Dr. Sanjay Gheyi - Coltishall Cosmetic Clinic Norfolk, England

Trained as a general surgeon in India, the UK, and the US, Dr. Sanjay Gheyi's Coltishall Clinic in Norfolk runs the gamut of cosmetic offerings from Botox and IPL to cosmetic surgery.

Name: Dr Sanjay Gheyi
Clinic: Coltishall Cosmetic Clinic, Norfolk, England
Website: www.coltishallclinic.co.uk

Brief Bio: MBBS and MS general surgery India. FRCS, UK. WOSAAM board certification in Anti-ageing Medicine. Paris France

Medical Director Coltishall Cosmetic Clinic, Norwich UK.

Coltishall Clinic offers a full range of dermatologic laser treatments, non-surgical treatments such as botulinum toxins, fillers, face and body contouring treatments. Laser, skin and vein treatments such as IPL photofacials, non-ablative skin rejuvenation and toning, CO2 laser resurfacing, sclerotherapy, EVLT and ambulatory phlebectomy. We also provide minimally invasive options and cosmetic surgery under pure local anesthesia. This includes microcanula tumescent liposuction, fat transfer, laser assisted liposuction, blepharoplasty and face and neck lifts.

What made you decide to get into Cosmetic Medicine?

I had my board certification in General Surgery and worked in various surgical specialties including plastic surgery. I was always interested in cosmetic surgery but after spending 10+ years in Surgery in India, UK and a brief period as a surgical resident in the USA, I felt that there was more to life then perpetual residency so I decided to opt out of the rat race. I worked part time in general practice and also surgery. Then I discovered lasers and after much trepidation and sleepless nights brought my first device in 2006 and have never looked back. That was the best thing I ever did. I started slow and gradually added more services. I did not market very much but emphasized on training and education. I was working in the NHS at the time and gradually reduced my commitment as my private practice expanded. In 2010 I reduced my NHS commitment to just one session in Dermatologic surgery which I enjoyed immensely. After 5 years I resigned from the NHS completely to focus on my aesthetic practice full time.

What could you tell us about your clinic?

We are located in a beautiful suburban area north of Norwich. I decided to stay away from busy city centre because last thing you want to do after having a CO2 laser resurfacing for example is to be walking through town centre with a red face.

We have 3 treatment rooms, a reception room and separate comfortable waiting room. My wife is the general manager and we have two receptionists and one aesthetician. We have a small team so most patients know us well and we all know them very well. We offer only evidence based, results oriented services and where patients ask for treatments or services where there is not a lot of evidence base I tell them this very clearly.

We offer a full range of cosmetic dermatology services, minimally invasive surgeries such as skin lesion removals, tumescent liposuction, blepharoplasty and SMAS facelifts. We also have a vein practice and offer services for thread and spider veins anywhere on the face and body and also varicose veins treatments of EVLT and ambulatory phlebectomy under tumescent anesthesia.

How have you decided staffing in your practice?

Hiring the right people is very important. I was very lucky that my wife agreed to deal with the phone calls in the early days. She is a nurse so she had considerable health care experience which helped a lot. At first we used our NHS premises and staff on a part time basis but quickly learnt that was not a great idea. It is very hard to mix NHS services [I guess similar to your insurance patients in the USA] with self-funding private patients. So we moved out to private rented premises. We also appointed and trained dedicated staff members who had no NHS experience. We moved again to our new premises in 2010 as we were running out of space very quickly as the practice was expanding. Our new premises are future proof to allow for more expansion. We do not have a formal incentive scheme for staff but they are well looked after and we pay them well. We offer generous discounts on treatments and products and some free treatments. We have formal policies and procedures in place which are updated from time to time. When we hire new staff we allow them an opportunity to come and spend a day with us to see if they feel we are right for them and vice versa. Then we would have them on a trial period before appointment. We allow flexible working and our aesthetician manages her schedule herself. The feedback we get from staff is that this is a happy place to work and what is not to like!

Tell us about the technologies you use.

We started with a Lumenis quantum IPL and I still use it. We are lucky to have a full range of dermatologic lasers. For vascular work on the face we use IPL, PDL and long pulsed Nd-Yag. IPL is very useful for rosacea treatments. For leg veins it is usually sclerotherapy or Nd-Yag.
We also have a full range of pigment and tattoo removal lasers including the q- switched KTP,Nd-Yag and Ruby lasers. For ablative treatments we use CO2 laser and endovenous laser treatment are carried out with a 1470 nm diode laser. For laser assisted liposuction I use 980 nm diodes and also a 1470 nm diode laser.

For skin tightening we use radio-frequency and for skin toning we use q-switched Nd-Yag lasers and also in quasi-synchronous mode.

I like IPL because it is gentle and can address a number of concerns simultaneously. I love the lasers and there is no laser that I dislike. If you know you lasers well, you know their indications and basic science- each has its place in our armamentarium. I do dislike some doctors giving presentations and insisting that it has to be a particular brand of laser to do the job best. Look beyond the hype. If you know the wavelength, pulse duration and fluence you can make your own conclusions. One note of caution though-please don’t transfer recommended settings of one device to another-unless you are practicing on yourself first! Please stick to recommended settings and you can improvise as your experience grows.

Although I like new technology I do not rush in to buy the newest device as it hits the market. I once heard a physician say that he does not try any new drugs on his patients till they have been on the market for three years. Well, in cosmetic medicine we can't be that long but I like to wait at least six months and make sure and the machine that I'm investing my money in works well.

What marketing strategies do you use?

Our practice has been growing slowly and organically over last many years. We deliberately stayed away from aggressive marketing. I see two types of practices opening up. The first is cut- price businesses which turn these procedures into commodities. The second type is the practices that focus on premium services. We belong in the second camp.

Internet marketing has worked well for us and we use SEO and also PPC advertising. I created my own website, however, now due to lack of time I am getting an external website designer to revamp our website and make it mobile friendly. We advertise in local magazines. We don’t do national media or radio advertising.

Increasingly we see patients through word of mouth which is the best form of marketing. We also get referrals from local family doctors and hospital consultant colleagues.

Which procedures or treatments do you perform the most?

Surgical procedures are more profitable but lower volume. Next on the list is Botox and fillers followed by IPL and laser skin rejuvenation treatments. Laser hair removal and tattoo removal has become a commodity as a number of cheap places have opened up. We have however seen patients that are either dissatisfied from these services or had complications and we are seeing an uptick in laser hair and tattoo removal. Our unique selling point is that we have a number of devices so we can optimize the treatment using the best device based on patient’s unique characteristics.

We are moving away from non-invasive fat reduction as they fall short and again a number of cheap places are opening up. I can provide such good results with tumescent liposuction that non-invasive technologies will have to improve a lot before I can be convinced to offer them on a bigger scale.

What are your thoughts about cosmetic medicine, would you perhaps have any stories to tell?

Medical knowledge is obviously important but cosmetic medicine is both science and art, especially if you're going to do facial or body contouring or both.

Choose your patients carefully and learn to say no. Patient expectations are very high and in some cases are completely distorted.

There is inherent variability in response which means that some patients may respond very nicely and others may not respond at all. So don't provide any guarantees. They don't work in medicine!

I saw this clinic opened up locally who started doing laser hair removal and advertised 100% guaranteed laser hair removal. Six months later the guarantee had gone down to 1 year period following your last session and I believe now the guarantee has disappeared. Obviously they must have learnt the hard way!

Complications are a part of life and you will get complications. Be honest and take good care of your patient if you get complications and they will usually be very understanding and forgiving.

What advice could you tell to your fellow physicians?

Education is key. Patient’s come to us for results and a good experience. If you can provide this you will succeed. Fortunately we have many resources available to us. I found the discussions on medical spa MD very useful and they also helped me stay clear of hyped up devices which over promise but fall short on delivering results.

Don't buy the latest cool device. Instead go to devices which have had a proven track record. Talk to your colleagues, visit clinics, attend conferences and keep up-to-date and good luck.

About Dr. Gheyi

Dr Gheyi has triple board certifications in General Surgery, Family Medicine and Anti-ageing Medicine. He devotes full time to his Aesthetic and Anti-ageing practice. He personally administers thousands of laser, injectable and surgical procedures each year. He worked in NHS hospitals for 21 years in surgical specialties and last 5 years in dermatologic surgery.

He is an invited speaker at laser seminars and mentors other doctors training in lasers and cosmetic dermatology and surgery.

He is a trained and qualified surgeon. He has extensive clinical experience both in the UK and USA and has attended numerous perceptorships in cosmetic medicine & surgery. He has built a premier laser practice with sixteen different state-of-the-art laser and light systems and he continues to invest in training and new technology.

Dr. Paul Cronin - Eternal Youth Clinic in Cheshire, England

Eternal Youth Clinic uses updated aesthetic technologies and sees returning and loyal patients in our interview with Dr. Paul Cronin.

Name: Dr Paul A C Cronin
Clinic: Eternal Youth, Cheshire
Website: www.eternalyouth.co.uk

Brief Bio:

A one time family doctor who branched out into aesthetic medicine over sixteen years ago. He has extensive experience in injectables, radio-frequency skin tightening, micro needling and laser resurfacing. He opened Eternal Youth clinic over ten years ago and offers Fraxel, Thermage, Ulthera, INTRAcel, ULTRAcel and VASER liposelection.

What made you pursue cosmetic medicine?

I blame it on my mum really. She rang me up very excited one day and said ‘you have to go and learn Botox.’ When I asked why she said that she had just had some treatment by a young doctor who used to be a GP and now does this. She thought it would be good for me and I might be good for it. It seems that she was right

Mind telling us a background about your clinic?

My clinic is a small and very personal run affair. We used to have a large clinic in Alderley Edge with several staff, but now we work from purpose built premises in our garden. My wife is in charge really and makes sure I know who is coming next and what for. we have a varied patient base from quite long distances in some cases. Our patients appreciate the discretion and the very personal services we offer.

What are your insights about your staff?

To be honest when we had more staff I didn’t think I was a very good picker. I think it is hard to find someone who will work as hard for your business as you will. That might say more about me than the staff I suppose…

Enlighten us with the technologies you're using for your practice.

We offer Fraxel Restore at EYC and have done for over ten years. I am always impressed that it is still doing a great job. So many pieces of kit cost so much money and become redundant when a newer/better one comes out. Fractal has definitely been my best investment. We have recently purchased ULTRAcel which is an excellent device offering three modalities of skin tightening and rejuvenation in a single platform.

What are your marketing strategies for your clinic?

I am not sure I am very good at this. I have spent a ton of money over the years on Cheshire Life magazine, radio ads and stacks of other stuff and I still think most of my new patients arrive through word of mouth. I really think you have to care about your patients and do the best you can and then over the years the list will grow. Probably slower than you would like but patients who come from personal referrals are usually patients for life. Adverts tend to produce more ‘tire kickers’ who come to suss you out. Personal referrals come with money in their pocket. They trust you already as much as they trust the friend who referred them.

Which treatments and procedures are popular in your clinic?

Botox and fillers always provide the ‘bread and butter’ but I love the results that the Fraxel and ULTRAcel can provide. They obviously cost more money but some of the before and afters are amazing. I would like to promote my cosmetics more as some of my colleagues seem to do better with products than I do. Maybe I’m just not ‘pushy’ enough?

Any stories about your career in cosmetic medicine?

My favourite bit is the fact that some of my patients have been coming to see me for 15 plus years. These patients see me three or four times a year and trust me implicitly. Knowing that if I recommend something new its not because I need the money and is because I think it will help them look better. It is this personal relationship which is the corner stone of my practice. Recently I had a consultation with one of my longer standing patients and just for fun we looked back at her original photos from over ten years before. We both agreed that the before photos today looked better than the after photos from ten years ago. That is priceless.

Share what you would like to tell fellow physicians.

Don’t worry so much about kit. You can waste a lot of money on devices which eventually sit lost and lonely in the corner of the room. There are however some technologies which do stand the test of time.

Care deeply about your result. Make sure the patient knows you care. The actual outcome of the treatment is really less important than whether the patient thinks you tried hard and really wanted to do your best. This may sound off but I do believe it is true.

Be particularly vigilant for patient expectations. It is always a whole load cheaper to ‘not take the money’ and ‘not do the treatment’ than pay for the litigation….

Get to know your patients. You don’t need thousands of patients to make a very good living in this business. A few loyal repeat customers will be a lot less work for the same money.

Don’t work too hard. Life is for fun too.

About Dr. Cronin

Dr Paul Cronin was once a local GP and has been in the medical profession since 1985. He has specialized in Cosmetic Medicine for many years and last year alone he performed over 1500 treatments to brighten up the lives and faces of the ladies and gentlemen of Cheshire including some very “well known” faces!

Now Dr Cronin has relocated Eternal Youth Clinic onto the outskirts of Congleton in Cheshire. Nestled into the hills overlooking the Derbyshire peaks, bringing the tried and trusted benefits of muscle relaxing treatments and fillers now combined with several new cutting edge treatments.

Dr Joshua Berkowitz - Wimpole Aesthetics in London

Wimpole Aesthetics is a small cosmetic clinic with a loyal staff on Harley Street in London. Here's our interview with Dr. Joshua Berkowitz.

Name: Dr. Joshua Berkowitz
Clinic: Wimpole Aesthetics, London
Websites: www.wimpoleaesthetics.co.uk / www.ivboost.co.uk

Brief Bio:

My school education was completed in Bulawayo (Rhodesia/Zimbabwe). In 1966 I started medical school obtaining a MB ChB degree from Birmingham University (UK). After several junior positions in Internal Medicine, General Surgery, Urology and General Practice I decided to specialize in Obstetrics and Gynecology. Thus, after further training in the Birmingham Teaching Hospitals, I obtained Membership of the Royal College of O & G followed later by the Fellowship in 1993. I was in private O & G practice in Johannesburg from 1982 till 1996 when I emigrated to the UK/London. During my years in private practice I was also a part time Consultant in the University Teaching Hospital in Johannesburg.

In 1997 I became the Medical Director to Ivax Pharmaceuticals. I was responsible for the Company’s medical activities in the UK, Europe and China. Ivax was sold to Teva in about 2005 and I took a redundancy package to start Wimpole Aesthetics in Wimpole Street, London W1.

Could you tell us your journey toward cosmetic medicine?

I started Wimpole Aesthetics after leaving the pharmaceutical industry in about 2005/6. I initially modelled the clinic upon a clinic I had visited in Israel several years previously. This clinic was using Botox & fillers and using IPL and Laser machines. I have always been interested in Women’s Health and Wellbeing/Functional Medicine and therefore expanded the clinic into these areas and into the treatment of several chronic diseases/conditions.

What could you divulge about your clinic?

I run the clinic together with several nurses and a non-medical assistant who is responsible for the internet sites and other aspects of management, the clinic is located in the medical district of London near Harley Street. Not a big clinic.

How are you as the Medical Director of Wimpole Aesthetics with regards to staff?

There are no stories to tell. I choose staff who are loyal and discrete and obviously capable and affable. I am also loyal to them. Bonuses are awarded when we have a good month.

What technologies are you using in your practice?

I have become disenchanted by the machinery in the aesthetics world since few instruments are able to meet the claims printed on the box. Also the machines are excessively expensive. Prices are based on perceived earning potential not on machine production and marketing costs. Furthermore, manufacturers now include a consumable to ensure that they remain a “partner”. Training is usually poor and inadequate.

I have Syneron IPL and Laser -- both very old and a very modern CO2 Deka.

I have a Vaser machine and several small machines plasma, etc.

What is your marketing strategy? 

 Marketing is by word of mouth by patient to potential patient referral and by internet.

We are a proper medical clinic, hence there are no incentives (buy one get another at half price type stuff) and no social media.

Any stories you would like to share? And what have you learned so far as a physician in cosmetic medicine?

No stories but I am concerned about the many doctors and their egos and many false representations of themselves (e.g.) calling themselves surgeons when they are not putting degrees on stationary they do not have and are not pushing treatments that are completely without merit; making up treatment combinations that are completely unproven; seeking publicity and making false claims about their expertise.

So what I have learned is that I respect and admire very few of my colleagues.

That there is very little evidence based med in the aesthetics field; and that morality and integrity are often absent; and that the aesthetics speciality is littered with doctors and others who are not properly trained or qualified to do the procedures they do or to manage the complications that may arise.

About Dr. Berkowitz:

Dr Josh graduated from Birmingham University Medical School in 1971. He became a Member and later a Fellow of the Royal College of Obstetricians and Gynaecologists (FRCOG). For nearly twenty years, Dr Josh was a Consultant Obstetrician/Gynaecologist in a private medical practice in South Africa. This has given him a helpful holistic perspective on women’s health and the ways that hormonal changes and child bearing can impact on a woman’s skin health, body shape and body image. 

Upon his return to the UK in 1997, and following additional specialist training, he diversified into non-surgical aesthetic and anti-ageing procedures for men and women.

Committed to providing patients with safe and reliable techniques, Dr Josh ensures that Wimpole Aesthetics uses the best quality materials and products. Dr Josh is an expert in all the treatments offered at Wimpole Aesthetics and and he frequently updates his own skills with continual professional development conferences and seminars.

Dr Josh is acknowledged as a preferred trainer of cosmetic medical doctors by the manufacturers of Vaser medical laser technology. Vaser Liposelection is a gentle and non-invasive alternative to liposuction surgery. Dr Josh was one of the first cosmetic doctors in the UK to introduce Vaser Liposelection treatment to his practice.

His warmth and approachability are frequently commented upon by patients, who appreciate the unhurried and thorough consultations offered by Wimpole Aesthetics. Dr Josh is registered with the General Medical Council (GMC). He is a member of the British Medical Association, The Royal Society of Medicine and the British Association of Cosmetic Doctors.