established reputation could end a career. It is so important to be careful and conservative especially for someone just starting out in this field. It is important also not to listen to the vendor who will show you unbelievable before and after images but they are usually an exaggeration. It is much better to ask an established colleague who is not financially vested in the company, i.e., someone you can trust.

What's the best advice you ever received as a physician?

“Don’t be a control freak”.

I was told this in my first week of my fellowship with Dr. Williams. Of course, I was crestfallen when I was slammed like this by my mentor but he was completely right. He taught me an amazing ability to lead and that is why I think I have great, loyal staff; an amazing culture; and a thriving business that has grown every year despite any economic downturns.

About: Dr. Sam Lam is a triple board-certified facial plastic surgeon, a diplomate of the American Board of Facial Plastic & Reconstructive Surgery, American Board of Otolaryngology, and the American Board of Hair Restoration Surgery. He is in private clinical practice with his specialty focused on facial cosmetic surgery and hair restoration. He has authored 5 medical textbooks and over 150 scientific articles and book chapters. He lectures throughout the year both nationally and internationally on his pioneering surgical strategies and philosophy. He is best known for his work with facial fat transfer, an incisionless type of facial rejuvenation that is far more natural than previous techniques; natural hair restoration; ethnic facial cosmetic work; and reducing and fixing enlarged lips.

He is the owner of the 27,000 square foot Willow Bend Wellness Center in Plano, Texas, that he built from the ground up. He also owns the Jose Eber Salon and the Spa at Willow Bend in the building.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Dr. Tahl N. Humes: Vitahl Medical Aesthetics In Denver

2012-05-21T14:00:00Z

With two physicians, 30 years of combined aesthetics experience, and inclusion in the top 1% of Botox injectors in the US, Dr. Tahl Humes is rocking it at Vitahl Medical Aesthetics in Denver.

Name: Tahl N. Humes, MD
Clinic: Vitahl Medical Aesthetics
Location: Denver, CO
Website: vitahl.com

That's interesting: Dr. Tahl Humes is a Laser Trainer and Spokesperson for Cutera Lasers. She is in the top 1% of Botox injectors and the top 5% of Juvederm injectors in the country.

In addition to serving as Medical Director for VITAHL Medical Aesthetics, Dr. Humes practices Internal Medicine at Saint Joseph Hospital in downtown Denver.

You're an Internal Medicine Attending at a hospital in Denver. How (and why) did you end up making a move into cosmetic medicine?

With the countless all –nighters as a resident and staying up studying through out Medical School, I started thinking of preventative ways to treat my skin. While researching ways that I could keep from aging, I became intrigued with lasers and how much they could change the skin. The more I learned about Botox and lasers, the more I realized how dynamic the aesthetic side of medicine is. My overall goal when starting Vitahl was to bring together a luxurious spa environment with the safety and professionalism of a medical office.

You've got two physicians, a NP, a PA, and a sizeable staff. How is your clinic organized and operated?

Vitahl is physician owned and operated. Our physicians are on-site to oversee all medical treatments performed in the office. Our Office Manager oversees all other day-to-day practices and supervises the employees. We have a team of ten employees, including doctors, nurse practitioners, physicians assistants, medical aestheticians and administrative staff. We offer a wide range of laser skin procedures, injectables, surgical and non-surgical body contouring, cosmetic surgery procedures, and facial treatments. vitahl is located in upscale Cherry Creek North in Denver, CO.

Staff compensation for clinical staff is a combination of hourly plus commission. We have different levels of clinicians, and pay increases as clinicians are promoted to higher levels. In the past we were commission only, however, we changed to hourly plus commission because we found that with commission only that our staff did not realize that patient care is about more than doing the actual treatment, it also about educating patients pre-treatment and following up with patients post-treatment.

We try to be smart about hiring, but often times it is difficult to get a good feel for a clinician until they are working in the office. We evaluate our new employees at 30, 60 and 90 days and if they are not meeting the standards we have set forth we fire them, and look for a new employee. Our goal is to keep turnover low, however, we also want a strong team that puts patient care first.

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

Laser technology is one of my specialties and passions; I have been on expert panels for Cutera and conducted laser trainings throughout the nation. We offer many different laser and light technologies including Vaser body dontouring – Vaser Lipo and Vaser Shape, Smooth Shapes, LimeLight IPL, Titan Skin Tightening, Pearl Fractional and Pearl Laser Resurfacing, Laser Genesis, Laser Tattoo Removal with the RevLite SI, Laser Hair Removal.

In addition, we recently brought on miraDry, the first long term treatment for hyperhidrosis and Cellulaze, the first FDA approved procedure for long term results of Cellulite reduction. We have been pleased with all of this technology as well as the companies who make the machines. I stay on top of laser lechnology and choose the best machines and treatments available through research in the field of Lasers. With a wide variety of Laser companies and the ever changing technology it is best to continually be watching the trends and technology to stay ahead of the game in choosing the best Lasers technology and Treatments.

Wha are the hits and misses in marketing your clinic?

Marketing has definitely evolved over the years. We have transitioned from all print ads 7 years ago to mainly online, some print, and billboards over the last few years. If you’re not on Google you aren’t relevant. Medical sites with aesthetic focus have been great for us as well. Local listings are very important for branding and we try to remain an active part of our community here in Denver.

What treatments or services are most profitable for you?

Lasers and injectables are our most profitable services on the aesthetics side. We keep in mind that with injectables we have a variable cost based off the number of units of Botox or syringes of Juvederm we use, while with lasers we have a fixed cost based off our monthly lease payment. So the more Botox we sell the more we have to pay to purchase the Botox, and with lasers, if we sell more we make more because we are paying the same amount for our lease whether we sell one procedure or 100 procedures a month. In addition, two years ago we added a plastic surgeon to our practice. Cosmetic surgery is a profitable and growing business model and only adds success to our business.

What have you learned about patient care?

Treating patients comes with the responsibility of making sure a patient is all at once healthy physically and mentally for the cosmetic procedure, this poses challenges from time to time. Many patients do not consider aesthetic treatment and cosmetic surgery to be medical treatments. I have learned that as with any other type of medicine, you need to keep patient safety a priority.

We have turned patients away

One of the most memorable stories came as I was injecting a patient, it was his first time getting Botox and as soon as I finished injecting him, he bent forward and passed out! I hollered for some help from the staff, but a few smaller females trying to catch a 6 foot man from sliding out of the injection chair was a comical experience to say the least. We have all heard the saying “Pain is beauty,” you would be surprised with the number of patients whom are afraid of needles and conquer their fear to get injected.

What advice would you give to fellow physicians starting or operating a medical spa?

It is better to start small, doing fewer treatments and then add on additional treatments as you get busy. That said, it is also good to have a variety of different treatments, like Botox, laser hair removal and laser skin treatments. There is not one treatment that will be good for the different patient markets you are targeting. I learned that the best time to buy a new laser is when patients are asking for it. For example, I added fractional lasers when I had a lot of consults where my recommendation for the patient was fractional lasers and I did not have one. Stay current on the latest technology, even if you are not offering it. Patients do a lot of internet research and they expect their physicians to know about all of the treatments available.

About: Dr. Tahl N. Humes graduated Medical School at Touro University in California, and Residency at Saint Joseph Hospital in Denver. She trains physicians, nurses, and PAs from across the nation on lasers as well as in Botox and dermal filler injection techniques. She has been interviewed for her cosmetic medical expertise by news affiliates ABC, CBS, and NBC. Dr. Humes has participated in philanthropic medical care throughout her career. She has worked with the indigent population of Denver as well as participated in Medical Missions in Guatemala through DOCARE International.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Dr. Stephen Bresnick: Plastic Surgeon in Encino, California

2012-05-19T17:00:00Z

Dr. Bresnick discusses how he balances his teaching career and private practice after 15 years as a plastic surgeon.

Name: Stephen Bresnick, M.D., D.D.S., M.S.
Clinic: Encino Plastic Surgery
Location: Encino, CA
Website: drbresnick.com

That's interesting: Dr. Bresnick has published nine books in medicine and science and has authored over 20 articles published in medical journals.

Dr. Bresnick has trained a lot of young plastic surgeons as a chief resident in plastic surgery at Stanford and assistant professor of surgery and clinical instructor at USC. We asked Dr. Bresnick about his thoughts on medical education in the US and his surgical practice.

You've spent a lot of time teaching. What have you learned about the differences between training physicians and running a practice on your own? Where do you think that US based medical educations are strongest and weakest in preparing young doctors?

Running a high-quality private practice is demanding and requires full attention to our patients. This gives us the opportunity to control the quality of the experience, offer excellent results, and form a bond with our patients. Working in a teaching hospital requires different skills. There is more delegation and supervision, and less ability to control a patient’s experience. The cases seen in an academic center are also more complex.

I believe that the US medical education system should focus on humanism, ethics, and continued education. Some of these things are done well, others not so well. Procedures are taught well as is the science of medicine. When I interact with some of my surgical colleagues, I wonder if the art of medicine and the humanistic components were taught well.

How are your clinic's staffing and operations organized? What problems or issues have you had with staffing your clinic and how have you resolved them?

Our plastic surgical practice has evolved to employ over 15 staff members. Each person has an expertise in their position. We have our front office staff and our operating room staff. There is very little overlap in job duties because of the different skill sets required. We have two plastic surgery nurses, patient care coordinators who guide patients through the experience in our office, insurance specialists, and other important people. We have had very few problems with staffing our practice because we select people very carefully for positions and offer appropriate training and guidance.

You're using Sciton Erbium laser, Lumenis Lightsheer and KTP laser. Can you tell us how you evaluated it and why you made the decision to go with these technologies?

We select technologies which have proven benefit for patients. There is a new laser available on the market every few months or so, but many offer disappointing results and overstated claims. We honestly tell our patients what to expect in terms of healing and results, and this has been appreciated. When we look at a new technology, we ask ourselves if our patients will be happy with the results. If we are not sure, we don’t consider it any further. If we believe that the results are very good, we are more likely to investigate further or commit to a purchase of the technology.

We are closely evaluating non-invasive radiofrequency devices and ultrasound technology for skin tightening and fat dissolution.

Do you see a time when cosmetic surgery is going to be replaced at least in part by nonsurgical technologies? Is this an opportunity or threat for surgeons?

I believe that surgery will offer more dramatic and effective results than non-invasive technologies for many years to come. Although some of the minor procedures I do will be affected by non-invasive techniques, the “bread and butter” of our specialty will remain quite stable. We encourage new technological developments and incorporate those into our practice to offer the most effective treatments.

How do you run your business in order to keep up with your competitors?

Our competitors are both plastic surgeons and non-surgeons who do cosmetic procedures. What keeps our practice busy is our commitment to excellence, top training and credentials, and a really good patient experience. These things make word of mouth by far our most effective marketing.

What is the best advice you've ever received as an entrepreneur and physician?

Treat your patients like family members and provide service which exceeds expectations. With this philosophy, some patience, and consistently good results, your practice will grow and thrive!

About: Dr. Bresnick is board certified by the American Board of Plastic Surgery and is committed to excellence in both surgical results and patient care. A native of Los Angeles, Dr. Bresnick completed his undergraduate work at UCLA, followed by both a Master’s degree and a Doctoral degree at UCLA. Dr. Bresnick earned his M.D. at the University of California, San Diego (UCSD).

Following graduation from medical school, Dr. Bresnick completed his surgery internship and surgery residency at Stanford University, followed by a three-year plastic surgery residency at Stanford. Dr. Bresnick was named Chief Resident in Plastic Surgery at Stanford in 1996. After becoming a fully trained plastic surgeon, Dr. Bresnick completed a Craniofacial Plastic Surgery fellowship at USC and Childrens Hospital Los Angeles. He was named Clinical Instructor in Plastic Surgery from 1996-1997.

Dr. Bresnick was appointed Assistant Professor of Surgery in the Division of Plastic Surgery at USC in 1997, and remained on the full-time faculty for five years. During this time, Dr. Bresnick taught plastic surgery and lectured extensively, both nationally and internationally. Dr. Bresnick has won many awards and is recognized as an expert in plastic surgery. He has published nine books in medicine and science and has authored over 20 articles published in medical journals.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Dr. Sabine Zenker: Aesthetic Dermatologist In Munich, Germany

2012-05-17T14:00:00Z

Dr. Sabine Zenker welcomes us to her clinic in Munich, Germany and she shares her thoughts on cosmetic dermatology, technology, and the operations of her clinic.

Dr. Sabine Zenker is a well know European dermatologist who has a passion for clinical research and teaching that we've been wanting to interview for some time. We finally got together to learn what this German dermatologist thinks.

Name: Sabine Zenker, MD
Clinic: Dr. Zenker Dermatology
Location: Munich, Germany
Website: dr-zenker.de

That's interesting: Dr. Sabine Zenker is the consultant dermatologist for L'Oreal Paris and an internationally recognized authority on micro-invasive techniques. She is well known for her clinical research into both established and innovative technologies and treatments, teaching, training, and continuing professional development both in Germany and internationally.

She contributes regularly to medical journals, public press, print, TV and multimedia. Sabine Zenker is a member of a large number of national and international societies including DDG, AAD, ASCDAS, AAAACS, EADV, ISDS, DASIL etc. She serves as executive board member of ESCAD. She is also a speaker and clinical trainer on almost any recognized national and international congress in the aesthetic medical field

Why did you choose to specialize in dermatology?

During my university days, I got attracted to Dermatology because our professor was fabulous. Dermatology is a specialty based on visual analysis: I learned to watch, to see, to describe, to analyze.

Having specialized in dermatology, I trained with one of the renowned dermatologists specializing in Aesthetics in Munich. This is where my enthusiasm for cosmetic dermatology started.

Can you share your working principles?

I am convinced that these days, being a doctor means you have to provide not only a high end service from the scientific point of view but also a special, exclusive and individualized care. This is why I kept my clinic small. It`s a single doctor based clinic with a handful cosmeticians, beauticians, as well as one anaesthesiologist who comes on demand.

In addition to this, I work with a vast multidisciplinary network of doctors with different specialities. I refer my patients-not only in Munich but internationally. I personally perform all major procedures and I follow-up all cases as well. I am reachable. I give out my cell phone number and I also call my patients personally. In addition to this, I take my time in discussing and proposing different solutions for any patient's needs, elaborating the case to the patient –even if this consultation might take an hour.

Once a treatment plan is decided, especially in aesthetics, I am convinced that offering all inclusive solutions with a “cost-airbag” makes the patient's life as well as the doctor's life easier.

Every day offers a chance to learn. Being a teacher and a trainer in Aesthetic Dermatology, I learn something new on any congress presentation, workshop and teaching course I participate all over the world. And this is how my patients can profit of these activities: breaking down this knowledge on every day's work means refining techniques for the provision of best patient care and the best aesthetic outcome of every procedure. Aside from being focused and up to date in aesthetic procedures, I am a strong believer that a medical doctor has to stay as a doctor. I do practice General Dermatology every day and with great passion as this provides the basic medical service to our patients and gives us the “right to exist”.

What's your staff management plan?

One of my principles in running a clinic is trust. It's not about controlling the staff but about working in a team. It's about knowing them in terms of character, work discipline and empathy. Having employees who cover segments you cannot perform is the key to success as competition is not the killing energy there.

In our team, it's all about a longterm relationship. We are a family. We all believe in one another. It's probably because all of us did found and raise the clinic together. Over the years, this welds together! Firing was in the early days due to the lack of my experience.

Compensation plan is very personal and friendly way in such a way that it will satisfy the individual desires and needs of the staff. For example, if there are unfortunate life events of our staff, they can get off work. No hierarchic and dictatorial behavior and management style. And for sure, I offer a higher salary than the usual in the market, with bonuses.

What are your thoughts about the technologies you’re using now?

I am not a machine-addicted girl. I still believe in good handwork and complex procedures. For me it's not about acquiring the latest technology simply because it's must-have but it's about finding the right solution for every patient's needs. I use IPLs, lasers and radiofrequency for various treatments such as permanent hair removal, treatment of broken vessels, lentigines, fat pad removal, etc. I am quite critical on using machines for skin resurfacing! I often prefer chemical peels.

I do always buy my machines! Being a KOL it might come to the point –lucky me- that I don't pay the list price anymore. Once I'm really convinced that a new technology is effective, I will teach on this technology later as well as do research on it.

What marketing techniques works well for you?

I personally don't like to promote myself. I think that promoting myself is shady and untrustworthy.It's also about people's perception of such activities done by a doctor. In Germany, end consumers stereotype doctors to be serious and professional, that one shouldn't advertise these. A doctor's credibility is very important. If a doctor supports something, it seems to be more reliable. But it certainly shouldn't be in a blatant manner.

I am lucky that I have been working with L`Oréal Paris for several years as their Consultant Dermatologist. Thanks to basically this activity, I know most of the relevant journalists in my country. They approach me directly and ask for interviews. This ends up nicely in editorials. Every job brings a new one-whether this might be another interview, a press conference contribution, a Facebook activity, a road show in some drugstores or a TV exposure. So I am convinced that it is very beneficial to built a good relationship with journalists.

I also contribute in scientific articles, peer-reviewed papers and end consumer press. I also write editorials and sometimes I am lucky to be part of the editorial board of medical journals such as American/European Aesthetic Guide, Bodylanguage and PRIME. It's more about sharing expert knowledge and specialized know-how on special procedures, individual concepts and innovative technologies in Aesthetic Dermatology.

As I am running a MedSpa too, I don`t have any problem in having someone who gives support in communicating the services we are offering. It may happen that I do hire someone to grow the business there too.

What treatments and service do you offer in your clinic? How do you stand out from your competitors?

Treatments which have low investment are chemical peels, Moh`s surgery and Platelet Rich Plasma for skin rejuvenation. Toxins and fillers are certainly among the most wanted procedures however, a doctor’s investment is quite high. There are certain products that eat up quite a big amount of earned money as well.

Treatments with low downtime or biostimulating/natural ones that are accepted and chosen easily by patients are light chemical peels and PRP.

Treatments with a high affinity to a special doctor, meaning those treatments are exclusive to the doctor's expertise/experience/invention. For example, I suffered from severe melasma for many years, missing any effective solution after trying out hundreds of topicals and countless unsuccessful treatments. As a consequence, I developed an anti-melasma-peel in cooperation with a local pharmacist. This works perfectly and resolved my problem. Many patients have known about this and they indirectly promote this in chatrooms and come for this treatment in my clinic.

Furthermore, it`s all about refining our techniques, being more accurate, distinguished and delicate. Treatments such as injecting a dermal filler material with an injection system will reduce injection pain, increase preciseness and lower material amount needed. This does attract people and let them undergo procedures such as injecting the lips more easily.

And it`s all about customizing our treatments, breaking them down to our patient's needs.

And last but not least it`s about being innovative and offering new technologies such as ones who do resolve problems we didn't have good options for in the past. Kinetic Hyaluronic Acid. It`s about a machine which jets in HA for mechanical fibroblast stimulation for collagen remodeling to treat stretchmarks, acne scars, and other scars such as hypotrophic ones effectively, with no pain and minimal downtime. This option hasn’t been available in the past. Doing and saying all this I want to emphasize that it's not easy. If ever a new technology fails or if it doesn’t work, your reputation is gone quickly.

Offering all these above-named concepts can help differentiate one's portfolio and expertise from the mainstream.

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

Do only whatever you would like to be done by someone on yourself. Feel secure and mature in whatever you do to others. Don't hurt anyone. Be reliable, transparent, honest, sincere. Never recommend treatments/procedures you don't believe in just to earn money. Give something for free! Don't be willing to negotiate your price. If ever a patient says he/she can get it for a 50% discount with the doc around the corner, tell him: “My gosh, go there! You will never get this so cheap anywhere else!” Some women patients NEED a MAN to treat them: send them to the best looking man doc around the corner! Don't treat the “shoppers” who go to every doc in town –and who didn`t find a good one so far. Otherwise YOU will be the next BAD doc!!! Aesthetic procedures are not necessary to survive: In performing them we have to be even MORE serious!

What’s the best advice you ever got?

Sorry, sounds selfish but it is: “Stay as you are.”

What’s the worst decision you ever made as a physician and what did you learn from it?

Honestly, nothing did ever go really wrong on the medical know how level. Only one thing: I lost a lot of money in the beginning of my practice. I trusted all my patients without any second thoughts. I didn't bill them immediately after the treatment for aesthetic procedures.

About: Dr. Sabine Zenker is an internationally renowned board certified dermatologist (Ludwigs-Maximilians-University Munich, 2003) and founder and owner of the Dermatology Surgery Clinic located in Munich, Germany.

Dr. Zenker is a member of many national and international medical professional associations including the German Dermatology Society (DDG), the American Academy of Dermatology (AAD), the European Academy of Dermatology and Venereology (EADV), the International Society of Dermatological Surgery (ISDS), and other American professional associations such as ASCDAS, AAAACS and the Dermatologic and Aesthetic Surgery National League (DASIL). She is also a member of the Executive Board of the European Society of Cosmetology and Dermatology (ESCAD).

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Dr. Karen B. Vaniver: A Plastic Surgeon in Seattle

2012-05-17T13:00:00Z

Breast cancer advocate, Dr. Karen B. Vaniver is paying it forward from her plastic surgery clinic in Seattle, Washington.

Name: Karen B. Vaniver, MD, FACS
Clinic: Seattle Plastic Surgery
Location: Seattle, WA
Website: drvaniver.com

That's interesting: Dr. Vaniver's essays on women in plastic surgery and the role of spiritual practice in plastic surgery have been published in the Journal of Plastic and Reconstructive Surgery. She has worked internationally with Interplast, a not-for-profit organization providing free reconstructive surgery for children and facilitates a support group named "Girltalk". She is the creator of Dr. Karen B. Vaniver Breast and Body Recovery Serum.

Can you tell us a little bit about how your interest developed in cosmetic medicine?

I’ve always loved skin care products and makeup. When I was eight, my grandmother bought me the much coveted Barbie Beauty Center, which consisted of a Barbie head on a stand with blonde hair. The set contained a hairbrush, rollers, eyeshadow, blush, and lipstick. I loved it. In college, I worked at the Clinique® counter at Wanamaker’s Department Store in Philadelphia. Later, as a fellow, I was assigned the review on skin care and non-invasive treatments, because all the other fellows were guys, and none could distinguish a cleanser from a toner.

Tell us what your clinic looks like. What kind of treatments do you specialize in?

My office is located on the 12^th floor of the 1101 Madison Building in Seattle, just off the elevator. It is part of the Swedish Medical Center Campus. It is 1100 sq feet. We have a very open space, with windows all the way across that look at the Olympic Mountains, Lake Union and the Cascades. While we have 2 exam rooms, we mostly use the front exam room. The back room is used for injectibles and minor procedures. Major surgeries are performed at the hospital. Cosmetic surgeries and secondary surgeries are performed at the Surgery Center. The vast majority of my patients are women. The majority of my practice is breast surgery, although I also perform cosmetic surgery of the face and trunk. I have a skin care line, which currently contains one product- Dr. Karen Vaniver Breast and Body Recovery Serum. I created this completely natural product for patients to use after breast surgery. I also have a commercial skin care line, lash enhancer, microdermabrasion, Botox® Cosmetic, injectible fillers, and sclerotherapy for spider veins.

We maintain a very small practice which is exceptionally personalized. . My dog, Lily, is a therapy dog who comes to the office two days a week to visit with the patients. I am a breast cancer survivor and this has been my chance to pay it forward to other women. We know all of our patients. Most of them get to know each other from our support group, or just from sitting in the waiting room. They have 24/7 access to me when I am in town.

How do you manage your staff? How do you instill the core values of your practice?

I used to have a 1700 sq ft office with 5 employees. At Seattle Plastic Surgery, we keep a very small staff, consisting of me, my office manager, and our assistant. We outsource our billing. I don’t have a nurse, so I am completely hands on. While some might see this as inefficient, I find it a rewarding way to maintain relationships with my patients, and to keep educating them while I am removing sutures or doing fills. I really enjoy doing injectibles. I find it relaxing. I think it is really important to hire for skill sets, work ethic, and personality, although you have to be careful that they all balance. I have never found experience to be most important in the long run, because every practice is different, and a self starter can learn systems quickly. My patients are extremely fond of my office manager, and she forms wonderful relationships with them. We also have routine meetings to keep on task. Communication is very important, as is establishing the values of the practice. You have to be the boss, which is sometimes like being a parent. The hardest firing I ever did was to a friend’s daughter who worked for me. She had received a DUI and had difficulty getting a job. I hired her with the understanding that she not receive another DUI. Sadly, she did, and I had to follow through and fire her. She is now doing very well. I am not always great at consistency, but I think it makes your life easier. I believe that everyone needs to be vested in the success of the business, so everyone has a base salary and a bonus system related to profit. I don’t penalize the employees in a bad month. I have tried commission, but it can be difficult to assign the commission, so I stopped. I try to be generous with lifecycle events, which works best in a small office.

Do you perform laser surgery procedures?

I used to be part of a coop, where one person owned and maintained lasers, and then brought them to various offices, We had laser Monday one day a month. We had a Light Sheer laser for hair removal and a Versapulse Laser for vascular lesions, spider veins, tattoos, lentigos, and skin tightening. I performed CO2 resurfacing in the Surgery Center. Currently, I don’t have access to a laser. I would never purchase a laser, because it would be obsolete before I paid for it. I recommend an excellent article Lloyd Krieger, MD, MBA,” Aesthetic Surgery Economics: Lessons from Corporate Boardrooms to Plastic Surgery Practices”, Plastic & Reconstructive Surgery: March 2000 - Volume 105 - Issue 3 - pp 1205-1210, on the financial analysis of capital equipment. If I were to run my laser 5 days a week, 8 hours a day, then it might make sense economically, but a surgeon makes money by doing surgery, and I am wary of designating “non-invasive” procedures to care extenders.

I prefer simplicity, which is flexible in a fickle economy. I retail one skin care line and personally have used all of the products. I keep small inventories, and work with rapidly responding, high quality sales representatives.

I perform my own office treatments. It is a great way to build relationships. It reduces potential complications. I don’t have an aesthetician, who might be building my practice, or trying to create their own. I believe that, even if you don’t perform every procedure in your office or sell every product, you should know how to.

What treatments or services are most profitable for you?

Breast augmentation is probably most profitable. Non-invasives, such as Botox® Cosmetic and injectible fillers can be very profitable on a high volume basis. As I mentioned earlier, I no longer perform laser procedures because of the capital cost outlay required.

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

Don’t rule out anyone as a prospective patient. Two of the happiest breast augmentation patients I ever had were 60 and 70. Try everything on yourself (although I chickened out on laser skin tightening). Use or develop a skin care line that you use yourself, and know every product. Keeping it simple gives you more credibility. I have used one skin care line that I have used for ten years. I fill in with products, such as superior sun-screens, that may be in other lines.

What food for thought would you give to other physicians based upon your experiences?

I look at Skin Care as a puzzle with interlocking pieces. Your practice is valuable when you can individualize treatments. Patients may come in requesting a specific service, but they are really coming in with a specific problem(s) for you to help solve. I do a full facial analysis on every new patient that includes evaluation of both skin quality and skin anatomy. This included Fitzpatrick scale, Glogau scale, skin sensitivity scale, photos, and anatomic analysis by region. I use the concept of the cosmetic triangle, which includes downtime, money, and expectations. Does the patient want a temporary, reversible treatment or a permanent change? Start simple. Start with one doctor bases skin care line and then add products as necessary. Look at your patients’ needs. If you live in a sunny area, have a fantastic sunscreen. My patients are mostly breast patients. I developed the Karen B. Vaniver, MD, Breast and Body Recovery Serum to aid in massage, smooth scars and reduce and treat capsular contracture. Have a simple exfoliating treatment, such as a glycolic acid or lactice acid peel or microdermabrasion. Add Botox®Cosmetic (or other FDA approved botulinum toxin), and fillers. Use reversible fillers (hyaluronic acid based), before you advance to more permanent fillers. As a physician, you should know how to perform every procedure and treat the complications, even if you are using other individuals as injectors. Learn how to do spider vein injections. Those patients are very happy! Keep the patients in your practice by building relationships and having specials, or giving a little perk to a frequent flyer. Make your office a place that you and your patients enjoy being. We serve coffee, tea and water in the waiting room and offer goodies that are often made by our patients. We also leave a candy bowl filled with samples in the waiting room. Know your patients and enjoy your work. It’s catchy. Good luck!

About: Dr. Vaniver attended medical school at the University of Pennsylvania. She completed her surgical residency at Brown University and her plastic surgery fellowship at University of Florida. She is board certified in Surgery and Plastic Surgery. She is a member of the American Society of Plastic Surgery, the American Society for Aesthetic Plastic Surgery, and the Northwest Plastic Surgery Society. She has served as Medical Director of the Heartland Regional Medical Center Wound Care Program, President of the Aesthetic Institute of Mid-America, Dr. Vaniver is currently owner and President of Seattle Plastic Surgery, and Medical Director of Skin Care at the Avalon Clinic. She is an affiliate surgeon at the Swedish Cancer Institute. She is a consultant and researcher for Lifecell Corporation. Dr. Vaniver specializes in breast reconstruction, and cosmetic surgery of the face, breast, and body.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Where Does Creating The WOW Factor Begin?

2012-05-16T04:04:34Z

Have you ever been put in the bad situation of believing you need to fill an opening out of need? You post and ad and literally the first few people that respond and can walk and chew gum get the job. How did that ever work out for you...

There is a real skill set to interviewing & selecting the "A" players that will create the WOW factor even without all the tech behind them. The question I'm most often asked is how to find them, interview them and hire them. Here are a few tips to consider.

1. Start with ad itself. Don't flour up the position or your establishment to make it seem like a dream job. Instead, think of what you specifically need for the position you're trying to fill and use language that will weed out anything other than "A" players. In other words don’t talk about your wonderful environment. Talk about the demands of the position.

2. Weed through the stacks of resumes and make piles of A & B applicants. All others can be put in a rainy day file for a possible another look. Now send an email to each of your A/B possibilities asking them to describe in specific terms what they can do for your organization. Then sit back and evaluate who you want to bring in for a face to face meeting. In order to hire a WOW employee they need to really impress you in this phase.

3. At this point you're now meeting the applicants. Remember your job is to find the best "A" level player. Now you have to find out if they can think on their feet and react positively to pressure. For myself I inform each applicant that regardless of what they are being hired for that every position also has three responsibilities.

A. Everyone is in Sales

B. Everyone is a Customer Advocate

C. Everyone is responsible for outside marketing activities and needs to bring in 5 new patient per month through those efforts. In short they will need Evangelize how we are and what we do.

Now at this point you will begin to weed out the producers from the pretenders but for me, there is still one more test. I call it my pen test but feel free to create your own. I tell the applicant that I need them to role play for me. I tell them that I want you to sell me a pen and not just any pen. I want you to pretend that there are 3 other pen sales people in the waiting room all trying to sell me the exact same pen you're trying to sell me. I then count down from 5 and it's roll play time.

What you're looking for is the applicant that can take the heat of the moment and find some way to shine. Funny thing is that I'd estimate that 75% of the over 1,000 people I've interviewed in my life fail this test. Some break down and cry, some stammer then shut down, some freeze and walk out and some hit it out of the park. I submit that if a candidate can't handle selling a pen how the hell are they going to sell aesthetic services? If they can't handle the pressure of a simple role play how will they handle the irate patient we get from time to time. If that can’t sell you a pen that’s the same as 3 others how can they sell Botox & Laser treatments that are same at other practices in your area. I’m constantly amazed at how few staff members at other organizations I meet can’t give a simple elevator pitch as to why I should buy from them vs. the competition. If they lead or bring up price in the first sentence or two I can assure you the organization is floundering on failure.

So, seek out the "A" level players. They exist but you need to attract them, hire them and retain them. The last one might be another topic to discuss...

Effects of Changes in the Medicare Physician Fee System

2012-05-15T19:30:34Z

Relatively newly practicing physicians may not know that the Medicare physician payment system changed pretty substantially in the early nineties. This was by design.

The perception of those who designed this new system was that certain services were overpaid and others underpaid. It likely had much more to do with ratcheting down the costs of health care. As physician fees constitute only 10-20% of the entire equation, the wisdom of concentrating on physician’s fees to change the system is perhaps questionable. This is what was done nevertheless.

A cornerstone philosophy of the new system was that procedure-based specialties were overpaid. The physician fee system prior to this was based on usual and customary fees. This newer one based payments on a model that paid for a service at a uniform rate regardless of who performed it. While this seems fair on the surface, it had predictable effects.

Why would a surgeon with much higher overhead remove a lump in a patient if the new payment system put the procedure in a revenue negative position? The practice of surgeons removing certain lumps gave way to family practice and dermatology physicians removing many of them. These were the only specialties that under the newer system could turn a profit doing so.

The Medicare fee schedule economically regulates procedures in medicine. It also indirectly fed the growth of cosmetic medicine and surgery as this was the escape hatch many practitioners sought as the Medicare boom feel upon us. Surgeons interested in turning a profit quickly figured on what paid adequately and more importantly on what did not. As my grandfather told me as a young child, everyone needs to make a living. It is perhaps unfortunate that doctors do not discuss these matters with patients when telling them why they cannot offer a service. Is it really ever wrong to tell your patients the truth?

Dr. Kevin D. Light: Cosmetic Surgery & Anti-Aging Medicine In Dallas, TX

2012-05-15T15:00:00Z

Bio-identical hormone therapies, cosmetic surgery, aerospace medicine and battling insurance policies with Dr. Kevin Light.

After meeting Dr. Light at the Medical Fusion Conference last year, we decided that we wanted to know more about this former vet turned cosmetic doc.

Name: Kevin D. Light, DO, MBA
Location: Dallas, TX
Website: tifm.com

That's interesting: As a board certified General Surgeon, he practiced internationally with the US Air Force for 8 years. He was also lucky enough to be selected to attend the USAF Aerospace Medicine program early in his Air Force career, so he also served as a flight surgeon, that put him in the back seat of T-38, F-15 and F-16 fighter jets for 8 years. He was one of the first medical teams placed in Saudi Arabia during Operation Desert Storm and has received two Air Force Commendation Medals. He was Chief of Surgery during extended assignments in Germany, the Kingdom of Jordan and Guantanamo Bay, Cuba.

As a US Air Force veteran, your surgery career included tours that were probably not focused on cosmetic or anti-aging medicine. How did you end up with in cosmetic medicine?

I became weary of the practice of general surgery…….the insurance game, the demanding call schedule, high risk patients, and the politics of primary care physician referrals. I wanted to deal with a healthier, more upbeat patient population and I wanted to be able to market them directly, which you can’t do in a totally referral based practice. I had always considered doing a plastic surgery fellowship but due to my Air Force commitment, I didn’t have time for the training. In 1997 I discovered the American Academy of Cosmetic Surgery and attended a training seminar in Buenos Aires, Argentina with the well known surgeon Dr. Jose Juri. I was hooked. I attended several training events internationally and had several surgeons travel to Dallas to proctor me in my practice as I developed the skill set needed for a successful cosmetic surgery practice. I am very active in this organization and attend several meetings every year – which are always excellent.

Your clinic offers bio-identical hormone replacement therapies. I'm very curious about how you've integrated this into your clinic. Is it a primary revenue generator or more to round out our offering? I'm under the impression that you're unable to mark up the actual hormones and can only charge for your time, making it difficult to make money with. Is that so or am I wrong?

That’s correct. However, bio-identical hormones are a small part of an age-management practice. It would be difficult to make much profit just offering bio-identical hormones. Revenue centers include nutritional IV’s, supplements (which is significant) and testing, which we bundle and price as a package. Just like a medical spa, the cosmetic surgery and age management side complement each other and serve as a great cross referral source.

It looks like you're also the medical director for an outside medical spa. Can you tell us what kind of legal entities you needed in order to make that happen and what have been your experiences as the medical director for another business? How have you protected yourself from liability or risk?

We executed a standard contract with a detailed description of what is expected of each party and several clauses included to allow dissolution of the agreement if desired. It’s critical to know the skills and capabilities of the personnel and to take an active involvement in quality control. Now is not the time to just collect a monthly fee to have your name on the door. The medical spa is also required to have a malpractice insurance policy. My association with them has been very rewarding and it has been a great referral source and a valuable adjunct in marketing my practice.

You're offering a number of treatments like buttock augmentation and labiaplasty. Do you see any trends with these less common or fashion driven treatments? Are they steady, increasing, or decreasing in popularity?

I have been doing facial fat transfers since 1999. Back then it was considered heresy in many circles. Now it’s on fire. Fat grafting to the face, hands, breasts, and buttocks is in high demand and growing. Yesterdays less common procedures can be all the rage tomorrow. These left-of-center procedures, if executed effectively and safely, can become your niche offering and separate you from the herd. You want to make sure that your ‘new’ procedure is based on real science and has a proven benefit. The trick is to be able to look down the road and see what is going to be ‘sticky’ to the public. It’s all about forecasting demand.

Do you see a time when cosmetic surgery is going to be replaced at least in part by nonsurgical technologies? Is this an opportunity or threat for surgeons?

I think that time has already arrived. The growth of non-invasive and minimally invasive procedures is well documented. The public is demanding more bang for their time – and are willing to settle for an improved, although attenuated result to avoid huge costs and significant down time. I think that prevention (age management medicine again) will also play a bigger role in the process. This is clearly a great opportunity for surgeons. Who is the better one to master these technologies and integrate them into total patient care than a well trained cosmetic surgeon. We have the audience and the platform. Of course, more non-surgical practitioners continue to enter the arena of cosmetic medicine every year. I don’t think this is a zero sum game – the pie is getting bigger and the physicians practicing high quality medicine with stellar results will always be busy.

You've got a blog on your site, you're on Facebook and Youtube... you seem to be comfortable with social media and reaching out to patients online. How much of your marketing efforts are now online? Are you seeing successes? Are there marketing efforts that you've found to be better than others?

The jury is still out on Twitter. Facebook is also intangible and has some indirect marketing value yet still difficult to quantitate. I feel that it can’t hurt to use these tools. I have done radio talk shows and that has been successful. I don’t use print media very often. Print media for cosmetic surgery is more of a ‘push’ marketing technique and I think that ‘pull’ marketing is the way to go for most of our patients who tend to be internet savvy and live on Google Search. Clearly, the most effective marketing modality for us is a well optimized web site with quality content. Blogs are also very powerful and are a close second. Videos put a face to the practice and connect the patient to the doctor unlike anything else available. It is a pre-consult trust builder and we are in the process of producing many more.

Where do you see the most competition from other physicians in your area? How do you run your business in order to compete with them?

I live in Dallas, Texas. I have competition on every corner. I try to be a specialist in a few procedures and strive to be to go-to physician in my area for those procedures. You can’t realistically be all things to all people in this competitive environment. I serve a niche market in these procedures and let everyone else battle over the breast augmentations and face lifts.

What is the best advice you've ever received as an entrepreneur and physician?

Probably to get out of insurance based medicine and learn how to run a medical practice like a business. It’s great to have a cash based practice at a time when insurance reimbursements progressively circle the drain. Getting an MBA after 17 years of practice was a huge eye-opener. I was shocked at how much I didn’t know about markets, marketing, and finance. It helped get me off the traditional medical practice wheel and helped to diversify and seize many other parallel opportunities in health care. It also helped my practice to become more patient (customer) centric. Concierge level service and delivery of a wow experience is a paradigm shift for many practices but is the secret sauce for success.

About: Dr. Kevin Light attended Michigan State University earning his Bachelors of Science degree with honors in Biochemistry. He is a Diplomat of the American Board of Osteopathic Surgery in General Surgery. He is an expert in his field and has over 28 years of surgical experience. After he left the Air Force, he practiced General Surgery. In 1997, he saw the writing on the wall and transitioned his practice to exclusively cosmetic surgery. In 2005, he began the MBA program at the University of Texas. He practiced ‘part time’ during this period as the medical director of an ‘age management clinic’. This turned out to be a blessing in disguise– it exposed him to a very powerful alternative to traditional medicine that fit quite well with his cosmetic surgical practice.

Dr. Kevin Light is a fellow of the prestigious American Academy of Cosmetic Surgery (AACS). He is an active member of the Texas Cosmetic Surgical Society, the American Academy of Anti-Aging Medicine (A4M) and the Age Management Medical Group.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

How To Use CT3+V: An Equation For Creating Facial Beauty

2012-05-14T15:00:00Z

CT3+V = A simple equation for creating or restoring facial beauty.

We all know that "Beauty" is in the eye of the beholder. When it comes to creating and restoring facial beauty, we collaborate and negotiate with our patients (and sometimes their family and friends) to optimize the result and reduce the risk by using more conservative aliqotes of different techniques and technologies. Each practitioner brings their own unique skill-set and biases to the procedure room. We (hopefully) listen to the patient requests, evaluate what the underlying structure, tolerance for downtime and discomfort, economic consequenses and duration of effect is, to be able to offer the patient a scientifically valid, safe, sensible treatment plan. Then, we present a palette of procedures, techniques and technologies to consider.

What sets successful docs with many happy patients apart from the rest of the competition is attention to detail, listening to their patients (and sifting out the unrealistic ones) and having a plan that is recreated in some form (it's never the exactly the same twice) again and again.

My equation (tool) for discussing and creating facial beauty (or re-creating a more youthful appearance) is CT3+V = Beauty... short for Color, Texture, Tone, Tightness and Volume (in proportion or re-establishing proportion)

When the patient (on request) brings pictures of their face and neck that show them in yourthful repose, it is a strong tool to build consensus of what procedures and when in the scheme of possiblities, to pursue. Compare the old photos to current digital pictures obtained in 5 views-front-quarter and side views against a solid background with decent lighting and a portrait lens. Now diagnose the changes and educate the patient on the many ways you have to enhance and revitalize the issues you uncover in a systematic manner:

Color-pigment mottling and broken blood vessels respond well to various IPL's, NdYAG's, PDL's and KTP lasers depending on the patient's heritage (Fitzpatrick or Lancer skin type);

T3 (Texture, Tone and Tightening)-decide if the issues are epidermal, dermal or sub-cutaneous and treat with chemical or laser peels, focused ultrasound or radio-frequency and remember the skin looks better when "on-stretch", so Volume and surgery fit here too. Toxins soften the dynamic wrinkles and shape the brow, but should be delivered in a artful manner that yields a natural, rather than "done" result;

Volume-Pierre Fournier, MD (Paris) taught us that "the look of youth is full" and the current saying "size matters" comes in to play here too. Youthful features are generally softer and rounder, age makes them more severe and hollow. Surgery helps take the luff out of the sail or the sag out of the jowl and neck, but does not effect volume very effectively. Volume is at least as (and maybe more) important long term. Fat and fillers (I prefer fillers for face) are a great way to go as long as you educate the patient as to how much it will really take and offer them permanent fillers (like Artefill in the USA) that can serve them well long term, once they find the look they want to preserve.

So-with every patient: define the issues, make a mutually agreeable long term plan, track the progress with digital pictures and keep an open dialog and flexibility, so that both you and your patient achieve happiness and WOW results long term. Happy patients refer their friends. Surviving aesthetic medicine these last 15 years is no accident....it's all been done with mirrors and this equation!

Dr. Todd Schlifstein On Integrating Medical Spa Treatments Into A Wellness Center

2012-05-14T14:00:00Z

Dr. Todd Schlifstein brings 4 years of management experience with his passions for sports medicine and cosmetic medicine.

We had a chance to talk with Dr. Schlifstein on combining his interests to develop a wellness center and medical spa in the heart of NYC.

Name: Todd R. Schlifstein, D.O.
Location: New York, NY
Website: fountainmedicalgroup.com

That's interesting: Dr. Schlifstein is a Patient's Choice Award Recipient from 2009-2011. He is a speaker and consultant for more than 12 pharmaceutical companies. Dr. Schlifstein has many published research studies on sports medicine and pain management in the Archives of Physical Medicine and Rehabilitation and Clinical Journal of Sports Medicine.

Your background (and practice) includes pain management, orthopedics, nutrition, sports medicine. How and why did you move into cosmetic medicine and open a medical spa?

My long time friend and colleague, Dr. Jeffrey Goldstein and I shared a vision to create a Wellness Center and Medical Spa that could provide patients a breadth of medically based wellness service. In 2008, we opened Fountain Medical Group, a comprehensive medical facility and medical spa. Patients who were working out and training were also the people who wanted to look their best. I have used Botox for medical purposes for 14 years so transitioning to cosmetic was both easy and natural. Our clientele base for the spa began with our sports medicine patients.

How is your clinic organized? What is their compensation plan?

We have three Aestheticians and one Physician Assistant. All receive a salary base with incentive programs.

Your medical spa is located in on the Upper East Side in Manhattan. What is it like running a medical spa in Manhattan which is both expensive and highly competitive?

New York City is a fast paced environment, always changing and very competitive. You must strive to be the best at whatever it is you do, stay abreast of the latest changes in skin care technology, and always provide great service. Maintaining a good reputation is so important in this highly competitive environment, we rely on word of mouth as the best form of advertisement. Often times when a client returns for their next appointment they bring a friend, co-worker, or relative with them which shows that are clients are happy, which is the ultimate goal.

You're using Sciton's ProFractional-XC and BBL. What other technologies are you using? How do you evaluate and make your technology comparisons and decisions based on efficacy and cost?

Sciton Profile with BBL is a great machine as it is “user” friendly and has the capabilities of a variety of advanced treatments. We have Intraceuticals Oxygen Facial, ProFect Skin Analysis, and the Hydrafacial. There is always new technology coming out. I try to evaluate each in several ways: does it really give the results that it claims? What is the scientific proof? What do the clinical studies reveal? As a medical spa we only offer medically proven technologies. The next step is to evaluate the cost and return on the investment. We need to take into consideration how long a treatment takes, how much money will be generated, and how long to make our investment back. Cost effectiveness is important.

Is there any technology that you're looking to purchase in the future?

We are currently looking at several different new technologies for cellulite and fat reduction. At this point, we are still researching these different technologies..

Where do you see the most competition from other physicians in your area? How do you run your business in order to compete with them?

At Fountain, we are focused on providing great service that is personal and professional, from the initial phone call to the follow phone call and emails, we take the time to make sure our clients are have the best experience possible. We try to treat every patient as you would a family member. We want every person to return and use all our services. One unhappy patient loses more business than ten super happy patients will get you. As always, it’s important to give patients’ realistic expectations. Do what you say you are going to do, and mean what you say, always.

You've got a active web presence and seem to be comfortable with social media and reaching out to patients online. How much of your marketing efforts are now online? Are you seeing successes? Are there marketing efforts that you've found to be better than others?

We do not advertise. We use our online presence, social media, word of mouth, and develop great relationships with our clients. If a client refers us a lot of business we will give them discounts on their future services. Our great clients set up their own events for cosmetic parties and we offer exclusive discounts and specials. The mood at these events is more like a private party for our patients and their friends with food, drinks, raffle prizes, gift bags, and more. It’s a fun way to have new clients introduced to our services, facility and staff.

What is the best advice you've ever received as an entrepreneur and physician?

Do your homework. Research costs, pricing, returns on investments, marketing, competition, and have a budget. Make a plan with goals for different time periods. Know when you need professional help. Most physicians need help on the business side of medicine; therefore we have a consulting physician business management company. They work with us everyday on every aspect of our business. There are so many ways to market yourself online at no cost so taking advantage of that is a must. Most importantly, always be yourself and let clients know that you’re passionate about making their experience a wonderful one!

About: Dr. Todd Schlifstein is a Board Certified Physiatrist who trained NYU Medical Center and the RUSK Institute of Rehabilitation Medicine. He has a Bachelor of Science from Cornell University in Clinical Nutrition. He was an Assistant Professor at NYU School of Medicine from 1999 to 2009. He was an Attending Physician at the Rusk Institute and the Hospital for Joint Disease from 1999 to 2008.He is a Consulting Physician at Lenox Hill Hospital, Department of Orthopedic Surgery from 2004 to Present. He has worked with professional athletes in football, boxing and mixed martial arts. He has testified at the United States Congress twice as a medical expert at the steroid hearings in 2005 and on Human Growth Hormone in 2008. He has more than 300 media appearances on television, magazines and newspapers.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Wilfred Brown, MD, FACS: Plastic Surgeon In Connecticut & New York

2012-05-10T15:00:00Z

Dr. Wilfred Brown has a medical spa and plastic surgery practice in Middlebury, Connecticut and belongs to New York Aesthetic Consultants, a group practice in Manhattan's Upper East Side.

Splitting time between two practices in different states poses some challenges.

Name: Dr. Wilfred Brown
Location: Middlebury. CT and New York, NY
Website: thenyac.com; drwilfredbrown.com

That's Interesting: Dr. Brown completed his medical training at the University of Witwatersrand in Johannesburg, South Africa then six years of General Surgery training through Yale University, followed by a fellowship in Plastic and Reconstructive Surgery and Pennsylvania State University.

You received your medical education in South Africa. How did you end up as a plastic surgeon in New York?

I was a very artistic child who loved to paint and construct various creations. As I grew older, I was fluctuating between a career in medicine or architecture. I applied to medical school at the age of sixteen. It was very competitive to get into medical school in South Africa, and was not something that one turned down if accepted. So, at that young age of sixteen, I was committed to becoming a doctor. The South African medical school system varies from the American system, in that there is no undergraduate study but rather, there are six years of medical school. During this time, I was innately fascinated by the aesthetics of the human form and focused on developing an eye for ‘normal’ proportions of the body and face .I knew wholeheartedly that I would pursue surgery, specifically plastic surgery, where I could apply my artistic tendencies to my work.

I began my plastic surgery training with internships in Johannesburg upon graduation from medical school. However, the political climate and safety concerns of my homeland led me to emigrate from South Africa to the States, where I began the arduous journey of training to reach my professional goals. Throughout this demanding time, I not only honed my surgical techniques, but also paid close attention to developing strong listening skills which I knew were paramount in order to provide each unique patient with the individual outcome for which they were striving.

I began practicing in 1999, focusing mainly hand surgery, breast cancer reconstruction, treatment of severe wounds, and treatment of skin cancers. I opened a medispa one year after the opening of my surgical practice, which attracted an aesthetic clientele. Over time, my practice began to evolve into an aesthetic one through word of mouth and cross-referral from the medispa. Today, my practice is nearly completely aesthetic.

Can you tell us more about your own clinic in Conneticut and your group practice NY?

I am currently working on two locations. Post-graduation, I opened my practice in Connecticut where I have a large office and spa/ skincare clinic. I offer an array of non- surgical rejuvenation procedures to complement surgical options. Minor procedures are performed under local anesthesia and/or minimal oral sedation in the office, and major procedures are performed at a local surgery center. Patients also have the option of having their operations performed at a local hospital.

My Connecticut practice is led by my wife, Carolyn, who is a Registered Nurse with an MBA, giving her the perfect combination of training to understand and implement both the clinical and business aspects of the practice. Our team consists of a wonderful team of women who are very dedicated to the success of my practice who have been with me for many years. We have become an extended family who works very hard and assists each other whenever the need arises. While we are very diligent and busy, we also have fun and even get together socially. I never have to deal with sick calls or interpersonal issues. The staff genuinely likes being there. They are all extremely knowledgeable about the procedures we offer and can provide a personal perspective to prospective patients as they have had both surgical and non-surgical procedures as well. The atmosphere in the office is very much light and easy, and the patients become our friends as we form strong relationships with them. Because the decision to have an aesthetic procedure can be very anxiety provoking, we are very diligent about putting the patients at ease beginning with the first phone call and visit to the office.

The director of the Upper East Side practice in New York office is Dr. Ron Shelton. The New York Aesthetic Consultants was one of the first MediSpas in NYC and was created in 2000. There are two plastic surgeons, one clinical nurse practitioner and one dermatologic surgeon, an aesthetician, four medical assistants, two lab Mohs technicians, two billers, three receptionists, and a practice administrator. The office is a 6,000 square foot office located on a tree-lined street with a private curved driveway and separate entrance for easy pick up of discharged surgical patients. The street is unusual in that it is a two way street, but quiet and allows access from both Third and Second Avenues. The convenient office location allows us to draw from a massive patient population.

There is an accredited operating suite where most procedures can be performed with the assistance of an anesthesiologist. In addition to standard surgical procedures, we offer a very broad range of non-surgical options, including, but not limited to, Zeltiq CoolSculpting, Ultherapy, Thermage, Fraxel, Portrait and Pelleve. The unique feature of our practice is that the collaboration of both a dermatologist and plastic surgeon offers patients various approaches to treat most, not one, of their concerns and provides them with a comprehensive treatment plan that will best suit their needs. Additionally, we offer the expertise of a highly experienced European-trained aesthetician as an adjunct to the procedures we offer. Each of us is highly experienced and focused in their respective fields thus ensuring that each patient is getting individualized top notch service/ treatment.

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?

I have been very lucky in that my staff turnover is nearly nonexistent. In the early stages, there was a fair amount of hiring and firing, which was mainly due to gossip and attempting to pit staff members against each other. It is very unusual to find a group of women like I currently have who are supportive and do not participate in these poisonous activities. Any prospective employee was interviewed by the entire staff and there was a meeting to discuss whether or not to hire the person. However, even this was not foolproof, and you never see someone’s true colors until they are actually in the position. We recently created a new position for which we thought we had the perfect candidate, though found out she was anything but perfect after performing a background check, which I highly recommend.

I have always been told by colleagues not to become friends with my staff, but I did not heed this advice. Rather, I have just found this to be a major advantage as patients have a palpable feeling of happiness among the staff when they are in the office. Again, this helps to put the patients at ease, particularly those who are anxious about being there for the first time.

How is your clinic staff compensated?

The staff is paid on an hourly basis and we do not incorporate a commission structure in either practice. I feel strongly that commission may create competition and upset the wonderful balance I have with my staff. However, there will often be team goals which will be compensated equally amongst staff with gift cards. Because we are a high volume practice to our vendors, they are very extremely generous with free products and services. I also am very open to performing surgical procedures on my staff, who can speak to patients firsthand about their perioperative experiences and show their preoperative photos. I find this to be an excellent selling point as the patient can see a “real person’s” result, not just a photograph.

What do you think of the nonsurgical technologies, IPLs and cosmetic lasers that are on the market?

In The New York Aesthetic Consultants, Dr. Shelton, who completed a cosmetic dermatologic surgery and laser fellowship, reviews new technology by reading the scientific literature and questioning colleagues across the country whom he trusts as being honest and who have great experience in that technology. Lasers such as: the V-beam 595nm. yellow-light laser for facial redness and port-wine stains and leg veins, the Alexandrite laser for sundamage liver spots and tattoo removal, Fraxel Clear and Brilliant for fine lines and sun damage, Fraxel Restore / Dual for moderate lines and darker pigmented sundamage and melasma and acne scars, Fraxel Repair for deeper lines and worse acne scars, Portrait plasma resurfacing, Thermage, Pelleve and Ultherapy for non-invasive radiofrequency and ultrasound tightening and lifting, Light Sheer diode laser for hair removal, and Liposonix and Zeltiq’s CoolSculpting for non-invasive fat reduction are the current devices utilized. Safety is an important issue when deciding on laser and energy sources. The device must have a proven good safety track record. Devices that are not found to provide a consistent good clinical effect or those that are considered to have a higher rate of scarring than normal are not purchased. Most of the time, we do not purchase new devices when they are first brought to market as there always is considerable knowledge obtained by the physicians who first use the device after the company has completed the FDA studies which the company had not been aware. Sometimes there are complications that occur that were not noted during the study period and we would like these new devices to be tested by others rather than subjecting our patients to an unnecessary risk. Once the new and improved protocols are released, and we can interview doctors who have used the device, we feel more comfortable to make a purchase decision based on ease of use, safety and effectiveness.

Driving patient flow is always a concern. What are you doing to keep new patients walking in to your clinic?

In my Connecticut practice, word of mouth is by far my largest referral source. We also send out birthday cards with discounts on various non-surgical procedures. Eblasts are our main form of communication of events, news and promotions, and this information is also available throughout the office. We recently began employing an SEO company and have noticed a significant rise in new patients stemming from this. This company also manages our social media platforms, but we need to begin being more aggressive in that arena. Girls Nights Out are always successful and fun, where we bring in outside vendors to create a boutique for shopping, offer raffles, drinks and hors d’oeuvres while I mingle and have informal chats with the attendees who are either existing patients or who were brought by a friend. I am currently planning a dual seminar with a financial services expert who will be speaking specifically about women’s wealth management.

The New York office, similar to the Connecticut practice, has evening seminars, sends eblasts, and has a very broad internet presence as it is becoming more involved with social networking.

What treatment modalities create the most sales for you?

Fraxel resurfacing, CoolSculpting fat reduction and Ultherapy non-invasive facial lifting are frequently performed and have a reasonable profit after the cost of the device’s lease and consumable tip/applicators are taken into account.

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

Aesthetic procedures can literally transform a person’s personality and outlook on life. Confidence and self-esteem are so vital to one’s view of themselves, and I receive such a sense of accomplishment if I can be a part of helping someone be the best they can be. I truly believe we feel our best when we look our best. Acceptance and comfort with one’s personal appearance is such a powerful aspect of how we feel as unique individuals.

Dr. Shelton remembers many gratifying moments when seeing a transformation of someone’s appearance affecting their confidence. People who used to walk with their heads down and not look others in the face when speaking, suddenly are new people after such procedures as acne scar revision or changing the appearance of facial features with fillers. I remember a story of a physician’s spouse who had one cheek much smaller than the other and was always so self-conscious about this. Dr. Shelton did one fat injection treatment and immediately post-operatively, upon gazing in the mirror, the woman started crying with tears of happiness. For the first time that she could remember, she looked normal in her mirror.

What insights or advice would you give to other physicians that could benefit them?

I believe that aesthetic plastic surgery can be very challenging not only from a technical aspect, but also from a psychological one. It often takes experience and insight to recognize in which direction a patient should be guided prior to their treatment. I think the most important advice for anyone considering a career in plastic surgery is the need to choose your patients wisely. One cannot perform a case with compensation as the driving factor. Each patient needs to be screened for any red flags in their personality that may signal they will not be happy no matter what the outcome. Many patients have unrealistic expectations and they need to be clarified in writing prior to any surgery being scheduled. A scenario that goes along with this is the patient who sees flaws that do not exist. My response is “I cannot fix what I cannot see”. Additionally, if you suspect the patient may not be compliant in the post-procedure period, you may want to rethink performing surgery on this patient. Pre-operative photographs are imperative because patients often forget what their appearance was prior to the procedure, then are unbelievably surprised when they see their before and after photos side by side. An overbearing spouse or significant other also signals that the decision is being done for someone else, not for themselves. Also, patients who blame their appearance on various failures in their lives may also not be viable candidates for surgery. I think the best advice is to treat all your patients with respect and do your best. They will be your best marketing effort when they tell their family, friends and colleagues about you.

Have cosmetic patients pay for their procedures when scheduling. Do not book a long or expensive procedure assuming the patient will pay the day of the surgery, or that the check they give you will clear. Don’t allow patients to leave after fillers and Botox telling you to bill them. They wouldn’t dare think of having a meal in a restaurant and not pay, so they should pay you. Have a finance plan available, such as CareCredit.

About: Dr. Wilfred Brown is originally from Johannesburg, South Africa where hek completed his medical school training at the University of Witwatersrand. He subsequently relocated to the United States where he completed a full General Surgery residency at Yale University, followed by a Plastic Surgery fellowship at Pennsylvania States University. He has been in solo private practice in Connecticut since 1999, and has been practicing at the New York Aesthetic Consultants in Manhattan since 2010. His clinical focus is that of aesthetic plastic surgery and aesthetic injectables.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.