Dr. Shehla Ebrahim - After Glow Skincare and Ambleside Dermedics, Vancouver

Name: Dr Shehla Ebrahim
Locations: Vancouver, BC
Website: www.afterglowskincare.ca, www.amblesidedermedics.com

Bio: I am a family physician with a special interest in dermatology. I am the owner and founder of 2 award inning medi-spas on the North shore in Vancouver, BC. As a graduate of the University of BC, I began a career in family medicine in 1992.I am a certificant and a fellow of the college of family Physicians of Canada. Responding to the urgent need for dermatological care in my community, I pursued a diploma in Dermatology through Cardiff University. I have a flourishing focused dermatology practice which has enabled me to reduce wait times for the patients in my community.

What made you pursue cosmetic medicine?

Having practised Family medicine from 1992-2005, I started feeling unfulfilled in my current profession. Pharmaceutical based medicine was disenchanting, patients were never satisfied, and the energy was wearing me down. I also realized that I possessed creative and artistic qualities and it would be a winning combination to merge art and creativity, with science and technology of the emerging aesthetic medicine industry. I recognised that I wanted to be in control of my own destiny and the only way to do that would be to be in business for myself. In 2005, I took a leap of faith and opened my first location in North Vancouver.

Kindly give us a background of your clinic.

I am the medical director of 2 award winning medi-spas on the North Shore, in beautiful British Columbia. I have a full service medi-spa and my patient population comprises mainly of women between 45-70 who have a disposable income of 60,000 or more. Most of my clients are women who are interested in positive aging. Wanting to be the best version of themselves and wanting to look the best for their age. Both the clinics offer a complete menu of medical aesthetic services covering the face to the body.

How do you manage your staff members?

I always used to tell my staff that customers come first. Now I tell my customers that my staff comes first. We all know that finding and keeping good staff can make or break your business. I have a successful business model that has enabled me to keep the same staff for 14 years and that business model is to have:
1)    humility in leadership.
2)    To respect and appreciate my staffs need to have work life balance.Most of these women are young,have children and unlike the baby boomers like myself who make work our number one priority,,these individuals have priorities other than work which needs to be balanced.
3)    To run the business like a family owned business.
4)    To respect and value who they are and making a daily effort to thank them for their service.
5)    Build a team that buys into my vision of providing exceptional and high quality service with integrity and authenticily.

My staff is paid hourly plus commission. Generally, between 20 to 27$ per hour depending upon their seniority. Commission is fixed for some treatments at 125$ and others as a percentage of the treatments sold. Varying from 5%-20%.

I hire staff based on my intuition and their personality. Technology can be taught but personality cannot.

It has been my experience that people leave your business because of who they are and not because they were not valued as we are taught in business and HR management seminars.

Which light based or laser devices are currently in use in your practice?

I use a number of laser and light and energy-based devices in my practice. IPL, fractional, fully ablative, microneedling, ultherapy and coolsculpting. My favourite is IPL and Micro needling with RF and total resurfacing. Over the years, it has been my opinion that many devices are overpriced and underperform and do not meet the expectations that sales people promise.
I now look at buying second hand devices esp. for hair removal. There are a number of companies in Canada and USA that sell second hand devices which will then allow you to pay them off quickly.

What marketing strategies do you employ?

Marketing is the most difficult yet the most exciting part of my business.

Because the industry is very competitive, it is important to find creative strategies that will set you apart from the other clinics. Other the usual website that use SEO and SEM strategies, the best way to now market your business is through social media. This would include Facebook, Facebook live, Instagram, paid google adwords, blogs, newsletters, videos and you tube. Having your own video channel and regularly posting videos is a very effective and inexpensive way to market one’s business.

Which treatments and procedures are usually done in your practice?

The most profitable treatments are injectables and constitute 60% of my business. These would include, botox, and fillers.

Over the years I have dropped treatments that no longer serve me or my patients. These include laser treatment of veins ,nonablative fractional and some chemical peels. I have added other treatments such as PRP for hair loss and vampire facial. I have recently invested in female rejuvenation treatments and threads.

Please tell us any anecdotes you can share.

Aesthetic medicine is a fascinating and everchanging industry.

The most exciting thing about this industry is how rapidly things change and all the different treatment options available to our clients. Clients are generally opting for little or no downtime treatments that get them back to work faster and are willing to pay a premium for these treatments. From treatments that slow down the aging process to treatments that may reverse aging, such as recent advances in regenerative medicine. Harnessing the power of blood to improve the quality of one’s skin to using stem cells for tissue regeneration and minimally invasive treatments such as threads to lift the skin.

What pearls can you share to fellow physicians in the field?

Having passion is the number one criterion if you want to be successful in this industry.
Everything else will happen effortlessly and money will come wherever it is supposed to come from as long as you are first happy without it. Treat your employees with respect. Honour and always thank them for their efforts in helping your business grow.

Dr. Joel Kopelman - Kopelman Aesthetic Surgery, NY & NJ

Name: Joel E. Kopelman, M.D. FACS
Locations: Park Avenue, NYC & Ridgewood, NJ
Website: https://www.drkopelman.com

Brief Bio:  
I trained in oculoplastic and facial plastic surgery at UCLA in 1983. I subsequently did another fellowship in orbital surgery at Moorfields Eye Hospital, London, England. I have been the director of multiple professional courses on blepharoplasty, endoscopic brow lifting, facelifting, laser resurfacing, and rhinoplasty across the United States. My current laboratory research is on how aging affects the eyelids.   

Can you give us a background of your career in cosmetic medicine?

The training that influenced my entire career really began at U.C.L.A. thirty-plus years ago. Under my fellowship director we performed primary and secondary cosmetic and reconstructive eyelid and eyebrow surgery. Our particular focus was fixing complications from overdone cosmetic eyelid surgery and forehead/brow lifts. Subsequently, my practice evolved into primarily a cosmetic practice. I began to incorporate facelifting techniques, chemical peels ,laser resurfacing techniques, and body contouring into my practice. I never stop learning.I bring new surgical and non-surgical techniques that offer safety and lasting benefits to my patients. I don’t jump on every new product or technique because I have learned from experience that there are fads that are not safe and have precipitated problems. Like everything else in life, experience counts.

What can you tell us about your NY and NJ practices?

I currently practice on Park Avenue in Manhattan in an office I share with three cosmetic dermatologists. I also have a second clinic in Northern N.J. where I have a certified surgical facility. I have four employees who include R.N.s, surgical techs who assist me in surgery as well as a board certified anesthesiologist. My New Jersey and New York practices are similar and consist of primarily women between the ages of thirty to sixty-five and men in their thirties to fifties.  

How do you manage your staff?

I highly value my employees and generally compensate them commensurate with their training and experience. Each employee is intensely vetted prior to hiring them so I don’t usually fire anyone unless they have been dishonest or rude to the patients.

What devices do you regularly use?

I currently use IPL for diffuse skin pigmentation, acne and telangiectasia. I have erbium/YAG, pulsed CO2, and erbium-glass lasers that I use for skin resurfacing. I usually prefer my erbium lasers because there is a very rapid recovery time. I also use a non-invasive ultrasonic body contouring device called UltraShape Power. I like this device because it causes little discomfort compared to CoolSculpt.

What marketing strategies do you employ?

Word of mouth, internal marketing ”awareness”, website and Instagram. The marketing that traditionally has worked is “word of mouth” recommendations. In the past few years internet ratings and ranking has increased traffic but I have found that these patients do not always have realistic expectations.

Which treatments do you consider the most popular in your practices?

Facelifts, blepharoplasties, endoscopic brow lifts. I plan on performing more PRP for hair rejuvenation. I no longer perform rhinoplasty.

In your many years of experience, what have you learned so far?

I tell my staff “If a patient is happy when they come to see me they will be happy when they leave but if they are unhappy when they come to see me they will be unhappy when they leave”- there is nothing that I can do to change their view of the world. 

Lastly, what can you impart to fellow physicians in the field?

Do great work, be passionate, show that you care. Patients will recognize, value and trust your service, see you as their medical guardian, and appreciate you as an outstanding physician and surgeon. You don’t have to wave a flag - your actions will speak louder than words.

Dr. Sarah Cenac Jackson - Audubon Dermatology, New Orleans

Part 1 of our interview with Audubon Dermatology in New Orleans: Dr. Jackson tackles the medical technologies used in their practice and her experiences as a Dermatologist.

Name: Dr. Sarah Cenac Jackson
Location: New Orleans, LA
Website: http://audubondermatology.com/

Of Interest: Dr. Jackson is a member of the Annenberg Circle of the Dermatology Foundation, the largest foundation of dermatologic research in the country. She lives in New Orleans, LA with her husband Konrad and their 3 children Adelaide, Henry, and Charles.

What sparked your interest in offering cosmetic medicine?

Botox and Restylane were FDA approved for cosmetic use when we were in training at a program that had an established cosmetic training clinic and education in place. It was a natural fit for us to continue using and perfecting our techniques with injections.

We have several leaders and mentors within the cosmetic field in New Orleans and we were inspired to stay at the cutting edge of this exciting time in dermatology. What keeps us in cosmetics is the high level of patient satisfaction with these procedures. People love looking better and it translates positively to other areas of their lives. The constant positive feedback stimulates a desire to continue training and offering our patients the best services possible.

What are the IPL and lasers you use? And how do you select the medical devices in your practice?

We use many lasers and energy devices. We started out by renting a hair removal, vascular, and resurfacing devices. As we became more booked up on the days we rented the lasers, we made business decisions to purchase devices. IPL and laser hair removal were our first purchases and remain very profitable.

We determine devices to purchase based on 1) demand 2) data on the device's success 3) profitability.

Consumables and warranties can become very expensive so we are sure to factor that in as we make purchase decisions. We calculate ROI per hour on devices including the time required for one of the doctors or aestheticians to operate it, including numbing and consents. More complicated and painful procedures have a cost to us in time!

Our Palomar IPL, Exilis radio frequency, and Cutera Hair Removal systems are fantastic because they require no numbing and have no consumable. Cool Sculpting is very popular as well. We do research to see how much competition we have locally with a particular technology, but we have found that our patients are very loyal and respect our expertise, so it has not been a big problem for us to compete with med spas or group-on type pricing.

Clear and Brilliant and Fraxel Dual are also very popular, but difficult to use in New Orleans in the summer as we have so many tanned and skin of color patients. We are starting to use Cutera's picosecond laser for pigment as it is more color-blind.

Our tattoo removal business has not been as busy as we had initially thought, but it is growing and we love having the picosecond technology as indications for that device grow.

Over the years we have become savvier about negotiating. We usually decide what technology we want (skin tightening, resurfacing, etc.) and then research which device by talking to other KOLs and peers. At meetings, we try to have meetings with laser companies and get to know their personality. We always, always demo the devices before purchasing. Prices are negotiable and we discuss extra warranty years, extra consumables, and what to do if the device is upgraded before ever signing.

What anecdotes can you share about your patients?

I think some of the worst patient situations that happened involved syncope secondary to patient anxiety about needles. As a physician injecting all day long, we need to be skilled in recognizing syncope and pre-syncope and be able to best treat our patients. We have had several episodes in the office of seizure-like activity as part of syncope. We have had patients jerk with these convulsions while a needle is near the globe and even fall off the exam table. One patient even had lateral nystagmus. After consulting with our Neurology colleagues, we learned these symptoms can be seen with syncope. We have found it very helpful to know the proper recovery for syncope. Most importantly to lay the patient flat and let the blood flow back to the brain. We keep juice and ice on hand and everyone in the office is ready and prepared in case it happens. People are not allowed to leave until fully recovered. We have had a young male patient try to leave to early and face plant the copy machine on his way out! So, we triage for this as part of the patient intake. “Have you ever passed out with needles?” We are always prepared with guarding the needle and stabilizing our hand in case the patient jerks. We have our staff prepared so the patient recovers fully and can have confidence in our care.

Bio: Dr. Jackson received her medical degree from Louisiana State University School of Medicine, where she was a member of AOA honor Medical Society. She also fulfilled her residency training at Louisiana State University Health Science Center where she served as Chief Resident in Dermatology. She received her undergraduate degree in Zoology from Louisiana State University, where she graduated cum laude. She is a board-certified Dermatologist with special interest and training in medical dermatology, dermatologic surgery, cosmetic dermatology and laser surgery. Dr. Jackson is a former President of the Louisiana Dermatological Society. Additionally, she served for several years as the Louisiana State Chair of the Dermatology Foundation. Dr. Jackson is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery and the Women’s Dermatologic Society.

Dr. Deirdre Hooper - Audubon Dermatology, New Orleans

Part 2 of our interview with Audubon Dermatology in New Orleans: Dr. Hooper of discusses marketing strategy and staffing.

Name: Deirdre O' Boyle Hooper MD
Location: New Orleans, LA
Website: http://audubondermatology.com/

Of Interest: Dr. Hooper is half of of Audobon Dermatology. She's an executive committee member of the Women’s Dermatologic Society, the nation’s 3rd largest dermatologic society. She also serves as Financial Vice Chair of the Women’s Dermatologic Society’s Legacy Council.  

Dr. Hooper lives in New Orleans with her husband and their 3 children.

Kindly give us a background of your clinic.

We have a condo in a medical office building across from a hospital. Being in a medical setting allowed us to become busy very quickly based on referrals from other doctors in the building. We offer a full range of medical, cosmetic, surgical, and laser dermatology. Treating medical patients over the years has fed our cosmetic business-for example, the mothers of our pediatric acne and wart patients become our injectable patients, and they often send their husbands to us as well!

We rented lasers until it became financially more sensible to purchase our own. We now each see about 35-50 patients each per day and have 2 full time aestheticians, 2 nurses who assist with cool sculpting and aesthetic procedures, and a skin care concierge. One of our early hires as an aesthetician has a business degree. As we have grown the practice, she has become more involved in the business and HR end and has now become our office manager.

We are committed to making sure that each and every patient is confident in our care. This means that we will take care of you every step of the way, whether your journey includes skin cancer surgery, skin diseases, lasers, injectables, or anything in between for a high-tech natural rejuvenation. At Audubon Dermatology, we specialize in comprehensive dermatologic care for all ages, skin types, and skin conditions. We utilize a wide array of the most innovative products and procedures to give you the best care possible. We are located in New Orleans but often have patients coming in from around the country to receive our services.

How do you approach staffing in your practice?

We offer quarterly bonuses that incentivize the office goals and behavior we want to achieve. We feel like it’s a great way to positively reward great employees and check in more frequently with employees who may still be learning. We have a policy that employees may not request a merit increase until they have improved on their evaluation scores for 3 consecutive quarters.

It’s important for employees to experience and try the products and procedures in your office so that they can recommend them to patients. However, we have found that not all employees utilize procedures, or they may not understand the value of a procedure or product when given absolutely freely. We offer "Audubon Bucks" quarterly based on very simple and specific measures we expect every employee to complete. If employees call in sick multiple times or are not completing items on their detailed job descriptions, they lose their Audubon bucks, we have found this to be an effective way to avoid giving free services to less effective employees, and to be a great way to allow employees to see the costs and value of services we offer.

Hiring and Firing seem to be the most common struggle we and our colleagues face. We have learned 3 important points: 1) Hire experience for the back, personality for the front. 2) Hire people that you personally like and would enjoy spending time with outside the office. 3) Incentives are not only monetary-appreciation and acknowledgement are just as important.

What are your marketing strategies?

We find that word of mouth is our biggest referral system. We rarely pay for advertising but do focus on our social media. The marketing world is changing, we are constantly trying to grow our online presence.

When we started our practice 10 years ago we had a yellow pages ad. That is long gone as we implemented a tracking module in our EMR and started tracking-how did you hear about us? 95% from my friend or another physician! In recent years, the number of patients who find us by google is growing, so we are sure to keep our website updated and search-friendly and we are utilizing social media, mainly Facebook (including Facebook live), Instagram, and twitter.

We use Constant Contact to email patients about specials and new services. In our office, we have discreet signs on the back of every door mentioning current specials and customized cards that give an overview of products and services we offer for varying cosmetic complaints such as red face, fine lines, or pigment problems. These often generate questions as patients read over them as they wait for us.

We have tried newspaper ads, ads in local magazines, even billboards. None of these have approached the success of internal marketing and social media.

What procedures are most performed in your clinic?

We try and focus on treatments that make a clinical difference. We are always bringing in new devices or products. Staying on top of all scientific and technological advances in skin care and device modalities has been a priority of ours from the beginning. We do track our ROI and if something is not selling we phase it out, but typically that goes hand in hand with new advances that we are upgrading to anyway.

What pearls and tips can you give fellow physicians?

One important lesson is not to let the patient tell you what to do. As we begin in cosmetic medicine, we may want to please the patient, and go against what we judge to be the best cosmetic outcome. We have learned that the patients are there for our expert injections, and also our expert eye. We know what looks best, and they benefit from our knowledge of beauty. Many patients come in and say “whatever you think, Doctor”, but unfortunately not all of them. For those patients we try to educate them, and offer them our best plan for a great outcome. If they cannot see our way, we do not inject them. You want as an injector to be proud of every patient that you work with. Be selective and always stick with what you know is best!

Bio: Dr. Hooper is an honors graduate of Louisiana State University School of Medicine. She received her undergraduate degree in biology from Louisiana Tech University, where she graduated cum laude. Her postdoctoral training included Louisiana State University Department of Dermatology as well as a Women’s Dermatologic Society Mentorship with Dr. Pearl Grimes in Los Angeles, CA. Dr. Hooper is a Board-Certified Dermatologist with special interest and training in medical dermatology, dermatologic surgery, moles and melanoma, cosmetic dermatology and laser surgery. She is an executive committee member of the Women’s Dermatologic Society, the nation’s 3rd largest dermatologic society. She also serves as Financial Vice Chair of the Women’s Dermatologic Society’s Legacy Council. She is a member of the American Academy of Dermatology and has served on that organization’s Youth Education Committee. Dr. Hooper is also a member of the American Society of Dermatologic Surgery and Louisiana Dermatology Society. Dr. Hooper lives in New Orleans, LA with her husband and their 3 children.