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.

The State of Aesthetic IPLs & Lasers

In the last few years there's been an explosion of new IPLs and cosmetic lasers.

While that's generally good for clinics - inducing some competition and pricing/sales pressure - it can be a problem trying to find the right system to invest in.

READ: Cosmetic IPL & Laser Reviews & Comparisons Forums

In 2011, Dermatologist Dr. Goldman wrote a journal article about using what kind of laser should be used for the practice. In the present, there are devices that have multiple modalities and treatment options, you can have a single laser device instead of two or more. These devices are now made convenient for physicians and practitioners.

Lasers are steadily gaining traction in the aesthetic field. Many aesthetic devices have been launched, and various companies continue to upgrade their devices or create breakthroughs. Physicians are able to choose devices, which is suitable for their practice, as there are many ranging from skin rejuvenation to fat melting to even vaginal rejuvenation. At the same time, not everything has been met with praise, as lasers have its downsides for the patients or the physicians or practice itself. Thus, it is best that physicians and practitoners practice laser treatments with care.

Multiple treatments are common in many practices. More and more aesthetic companies are making more integrated systems with multiple modalities. Alma, Sciton, and Cutera are some of the aesthetic laser companies that have begun or launched a multiple modality device for one’s practice. No studies have been made about the efficacy of using multi-modality systems, but the technology is promising.

Having multiple modalities could mean multiple or combination treatment options. Effectiveness has been proven in several studies. Prior to multiple modality in a single device, physicians have been combining treatments.

Findings:

• In a dermatologic setting, treatment of non-melamona skin cancer with laser and photodynamic therapy was proven successful and effective. Er:YAG and ALA-PDT had the most efficacy rate with 98.97%
• Goldberg, 2012 suggests that IPL is better at removing hair considering it will be done with multiple sessions
• As for skin rejuvenation, an alternative to fillers would be repeated Erbium:YAG laser mini-peels (El-Domyati et al., 2013), leaving patients with an average of 88% satisfaction rate after the treatment.

Lasers remain to have some controversy over lawsuits filed by patients and complications brought about by its usage. One common issue faced by practices is negligence or mishandling by a non-physician administering the laser procedure. Several state laws allow non-physician practitioners, so long as the doctor is present in the practice. However, unhappy patients experieince some adverse side effects possibly due to poor handling and patient screening.

Training is important to avoid any of this concerns to rise and be the cause of lawsuits. According to E. Victor Ross, dermatologist, vigilance is key when administering laser treatment.

In 2016, a study was published by Dr. Gary Chuang, noting that fumes were present in a laser hair removal system. There are 13 carcinogenic compounds present in the laser hair removal plume. It is a cause for alarm as it could affect the respiratory systems of those performing the procedure and those receiving it. The researchers suggest that better ventilation systems and protection would help prevent any further issues.

Aside from this finding, Laser Service Solutions provides us with a list of common issues with laser devices. Technical issues like LCD screens and circuit boards should not be taken lightly. Other problems include: water issues, calibration, and handpieces.

It is expected that despite issues and problems, aesthetic laser procedures will still rise according to several market research reports.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390232/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376014/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632833/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100114/

http://dermatologytimes.modernmedicine.com/dermatology-times/news/laser-fundamentals?page=0%2C1

http://jamanetwork.com/journals/jamadermatology/article-abstract/2532614

https://www.laserservicesolutions.com/most-common-aesthetic-laser-issues/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390232/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376014/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632833/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100114/http://dermatologytimes.modernmedicine.com/dermatology-times/news/laser-fundamentals?page=0%2C1http://jamanetwork.com/journals/jamadermatology/article-abstract/2532614https://www.laserservicesolutions.com/most-common-aesthetic-laser-issues/

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. 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. 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. Sanjay Gheyi - Coltishall Cosmetic Clinic Norfolk, England

Trained as a general surgeon in India, the UK, and the US, Dr. Sanjay Gheyi's Coltishall Clinic in Norfolk runs the gamut of cosmetic offerings from Botox and IPL to cosmetic surgery.

Name: Dr Sanjay Gheyi
Clinic: Coltishall Cosmetic Clinic, Norfolk, England
Website: www.coltishallclinic.co.uk

Brief Bio: MBBS and MS general surgery India. FRCS, UK. WOSAAM board certification in Anti-ageing Medicine. Paris France

Medical Director Coltishall Cosmetic Clinic, Norwich UK.

Coltishall Clinic offers a full range of dermatologic laser treatments, non-surgical treatments such as botulinum toxins, fillers, face and body contouring treatments. Laser, skin and vein treatments such as IPL photofacials, non-ablative skin rejuvenation and toning, CO2 laser resurfacing, sclerotherapy, EVLT and ambulatory phlebectomy. We also provide minimally invasive options and cosmetic surgery under pure local anesthesia. This includes microcanula tumescent liposuction, fat transfer, laser assisted liposuction, blepharoplasty and face and neck lifts.

What made you decide to get into Cosmetic Medicine?

I had my board certification in General Surgery and worked in various surgical specialties including plastic surgery. I was always interested in cosmetic surgery but after spending 10+ years in Surgery in India, UK and a brief period as a surgical resident in the USA, I felt that there was more to life then perpetual residency so I decided to opt out of the rat race. I worked part time in general practice and also surgery. Then I discovered lasers and after much trepidation and sleepless nights brought my first device in 2006 and have never looked back. That was the best thing I ever did. I started slow and gradually added more services. I did not market very much but emphasized on training and education. I was working in the NHS at the time and gradually reduced my commitment as my private practice expanded. In 2010 I reduced my NHS commitment to just one session in Dermatologic surgery which I enjoyed immensely. After 5 years I resigned from the NHS completely to focus on my aesthetic practice full time.

What could you tell us about your clinic?

We are located in a beautiful suburban area north of Norwich. I decided to stay away from busy city centre because last thing you want to do after having a CO2 laser resurfacing for example is to be walking through town centre with a red face.

We have 3 treatment rooms, a reception room and separate comfortable waiting room. My wife is the general manager and we have two receptionists and one aesthetician. We have a small team so most patients know us well and we all know them very well. We offer only evidence based, results oriented services and where patients ask for treatments or services where there is not a lot of evidence base I tell them this very clearly.

We offer a full range of cosmetic dermatology services, minimally invasive surgeries such as skin lesion removals, tumescent liposuction, blepharoplasty and SMAS facelifts. We also have a vein practice and offer services for thread and spider veins anywhere on the face and body and also varicose veins treatments of EVLT and ambulatory phlebectomy under tumescent anesthesia.

How have you decided staffing in your practice?

Hiring the right people is very important. I was very lucky that my wife agreed to deal with the phone calls in the early days. She is a nurse so she had considerable health care experience which helped a lot. At first we used our NHS premises and staff on a part time basis but quickly learnt that was not a great idea. It is very hard to mix NHS services [I guess similar to your insurance patients in the USA] with self-funding private patients. So we moved out to private rented premises. We also appointed and trained dedicated staff members who had no NHS experience. We moved again to our new premises in 2010 as we were running out of space very quickly as the practice was expanding. Our new premises are future proof to allow for more expansion. We do not have a formal incentive scheme for staff but they are well looked after and we pay them well. We offer generous discounts on treatments and products and some free treatments. We have formal policies and procedures in place which are updated from time to time. When we hire new staff we allow them an opportunity to come and spend a day with us to see if they feel we are right for them and vice versa. Then we would have them on a trial period before appointment. We allow flexible working and our aesthetician manages her schedule herself. The feedback we get from staff is that this is a happy place to work and what is not to like!

Tell us about the technologies you use.

We started with a Lumenis quantum IPL and I still use it. We are lucky to have a full range of dermatologic lasers. For vascular work on the face we use IPL, PDL and long pulsed Nd-Yag. IPL is very useful for rosacea treatments. For leg veins it is usually sclerotherapy or Nd-Yag.
We also have a full range of pigment and tattoo removal lasers including the q- switched KTP,Nd-Yag and Ruby lasers. For ablative treatments we use CO2 laser and endovenous laser treatment are carried out with a 1470 nm diode laser. For laser assisted liposuction I use 980 nm diodes and also a 1470 nm diode laser.

For skin tightening we use radio-frequency and for skin toning we use q-switched Nd-Yag lasers and also in quasi-synchronous mode.

I like IPL because it is gentle and can address a number of concerns simultaneously. I love the lasers and there is no laser that I dislike. If you know you lasers well, you know their indications and basic science- each has its place in our armamentarium. I do dislike some doctors giving presentations and insisting that it has to be a particular brand of laser to do the job best. Look beyond the hype. If you know the wavelength, pulse duration and fluence you can make your own conclusions. One note of caution though-please don’t transfer recommended settings of one device to another-unless you are practicing on yourself first! Please stick to recommended settings and you can improvise as your experience grows.

Although I like new technology I do not rush in to buy the newest device as it hits the market. I once heard a physician say that he does not try any new drugs on his patients till they have been on the market for three years. Well, in cosmetic medicine we can't be that long but I like to wait at least six months and make sure and the machine that I'm investing my money in works well.

What marketing strategies do you use?

Our practice has been growing slowly and organically over last many years. We deliberately stayed away from aggressive marketing. I see two types of practices opening up. The first is cut- price businesses which turn these procedures into commodities. The second type is the practices that focus on premium services. We belong in the second camp.

Internet marketing has worked well for us and we use SEO and also PPC advertising. I created my own website, however, now due to lack of time I am getting an external website designer to revamp our website and make it mobile friendly. We advertise in local magazines. We don’t do national media or radio advertising.

Increasingly we see patients through word of mouth which is the best form of marketing. We also get referrals from local family doctors and hospital consultant colleagues.

Which procedures or treatments do you perform the most?

Surgical procedures are more profitable but lower volume. Next on the list is Botox and fillers followed by IPL and laser skin rejuvenation treatments. Laser hair removal and tattoo removal has become a commodity as a number of cheap places have opened up. We have however seen patients that are either dissatisfied from these services or had complications and we are seeing an uptick in laser hair and tattoo removal. Our unique selling point is that we have a number of devices so we can optimize the treatment using the best device based on patient’s unique characteristics.

We are moving away from non-invasive fat reduction as they fall short and again a number of cheap places are opening up. I can provide such good results with tumescent liposuction that non-invasive technologies will have to improve a lot before I can be convinced to offer them on a bigger scale.

What are your thoughts about cosmetic medicine, would you perhaps have any stories to tell?

Medical knowledge is obviously important but cosmetic medicine is both science and art, especially if you're going to do facial or body contouring or both.

Choose your patients carefully and learn to say no. Patient expectations are very high and in some cases are completely distorted.

There is inherent variability in response which means that some patients may respond very nicely and others may not respond at all. So don't provide any guarantees. They don't work in medicine!

I saw this clinic opened up locally who started doing laser hair removal and advertised 100% guaranteed laser hair removal. Six months later the guarantee had gone down to 1 year period following your last session and I believe now the guarantee has disappeared. Obviously they must have learnt the hard way!

Complications are a part of life and you will get complications. Be honest and take good care of your patient if you get complications and they will usually be very understanding and forgiving.

What advice could you tell to your fellow physicians?

Education is key. Patient’s come to us for results and a good experience. If you can provide this you will succeed. Fortunately we have many resources available to us. I found the discussions on medical spa MD very useful and they also helped me stay clear of hyped up devices which over promise but fall short on delivering results.

Don't buy the latest cool device. Instead go to devices which have had a proven track record. Talk to your colleagues, visit clinics, attend conferences and keep up-to-date and good luck.

About Dr. Gheyi

Dr Gheyi has triple board certifications in General Surgery, Family Medicine and Anti-ageing Medicine. He devotes full time to his Aesthetic and Anti-ageing practice. He personally administers thousands of laser, injectable and surgical procedures each year. He worked in NHS hospitals for 21 years in surgical specialties and last 5 years in dermatologic surgery.

He is an invited speaker at laser seminars and mentors other doctors training in lasers and cosmetic dermatology and surgery.

He is a trained and qualified surgeon. He has extensive clinical experience both in the UK and USA and has attended numerous perceptorships in cosmetic medicine & surgery. He has built a premier laser practice with sixteen different state-of-the-art laser and light systems and he continues to invest in training and new technology.

Medical Devices & Estheticians

It's true, medical devices are used by Estheticians.

In most clinics in the US, esteticians are often used to perform treatments... but outside the US not so much. Here's an email I received from Susanne Warfield, Executive Director of NCEA, taking us to task for 'misinformation'.

Susanne Warfield - Executive Director NCEA

I received a call from one of our members regarding your website and the statement about estheticians using medical devices.

Estheticians are using medical devices every day...- even an electric tooth brush is a medical device as defined by the FDA. It is very important that we understand that any device sold and marketed in the United States must be registered with the FDA and laser and light therapy devices are just another medical device that have "Indications for Use" and "Intended Use".

Please update your misinformation on your website as it it incorrect. Thank you

Anyone have thoughts on what an esthetician in the US (or each state) can or can not perform? Where's the line?

I Want To Be A Fibroblast!

What criteria is most important when choosing a treatment or technology to stimulate fibroblasts for skin rejuvenation?

Being a dermatologist focused on aesthetic treatment options for improving skin's condition  it's quality and overall appearance – I clinically and scientifically overlook tons of different approaches.

Basically, and I think we can agree on this, many treatments try to target the fibroblast. Its about the stimulation of this branched tissue cell who's function is to maintain the structural integrity of connective tissues by continously secreting precursors of the extracellular matrix such as ground substance, a variety of fibers notably the reticular and elastic ones and cytokines.

The goal in many skin rejuvenation treatments is to activate and stimulate the fibroblasts... and there are countless strategies to do this: You might choose chemical peels, energy based devices such as non-fractionated or fractionated resurfacing lasers, intense pulsed light (IPL), infrared light or radiofrequency. One might think of dermal filler substances such as hyaluronic acid or – better – calciumhydroxylapatite (there are even publications on a stimulating effect botulinum toxin type a...). Further one might consider microneedling, dermabrasion, etc..

Or think about "newer" technologies such as platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid). And last but not least cosmeceuticals (this list is not exhaustive!!).

Which strategy to choose? It's actually very difficult to find way through this jungle!

I would like to encourage and activate the discussion here and ask for your opinion: What are the most important criteria for you when you do your choice? Is it about mangeability, about downtime, about scientific proof, about safety, about treatment protocols (such as e.g. multiple treatments), about clinical experience of other physicians, about availability, about the learning curve, about the deligability, about the costs?

What's your decision maker here?