Dr. Jose A. Garcia takes part in molding new physicians in cosmetic medicine and surgery. Is he seeing a paradigm shift in medical education?

Name: Jose A. Garcia, MD, FACOG, FACS, FICS, FAACS
Clinic: Aura Laser Skin Care
Location: Kirkland/Bothell, WA
Website: AuraLaser.com

That's interesting: As a faculty member of the International Society of Cosmetogynecology. The International Society of Cosmetogynecology is the world’s first and largest association of gynecologic specialists in female cosmetic medicine and surgery. Dr. Jose A. Garcia is a featured speaker and panel participant at their annual convention.

Can you tell us more about your career transition from Ob-Gyn to Medical Aesthetics? 

I have since 1974 after completing my residency at the University of Washington gone into solo practice in Tacoma, WA. With the increased demands of solo practice and the desire to remain solo I began to develop a cosmetic practice. I understood that the evolution in third party payers would not allow me to remain solo unless I made the transition to aesthetics. 

You offer both invasive and non-invasive technology. Is there any move towards nonsurgical technologies?  

Aura Laser Skin Care is unique in a sense that we offer a combination of invasive and ablative aesthetic and cosmetic treatments. The majority of medical spas offer the noninvasive treatments such as laser hair removal and IPL, microdermabrasion, and some offer Botox and fillers. The ablative or semi invasive procedures such as the Fractional CO2, SmartLipo, and NeoGraft are normally offered at a medical office. We have decided to include both aspects of cosmetic procedures that proved to be a sound decision. A lot of our patients who come in for laser hair removal would also inquire about liposuction and hair restoration as well as skin resurfacing. We looked into many fractional technologies and found the SmartXide DOT by Deka to be superior to the rest based on its versatility and flexibility. Another advantage of the SmartXide is that it requires no consumables.

As far as lipo, we decided to use a combination of tumescent lipo with the BodyJet by Human Med along with the SmartLipo by Cynosure. The advantage of the water assisted liposuction or WAL with the BodyJet is that it allows us to perform lipo on larger areas like the abdomen and buttocks relatively fast and with local anesthetics. The SmartLipo comes in handy when treating smaller areas such as the neck but is also great for tightening the skin after performing the tumescent procedure.

As for the NeoGraft hair restoration it is a revolutionary way in automated hair restoration that is very safe and minimally invasive and most of all produces no linear scarring that manual hair restoration requires. As far as technologies we had to withdraw from our clinics, I would say Thermage based on the fact that only 30% of our patients experienced good results and that was a small percentage to contend with.  

There is no doubt of the shift to the Web in recent years especially the use of webinars and online discussion boards. It makes financial sense to both the presenter and the attendee. However, I strongly believe in traditional hands on and peer interaction in conventions as it has that human touch that the Web cannot provide. When you are attending a convention or seminar you can network with other physicians and get to meet them in person and share your experience with them and in my opinion there is no substitute for it. In general people tend to pay more attention and learn more when they are in a classroom environment. It’s just human nature.

In recent years I have noticed that many physicians in traditional medicine are seeing huge erosion in their income and they are being pushed to be in survival mode. In our training we emphasize the procedures and products that are in high demand but require limited capital investment. Botox and fillers are a prime example. When a physician comes to me for advice the very first thing I ask is: What do you think your ROI or return on investment be in the upcoming year if you were to invest X amount of dollars into equipment. 

How did you decide on that technology and what did you compare it with? What completed your buying decision? 

From the inception time of Aura Laser Skin Care back in 2005, we looked at the many technologies that were available and decided to go with the ELOS technology by Syneron. ELOS stands for electro-optical-synergy and combines both radio frequency with light energies to produce safe and effective treatment. Furthermore, for laser hair removal, Syneron uses the 810 diode which is fast and works for all hair color and skin types. We initially looked at the ND Yag by Cutera as well as the Alexandrite. The problem was that the Alex is painful and good for skin types 1 and 2. The ND Yag is best suited for skin types 3,4, and in some cases 5. That meant that we had to purchase 2 lasers or a combo Alex-Yag laser as opposed to only one laser with Syneron. 

Have you ever switched from a technology platform? If so, why?

Not really, aside from Thermage, we always went through great lengths in investigating the technologies we wanted to invest money in. One good strategy was to bring a demo laser in house and try it on patients and wait for a couple of months to gather info about the effectiveness of the laser and procedure safety.

How do you market yourselves to patients and what do you do that your competitors aren't doing? 

In my opinion word of mouth trumps the thousands of dollars you can spend on advertisement. We do, however, offer a lot of outside and inside promotions. We use the Web as a powerful tool using Facebook and Twitter to reach the masses. We also have an online chat line on our web site which makes it easier for patients to reach us. As far as our existing patient base, we have a powerful way of performing data mining that enables us to send promotional invitations based on their birth dates, past services they received, the total amount they spent with us, and much more. 

Are there any new technologies that you think are especially promising?

I have heard a lot of buzz about the PicoSure for tattoo removal by Cynosure. For a long time we have been interested in bringing in Tattoo removal to our clinics but so far lasers have been unsuccessful in removing multi-colored tattoos. The patented Pressure Wave technology with PicoSure sounds very promising but we still need to investigate some more.

What's the best advice you've ever received as a physician? What advise can you give to physicians who want to start their own clinic?

The best advice was from my father, who was a physician himself. I remember him telling me all the time “Take a look at what the other physicians are doing ... and then, do the opposite.” His advice still applies today.

On the other hand, my advice to physicians is “do your homework before you embark on this adventure”. Many physicians have the misconception that by adding aesthetics to their practice the money will start flowing in. The fact is, physicians are not business people, and the machines do not invite people in and sell the procedure. There has to be this magical harmony between all team members of the clinic. It takes a team to make a business successful and more times than not, many clinics fail due to the physician not fully understanding all aspects of the business starting in marketing, promoting, all the way to staffing and payroll. A business is a living organism that thrives when only harmony exists between the different players.

What's the best business advice you've ever received?

Always go with your GUT but first verify.

About: Dr. Jose A. Garcia was born and raised in Corpus Christi, Texas. His father, three uncles and two aunts were physicians in private practice in Corpus Christi. He completed his college education at Yale University and then received his M.D. degree from the University of Pennsylvania. After completing his residency at the University of Washington in Ob & Gyn, he began his private practice in Tacoma, Washington in 1974.

He is a fellow of the American Academy of Cosmetic Surgery and a member of the International Society of Hair Restoration Surgeons, the International Society of Cosmetogynecology and the American Society of Cosmetic Breast Surgery. 

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.