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.

Juvederm Ultra XC: Year-Long Lip Fillers

The US FDA has approved Allergan's JUVEDERM® ULTRA XC for the injection into the lips and perioral area for lip augmentation in adults over the age of 21.

Allergan's trials show that results last up to a year in the lips, but as always, there are two sides to the coin.

Since 2006, Juvederm formulations were already FDA approved for correction of moderation to severe facial wrinkles and folds such as parentheses lines around the nose and mouth. Then in 2013, the Juvederm XC for age-related mid-face volume loss was introduced.

Clinical trials for Juvederm revealed that 79% of subjects showed an improvement in lip fullness three months following the treatment. More than 78% of the subjects reported an improvement in their overall satisfaction with the smooth and natural look and feel of their lips at one year after treatment.

Executive Vice President & President, Allergan Medical Philippe Schaison said that:

As the leader in medical aesthetics, Allergan is committed to continued research and development in this area. Providing physicians and patients with premium products that allow them to achieve the aesthetic results they want is always our goal. Understanding that the desire with lip augmentation is to achieve a natural-looking and lasting result, we continued our research of JUVEDERM® ULTRA XC for the lips. With this approval, JUVEDERM®ULTRA XC is now the only filler that is approved to last up to one year in the lips while providing natural-looking results.

Juvederm Ultra XC contains a smooth gel formulation of modified form of hyaluronic acid (HA) and a small amount of lidocaine. The hyaluronic acid helps the skin to maintain its moisture and softness and the lidocaine acts as a local anesthetic to improve the comfort of the injection.

While the increase in the time between injections is going to be welcomed by patients, there are some physicians and clinics that might lose income since patients are not coming in as frequently. Additionally, these longer fillers might not be appropriate as a "first-time" filler for patients who are unsure if thy're going to love the effect. There's a big psychological difference between living with a change for a few months and an entire year. Still, the general increase in lenght is a good thing for clincs and patients who are familiar with the effects.

Radiesse: FDA Approved For Hand Rejuvenation

Radiesse is now FDA approved for "hand rejuvenation".

Radiesse is an FDA approved dermal filler for smoothening out facial wrinkles and facial contouring. Recently, Radiesse got its FDA approval, making it the only FDA-approved filler for the hands although hyaluronic acid has been used by physicans for years.

The product, according to its website, can hide visible bones and tendons, making the hands look more youthful and smooth. Radiesse utilizes a safe gel formula that contains calcium microspheres (CaHA). These can immediately create added volume and then stimulate the body to produce collagen which results in volume augmentation that can last for around a year.

According to board-certified plastic surgeon Dr. Brent Moelleken, MD FACS:

Radiesse is a great option as a filler for hands. It’s safe for all skin types, and leaves no obvious line between the hand and wrist. The hands are the last frontier, so-to-speak, and often give away the true age of a woman.

Depending on the severity of the volume loss, patients should expect to pay for about one to two syringes of Radiesse at an average cost of $800 - $1,200 per syringe for their hands.

Dr. Moelleken adds that because of the product's pliability and softness, it is a great filler which may also be used for deep filling in the face.

Patients are cautioned to seek out experienced and board-certified plastic surgeon in using the Radiesse hand filler because of the many veins, nerves, and arteries in the hand. During the clinical trials, patients showed swelling, redness, bruising and pain in injection sites.

Because of this recent development, cosmetic doctors may now offer enhancement and rejuvenation for both the hands and faces of their patients.

For more information, you may visit:

https://global.radiesse.com/treatment-options/hands#hands

Filler Injections: Achieving the Ideal Lip Shape

Our lips provide competence to the oral cavity when we chew our food. They may also affect sounds and facilitate facial expression which help us communicate what we feel. Lips also have their own aesthetic value.

Earlier this year, the Kylie Jenner Lip Challenge went viral on the internet. People who took the challenge sucked the air out of a glass to create fuller lips that is said to be more attractive. Of course, everything did not go well for others because many attempts ended in painful bruisings and trips to hospitals.

Sucking glass cyclinders did not make Kylie's lips look plump - it was cosmetic enhancement that did it. In an interview with Cosmopolitan magazine, she admitted using a filler and advised others who want a similar look to try a filler that lasts about two to four months, in case they change their mind and want to give it up.

For dermatologists and Medspa owners who work with patients desiring for plump lips, giving advice to patients during patient consultation may boost patient satisfaction rate.

A study in Germany was conducted "to clarify what it is that makes lips attractive - and whether there are gender-related differences of an attractive lip and lower third of the face".

After patients' lip and chin regions were photographed and evaluated by voluntary judges through a Likert scaling system, the results showed that there were certain parameters of the lips that add attractivity of both male and female individuals. Further, gender-related differences were manifested in the form and shape of an attractive lower third of the face.

• There is a significant higher ratio of upper vermillion height/mouth-nose distance in frontal-view images of attractive compared to unattractive female (p < 0.001) and male (p < 0.05) perioral regions.
• Furthermore, the ratio of upper vermillion height/chin-nose distance was significantly higher in attractive than in unattractive female (p < 0.005) and male (p < 0.05) lip and chin regions.
• The nasolabial angle was significantly sharper in attractive compared to unattractive female perioral regions (p < 0.001).
• Attractive female lip and chin regions showed a wider mentolabial angle compared to unattractive female lip and chin regions (p < 0.05).
•  Comparing men and women, we found that attractive female perioral regions showed a higher ratio of lower vermillion height/chin-mouth distance (p < 0.05) and lower vermillion height/chin-nose distance than attractive male perioral regions (p < 0.05).

Read more on: http://www.jprasurg.com/article/S1748-6815(15)00137-0/abstract

Top 5 Male vs Female Non-invasive Cosmetic Treatments

Are men getting more nonsurgical treatments?

With all the talk of men making up a growing percentage of cosmetic treatments, it's just not the case as the infographic above shows.

Using Artefill

Are you using Artefill? How do you like it?

There have been a few chapters in the story of this filler, and I know that many doctors are not using it due to fears of permanent fillers and fears of longterm complications. Also, it went off the market for a while as Artes Medical went bankrupt, but came back from a new company called Suneva.

I am a fan of the product and have used it quite a bit in my practice for the last 6 years. I have seen no concerning longterm issues. No granulomas, no migration, no product lumps. In Europe it sounds like doctors encountered quite a few serious problems with the Artecoll and Arteplast iterations of the product, including granulomas and lumps. It was so much so that a fairly strident call went out to never use permanent fillers. This boycott was enthusiastically supported here in the states by many plastic surgeons and dermatologists (most notably Arnie Klein). Even now, it seems that doctors who use Artefill are considered somewhat fringe by the core group of physicians.

I think that this is a shame. I have used the product on over 1000 patients without a single adverse event and I find it to be soft, natural appearing and forgiving. My main issue is that when the collagen component gets absorbed it is often not fully replaced by the patient's tissue. The result is that I frequently have to do several sessions in order to get good results and this can get costly. I inject in the deep as well as the superficial planes, but i try to have most of the product stay superficial. Because the product is so soft, I have found that if I inject it deep I do not see great results.

What is your experience?