Dr. Jose A. Garcia, Medical Director of Aura Laser Skin Care

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: 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.

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Dr. Barry L. Eppley, Indianapolis Double Board Certified Plastic Surgeon

Dr. Barry Eppley Indianapolis Plastic Surgeon

Dr. Eppley is both a licensed physician and dentist. He's board certified in Plastic and Reconstructive Surgery as well as Oral and Maxillofacial Surgery.

Name: Barry L. Eppley, M.D., D.M.D.
Clinic: Eppley Plastic Surgery
Medical Spa: Ology Spa 
Location: Carmel, IN 
Website: eppleyplasticsurgery.comologyspa.com

You're using SmartLipo technology. What do you think of SmartLipo's efficacy?

It is important to recognize that Smartlipo, like any technology, is a tool and has no magical properties. It is only as good as the skill and experience of the physician holding it. When used properly and judiciously, my experience has been that it can lead to better outcomes and less bruising. One of Smartlipo's biggest claims to fame has not been particularly useful for me...being able to do most of the procedures under local anesthesia. But this may be reflective that many of my patients are looking for treatment of multiple body areas with bigger volume reductions and it is often combined with other procedures which need to be done under general anesthesia anyways. Its biggest disadvantage is that it is a very costly device and requires extra time to pre-treat the areas before suction evacuation. Thus it requires a motivated user and one who believes that the cost and extra time to do it are worth it to their practice.

How do you evaluate and make your technology comparisons and decisions based on efficacy and cost? 

I view technologies and devices as either comparative or innovative. This means does it offer similar treatments as other technologies or devices on the market (with some claimed minor advantage) or is it the only one that can produce its aethetic effects. Most cosmetic technologies are comparative and thus must be judged primarily from a business perspective on its return on investment. Every technology costs a lot more than the price tag when you factor in labor, disposables (if they exist) and marketing. One must look very carefully at the cosmetic market and have realistic projections about what it can really generate. Very few technologies fall in line with ‘buy it and they will come’. Most sales are driven and do not magically fall off the street and through the door. This understanding allows me to apply a basic capital purchase philosophy... if it can not generate in gross sales what it cost to buy in one year or less, it is not a good business decision.

Innovative technologies, uncommon as they are, are different. Because they have less competition and offer something new, being an early adopter is less of a business risk. When the market cap is undefined, it is sometimes easier to take the risk.

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Steven J. Pearlman MD, FACS, Facial Plastic Surgery In Manhattan

Dr. Steven J. Pearlman is a plastic surgeon practicing in the heart of Manhattan.

Name: Dr. Steven J. Pearlman
Location: New York, NY
Website: MDFace.com

That's interesting: Dr. Pearlman is the Founding President of the New York Facial Plastic Surgery Society — a society founded in 1993 to promote advanced education for Facial Plastic Surgeons in the New York Metropolitan area. It provides a forum for accomplished, practicing physicians to exchange ideas, new techniques and procedures on a continuing basis.

How did you end up as a plastic surgeon in Manhattan?

I did my Otolaryngology training at Mount Sinai Medical Center. Our clinical training was heavily weighted in head and neck oncology and facial plastic surgery. Mount Sinai ENT department has been running courses in facial plastic surgery, including rhinoplasty, facelift, blepharoplasty and browlift since

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Dr. Carey Nease, Southern Surgical Arts In Chattanooga, TN

Dr. Carey Nease Board Certified Tennessee Cosmetic SurgeonDr. Carey Nease's goal is to impact the lives of his patients in a way that they are transformed, but not different. 

Name: Carey Nease, MD
Clinic: Southern Surgical Arts
Location: Chattanooga, TN
Website: southernsurgicalarts.com

That's interesting: Dr. Nease is a Fellowship Director of the American Academy of Cosmetic Surgery and trains surgeons from around the country the latest techniques in cosmetic surgery. The fellowship is a one-year training program open to current ABMS-certified general surgeons, plastic surgeons and head and neck surgeons. He is also a board-examiner and trustee of the American Board of Cosmetic Surgery and trains other surgeons around the United States in SmartLipo and Affirm fractionated CO2 laser resurfacing.

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Brian Howard MD FACS, North Fulton Plastic Surgery

Dr. Brian Howard FACS

Dr. Brian Howard runs his solo-practice in Roswell, just outside of Atlanta, Georgia.

Dr. Brian Howard is boarded in both plastic surgery and otolaryngology. In this interview we got together to find out what he thinks of his practice, cosmetic technologies and staff compensation.

Name: Brian Howard, MD, FACS
Location: Roswell, GA
Website: drbrianhoward.com


That's interesting: Dr. Howard is a recipient of the Outstanding Research Award given by the American Academy of Facial Plastic and Reconstructive Surgery and was recognized by the Consumer Research Council of America as a Top Physician.

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Dr. David A. Caplin, Plastic Surgeon At Parkcrest Plastic Surgery in St. Louis, MO


Parkcrest Plastic Surgery St. Louis, MOParkcrest Plastic Surgery doctors: Dr. David Caplin second from left.
David Caplin MD is one of four plastic surgeons at Parkcrest Plastic Surgery and draws patients from across all of Eastern Missouri.

In this interview, Dr. Caplin shares his thoughts on training, technology, and even marketing a busy cosmetic practice.

Name: David A. Caplin, M.D., F.A.C.S.
Specialties: Cohesive Gel Implants, SmartLipo laser assisted liposuction
Location: St Louis, Missouri
Website: ParkcrestPlasticSurgery.com

That's interesting: Dr. Caplin is a recipient of the American Society for Aesthetic Plastic Surgery’s "Certificate of Advanced Education in Cosmetic Surgery" and been a principal clinical investigator for the Mentor CPG (gummy bear) Cohesive Gel implant since 2002 with one of the longest and largest clinical experiences with this procedure in North America.

(Cohesive Gel implants have been used with great success in Europe and many other countries for many years but are currently only available to surgeons who are investigators in this study. Cohesive Gel implants have unique qualities including their form-stabilized anatomic shape and their resistance to implant leakage. The distinguishing factor is that the implant is a "soft solid". If the Cohesive implant is cut in half the implant maintains its shape.)

What do you think is most important to train a well rounded plastic surgeon?

In order to be a good aesthetic surgeon I have always felt that a strong background in...

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Arturo Muñoz Meza MD, A Plastic Surgeon In Tijuana

Haima Stem Cell Therapy Clinic

A short visit with Dr. Arturo Muñoz Meza, a Guatemallan plastic surgeon practicing in Tijuana, Mexico.

Arturo Muñoz Meza MD, A Plastic Surgeon In Tijuana

Name: Dr. Arturo Muñoz Meza
Location: Tijuana, Mexico
Website: haimastemcelltherapy.com/
Facebook: Dr. Munoz

That’s Interesting: Dr. Munoz is a plastic surgeon at HAIMA Stem Cell Therapy Clinic which is located in Tijuana’s financial district; just 5 minutes from the international border of San Diego, CA.

Yes. In Mexico Stem Cell Treatment is currently being practiced at a clinical level; it is mandatory to have a license from the Health Department COFEPRIS (FDA in Mexico) This license allows the use of stem cell types beyond those approved in some western countries such as the United States, and some parts of Europe

Several years of education and training is involved to become a leader on the field. Can you share on how you started your career?

I was trained as a general surgeon in the Social Security General Trauma Center in Guatemala during the civil war. There was a large demand for medical services that time. That was the beginning of the acquisition of my expertise in the surgical arena. When I went to Mexico to complete my plastic surgery training, I was asked to stay and teach in the Resident Program by my mentor, Dr. Jose Guerrerosantos who is an all time recognized master in modern plastic surgery.

I was chosen by Dr. Guerrerosantos as his own Post-graduate fellow in Aesthetic and Cosmetic Surgery. This was considered to be a privilege in the Guadalajara University’s “Instituto De Cirugia Plastica y Reconstructiva de Jalisco”—an honor to be the master’s right hand.

Consequentially, I was exposed to the best plastic surgeons around the world, most of them are esteemed members of the American Society of Plastic and Reconstructive Surgery and the American Society of Aesthetic Plastic Surgery.

Why did you choose to specialize in aesthetic cosmetic surgery?

From what I remember during my younger years in school, I had exceptional A+ grades in Arts-drawing, sculpture and music. From then on, I felt that I needed to fulfill something in my life. When I started medical school, I wanted to be a Gynecologist so that I can advocate women’s health. But then, things changed when I was in my fourth year of General Surgery training. During a rotation in the Emergency Room, a patient came in with a chief complaint of cardiac arrest due to a gunshot wound. There were no vital signs so I had to proceed with a direct cardiac massage. In two minutes, we were in the Operating Room and I have successfully completed the anterior thoracotomy to access the pericardium and I found the right ventricle’s rupture and it took me seconds to set the suture. To cut the story short, my patient survived this!

The following day, I was asked by the Department Chief to report in his office. I admit that I was scared by the tone of his voice. The patient I treated wasn’t an ordinary citizen—he is an authority of the Police Department. I was a hero to my mates. After that, I was chosen as a candidate for the Cardiovascular Surgery Program.

I saw my patient again after 30 days for the revision of his scar. He brought me a thank you gift. I felt blessed. Before he left, he asked me a question:

“Can you please tell me why you left an ugly mark on my chest? Didn’t you promise that this will be removed?”

We just both laughed. I concluded my residency program with that in mind.

For some people, to live and be good looking is the same.

That’s where I began to look into plastic surgery. It is truly an art of giving the human body anatomical modifications to restore and rehabilitate until it is aesthetically pleasing.

Your practice is located inside HAIMA Stem Cell Therapy Clinic which is located just over the US border in Tijuana, literally five minutes from San Diego. Can you tell us more?

Several of us are business partners. We have a CEO who manages administrative issues and we have 80 attending doctors whose specialty range from Orthopedics to Neurosurgery.

Because of the geographical situation of Tijuana City, we are the first alternative choice of the American population in California as medical providers because of the cost and quality of our services. Before the crisis, this city was considered to be “Tiny Houston City” for medical services.

In my office, we have 3 nurses, 2 front desk assistants and 3 patient coordinators to run the consultation services. Before hiring them full time, we check their performance with a trial period to make sure that the're a fit.

I have a high compromise with my personal quality standards and try to radiate a persona that I’ve learned during the Guatemallan Civil War. It is something that the “Kaibiles”, the elite forces of the army, shout: “The possible is already done, the impossible is going to happen now.” It reminds me to do the best I can even without the latest ideal technological support and resources.

We give bonus's to our staff depending on the number of referrals that come in and the number of patients that decide to undergo surgery. For example, if we have 1-5 patients, they will have 5% of the total cost of services and treatments done. If we have 5-10 patients, they get 10% and if we have more than 10 patients, they get 15% per week.

Extra bonuses are given to our staff when we hear good comments from patients. They also get discounts on their own plastic or cosmetic surgery.

What IPL or laser technologies are you using?

I have SmartLipo which is a Nd Pulse Yag Laser, 1064nm WL,18W. It is expensive but this one’s a very useful state of the art tool for liposuction. We use this on selected body areas with limited adipose tissue like on the neck and waist. We also use this for axillary hyperhidrosis, lipomas and pseudogynecomastia. We also have Vaser for patients who have previously undergone more than 2 liposuction procedures. We have used the Microair machine in the past but it takes twice as much time in the Operating Room. Results are basically the same (or none at all) and patients reportedly had swelling, pain and numbness after the procedure.

You clinic is unusual in that it's inside a much larger clinic. How is it marketed?

Thankfully, word of mouth has been the most valuable resource for us. We always educate our patients with the procedures. I will never compromise quality over quantity. I take a number of patients I know I can handle daily. If I am saturated, I refer my patients to my colleagues. As much as possible, we try to be organized for our patient’s satisfaction.

We used to advertise in the Yellow Pages but that didn't pay off.

Personally I feel that my work is good enough to compete with the best. Patients feel that my services are also affordable when they evaluate the whole surgical experience.

The hospital has it’s own marketing program and we have commitments and policies in taking part to make it successful.

What is the most popular and profitable treatment in your clinic?

Sometimes, before we sleep,  I jokingly tell my wife “I am going to pray that everyday is “Lipo Day” because this particular procedure is in demand and very good in terms of outcomes. Basically, expenses are based in the O.R. charges and hospital rooms. Rhinoplasty is also perfect. We just need Lidocaine with Epinephrine, a couple of sutures, saline solution, nasal packs, antiseptics, micropore and external ferula.

We have good quality equipment and replace 1 or 2 pieces every year when we attend symposiums, congresses or meetings.

I left hair transplantation because it takes a considerable time of consultation and it requires me to train and supervise technicians as well. Honestly I don’t love this procedure enough to give this a substantial time in my practice.

I am a member of the Board of Specialists in Stem Cell Therapy. I am excited to offer this soon in our office.

What are the lessons you learned as a plastic surgeon? Can you share memorable moments?

Plastic surgery has given me a lot of experiences whether it be challenging, interesting or successful. But above all, the most fulfilling experience is observing the patient’s reaction when they look at the mirror for the first time to see the result.

On May 1997, I attended the ASAPS meeting in New York. I had the honor to meet many of my favorite authors like Jack H. Sheen and George C. Peck and took the courses with them. It felt great when I went back to Guadalajara and performed a reduction and balance rhinoplasty on Karla, an 18 year old who asked for rhinoplasty because she had a problem known as nose kyphosis. This is my most unforgettable experience, as this was my first rhinoplasty. 

After 4 weeks, I finally removed the patch and told her that it’s done. For me, the result was okay, a little swollen than normal. But I didn’t know what she was thinking and so I instructed her to look at the mirror on the next room to check her self. I couldn’t see her for a while and then suddenly I heard her crying. Jesus Christ!! I’m dead! I waited patiently for her to come back.

She looked at me and exclaimed “This is beautiful! All I can say is thank you!”.

For me, that is truly a gratifying experience.

What advice would you give to other physicians?

I think the best advice I can give to everyone in the cosmetic industry is to never perform anything that you are not trained for. If you are not qualified and naturally skillful, you are not the best option available for the patient. What people expect from plastic, aesthetic and cosmetic surgeons are natural, longlasting results and safe procedures. There is no one surgeon who is good at every procedure. He doesn’t exist. In time, he may develop his specialty. The procedure you do often which have exceptional results are highly recommended to your patients. Always do your best when performing a procedure because patients want to achieve perfection.

Avoid disasters in the cosmetic industry by eliminating greedy thoughts. As for myself, I don’t feel good with calf or gluteal implants, neither with hair transplantation. I am knowledgeable of those procedures but I am not passionate of these. When a patient asks for those, I usually refer them to an expert in order to eliminate the potential risks and fake unnatural results. I want to be honest to the patient. In this way, we can increase our credibility and gain the public’s confidence.

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

Medical Spa MD Podcast: Dr. Thomas Young & Smartlipo

Dr. Thomas Young

In episode 8 of the Medical Spa MD Podcast, Dr. Thomas Young of Young Medical Spa discusses new Smartlipo techniques and training, choosing cosmetic lasers, and cosmetic stem cell treatments.

We discuss the latest trends and nonsurgical cosmetic technologies including Smartlipo, stem cell treatments, laser liposuction, technology choices and integrating new surgical techniques into your cosmetic practice.

Dr. Young began performing SmartLipo Laser Body Sculpting soon after it's FDA approval and was the first physician to introduce awake tumescent laser liposuction to the Lehigh Valley. He trains other physicians across the country in awake tumescent liposuction and liposculpture procedures and was the first physician to perform Vaser® Lipo, SlimLipo, Body-Jet®, Stem Cell Enriched Fat Transfer Natural Breast Augmentation, Brazilian Butt Lift, ZERONA, VelaShape, and the Soprano XL Pain-free Laser Hair Reduction procedures in the region.

Laser Lipo ~ One Lump, or Two?

I like to regularly read through various self-help forums to understand the patient’s point of view on the types of procedures we perform. (Laser Lipo, SmartLipo) I believe in doing so, it can help fine tune our procedures, prepare us better for responses to patients with similar experiences, and help us perform overall better customer service.

One of the common complaints I have continually come across was lumps and bumps patients have experienced post laser lipolysis. Many seem somewhat traumatized by the bumps, others state their physicians have given them no explanation or even treatment for the lumps.

Let me first preface that this is in no way comparable to the lumps and tracts after traditional liposuction for reasons we’re all well aware of. In fact, many of our patients are coming in to have those lumps and tracts removed with laser lipo. Patients need to be well educated about the healing process of the lymphatic system, underlying tissue layers, the remaining layer of fat post laser lipolysis, and that lumps can be part of that process for some. How many lumps remain visible after the healing process has been completed (6 months or more) is dependent upon how much fat was left underneath the skin from the procedure, how aggressive the procedure was (amount of fat removed and severity of manipulation), and how the area was treated during the healing process. These lumps can be pockets of just fat, or consolidation of scar tissue and body fluid, even seromas that require regular draining until gone.

It doesn’t matter if the device used was a lipo lysing laser or the ultrasound Vaser, lumps can occur and tend to be more operator dependent than anything. No surprise to any of us, I noticed with many physicians I talked with experienced more lumps at the beginning of their training and had to bring many patients back for touch-ups. These physicians tell me that as their experience level increased they began to see fewer lumps and attributed the reduction to technique enhancements from training with more experienced physicians, choices of suction devices and cannulas, aggressiveness of suction post lysing, and post treatment regimens.

Because you can’t rush a physician’s level of experience, what you can do is offer your patients methods to help keep the lumpy bumpies away. These treatments can be started as early as 2 weeks post-procedure or as early as tolerated by your patient.

Here are some of the laser lipo remedies that we currently use or have been suggested to me by others.

  • Proper garment fitting
  • Placement of large foam surgical pad across abdomen under garment to disperse pressure evenly
  • Lymphatic massage, or deep tissue massage, by an experienced massage therapist
  • Use of a roller ball. We like the Omni roller ball suggested to us by our dear friend Dr. Richard Goldfarb (thanks Rich!)
  • Ultrasound therapy
  • VelaShape, or comparable device. We give our patients 2 free sessions with every laser lipo procedure. We like the blending of the infrared, radio frequency, roller motion and suction to help our patients smooth out and tighten the skin.
  • Endermologie
  • Use of a small cannula to excise the areas of fat (plastic surgeon suggested)

More theories and suggestions are welcome!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Smart Lipo ~ Young Medical Spa

Young Medical Spa offers smart lipo in Allentown.

Paula runs Young Medical Spas website marketing, SEO, Twitter and video marketing and she's obvioulsly getting to be pretty good at it since they're booked for smart lipo procedures into mid July.

How? Well, first she understands that it's needed and actually puts time and energy towards it. I'll let her answer but I know that writing for Medical Spa MD has raised her profile more than a little and actually turned into both patients and revenue.

Paula actually did something proactive and contacted Medical Spa MD rather than just sitting back. That lead to Medical Spa MD deciding to publish her upcomoing book on med spas and laser treatments for medical estheticians (coming soon) as well as Paula writing for Medical Spa MD.

The fact that this video is now on Medical Spa MD and in front of our close to 2million page views this year means that the competitors of Young Medical Spa just took a whoopin.

(If you'd like to write for Med Spa MD you can contact us here.)

Stepping Your 'Smart Lipo' Laser Clinic Out Of The [Branding] Box

Let's say you needed a tissue and asked a friend for a Kleenex... would you be perturbed if they handed you a Puffs instead?

Silly point, but it seems to be somewhat of an ethical conundrum that I came across at ASLMS while talking with a group of physicians who are contemplating adding laser lipo to their already successful aesthetic practices and are unsure of how to market it.

Let’s face it, there have been quite a few technological advancements since the FDA approval of the first SmartLipo in November of 2006. There’s ProLipo, Vaser Lipo, SlimLipo,... let me take a breath here... Cool Lipo, LipoLite, Lipotherme (I know I have omitted some, but you get my point).

Since SmartLipo was first to market, it has now become a household name like Band-Aid or Clorox even though we know there are more brands of those products. In fact, the same situation is going to happen once Reloxin is released.

These physicians made a valid point when they stated patients are calling in asking for “SmartLipo”. So what if the physician decided they want a different laser lipo device? How would they market it since the public is primarily only aware of “SmartLipo” and are specifically asking for it?

Ethics suggest to me to market it as “laser lipo” and that use of the name “SmartLipo” would not only be misleading, but probably even illegal for false advertising. So what’s a physician to do if he wants different technology? What’s the best marketing strategy?

  • Purchasing a used SmartLipo device on eBay, perhaps, just to say they own one?
  • Advertising your device as a “SmartLipo-like” device?
  • Co-purchasing a SmartLipo device with another practice?

It definitely proves the point that first-to-market has sustaining branding longevity.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.