Dr. Glynis Ablon - Ablon Skin Institute, California

The Ablon Skin Institute in Manhattan Beach is a single physician clinic where dermatologist Dr. Glynis Ablon provides a wide range of cosmetic care and research.

Name: Glynis Ablon
Clinic: Ablon Skin Institute
Location: Manhattan Beach, California
Website: http://abloninstitute.com/

Brief Bio:

Glynis Ablon, M.D., F.A.A.D., is a board certified dermatologist and cosmetic surgeon, who completed her training at Baylor School of Medicine in Houston, Texas. Dr. Ablon is an Associate Clinical Professor at UCLA, practicing at both UCLA and LCMH. She is active in clinical research and the first published author in the United States in mesotherapy. Dr. Ablon is an on-camera medical consultant for The Doctors Show, E! Entertainment, Extra, ABC, CBS, KCAL and Lifetime. She is a Fellow of the American Academy of Dermatology, American Academy of Liposuction Surgery, American Society for Laser Medicine and Surgery, and American Society for Dermatologic Surgery. Dr. Ablon also received the IMCAS Research Award 2010 for innovative research on Botulinum Toxins.

We got together with Dr. Ablon to ask her a few questons about her career and clinic.

How did your background influence your journey to cosmetic dermatology?

I always wanted to be a doctor. My parents called me a “Red Cross Nurse” because I always wanted to help people. I loved the diversity found in dermatology from medical, pediatric and surgical dermatology, to cosmetic dermatology. It is nice to follow entire families through their lives. We can offer our patients a more full service clinic and lifestyle.

I really started in the cosmetic dermatology realm in my residency at Baylor with mentors like Ted Rosen and Leonard Goldberg, and lasers with Dr Moise Levy. I liked the challenge of difficult cases, but also making people look and feel their best, starting with my very first and most difficult cosmetic client, my mom.

You're in a LA which has to be a hyper-competitive market. What can you tell us about Ablon Skin Institute?

My clinic is located on the Manhattan Beach Studio Lot in Manhattan Beach, California, offering full service medical, pediatric, surgical and cosmetic dermatology.

I am still a very type A solo practitioner with a staff of 8 and an office that includes a research center of almost 5000 square feet. I oversee everything, but am good at delegating tasks. I think it is critical if you run a small solo practice to have good checks and balances. A good office manager can really lighten your load, but finding one that will do diligence evaluating office expenses to keep your overhead as low as possible can be challenging, so I do it myself.

Staffing is always and issue. How have you made that work?

Staff is probably the second most critical issue in a medical office (first being your talent as a physician). My staff is paid well; I give bonuses every year (and sometimes during the year, if they are performing exceptionally). I also offer 401K and profit sharing. If you have good staff you want them to stay, so you must be a great boss and offer competitive monetary compensation. I don’t like commissions because I don’t want my staff promoting things they don’t believe in just to make extra money. If my patients are happy, which means the office is doing well, then my staff is rewarded. I have individuals that have been with me for 5-15 years. If you have a problem employee, move on it quickly. Give them written warning, and then say goodbye; they can be a cancer in your office if you don’t.

You also have a lot of technology. What are your considerations before buying laser or IPL technologies?

I have 20 lasers in my office. I love new technology but it has to fit into your practice and patient population. Don’t just buy to buy. I test all technology before purchasing. I have only one laser purchase regret and it’s the one laser I didn’t test out before buying. I went along with a colleague’s recommendation and It sits in my storage closet. I love radiofrequency with microneedling. I still love my IPL and versapulse. Always look at the revenue you can generate from a laser against the purchase price. Always negotiate prices! I don’t like machines that are extremely painful even if results are decent.

Your thoughts on marketing?

I have been lucky to have some free media exposure early on in my career, so I have never advertised. I have recently started social media, as it appears to be the wave of the future and not going away anytime soon. I do charge for all cosmetic consultations. I don’t want looky-loos. If patients are willing to pay for consult they are more likely to do the procedure. We do apply our consult fees to future treatments, so it is not lost or wasted. I do believe word of mouth is still the best way to get new patients.

Are you looking to add any new treatments in the near future? Is anything on your radar?

I am always on the look out for new treatments, but I am extremely picky. It is important to try out new technology in your office to know how it works, how it feels, what’s the pain level, and who needs to run the machine. You don’t really want to buy just to have “the newest” technology but rather the best. And you must look at your specific patient population and what they need (you wouldn’t spend money on a new hair removal laser if you are treating the majority of light haired individuals). I think radiofrequency with microneedling is an amazing advancement. We can treat all skin types and don’t have the complications like lasers with pigmentary alteration.

What are things you've learned that you'd like to share?

You can’t please all of the patients all of the time! It is so important in this time of social media that you stay true to yourself. Do your best, and if you get a bad feeling from a patient before you start performing cosmetic procedures on them, don’t do it. If a patient comes in complaining about another good doctor you know, don’t treat the patient. And if your staff has a really bad feeling about the patient, don’t treat that patient. It will make your life less stressful, and I really believe less stress is the key to longevity both in life and the profession. This business can be life altering (I treated a patient with fillers status post brain surgery with a skull depression that hadn’t looked or felt normal in 6 years since her surgery, making her skull now a normal shape leaving her ecstatic), but it can also drain you if you don’t stay true to your self. Going to work doesn’t feel like a job because I love it so much, but I think that’s because I have found a great balance in work, home life and playtime.

It took my mom’s meningitis and near death experience and my own attack of facial paralysis to realize 5 years ago that I needed to be more serious about reducing stress. I wrote a book called What’s Stressing Your Face to teach others what I learned and how to better manage the environment we live in. My best advice is to find balance in your life. Work on lowering stress in every aspect of your life. Spend time with those you love, doing what you love. Surround yourself with great people, great staff and great friends who bring you up, and envelop you with love. Life is short, don’t waste a day not being happy!

About Dr. Ablon and the Institute

ASI Research Center is an independent clinical research site specializing in cosmetic and medical dermatology clinical trials. The Center was founded by Glynis Ablon, MD, FAAD in 2008. Dr. Ablon began her interest in research at Pomona College in the Genetics Department in 1990, and has expanded her research experience over the past 20 years culminating in the opening of ASI Research Center. The center has its own full-time staff and dedicated office within Ablon Skin Institute. Our research center is equipped with more than 20 laser systems and state of the art photography systems including Visia, Janus, FotoFinder Mediscope and Nikon Dermalite Macrophotography. ASI provides a full range of medical, surgical, and cosmetic dermatology services.

Dr. Michael Gold - Gold Skin Care Center, Nashville

With 30 years of cosmetic dermatology experience Dr. Gold shows no signs of slowing down as he continues to grow his Nashville practice.

Dr. Michael Gold is a cosmetic dermatologist in Nashville Tennessee who was kind enough to sit down for an interview and give us his insights into how he runs his clinics, what technologies he uses, and what he's learned.

Name: Michael H. Gold, MD
Clinic: Gold Skin Care Center
Location: Nashville, Tennessee
Website: www.goldskincare.com

You've been working in this area for quite a while. What made you pursue cosmetic dermatology and aesthetic medicine?

I actually got started thinking about dermatology and aesthetics when I was 16 years old due to a bad case of acne, that I had when I was a young man. My dermatologist was Dr. Albert Kligman who invented Retin A and I was one of his first patients he placed on this medication. It was a strong formulation and within a week I had peeled the equivalent of today’s medium depth chemical peels. My skin was really smooth after that, and I thought - derm is the route I want to pursue in medicine. In my residency - actually my first day, I did a hair transplant with Dr. JB Pinski and the second day I did a liposuction procedure with my chairman Dr. Henry Roenigk. Dr. Roenigk was keen on cosmetic dermatology and instilled this love for aesthetics and surgery into me. I learned much from him and my other professors at Northwestern during my time there - especially from Drs. Jerry Garden, Ruth Frankel, and June Robinson. When I finished my residency I moved to Nashville, TN where I began seeing lots of patients interested in cosmetic concerns. This, along with my love of dermatology in general, helped propel my career in this field.

I was very fortunate to have played a role in the use of topical silicone gel sheets for hypertrophic scars and keloids and was part of the team that helped bring topical ALA into the US for not only AK use but for rejuvenation of the skin as well. I have been involved in lasers and light sources for years and had the first dedicated IPL for hair removal, which became a popular method around the world for hair removal. And I have played a role in absorbable suture technology for skin lifting.

Cosmetic dermatology has been very good to me - and with hard work and determination it can be for anyone who so desires.

You must have learned a little something about what you want as a work-life balance overseeing what is really quite a large clinic. What can you tell us about how you run your clinic and how it's organized?

Our clinic is very efficient - at least we like to think so. We have about 25,000 square feet of space all under one roof. We have many facets of our business and we have proven leaders who help oversee the various parts of our puzzle. We have a general dermatology area with 22 exam rooms that is staffed with 3 mid-level providers and myself. We have a medical spa with a dedicated aesthetician staff who perform services and sell skin products - which number about 500. We have a dedicated laser and rejuvenation center with their own dedicated staff where cutting edge treatments occur with either energy based devices (n=43) or with one of the injectable products we use. And we have a separate, dedicated research center, staffed with trained and outstanding nurses - all certified research professionals under my guidance. We have recently just added one of the most respected plastic surgeons in the US, he is now focusing his attention on hair transplants.

We have a staff of almost 50 employees and they are coordinated by our COO and CFO, Ms. Amy Anderson and for the research department we have Ms. Julie Biron. Amy uses department managers to assist her in the daily operations of the practice, which has been estimated by some to be one of the busiest practices anywhere in the nation. Our patient population varies from day to day but on average between 200 and 250 people pass through our doors daily. Patients come to us from all over the region and from most states in the US as well. Because of my international travel, we have visitors train with us on a regular basis and teaching these young and eager students has been some of the most rewarding work we have done.

A clinic that large, with that number of patients every day, is some serious work... It had to take some time to build out. How do you manage your team?

At the beginning it was easy - find the best of the best and pay them more than anyone else. But most importantly, treat them with respect and allow them to do the work that you hired them to do. Do not micromanage your senior staff - trust them to have your best interests at heart, and have the proper checks and balances in place to make sure that things run smoothly and efficiently.

We do use commission for our spa staff - shared amongst them so not to have a competition for each and every patient who comes to our spa. This has worked for me and therefore we have used this plan the longest.

Which technologies - IPL, lasers -  are you using in your practice and how do you decide what to buy?

I may be a little different when it comes to IPLs and how we use them and how we decide to get them into the clinic. I had the second dedicated IPL for vascular lesions way back when and had the first dedicated IPL for hair removal after that. Which means that we have been working with IPLs for over 23 years now. Our clinic, along with a few others, studied and worked through the parameters to make what we now have - safe and effective and reproducible IPLs. When you decide to purchase an IPL make sure that it has a squared pulse, contact cooling, and sophisticated software parameters. The major device companies all have great IPLs - we usually stick with Lumenis, Syneron, Alma, Venus, and Sciton - where we have devices from. These are well made, well studied IPLs that one can surely trust.

Technology purchases are run through the committee in my office - I want everything so we have my office COO and CFO who must sign off on anything I want, which means we only get what we need. You don’t need devices sitting around and collecting dust - you need them to be productive and used on a regular basis. If we buy a new device today, we try to set a time line as to when that device needs to be paid off for us to be successful. It works most every time, and makes us concentrate on the task at hand.

What can you tell us about your marketing strategies?

Marketing has changed over time and I do things a lot different than I did when I first started in practice 30 years ago. Now things like social media are key to getting the message out there and we do use social media to spread the word and advertise what we are doing in our clinic. I think intrinsic advertising - using your own data base for advertising is the way to go today and having means of getting referrals from patients and colleagues as well. This is where we are today, plus newsletters and e-mail blasts and signs in the office.

In the past we used a lot of print advertising which at the time made sense - it really does not any more.

The other thing that we did 30 years ago was to be very involved in the community and we attended almost every charity event in town which was a great way to meet people and to determine which charities and causes would shape our giving’s over time. We still participate as often as we can and our community has been incredible kind to us over these 30 years.

Where do you see the aesthetic market going? Which treatments are the most popular?

Everything we do hopefully is profitable. As I said, we value our purchases and try to have them paid off in a specific period of time to make sure that profit starts at an appropriate time. If you buy a 100K machine and use it once a year, it is not going to be profitable. If you use that same device 5 times a day, then it is a different story.

My most profitable device at this time is the Aerolase Neo - I have a large acne population - as you can tell from question one - and we use the Neo to treat acne painlessly and successfully. It can be used for many indications but for us acne is number one.

But every procedure needs to be profitable and I am happy to say that almost everyone is in our clinic.

You've undoubtedly seen a lot running a large clinic with thousands of patients. What have you learned, and what advice would you give to other physicians?

I have learned much over these past 30 years. I have learned that my best friends do the same things that I do - David Goldberg, Mark Nestor, and Mitch Goldman. All of my mentors and friends taught me to be ethical and honest, to work harder than anyone else, and to give back to my specialty whenever I could. And hopefully the examples I have set for some of my mentees over the year have shown that drive, determination, compassion, and skill make for the best cosmetic practitioner and dermatologist.

My advice to others is real simple - learn your craft well, treat it with respect, and always put the interests of your patients above your interests.

We are blessed in what we do and we need to remember this each and every day.

About Dr. Gold

Dr. Michael H. Gold is the founder of Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser & Rejuvenation Center, and Tennessee Clinical Research Center located in Nashville, Tennessee. Dr. Gold is also a Clinical Assistant Professor at Vanderbilt University School of Nursing and an Adjunct Assistant Professor at Meharry Medical College, School of Medicine, which is also in Nashville. He is a Visiting Professor of Dermatology for Huashan Hospital, Fudan University in Shanghai, China (11/2006), Guangdong Provincial People’s Hospital, Guangzhou, China, as well as a Visiting Professor of Dermatology at Number One Hospital of China Medical University (11/2008) in Shenyang, China.

Dr. Gold is a board-certified dermatologist and cosmetic surgeon who oversees the various facets of the Center’s operations: a combination of medical and surgical dermatology, cosmetic dermatology, aesthetic services, and research endeavors. Dr. Gold has earned a national and international reputation for providing patients with leading-edge technological advances and has expertise in all facets of dermatology and aesthetic care. The Tennessee Clinical Research Center is now one of the leading dermatologic research institutions in the U.S.

Dr. Gold speaks on national and international fronts, focusing on dermatology issues related to the use of lasers and energy-based devices, as well as the use of fillers and toxins in aesthetic and cosmetic dermatology. He lectures in venues around the world and is a sought-after contributor to educational meetings globally.

Laura Carlsen, RN - Colorado Skin & Vein Center

Vice President and Clinical Director of the Colorado Skin & Vein Center, RN Laura Carlsen proves to be an all-around cosmetic provider.

Colorado Skin & Vein Center provides a wide range of services from clinical dermatology (provided by a physician) to cosmetic care (provided by an RN), a common strategy. In this interview Laura Carlsen RN discusses her work and path to a successful career and business.

Name: Laura Carlsen, RN
Clinic: Colorado Skin and Vein Center
Location: Englewood, CO
Website: coloradoskinandvein.com

Brief Bio:

I graduated from Northern Illinois University in 1989 with a marketing degree. After graduation, I sold IBM electric typewriters, computer maintenance contracts and Aveda skin care. In 1990, I started a home-based business performing facials, microdermabrasion and waxing treatments. I ran that business for 13 years, before graduating from the University of Colorado Denver with a nursing degree in 2009. As a Registered Nurse, I went to work for Colorado Skin & Vein (which was previously known as Colorado Center for Photomedicine) where I have proudly worked for eight years.

What sparked your interest in cosmetic medicine?

When I went to school to become an RN, it was with the intention to stay in the cosmetic industry. I loved doing facials and skincare but wanted to expand on that knowledge. I was doing a lot of acne facials and had several patients ask me about blue light. I knew then that I had to know more about what was available and how I could be involved.

What can you tell us about the clinic?

For eight out of the 11 years that Colorado Skin & Vein has been in practice, we operated with one doctor, one nurse (myself), and one to two support staff. Sometimes we had an esthetician, yet oftentimes we did not. We went from a 2500 square feet space in Highlands Ranch to our current building at I-25 and County Line with over 20,000 square feet. We occupy the top floor and rent out the bottom floor. Our staff has grown to 10 full-time and a few part-time employees. We have three main areas of focus: Dr. David Verebelyi, who does vascular treatments (leg veins, facial veins, port wine stains, etc.), Smartlipo and CO2 resurfacing.

Dr. Kimberly Neyman is our dermatologist and dermatopathologist, and I am the clinical nurse manager who oversees all the aesthetic treatments in our office. The areas that I manage include: Botox, filler, Kybella, cosmetic sclerotherapy, tattoo removal, hair removal, Genesis, IPL, PDL, CO2 for stretch marks, and chemical peels. Our patient population is diverse due to the multitude of services we provide. The cosmetic side is dominated by females in the 30-60-year range, but veins and dermatology attract a more equally mixed ratio of male to female clientele.

As a hiring manager, how do you manage staff?

I am personally involved in most of the hiring. The one thing we found that has worked very well in our favor is doing working interviews. We begin by doing phone interviews, progress to face-to-face interviews and then take our top 2-3 candidates and have them spend a day with us. This allows us to see how they interact with our clients and staff, to see what type of questions they ask and to see if they offer any insight into our current way of doing things. This has dramatically changed who we extend offers to and the culture of our practice. We currently have a staff that we truly love and that are passionate about being here.

The cosmetic providers receive compensation in the form of a base salary and commission based on profit. We used to do it based on revenue, but found that it made sense to the office and provider to focus on profit. When the business makes money, the provider makes money. The front office staff also receives a base or hourly wage, plus commission. Each employee’s commission may be based on increasing production totals, or collection levels, and each year we review their commission structure and decide what to focus on for the coming year.

Which technologies do you usually use in the clinic?

We have a lot of technology in our office which includes: Cellfina, Ulthera, Smartlipo, and CoolSculpting. We use the Lumenis FX for our CO2 procedures and for IPL, Nd:Yag and Genesis, we use the Cutera Xeo. For laser hair removal, we use the Cynosure Apogee Elite and the Lumenis LightSheer Duet and we can treat all skin types. The Lumenis Fotona is used to perform tattoo removal and for superficial vessels, we use the Candela Pulsed Dye Laser.

We are very cautious with how we buy equipment. Years ago, you would buy a machine and own the right to use it. Today, companies like Ulthera and CoolSculpting require disposables or cards to operate. When CoolSculpting came out with the Cool Mini, we had to evaluate whether the $10,000 new hand piece would generate enough business to justify its cost. Since we offer multiple modalities, we had to ask ourselves “could we treat those same areas with Kybella or liposuction” and “could we offer better results than the Mini?”

We never want to be put in a position that we must sell something because we are trying to recoup our investment. We currently do not have the Mini hand piece, but we will constantly revisit this decision as demand grows.

What ways do you get the word out for new patients?

Converting a new patient is always more expensive and time consuming than obtaining more business from a current patient. We try to focus on what our patients want and what they are asking for and we enjoy offering two annual parties per year. One focuses more specifically on new equipment or offerings, while the other is more of a patient appreciation party. Our patients look forward to these parties and enjoy the education, specials and goody bags they receive at them.

As for advertising, we often test the waters. We will try an avenue such as print media and track how many calls came based off the ad. If we don’t see our money back, we don’t continue our business with them. Over the years, we have tried billboards, radio advertising, local print media and community events. While advertising a procedure, like CoolSculpting, can generate some interest, we found that when other practices advertise, it helps drive business to our practice also. Often patients will hear about a procedure they are interested in and then Google to see who offers it at the most convenient location.

Which equipment do you think would be helpful in the practice?

We are currently excited about Cellfina and are planning to see a good return on investment. The research is very good and the patient satisfaction is very high, even after 4 years. We also do very well with CoolSculpting and sclerotherapy. We used to offer facials and microdermabrasion treatments, however, we have dropped those offerings as the profit margin was low. We are considering adding miraDry to our practice.

Can you tell us about any encounters in your eight years of working in the clinic?

I always try to meet or exceed expectations, and I often turn patients away if I don’t feel we are a good fit for each other. Even with that said, you cannot hit a homerun 100% of the time. For instance, I just finished a follow-up appointment with a patient who had recently visited a plastic surgeon for a facelift, but ultimately decided she did not want to have surgery. She wants lift in the cheek area but is cautious. We did Botox and one vial of Juvederm UltraPlus split between both cheeks. Normally, I would have done Voluma, but the patient wanted a natural lift that would perk her up a little and money was tight. I was concerned that doing such a small amount of filler would leave her unhappy as it would not be enough product to lift her cheeks significantly, yet she assured me she would be happy with trying anything.

Now, two weeks later, patient feels she is too full in the cheek area. The photos are beautiful. One half vial of Juvederm in the cheek of a 54-year old woman cannot possibly be too much filler. At the end of the follow-up she asked me to do filler on her jawline, but also stated that she didn’t want it to look any fuller. I told her I could not meet that expectation. I had her take a picture of her before and after on her phone so she can remember what the service did for her and perhaps also get advice from family and friends. As hard as I tried with conversation and showing before and after photos, somewhere the communication was not clear enough that filler will provide a more volumized look. It reminds me to keep attempting to be as clear as possible.

What advice can you impart to physicians or to any provider that is in the aesthetic business?

The best advice I could give is to take great before and after photos and to listen intently to what the patient wants. In the above story, if I had not taken photos, I may have believed that I made the client look worse than before they came in.

About Laura Carlsen, RN

Armed with a Nursing degree and a certificate of Registered Nurse, Laura went to work for Dr. Verebelyi in 2009. Laura has been able to contribute to Colorado Skin and Vein by writing protocol and assisting in surgery, learning laser safety and parameters, taking over the injectable practice, training and overseeing estheticians, and being responsible for all clinic supplies. The number of Botox patients has tripled in the last few years and her filler numbers put her practice in the top 6% in the nation.

Laura’s passion is in helping people to look younger and better, but not “done”. She prefers a conservative, natural approach. Because of her dedication to the long-term care of her patient’s skin, she still retains many of her original clientele from Secret World Day Spa. If you have an interest in perking up your looks but are not sure what to do, meet with Laura for a complimentary consultation. Her expert eye combined with incredible training from some of the top injectors in the world, will have you smiling in no time.

Dr. Mohiba Tareen - Tareen Dermatology, Minnesota

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

Name: Dr. Mohiba Tareen
Clinic: Tareen Dermatology
Location: Minneapolis, Minnesota
Website: www.tareendermatology.com

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

About Tareen Dermatology:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Dr. Tareen

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

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

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

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

Brief Bio:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Any marketing strategies or tips you can share?

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

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

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

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

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

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

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

Believe in yourself!

About Dr. van Aardt

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

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

Dr. Shuba Dharmana - Le Jeune MedSpa, India

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

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

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

Brief Bio:

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

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

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

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

What made you decide to pursue cosmetic medicine?

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

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

Could you tell us more about your clinics?

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

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

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

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

How do you manage your staff?

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

What available technologies do you use for your patients?

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

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

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

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

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

What are your marketing strategies?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About Dr. Dharmana

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

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

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

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

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

Dr. Ebtisam Elghblawi - Aesthetic Dermatologist in Tripoli, Libya

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

Name: Dr Ebtisam Elghblawi. MD, MBBCh, MScRes, ADD, DRH and PGC skin cancer
Clinic: Tripoli, Libya
Specialties: Clinical, medical and aesthetic dermatology
Website: l2106.wordpress.com

Brief Bio:

I am based in the capital. (Tripoli)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Question: Can you tell us more about your clinic?

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

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

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

Not applicable.

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

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

• Alex Laser Hair Removal with Candela GentleLASE®; http://blog.healthjobsnationwide.com/alex-laser-hair-removal-with-candela-gentlelase/

Question: How do you market your clinic?

Not applicable.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Alan Matarasso - Park Avenue, Manhattan

Dr. Matarasso He has published more than 200 articles, letters and abstracts in prestigious peer-reviewed medical journals; delivered over 500 lectures, invited lectures, exhibits, panel presentations and instructional courses.

Name: Dr. Alan Matarasso, MD, FACS, P.C.
Clinic/Office: Park Avenue, Manhattan NYC
Website: alanmatarassomd.com

What factor made you decide to venture into cosmetic medicine?

I was influenced by a professor D. Ralph Millard while a medical student at The University of Miami School of Medicine. I completed a residency in Plastic Surgery followed by a specialized fellowship in Aesthetic Surgery at Manhattan Eye, Ear and Throat Hospital in NYC. Cosmetic surgery became the sole focus of my practice. With the introduction of non-surgical procedures, like Botox we evolved into the ability to offer the full range of surgical and non-surgical treatments, fillers and energy based treatments (lasers, ultrasound and radiofrequency devices). I then became the first cosmetic medicine section editor of the Aesthetic Surgery Journal.

What can you tell about your office?

Our office is located on 85th and Park Avenue. I have a wonderful team of nurses, physician assistants and assistants who specialize in cosmetic medicine. The staff is overseen by our coordinator. We provide a full range of cosmetic surgery services (face and eye lift, rhinoplasty, liposuction, abdominoplasty and breast surgery) and all of the non- surgical procedures (neurotoxins, fillers, lasers etc.) We have an accredited operating room on premises, I perform many procedures at Manhattan Eye, Ear and Throat Hospital/Lenox Hill Hospital which is a world known ambulatory surgery center specializing in aesthetic surgery. 

Tell us more about your staff and your hiring process.

There’s a saying “slow to hire fast to fire.” Your staff represents the doctor, their thought process and can be the patient’s first interaction with the office. We constantly look for intelligent people who are consumer orientated, always keeping in mind that we are a service business and that the patient’s satisfaction comes above everything. Members of the team receive a guaranteed salary and generous benefits package that includes health insurance and a retirement plan.

Which non-surgical cosmetic technologies do you use?

Surgery addresses the quantity of tissue, skin, fat etc., but not the quality. Non-surgical treatment often addresses other issues and can complement or enhance surgery or address areas that surgery will not improve. It’s ideal to be able to offer the patients a full range of surgical and non-surgical procedures based on their needs, rather than a practice that can only offer what they have available.

Our Nurse Practitioner, Tiffany M. Rice, N.P., manages the nonsurgical side of the practice. The InMode Platform is the nonsurgical technology that Tiffany is currently using along with fillers (Juvederm, Voluma, Restylane, Kybella etc) and neurotoxins.

In regards to IPL specifically, Lummeca is our preferred treatment. Patients are satisfied with the results of Lummeca as clearance of pigmentation is typically achieved in 1-3 sessions as compared to 3-6 sessions with other IPL technologies that we have used in the past.

We are approached on a regular basis with new technologies which we appreciate and evaluate according to the needs of our patients.

How do you market to patients?

Our referrals come from word of mouth and doctors. Periodically will do blogs about our professional activities such as lecturing to medical groups and writing medical journal articles. I do an extensive amount of plastic surgery education, lectures and journal and textbook writing. I have always been involved in plastic surgery and I’m currently American Society of Plastic Surgery Vice President of Aesthetic Plastic Surgery and Private Practice Committee.

What do you find as profitable for your practice?

What is most profitable is a happy patient. Happy patients refer friends and family and usually remain patients for life. We are always looking into adding new proven techniques that benefit the patients. We also consider adding trained personnel that preform services we do not currently provide such as hair removal or tattoo removal.

Can you tell us any stories in your current career in cosmetic medicine?

Everybody looks into their own mirror, in other words different things bother different people. I recall a young male with a large mole on his nose and when I introduced myself in my typical fashion of asking what was bothering him, he mentioned something completely different then what I would have thought and never mentioned the very apparent mole on his nose. Or, when a girl comes in and says she wants a B-cup but shows me a picture of an exotic dancer size breast. What most people want is a better more natural version of themselves, not to look different. Another part of the patient encounter is predicting satisfaction, who will be happy and less so. I’ve learned that for any surgical or non-surgical procedure to the extent possible to have an in depth conversation and understanding of all your patients goals. I find we spend more time explaining what the procedures won’t do rather then what it will do. “Under promise over deliver”. Remember pre-treatment it is an explanation, post it is an excuse.

What can you tell your fellow physicians?

It’s all about delivering a good product and being forthright with the patients. In order to showcase your ability it requires communicating with patients in a language they understand. It’s also about the complete “experience”, from the moment they call to their final follow up appointment.

With regards to insights into cosmetic medicine it is a rapidly evolving exciting speciality and staying abreast of all the surgical and non-surgical advantages is essential. Always work hard and put the patient first.

About Dr. Matarasso  

Dr. Matarasso is a native of Westchester County in New York. He attended public schools where he was a 3 letter varsity athlete. He is a magna cum laude graduate of Boston University and a graduate of the University of Miami School of Medicine. Dr. Matarasso trained in general surgery at the Albert Einstein College of Medicine-Montefiore Hospital where he continued as resident and then chief resident in plastic surgery. He completed a fellowship in cosmetic surgery under the direction of Dr. Thomas D. Rees at Manhattan Eye, Ear and Throat Hospital/Institute of Reconstructive Plastic Surgery-New York University Medical Center. He was certified by the American Board of Plastic Surgery in November 1986. Dr. Matarasso achieved the rank of Clinical Professor of Plastic Surgery at Albert Einstein College of Medicine. His clinical practice is located in Manhattan, New York. He maintains an AAAASF-accredited operating room and has hospital privileges at numerous New York City medical centers. Dr. Matarasso has devoted his entire career to the specialty of aesthetic plastic surgery.

Dr. Alison Brooks - The Mirabel Clinic in Swindon, England

Located in Swindon, England, Dr. Alison Brooks made the switch from general practice dealing with Britan's NHS to focus entirely on cosmetic medicine.

Name: Dr Alison Brooks
Cosmetic Clinic: The Mirabel Clinic, Swindon, Wiltshire, England
Website: www.mirabelclinic.co.uk

Brief Bio:

I qualified as a doctor in London in 1989 and spent the next few years working as a junior hospital doctor and then became a General Practitioner (GP) in 1996. I worked as a GP in various locations in the South of England and then became a salaried partner in Swindon in the early 2000s. I established The Mirabel Clinic in 2006 and left General Practice in 2014 in order to concentrate entirely on cosmetic medicine

Let us know more about your journey to cosmetic medicine.

I have a lot to thank my sister for as it was her who got me started! She got divorced in 2005 and was back out on the dating game so decided to get some botox and fillers to help boost her confidence. When she told me about the experience saying that the person who administered her treatment was a General Practitioner this got me thinking and stimulated me into considering training to do this work. Almost immediately I looked up on the internet how to get trained in toxin and filler administration and I booked on a course with Adrian Richards – a plastic surgeon in Buckinghamshire. I spent a day training. I then came home and contacted two local beauty salons to ask if I could use their premises on a fee per patient basis. I started advertising in a local magazine and set up a website. For the next two years I gradually built up a small practice in the two salons, which was in addition to my usual work as a General Practitioner. In 2008 I bought a second hand laser/IPL machine from a local colleague, which precipitated a change in premises as I had to register my clinic with the Health Care Commission and I would never have been able to do that whilst working out of the two salons. So I approached The Shalbourne Suite, which is the private wing of the local NHS Hospital and asked if I could hire a room for a few hours a week. They agreed to this and I then spent the next 8 years working there, gradually building up to two really busy days a week. I gave up General Practice finally at the end of 2014 and haven’t looked back since. I have just moved into high street premises in Swindon, having taken a 10 year lease on a old property above a shop and completed a complete refurbishment on it. It has 3 clinic rooms, an office, reception room and a waiting room and is just about perfect!

What could you tell about your clinic?

Currently the clinic consists of me and my clinic manager, Debbie. She has worked for me for 6 years and now does all her back office work whilst sitting in the reception room greeting patients and answering the phone. We are in the process of taking on two other new aesthetic doctors to do half a day per week, as well as a receptionist and a laser trained beauty therapist. We open 4 days per week with two late evening till 8pm every week. We are located on a lovely street In Wood Street, Old Town, Swindon with a number of cafes, delis, restaurants etc. Wood Street is the most prestigious street in Swindon and is definitely the best location for a high end Medical Cosmetic Clinic such as Mirabel. We offer the usual toxin and filler injections, Laser and IPL for skin and hair as well as tattoo removal. I also do chemical peels, diathermy for minor skin lesions, Dermapen for scarring as well as Sculptra and Silhouette Soft thread lifting. We have a new Lipomed cryolipolysis machine that is waiting for a therapist to operate it! We have a database of about 2000 and I usually see about 40 to 50 patients per week but these numbers are expanding rapidly. Our patient demographic is mainly female with an age range of about 35-65.

Tell us about your staff also.

I have been very fortunate in finding a very good friend who has now become my irreplaceable Clinic Manager. I remember asking Debbie about seven years ago if she could spread the word about my need to find someone to do my back office work of filing and accounts. She suggested herself and I laughed saying that I thought she was overqualified for the role. She persuaded me to take her on and it has been the most amazing journey for her and me. She is one of the most organised and reliable people I know and is an incredible manager. I genuinely could not have developed the clinic into what it is now without her. We are now taking the next step of hiring staff and I am very aware (from other doctors in this business) of the pitfalls. Watch this space…..!

Which technologies do you use in your practice?

I have a Lumenis Quantum IPL and Laser multiplatform machine which I bought second hand in 2008 which I am very fond of and use a lot. I do IPL for hair removal and skin rejuvenation and it has an ND Yag head which I used for deeper thread veins and a Q-switched ND Yag head which I used for blue/black tattoo fading. I bought a second hand Alma Soprano Hair Removal diode laser for hair removal in sensitive areas and on darker skin types. I love this machine but use it less at the moment and will hand this one on to a laser therapist to administer treatments shortly. I also bought a new Lipomed machine last year but have yet to get going properly with this as it will be a therapist administered treatment. I am constantly on the look out for new machines and have considered getting a radiofrequency machine for skin tightening and more recently have looked at the new plasma soft surgery devices for non-surgical blepharoplasty and removal of benign skin lesions such as seborrheic warts. That said, buying new machines is a bit of a minefield. The reps will tell you that you will recoup your money in six months and that never happens! I find getting truthful advice about expensive machines is very difficult. I mainly take advice from other medical colleagues in the cosmetic medicine world.

Any marketing strategies that work for you?

I think marketing is a very difficult thing to get right. I and all my friends in this business have, at some point in our careers, been sold advertising in magazine and locals papers (at great expense) which have made absolutely no difference to our turnover! At The Mirabel Clinic do a little advertising in a free local paper and have a good website with some online selling. We don’t do much in the way of social media marketing and know that we should focus more on that area. The one single thing that made the biggest difference was investing in a radio ad on a local radio station. We have used this for the last 4 years and it constantly brings more custom into the clinic and has paid for itself several times over in terms of new customers and repeat business.

Which procedures do most of your patients undertake?

Without a doubt toxin treatment is the most profitable treatment I do, followed by dermal fillers and then IPL treatments. My least profitable treatment is in fact laser tattoo fading which is almost a non-profit making enterprise. I had to replace my Q-switched laser head last year and had a good long think about whether it was worthwhile, from a commercial perspective, to carry on doing tattoo fading. In the end I felt that I could not let my patients down and bought another head! It is a pro bono treatment but it makes me feel better about myself. I have just started Silhouette Soft Thread Lifting and am really enjoying the new technique. It definitely helps with the lower half of the face and I sell it as the only treatment I have in my armoury of non-surgical treatments that will do much for the jowls. The next step is really plastic surgery, and that is not for everyone.

Any stories you would like to share as a physician in cosmetic medicine?

I definitely have some stories of strange characters who have turned up in my clinic asking for unusual hair removal treatments and I remember one particular time early on when my children were very small and I was still taking calls for appointments on my personal mobile. I was in the changing room of a local swimming pool getting the children dressed when I took a call from a rather breathless man asking if I performed certain unmentionable services. I was so flustered that I almost dropped the phone and a baby too! I said “No!” and put the phone down feeling very shaken but I did have a good laugh about it later.

What is your advice to your fellow physicians?

Be brave. It is quite terrifying stepping out into the big commercial world – especially in the UK where most doctors are NHS employees. The rewards from growing a successful business can be huge, both financially, and in terms of your own personal self-esteem. Take a big breath and do it. Dig deep and you will surprise yourself.

About Dr. Brooks

Dr Brooks set up Mirabel Clinic in 2006 after completing advanced training in cosmetic injection and filler therapies at an expert training course run by a team of Consultant Plastic Surgeons. She completed her laser training in 2009.

Dr Brooks is a member of the British College of Aesthetic Medicine, regularly attending conferences and training updates to learn about the latest advances in cosmetic medicine and laser treatments.

Dr Brooks always offers free initial consultations as she feels that it is very important to advise you on the most suitable treatments, tailored to your individual requirements, before any committment is made by you.