Dr. Sabine Zenker: Aesthetic Dermatologist In Munich, Germany

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

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

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!

Interview With Barbara Strafella: Permanent Makeup & Medical Spas

Permanent makeup has made an appearance in a number of medical spas and clinics. Does it have a place in your practice?

Permanent makeup spans a gamut from cosmetic eyeliner to aesthteic treatments like areola repigmentation after mastectomies. While not a medical treatment, there's always some interest about adding aesthetic treatments that patients may be interested in. In this interview we wanted to find out more about what permantent makeups offer, and where (if anywhere) they may fit inside a clinic.

Name: Barbara Strafella, DAAM, CPCT, LMTA
Location: Staten Island, NY
Website: iwakeupwithmakeup.com

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Dr. Adam D. Schaffner: Juva Plastic Surgery & Medical Spa In Manhattan

Double board certified in Facial Plastic and Reconstructive Surgery and Otolaryngology, Dr. Adam Schaffner is the Director of Juva Plastic Surgery in NYC.

Name: Adam D. Schaffner, MD FACS
Clinic: Juva Plastic Surgery
Location: New York, NY
Website: drschaffner.com

That's interesting: Besides being the Director of Plastic Surgery at Juva, Dr. Schaffner is clinical assistant professor of otolaryngology at Weill Cornell Medical College, the medical director of Reconstructing Hope and on the medical advisory board of the Little Baby Face Foundation.

Juva Skin & Laser Center is well known as one of the first 'medical spas' 

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Dr. Naila Malik, Cosmetic Physician & Skin Care Entrepreneur In Texas

From family practice to cosmetic medicine, Naila Malik MD has come a long way. 

As a family practice physician who has made a switch to cosmetic medicine, Dr. Malik has built both a thriving practice and found the time to launch her own skin care line. We wanted to learn how she did it.

Name: Naila Malik MD
Location: Southlake, TX 
Website: nailamalikmdskin.com

That's interesting: Dr. Naila Malik had both an MD in the US and a MBBS (MD) degree in Pakistan. She's also launched her own line of Naila MD skin care line.

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Dr. Sammy Sliwin, New Cosmetic Stem Cell Treatments In Toronto

Dr. Sammy Sliwin practices at the Forest Hill Institute of Aesthetic Plastic Surgery in Toronto, Canada, and is working with new stem cell therapies.

With the growing interest in stem cell treatments, we thought we'd see what Dr. Sliwin thought. We got together with Dr Silwin to discuss his plastic surgery clinic, his practice, and talk about his work with adipose derived stem cell therapies.

Name: Sammy Sliwin, MD, FRCSC
Location: Toronto, Canada
Website: sliwinplasticsurgery.com

That's interesting: Dr. Sliwin is the Founder and Medical Director of AdiSave – The Canadian Adipose Derived Stem Cell Bank.

Can you tell us more about the cosmetic Stem Cell therapies and clinical research you're involved with?

First we are doing research to optimize the harvesting of fat by liposuction to maximize the number and quality of the stem cells that we separate. We are as well doing research to optimize the separation process as well as a method of cryopreserving the stem cells in a completely autologous method (not using any animal or other human products). Once completed we will open up the stem cell bank utilizing these methods that we found. We will then apply to Health Canada to begin clinical trials for homologous uses which include cosmetic filling of facial areas, scars as well as deformities on the body. Once safety is proven we will apply to Health Canada to begin clinical trials for non homologous uses such as regenerative medicine and autoimmune therapies. In the future I believe that stem cell therapy will change the treatment of many degenerative and autoimmune diseases.

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Warren Seiler MD, A Laser Center & Medical Spa In Alabama

Dr. Seiler is a speaker, preceptor and physician trainer for Lumenis Laser Company and injection trainer for Allergan (manufacturer of Botox & Juvederm).

Birmingham Alabama is home to Seiler Skin, Cosmetic Laser Center & Medical Spa, a single-physician clinic run by Dr. Warren Seiler and his wife. We sat down with Dr. Seiler to find out what he thinks of the current crop of cosmetic lasers, how he runs his clinic, and hear what advice he has for other physcians.

Name: Dr. Warren B. Seiler III
Location: Homewood, AL
Website: seilerskin.com

That's interesting: Dr. Seiler is a Board Examiner and the Executive Director of the American Board of Laser Surgery and co-author of the ABLS examination text book and board certification exam.

As a single physician owner, how does your clinic operate?

My practice, Seiler Skin Cosmetic Laser Center, is a single physician driven cosmetic practice. I personally perform the laser and injectable procedures. I have a very good medical aesthetician working directly under me who helps patients with skincare programs, Hydrafacial, chemical peels, and laser hair removal. My wife is our marketing and website director and she is co-owner with me in the practice. We run the practice together, but we have an office manager that helps.  I perform fractional CO2, Fraxel, Thermage, Laser Hair Removal, Laser Spider Vein treatments, IPL, and others. Botox and Juvederm are the only injectables, although I have tried many others, I feel they are the best. Our practice is really the only one in Birmingham in which the physician specializes entirely in cosmetic laser procedures and nothing else, which really helps to offer the experience that I provide.  

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Dr. Shervin Naderi, Rhinoplasty, Botox, & Injectables In Virginia & Maryland

Shervin Naderi MD focuses on Rhinoplasy and injectibles at the Naderi Center for Rhinoplasyt & Cosmetic Surgery in Herndon, Virginia and Chevy Chase, Maryland.

With his emphasis on Rhinoplasty, Botox, Dysport and filler injections, Dr. Maderi has other plastic surgeons referring patients to his clinics in Virginia and Maryland. We thought we should sit down and learn from Dr. Naderi what he thinks about running a cosmetic practice.

Name: Shervin Naderi, MD, FACS
Location: Herndon, VA and Chevy Chase, MD
Website: VirginiaFacialPlasticSurgery.com

That's interesting: Dr. Shervin Naderi is Board Certified Facial Plastic & Reconstructive Surgeon and ultra specialized in Rhinoplasty and minimally invasive facial injections.  Hes' also a Board Examiner for the American Board of Facial Plastics & Reconstructive Surgery and a consultant and instructor for Allergan and Medicis, teaching Botox, Dysport and facial dermal filler injections to other physicians and nurse injectors.

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Daniel P. Greenwald MD, A Plastic Surgeon In Tampa

Name: Dr. Daniel P. Greenwald
Location: Tampa, FL
Website: danielgreenwaldmd.com

That's interesting: He’s received numerous accolades. He was named one of America’s Top Surgeons by the Consumer Research Council in 2009 and was recognized as one of the Best Doctors in Tampa Bay and one of the Best Doctors in America that same year. He also holds a certificate of Added Qualification in Hand Surgeries.

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Interview: Dr. Edward M. Zimmerman, A Cosmetic Surgeon In Las Vegas

Edward Zimmerman MD is a cosmetic surgeon and owner of Las Vegas Laser & Liposuction.

Name: Edward M Zimmerman, MD
Location: Las Vegas, NV
Website: lasvegaslaserandliposuction.com,  zimmermanmd.com

That's interesting: Dr. Zimmerman is currently serving as the President of the American Board of Laser Surgery.

What inspired you to enter the realm of cosmetic medicine?

I grew up in DC, the son of a professional artist who allowed me to build, dismantle and tinker with just about everything mechanical and biologic. I brought the first CO2 laser into an outpatient office in Western PA as part of our faculty practice in the early 1990’s. One day a patient asked me to take off a benign mole, which is my first cash paying procedure. The rest is history.

Can you tell us more about your clinic and how it's organized? 

I designed it and I am the Medical Director of Las Vegas Laser & Lipo, an 8000sf, state licensed, state of the art facility. I supervise and perform aesthetic procedures including Botox and filler injections; ablative resurfacing, lipo-sculpting, laser assisted blepharoplasty and facelifts using monitored tumescent anesthesia and conscious sedation. Our goal is to educate and help design programs and treatments that help patients regain and keep their own natural, youthful appearance and vitality. We welcome new cosmetic laser technologies. We have medical students and MA’s rotate through the office and and physicians to observe and train. 

My wife Marilyn in the practice manager for 15 years.  My RN and most of my staff have been with me for years as well. Our patients are 80+% women-mainly 30 to 65 years old, from a mixture of backgrounds, economies and ancestry. The office is conveniently located just off the SW bend of the I-215, a short drive from the airport and the Strip, in the first floor of a newer professional building. It is close to 2 of the newest hospitals in Las Vegas.  Patients come and go with privacy and security in one of Las Vegas’s newest professional centers, featuring plentiful, well lite parking and attractive landscaping.

Creating a successful medspa can depend on the staff. Have you developed a set of hiring practices? 

We have little staff turnover... usually when spouses relocate etc.  We are a small, tight knit group who have to help each other.  Base salaries with communal compensation and bonuses seem to encourage that better than straight salary or 1099 employment.  

We recently had a front office staff move to Zappos after I lent her their CEO’s book on “Delivering WOW and Creating Happiness....through Service..” In interviewing dozens of candidates, and trying a number on for a day to a week before we settled on one person to bring in to training and probation, we developed better job descriptions and training policies with measurable guidelines and endpoints. Having written policy and procedure has helped us evolve from a “mom and pop” clinic to an organization that is run like a business.

What IPL or laser technologies are you using? What are your considerations before buying a new equipment?

We utilize cosmetic lasers, light, IPL, CoolSculpting, laser/water/power assisted liposculpting and fat grafting with and without PRP at this point.  We are on the verge of bringing in focused US. With limited funds and minimally cooperative banks, it’s important to analyze every purchase with the most pessimistic but realistic ROI, shop for the best lease and lending rates and know when to back off and cut your losses if things don’t work out.

The laser companies “sell” me by putting me in touch with like-minded docs who have made their tech work in similar practices and have excellent reputations with others - like Medical Spa MD - and being flexible with letting us try the equipment to see if it’s a “fit” for the practice. Companies that offer extended warranties, help with marketing, training and negotiate the cost of disposables and have good delivery and service reputations get more attention from me.  

What are your core strategies for marketing your clinic?

We use the FotoFinder Suite to take digital pictures of just about everything-for patient education and to remind patients of how far they’ve improved, plot their continuing procedures and maintenance and  to analyze the success of our treatments.  It is a tool that has paid for itself many times over.  

We also use Patient Pads for information intake and consents and Touch MD for our consultations-all high tech devices that let us show lots of before and after pictures, educate patients on realistic results and confirm that the patient-practice relationship is solid from the start and stays that way.  We screen all procedure patients for Body Dismorphic Disorder with a standardized set of questions and discuss the results frankly with patients.  We don’t take short-cuts that compromise patient safety or results and we’re not afraid to refer patients elsewhere if we don’t seem to be on the same page.  I have lots of my own before and after pictures and the practice mission and philosophy on our new website, which I built with my daughter.

I employ social media to maintain our Facebook, Linked-In and Twitter accounts. We run monthly internet “specials” on different fillers, procedures and toxins and have regular “Evenings of Beauty” where we cater a Power Point presentation at the office and offer free consultations, drawings and special pricing. We are not shy about asking patients to post positive reviews about their experiences and send them personalized thank you notes with coupons good for discounts on future procedures when the send friends who actually do new procedures.

We have a billboard a couple of exits up from our office and a 4 x 26 foot, backlit sign “Las Vegas Laser & Lipo” across the top of the building that is easily visible to the hundreds of commuters on the I-215 each day-one of the reasons we choose this location for our new office.

We also have uniform scrubs with the practice logo, water bottles, pens, day-timers, chap sticks and business cards and brochures that all brand the practice and purvey the passion and professionalism of our special practice.  

You and your staff should be enthusiastic, walking examples of the procedures you offer. Talk the talk and walk the walk! Have a list of patients who will rave about your work and your office to perspective patients who want to talk to someone who had a similar procedure already.

What are the most sought after treatments and how do you select cosmetic treatments that will most likely fit to your patient's needs?

I simply don’t offer treatments that I don’t have passion for and skill at delivering optimal results, which is to say, I don’t offer every procedure because I choose NOT to.  I refer patients out to physicians I would send my family to who would benefit from more invasive procedures or ones that I feel are beyond my training, experience or enthusiasm.

That said, do your homework and invest time and money in technologies that “fit” in your practice. Market the coming of a new tech/procedure well in advance of it’s arrival, have a waiting list of patients to schedule after your training and offer special pricing during it’s initial use so that you get plenty of your own Before and After pictures as soon as possible. 

In Las Vegas, most patients want easily visible, even dramatic, but natural results. Non-ablative technologies have not been a good fit in my practice. Minimally invasive surgeries utilizing proven technologies are money makers in my practice along with fillers-especially Radiesse and Artefill. Toxins, laser hair removal, IPL and superficial peels are all good, solid procedures, but more “loss leaders” which allow us to educate patients about what else we offer.  We are always looking at new cosmetic technologies and teaming up with other physicians and technology companies to joint venture and share risk as well as profit. Technologies that consistently perform stay and those that don’t are replaced.

Patients appreciate that we are both innovative, honest and always searching for the next brick in the fountain of youth.

Any lessons learned from practicing cosmetic medicine? 

I’m lucky to have a job that I have passion for and actually get paid to do and teach to others. I’ve surrounded myself with upbeat, supportive and talented staff and peers. I try to stay open to suggestion and criticism. We continually evolve and re-invent ourselves and the practice to perform our mission. That requires continual surveillance, honest evaluation and directed education-output of time, money and effort. I think the most successful practices operate as a business, have a reasonable sense of humor and demonstrate their care and respect for their patients by being honest and respectful--especially when what the patient asks for is unsafe or too much.

I have no qualms about charging a reasonable amount for our expertise and what we’ve built and most patients respect that and feel they are getting more than their money’s worth.  We routinely create happiness by delivering safe, sage, science-based WOW.

Want some stories?...we’re actually keeping track...you can’t make this stuff up, but you can buy the book when it comes out!

Finally, never allow a patient to cajole, compliment, beg or embarrass you in to performing a procedure you are not comfortable doing.  Don’t be afraid to share your passion and excitement about what you do.  It’s contagious and you’ll attract patients who will really appreciate and enjoy your services.

About: Edward M. Zimmerman, MD has a passion for office-based cosmetic procedures. He has degrees from Johns Hopkins and Georgetown University and The George Washington University School of Medicine. He is a Fellow of the American Society of Laser Medicine and Surgery since 1994; member of the American Society of Cosmetic Laser Surgery; member of both the American and European Academies of Cosmetic Surgery and the American College of Phlebology. He has received the prestigious Award for Academic Excellence in Cosmetic Surgery Education from the American Academy of Cosmetic Surgery. Dr. Z is a Diplomate of, and currently serving as, the President of the American Board of Laser Surgery. He received the “Best of Las Vegas” award for Cosmetic Surgery for 2009, was selected as one of America’s Top Surgeons-2010 by the Consumer’s Research Council of America, was elected a Lifetime member of the Cambridge Who’s Who Registry. He has been a PSP “Top Doc” in 2010 and 2011. His office has been acclaimed for Excellent Customer Care by CMUS Talk of the Town - 2010, 2011, 2012. He has held multiple faculty appointments, lectured nationally and internationally and is a sought after consultant in the aesthetic industry. 

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.

Jeffrey W. Kronson, MD, of Gia Laser Aesthetic Center in Claremont CA

Talking medical spas with Dr. Jeffrey Kronson of Gia Laser Aesthetic Center in Claremont, California.

Physician: Jeffrey W. Kronson, MD, FACS
Location: Claremont, CA
Website: http://www.gialaser.com

Profile:  Jeffrey W. Kronson, M.D., F.A.C.S. is the founder of both the Whittier Vascular Surgery Center and Gia Laser Aesthetic Center and a Past-Chair of the Department of Surgery at Presbyterian Intercommunity Hospital in Whittier, California. He currently practices at Methodist Hospital in Arcadia and Huntington Memorial Hospital in Pasadena. Dr. Kronson is Board-Certified by the American Board of Surgery in both general and vascular surgery and is a Fellow of The American College of Surgeons.

He currently serves as Medical Director at Gia Laser Aesthetic Center, which he founded in 2007.

How did you get started in cosmetic medicine?  

I had a large varicose vein practice where I was treating literally thousands of legs that were pathological but I had a real hard time with the cosmetic needs of the patients, usually for an insurance or financial reason. I opened the Medical Spa as a way to engage these clients in services that they requested, giving them different options and avenues. From there, it grew into the full complement of injectables (Botox and dermal fillers) IPL, body contouring, medical aesthetics and cosmeceuticals.

Now we have a full service Medical Spa. It is run by 5 full time employees, as I am there 2 days a week or by appointment. Our average patient is 30-65, educated, upper-middle class and often executive. Being just outside LA proper, we see our fair share of A-list celebs who don’t want the paparazzi chasing them. We offer complete privacy, complementary car service and a discreet, professional standard that is difficult to find elsewhere.

How do you select and manage your staff? Did you encounter any problems?

I have a full-time manager who screens candidates, we interview them then together and make a decision. We are part commission and part salary. Before I had the excellent woman that is currently working with me now, I had DISASTERS in finding supervisory personnel. I unfortunately ran into theft, deceit and dishonesty. Right now, that is a thing of the past.

It is also very difficult to find an RN who is as good clinically as she is selling retail. We also have finally found such a person but we need one more.

What laser technologies are you currently using?

We use Syneron EMax, Velashape and Lipolite. I bought these systems from the end of 2007 to the middle of 2009. The non-invasive Elos technology continues to give us superb results with no down time.

The new systems are interesting, less expensive as the economy has fallen, but all seem to require less individual treatments and fewer patient visits. It stands to follow that most are more invasive or ablative, though there is no long-term data that I am aware of on all these new ones out there.

If there was such a product that clearly was faster, non-invasive and gave outstanding results, we would certainly entertain the idea of purchasing it.

What marketing strategies have you found effective for your clinic? 

• Social media (FB), the internet, many marketing sites.
• Clipper coupon ads
• Some print
• Glossy postcards
• Word of mouth, specials and invertising still the best.

What treatment/s generate the most revenue?

Lipolite and laser in general are most profitable as there are no disposables.

Any parting advice for other docs starting or running medical spas?

 Know everything. If there is a “rogue” RN operating outside the boundaries of your practices and policies, you will be meeting an attorney sooner rather than later;.

Doing this job well is a FULL-TIME commitment. It is far different to add a laser to an MD’s practice than to open a free-standing Medical Spa in addition to a busy practice. Learn finance. Hire people you trust. Know what you don’t know and hire someone to know it.

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.

Purchasing Used Cosmetic Lasers

Looking for a used cosmetic laser or IPL?

By Mickey A. Couvertier, CBET, CLRT

Starting or expanding a private medical or cosmetic practice can be a complicated experience. Location is of the utmost importance, followed by branding, and marketing. Staffing, clinical needs, pricing, advertising- all of these things can be an added headache to the whole process… not to mention acquiring quality equipment, and the follow up service.

While all the other parameters mentioned can be worked, and reworked, the one aspect that can make or break your entire practice is purchasing and servicing used medical lasers. There are hundreds of wholesalers, distributors, and other second source vendors offering as wide a variety of aftermarket options as there are options for new equipment, and even more. OEM’s are also in the market, and while basic supply and demand dictates that so many options should be a benefit to the consumer, the process of choosing which devices to purchase is amongst the most discussed, asked about, debated, and argued about amongst clinicians, salesmen, and repair companies alike. I have written this short guide with the hopes of assisting anyone in the market for a used medical laser in making the right decision.

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