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

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

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

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

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

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

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

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

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

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

Do you perform laser surgery procedures? 

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

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

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

What treatments or services are most profitable for you?

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

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

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

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

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

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

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