The Best of The Best by Big Medicine Magazine

MEDICINE MAGAZINE™ The Magazine for Big Thinkers ICONS of Plastic Surgery! Thinking of Going Into Private Practice?

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MEDICINE MAGAZINE™ The Magazine for Big Thinkers

Editor-In-Chief Angela O’Mara Copy Editor Brandon Murphy Barnes Beauty & Grooming Editor Sally Smith Contributing Editor Michael O’Mara

Angela O’Mara

Graphic Design Joe Felipe

Editor-In-Chief Founder

Publisher Giles Raine Tel: 949 768-1522

Letter From The Editor

www.bigmedicinemagazine.com info@bigmedicinemagazine.com

Hello and Welcome to BIG Medicine Magazine™ – The Magazine for BIG Thinkers!

Advertising Sales 949 768-1522 All content in this magazine is protected and may not be copied, reprinted or republished without written permission of Publisher. All rights reserved. BIG Medicine Magazine™ is a Registered Trademark.

ing Theatre Garrett homas

2015 promises to be a year of significant change at all levels of the aesthetic medical industry. Change creates opportunity and we hope that some of the ideas and articles featured in BIG Medicine Magazine™, have already helped excite and inspire you and your staff to take new and bold actions to build on your current success. For this digital issue our editorial team has compiled a year in review featuring The Best of The Best from BIG Medicine Magazine™. We hope you enjoy it!

don, England

eatre existing in Europe as Church in London and off the original site of St. 1822, surgical operations omas’ Hospital took place tal Governors, displeased ital ed that part of the nearby d into a new purpose-built y for female patients. By old wooden Church roof, h a well-lit teaching space. ted Guy’s and St. Thomas’ mportant and prestigious perating Theatre provided entice surgeons to watch Among them was famous Astley Paston Cooper.

Photo: Gareth Miles, museum officer, lecturing at The Operating Theatre and Herb Garrett of St. Thomas.

Step back in time to 18th century London. The theme of this issue is History, Education and International Leadership. Join us at Europe’s oldest operating theatre, and meet three international iconic plastic surgery leaders...

MEDICINE MAGAZINE™ The Magazine for Big Thinkers

... begins on page 66

www.bigmedicinemagazine.com

Why Are We Waiting? How often do you sit down in your practice waiting room (or as we at BIG Medicine Magazine prefer to call it, the reception area) and take stock of what your patients experience each time they pay you a visit? We dare you to arrive at the office 15 minutes earlier than usual and take a moment to sit down in your reception area. Put yourself in the shoes of a patient. What does your reception area say about YOU? Does it showcase your academic background, your surgical skills and medical talent? Remember you only have one chance to make a FIRST impression.

What do you see? • How comfortable is the environment? • Is it clean? • Are there educational materials about you? • Does it project first-class service and medical expertise? • Is there video streaming your messages? Or the services you provide? • Ask yourself: “If I was a patient, is this the kind of place where I would want and choose to spend MY money?”

Is Your Receptionist Losing YOU Money? No matter how much money, time and effort you spend on marketing your medical practice it will all be for nothing if each new patient caller reaches voice mail, gets lost in a dizzying array of options, gets hung up on, or, EVEN WORSE, gets stuck on a call with someone who does not know how to handle a patient call. Do you realize that a poorly managed telephone call could cost you many thousands of dollars in lost revenue? The majority of medical practices pay the least amount of money for what is one of the most important jobs in the office next to the doctor’s job. Yes. You got it right the first time. The receptionist is often the most UNDERPAID and least trained person in the office. No wonder you’re losing money. The receptionist is not just answering the phone. They are your immediate connection with the outside world. They are the FACE and VOICE of YOUR practice. Your receptionist holds the power to turn that caller into a paying patient, or to lose them, allowing that patient to go elsewhere for a procedure that you could have performed. Also, consider the fact that we are not talking about

A prospective patient will never have the chance to consult with you if they have a bad experience with your receptionist. Your medical practice is a business that sells medical services. In any other business organization

just one procedure. That same patient may have returned to you for further procedures, and referred their friends and family.

these types of calls would be called Sales Leads. These calls must be treated with importance.

Your Receptionist Should NEVER • Refer prospective patients to any of your competitors. If you do not offer the procedure they are requesting, you should have a clear protocol of how to handle this type of caller. • Sound anxious to get off the phone. • Be discourteous or uninterested in the patient’s needs. • Give any medical advice, e.g. determine the length of recovery time if a caller is planning to have surgery before a big event. • Think they are offering good advice when, in fact, they are putting the caller off having a procedure with you. • Forget to take down the name and contact info. • Hang up without booking a consultation.

Your Receptionist Should ALWAYS •

Greet the caller with a warm, friendly smile.

•

Ask how they can help them and listen.

•

Ask how they heard of you.

•

Only offer basic information and then suggest a consultation with you.

•

Obtain contact information and put it on the Tracking Sheet.

•

Book a consultation.

•

If the caller is not ready to book a consultation, they should ask if they can add them to your e-newsletter or if they can send literature in the mail, then schedule to call that patient back in one week’s time.

While your receptionist should be able to answer basic practice and treatment information, they should not try to play doctor on the phone. Booking the consultation or an appointment with you is the best thing they can do.

You know that space between where you are now and where you want to be? The gap of space that exists between where you are currently standing and the journey into the future that you want to create. At BIG Medicine Magazine™ we call it “The Gap” and in order to help you cross that fateful gap, we have created BIG Strategy, a special tool to help you bridge this gap to your future practice success. You can access this FREE practice assessment at www.bigmedicinemagazine. com/bigstrategy.

Are YOU Working HARDER For LESS Money? The New Economy of Medicine. By now it is agreed that the economic world has changed. The common theme amongst doctors (and, understandably, the rest of the planet) is that they are working harder and for less than sufficient dollars. There is no doubt that as a people we are living a faster paced lifestyle, and that there are more choices available to patients thanks to the amount of content and information available on the Internet. Let’s face it people expect VALUE as well as excellent care from their health care provider whether for an elective procedure or a medical emergency. The late great master of self-help books, Stephen Covey who authored The Seven Habits of Highly Effective People can teach us a thing or two about working SMARTER rather than HARDER. This book has sold more than 25 million copies in 38 languages worldwide, and the audio version has sold 1.5 million copies, and remains one of the world’s best-selling nonfiction books. So what are those seven habits? •

Be proactive

•

Begin with the end in mind

•

Put first things first

• Think WIN-WIN •

Seek first to understand, then to be understood

•

Synergize

•

Sharpen the saw - Self Renewal

For more information go to www.stephencovey.com

Set Your Ship To Sail Navigating The New Economy

Is itit time time for foryou youtototake takefleet fleetand andset setsail? sail? Once you make choice that want to build A Successful Is Once you make thethe choice that youyou want to build A Successful World Class Medical Practice you are embarking on a life changing journey and you must prepare. When Sir World Class Medical Practice you are embarking on a life changing journey and you must prepare. Edmund Hillary, who was the first man officially recorded to climb Mount Everest in 1953, made the decision When Sir Edmund Hillary, who was the first man officially recorded to climb Mount Everest in 1953, made the to embark that potentially treacherous climb, theclimb, first thing he did was his sea passage to Bombay. decision toon embark on that potentially treacherous the first thing hebook did was book his sea passage to Bombay. With clear his vision and thetomeans to help him his destination set inhe place, then training started With his vision andclear the means help him reach hisreach destination set in place, then he started training and mastering his climbing other mountains in preparation for thefeat grand feat of Everest. As and mastering his climbing skills on skills otheron mountains in preparation for the grand of Everest. As master master YOUR craft, you must ask yourself: of YOURofcraft, you must ask yourself: • • • • • •

Where am I headed? Who is on this journey with me? How do I need to prepare myself and my team for this journey? What do I need to bring with me? What problems might I encounter along the way? Is this truly the journey that I want?

If you can’t answer these questions, DON’T climb on board the ship, or attempt to scale the mountain, until you can.

Self-help books are read by many. If you are in need of a book that can help you understand them further, try try reading reading Revelations Revelations of ofYour YourSelf SelfHelp HelpBooks Book authored Secrets by Lancaster a practicing This book is aThis realbook journey inner workings authored by Adams, Lancaster Adams, a doctor. practicing doctor. is ainto realthe journey into the of theworkings brain. Toof read www.sbpra.com/lancasteradams. inner the more brain.go To to read more go to www.sbpra.com/lancasteradams.

How Clearly Can You See? Take Our FUTURE Vision Test! •

Where will you be this time NEXT year, or in 10 years?

•

What will your practice/personal life look like?

•

Remember that first week back in the office after the New Year? How was it? What is your staff doing? What type of cases did you have?

•

Now project how you want it to be AFTER the next New Year celebration

•

What kind of year are you looking at?

•

What/who have you surrounded yourself with?

REMEMBER: This is YOUR vision. Nobody sees what YOU see. Make it as big and colorful as you like. Write it down. Sleep on it. Go back to it and perfect it to exactly what you want. Once you see it, you can have it!

What Might YOUR Vision Be? For those wondering where to start on Vision Building, here are some BIG suggestions!

VISION •

100% elective surgery practice by

•

Add a medi-spa, product line or wellness center to your practice

(choose a date that suits you)

•

Escape to a deserted island more often

•

Have multiple practice locations

•

To earn $10+ million dollars this year

•

Bring your practice back to where it was pre-recession

•

Bring in an associate so you can expand your practice

•

Bring in an associate so you can spend more time with family and friends

•

Patent an invention you are working on outside of the practice

•

Develop your own skin care or vitamin line

•

Live the life you deserve

“Follow an old path and you will find the expected. Blaze a new trail and you will will have have an an adventure,” adventure.” Anonymous. Anonymous you

What’s YOUR Current Practice Reality? •

Take your own temperature – self-diagnosis can go a long way

•

Don’t hide the truth

•

If a staff member is not up to par, cut them loose. You deserve a good crew

•

Does your office need an upgrade?

•

What is your financial status?

•

Are you doing the surgeries you really want to be doing?

•

Is your office location ideal?

•

Are you in the kind of physical condition you want to be in?

•

How much time do you spend outside of the practice?

•

Are you doing the things you LOVE to do?

•

Are you happy?

IfIf you need further help with understanding your own current reality, try the BIG Medicine Magazine™ Practice you need further help with understanding your own current reality, try the BIG Medicine Magazine™ Practice assessment tool called The GAP. You can access The . You can access The GAP FREE at www.bigmedicinemagazine.com/bigstrategy. FREE at www.bigmedicinemagazine.com/bigstrategy assessment tool called The

Write YOUR OWN Prescription For Success TODAY! Developing a PRACTICE STRATEGY can be likened to an architect creating a detailed blueprint and then watching as the house is built to completion. Here are a few areas for review before you put ink to paper. Step 1.

Step 2.

• Set 30, 60 and 90 day achievable goals

• Make a commitment and schedule for practice building and future planning time

• Help your staff with accountability – require them to provide you with Weekly Action Plans • Take a long hard look at your financial needs over the next 12 months • Review practice growth opportunities • What is your current and future staffing requirement? • Do you have complete and clear job descriptions and role designations for all staff members? • Have you set a realistic budget?

• Set new patient acquisition goals • Project future product sales objectives and set sales goals • Set time aside for creative time • Set time aside for Golf Time (or leisure activity of choice) Step 3. • Take Action • Take a leap. Not just a leap of faith

It’s important to schedule time to work “on” your practice.

Presentation Skills

LEARNING A TRUE VALUE! We all agree that we learn in different ways. Some of us learn visually, others verbally, auditory and so on. But understanding how others might learn is beneficial, whether you will be educating patients on the services you offer, or are in academia and are teaching other medical students how to be a real doctor. This graph will help you understand more on learning retention something that can bring value to your future career as a medical doctor.

This Little Piggy Went To MARKETing With all the coming changes with OBAMACARE, insurance premiums and payouts (or lack of) at some point in the not too distant future you are going to have to determine which side of the medical fence you are going to sit. And when we say â&#x20AC;&#x153;This Little Piggy Went To Marketing,â&#x20AC;? we are not kidding. Using the method of Learning Retention (above), how can you apply this knowledge to your marketing? Think about it. Where are you going to spend your dollars so that you can keep the piggy bank full and fat? For more information, write to us at increaseprofits@bigmedicinemagazine.com.

Q. How many times do you have to make a first impression?

STOP Wasting Your Time on Facebook! Let The EXPERTS Help You!

Facebook is NOW a critical component of your overall practice marketing. It is yet another gateway to you, and can be the bridge that helps a prospective patient decide whether or not you and your practice are the right choice for them. Remember that even before a patient ever picks up the telephone to call your practice, they most likely have looked at your website and developed an ‘emotional’ opinion about you and your practice that may significantly influence them in taking the next step to call for a consultation. • What message does your Facebook Page give about you and your practice? • Does it engage and maintain interest? • Do people want to “FRIEND” or “LIKE” you? • Are friends referring YOUR page to their friends? Some of you might find yourself saying “WHO CARES?” Well, we do. Why do we care? Because at BIG Medicine Magazine™ we know how important making a first impression is, no matter where that impression is made. In today’s online community making a good first impression is more important than ever.

How SOCIAL Are You? What is seen on social media networks and in e-newsletters and announcements is now influencing the decisions of everyday people. People are sharing their experiences with their friends and colleagues, experiences that can influence their future buying decisions too. Remember this; Medicine is a commodity.

DID YOU KNOW? There are now over 1 billion daily users on Facebook and over 30 million exchanges of content are made each month online. People are ingesting content and information on a moment to moment basis. How you build your social media network and share content is up to you. However, one thing we can be sure of is that Facebook and other Social Media networks ARE NOT A FAD! They are here to stay. Social Media can be likened to a cocktail party. When you meet someone at a cocktail party the general rule of thumb is to introduce yourself, get to know them, enjoy the conversation and, if appropriate, share business information. Think of Social Media as a cocktail party. Generally speaking, it is a forum where people go to connect and interact with others like them. People do not go onto Social Media sites to be sold to. However, once you develop a network, interact with them in a favorable way, and create a safe environment, the chances of you selling your product or service to that network increases tremendously. So remember, go to the party to have fun. Great things await you!

The Social Media Revolution Here Are 6 Clever Thoughts! 1. To gain people’s trust, make sure the tone in your Social Media posts sound friendly, honest and call for interaction 2. Be more personal. Adding photos on your Facebook, Pinterest or Instagram accounts, will make you more approachable but do remember that you are a doctor first and that a picture can speak a thousand words 3. Don’t go overboard. We know you want to add friends, and you may be using an add-friends software program, but you should add no more than 50 friends a day, otherwise it might come across as spam 4. Remember, people love to look at pictures and videos. Use them in your messaging campaign 5. Interact with others on Facebook and Twitter. Create conversations and engage with other people’s conversations 6. IMPORTANT! During all of your social media marketing efforts, make sure that you remain professional at all times. It is fun to be engaging and personal, but remember when and where to draw the line

7 Tips for Measuring the Return On Your Social Media Investment Joining the Social Media revolution is exciting but most of us still need to know what the bottom line is, i.e. is your investment producing new prospective patients and branding your practice effectively? Here are 7 tips to help you measure your Social Media Success! 1. Focus on the metrics that drive the bottom line:

Measure key performance indicators such as subscriber growth, share of conversation, inbound prospect traffic, patient conversions and interaction

2. Measure what matters and analyze changes:

Measuring share of voice demonstrates where you rate next to competitors, but understanding why your share of voice has increased or decreased can help with future messaging techniques

3. Measure and plan social activities within the media mix: Campaign success can be measured and reported by analyzing monthly results of all media, including traditional media, blog impressions, tweets, website, etc.

4. Set Social Media goals:

If your goal is to increase the number of subscribers or inquiries to your medical practice set the number

anticipated and track it

5. Tracking: There are many CRM (customer relationship management) software applications available. Using one to help with tracking can be very helpful for all your Social Media and Traditional Media Marketing campaigns

6. Create your own social ROI executive dashboard:

Today’s social scorecard details has fans and followers, social mentions,

prospect traffic and valid leads

7. Don’t forget the human side of analytics: The tools available through CRM and other tracking services are only as effective as the person using the tools and the clarity with which you are guiding them

Here’s To Your Health Did you know that the Centers for Disease Control stated that four out of five U.S. adults do not meet the basic guidelines for healthy physical activity? While this may not come as a surprise to any of us in the health care industry, let’s face it many of us have seen the movie “Supersize Me”, but what may come as a surprise to you is how this statistic can be of benefit to your practice. Research by the Center for Medicare and Medicaid Services shows national health care expenditures are nearing $3 trillion dollars per year. And it seems that doctors, engineers and entrepreneurs in the health, telehealth and wearable device industries are embracing new technology that can literally put more new patients at your fingertips daily! Everything from digital heart attack detector implants, on-line personal training, mobile app physical exam scanners, virtual doctor visits, wearable biosensor “tattoo” stickers that measure vital signs and secure medical social networks, to name a few, are available to you and your patients on your laptop and on your phone.

Just imagine the possibilities of practice growth available to you. The sky’s the limit. Or, as singer/songwriter Paul Simon might say, “one man’s ceiling is another man’s floor.”

Get Smart! According to a survey by American HER Partners of 696 physicians, 150 allied health professionals totaling approximately 1500 responses, doctors in a clinical work setting say they use their Smartphones to: 1. Send and receive emails (65 percent) 2. Use apps (51 percent) 3. Instant message (50 percent) 4. Researching information about medications (35 percent) 5. Communicating with other physicians (32 percent) However, when they switched “smartphones” to “tablets” well, judge the findings for yourself. 1. Send and receive e-mails (52.4 percent) 2. Access electronic health records (50.6 percent) 3. Access diagnostic information (41.7 percent) 4. Research information about medication (33.3 percent) 5. Staying up to date with medical journals and papers (29.8 percent) Embracing new technology is nothing new to a physician. Using that new technology in a meaningful and more useful way is. Using what’s convenient – the Smartphone, versus using what’s easier to read – the Tablet – especially for EHRs on a wider screen. Next time you’re asked what you would like to receive as a gift, hopefully this tidbit of information will help you Get Smart about your decision.

Who’s Really Making The Moola? Forbes Magazine released the results of a survey they conducted on the Highest Paid Jobs for Doctors in the USA. Ever questioned your medical specialty of choice? Here’s a look at where the money is when it comes to doctor salaries last year. 1: Orthopedic Surgery - $563,074

6: Urology - $420,516

2: Invasive Cardiology - $532,000

7: Ophthalmology - $384,000

3: Gastroenterology - $521,216

8: General Surgery - $367,885

4: Dermatology - $471,555

9: Emergency Medicine - $306,682

5: Hematology/Oncology - $427,000

10: Obstetrics/Gynecology - $301,737

Did you notice not a squeak about the salaries of aesthetic surgeons which leaves us to summize that you are either a bunch of wonderfully philanthropic gift givers or you’re not fessing up. Either way, it will be interesting to compare these salaries in years to come as health care cuts and budgets continue to affect medicine in general.

HELP! I’m Going On Skype Meetings on Skype, Google Hangouts and other Internet video communication centers should be taken as seriously (or even more so) than regular in-person meetings. When you conduct a meeting where someone is looking directly AT YOU from their computer screen you might as well be under a microscope. Not only can they see every flaw about you, but everything that surrounds you, on your desk and is over your shoulder. If you are considering becoming a member of any website that offers patient concierge services or are being interviewed on-line by a national news organization, Here are the TOP THINGS TO CONSIDER WITH ON-LINE INTERVIEWS 1. Dress professionally. Either in a business suit, lab coat or even scrubs 2. Make sure your name is obvious. Embroider it on your lab coat or scrubs, display it on your desk, or even along the sides of your glasses if you wear them 3. Hair and make-up is very important. Keep it clean, keep it fresh. Brush your teeth, making sure to not have any trapped food, especially in your front teeth 4. Position yourself so that you are seated at a good height in front of the camera and are not continually leaning forward and peering into the computer screen. Try and hold still and appear relaxed. The bandwidth of the Internet connection rarely moves as fast as you do and you will appear both jumpy, pixelated and delayed to the viewer 5. Set up a pre-call with yourself so that you can view what a patient or caller will see and hear when they connect with you 6. Make sure the space around you that is in the lens of the camera is tidy. Do not have any patient charts on your desk or any clutter surrounding you 7. Be seated in a position where nobody will be walking behind you at any time during the conversation. You should be the ONLY person on the camera, unless it has already been arranged for more than one person to be on the video call 8. Do not sit against a window with a view to the street or a view where there is any activity going on behind you 9. Be sensitive to how what you are wearing looks to the viewer. Male docs – keep the hairy chest covered. Female docs – no cleavage. 10. Most of all be prepared, be relaxed, be on time and be present

Red Carpet RETAIL While on-line shopping and on-line consultations are at an all-time high, let’s not forget that the real way that doctors treat patients is in person at their brick-and-mortar medical offices. Traditional retail businesses such as Macy’s and JC Penney, while continuing to see their on-line sales increase, understand the need for continuous branding in the form of customer visits to their stores. Recently they began offering craft workshops and yoga sessions (among other things) at several of their locations and, while they did see some people leave the stores empty handed, they say what they reaped in terms of customer and brand loyalty was priceless. Here are a few ideas of ways you can keep patients coming back: • Offer a monthly Beauty Bar – a casual event where patients can learn about the new non-invasive health and beauty treatments that you offer • Develop a Retail Center offering a variety of skin care products, recovery garments and health supplements that will keep your patients coming back in to purchase more • Team up with a local Fitness Pro and offer a monthly fitness activity such as a morning walk, or late afternoon run. Building team spirit among patients and staff can be very influential and develop a great referral network

Connect with a local charity and raise awareness by offering monthly promotions with a portion of the funds going to the charity of your choice.

What EMPLOYEES Do When YOU Are NOT In the Office? Many of us think that the best way to get an employee to do a good job is to watch over their shoulder and give constant direction. However, according to a new study authored by Harvard Business School Professor Ethan Bernstein, that assumption couldn’t be further from the truth.

The study lasted five months and the staff were shielded from their manager. Here are the details: • 10 to 15% were more productive, than those staff members being observed • Employees were more resourceful and thought decisively when left alone • Workers were more efficient as they felt less pressure • Camaraderie among workers was higher

Next time you’re out of town make sure you have left instructions on the work you expect to be accomplished during your absence. Then go and enjoy your trip with the assurance that while the cat’s away, the mice will most likely get the job done.

To Network or Not Deciding where to spend time on social media networks leaves many of us perplexed. According to the Pew Research Center, three out of four Internet users are on social media. Their site preferences, however, are split. Perhaps these statistics will help you decide where to best place your efforts. • 71% of Internet users like Facebook, and nearly half of them are seniors • 22% of Internet users like Pinterest and LinkedIn. Those users with a college degree and an income of at least $75,000. prefer LinkedIn, and four times more women than men use Pinterest • 18% of Internet users like Twitter and Instagram • Instagram users are aged between 18-29 and that demographic has increased from 28 to 37% since 2012 • Few Internet users over the age of 50 use Twitter or Instagram

Want To Do MORE Of What YOU Are Good At? In the early days of practice building most physicians find that they enjoy wearing lots of different hats as they begin to grow their business. When the practice is more established they become better skilled in their chosen medical profession with a patient base that supports the practice specialty. However, with success comes less time to do many of the smaller daily tasks, and the only way to continue to grow is to hire people to help. So how do you do more of what you are good at and turn the rest over for other people to manage? Here are a few hints at what Corporate America does. • Hire an experienced Practice Manager or CEO – one who sees the business growth potential and one that understands your specialty • Take an inventory of what is lacking at the practice in terms of staff support • Ask colleagues what their best hiring practices are • Look for real talented people. Don’t hire based on hourly wage acceptance

Hire people who are as good at what they do, as you are at being a doctor.

Thinking of Going Into Private Practice? 5 Reasons Why a Small Practice Should Incorporate Making the leap from medical school student to medical practice owner can be a challenge. Setting your medical business up as a business entity at the start of your career can save you countless headaches in the future. Formatting your practice as a Corporation or a Limited Liability Company (LLC) can offer a range of advantages. Most notable is that a Corporation or LLC protects your personal assets should a case of debt or a legal judgment be claimed against the business. 1. Personal asset protection 2. Additional credibility and name protection 3. Perpetual existence 4. Tax flexibility 5. Deductible

Should You INCORPORATE Your Practice Or Form An LLC? Consider This!

The chart below can help you in your decision-making: Sole Proprietor Benefit Owners have limitied liability for business debts and obligations Created by a state-level registration (usually protects the company name) Business duration can be perpetual May have an unlimited number of owners Owners need not be U.S. citizens or residents May be owned by another business, rather than individuals May issue shares of stock to attract invvestors Owners can report business profit and loss on their personal tax returns Owners can split profit and loss with the business for a lower overall tax rate

LLC

C Corp

• Corporations and LLCs are separate legal entities (business structures) that enjoy certain protections under the law. Most people form a legal business structure to safeguard their personal assets. Even if you don’t have any personal assets yet, hopefully you will in the near future. • Incorporating or forming an LLC allows you to conduct your business without worrying that you might lose your home, car, or personal savings because of a business liability.

Deciding Which Business Structure is Right for You Choosing the right type of company structure for your new practice/business helps maximize your chances of financial and operational success. To get the most out of your medical practice, ask your attorney or accountant to help you select the right structure.

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The Trickle DOWN Factor An Imaginary Story. Or is it? The doctor arrived at his office at his habitual 8.50 a.m., and he strolled up to his office via the back stairwell. After calmly entering the back entrance of his established medical practice, he proceeded to hang up his jacket, gave his briefcase to his nurse (who handed it over to his personal assistant) and went into the locker area to change into clean scrubs. From there he went to the OR area and began to scrub in for his first surgery of the day. It never occurred to him that surgery was scheduled to begin promptly at 8.30 a.m. as he had requested. Nor did it occur to him that his staff, patients and anesthesiologist were waiting on him. Or that this 20 minute wait was going to put his whole day’s schedule behind…… again! Surgery went very well as expected. After all, this wasn’t your average medical doctor, this was one of the world’s most premier cosmetic surgeons and the results of his work were known throughout the world. His reputation was stellar. And his

TV presence was untouchable. The other three surgical procedures he had scheduled that day also went well, exceedingly well.

At 1.30 p.m., the doctor was finished with surgery. He came out of the OR area, quickly showered and changed into his tailored suit. Breezing through the back of the reception area, he noticed that the waiting room was crowded. It looked like a busy afternoon of consultations was waiting for him. He stepped into his office and closed the door. The next minute his personal assistant came in with lunch and a stack of files to be reviewed, letters to be read and checks to sign. He insisted that this be done everyday so he could keep on track of paperwork and still do surgery every day. The only problem was, he was almost one hour behind in the day now. (Damn it.) He had a few bites of lunch, quickly looked at the afternoon patient files and then, perturbed, he told his personal assistant that because he had been overbooked with too many patients again, he would not be able to go over any important paperwork until later. With that he began his round of consultations, getting more and more irritated with each one, although his patients would never

He felt like a hamster on a wheel, the wheel he had been running on for the past decade of his practice life. know of his inner angst.

He was a medical doctor, a plastic surgeon, and one of the finest. Medical school did not prepare him for the real world of managing a business. Everything he had learned about running a medical practice came out of fellowship training, personal hard work and determination. He had not been taught anything about business, and after all these years in practice he still didn’t get it. He was fortuitous, however. The effect of his business naiveté was not diminishing his wallet. He was making ample money and, by all appearances, has reached the heights of success. However, keeping up with this pace was taking a toll on him and he knew he needed to make changes.

He was getting to the point of realizing that “it all trickles down from the top.” In other words, the ramifications of his daily habits and actions were having a direct impact on his staff, his practice and his health. It was time to make a change. Does this sound familiar to you? Many doctors feel that they have a little bit of this person in them. Others have a lot. Wherever you fall on the scale, however, there is always room for change and practice growth. The first realization that you are at the top of the pyramid can be quite daunting. You might even feel unbalanced, or unsteady. However, once you realize that by focusing your attention on making sure that your first step everyday is the right one, pretty soon your confidence and tenacity will grow as you realize that your staff is following every step you take.

Leader Worthy Traits In the book, Lessons From The Top: The Search for America’s Best Business Leaders, Howard Schultz, the CEO of Starbucks, made the following observation: “I think it’s very difficult to lead today when people are not really truly participating in the decision. You won’t be able to attract and retain great people if they don’t feel like they are part of the authorship of the strategy and the authorship of the really critical issues. If you don’t give people an opportunity to really be engaged, they won’t stay.” As a medical doctor you really are similar to other entrepreneurs with employees and one of your primary goals should be to attract (and keep) motivated staff. So let’s explore the six key traits that will help you become the kind of leader people love working with.

1. The BIG Medicine Vision As the leader, you must communicate your vision, or the vision of your practice, to the people you want to follow you. To do this, paint a picture with words. Speak it, write it, and draw it. Whatever methods you can use to create a picture, do it. As they say, “A picture is worth a thousand words.” Ask each of your staff members to repeat back, in their own words, about the vision of the practice. How close is it to what you thought they understood? Is your team on the same page as you? Your practice vision should be in your mind every day, and you should reevaluate it occasionally so that it stays current.

2. The BIG Medicine Passion We all want passion. You want passion. Your employees want passion. In fact, some of us will travel to the end of the earth for it. Christopher Columbus explored unchartered territory. Why? Simple. His leaders’ passion inspired him to take on new and very dangerous challenges. For you to build an extraordinary medical practice you have to get your team really excited about you and your vision.

3. The BIG Medicine Decision You must learn to make sound decisions. How are major decisions made at your practice? What is your process for making them? Some leaders have a set process. Others meet with their management team, while others fly by the seat of their pants. Most of all you don’t want to become an isolated leader who doesn’t consult anyone before making a decision.

4. The BIG Medicine Leader To become a great leader, you must develop a great team. But how do you do that? You can start by carefully handing off responsibility to your team and letting your team run with it. Don’t breathe down their necks and DON’T micromanage! DO make yourself available if questions or problems come up. Don’t forget to use humor to keep your team’s spirits up during a crisis. When an emergency hits, your team will look to you to be a tower of strength, endurance and leadership.

5. The BIG Medicine Character Without character all the other “key traits” are meaningless because it is your innate character strengths and limitations that play a critical role in your leadership style. The real question is, are you aware of just what role you play? All great leaders have taken steps to learn about their individual personality and what part it plays in their leadership style.

6. The BIG Medicine Clarity If you are able to explain complex ideas in a clear and simplified manner, you will ultimately achieve the best result. Make sure that everyone on your team is crystal clear on their specific task, roles and responsibilities.

Learning your personal leadership style through a simple assessment such as the popular Myers-Briggs Assessment, can help you begin to understand how you can effectively manage your medical practice all the way to the top. As Nike says, “Just Do It”.

Fingerprint Is The Same

You’ve heard all the clichés about individuality. You know, things like “you’re one of a kind”, or “one in a million”, “cream of the crop”, you get our drift. True as those clichés might be, many doctors don’t see themselves as individuals. They see themselves as part of a specialty within the medical field. They see themselves as more experienced than other members of that specialty, less experienced or about the same. But they don’t necessarily see themselves as being unique. However, if you asked 100 or more patients why they selected you or a particular doctor to treat them, each of their answers would be different.

In recent research by BIG Medicine Magazine we asked patients this question and received some surprising answers: We asked patients if they remained loyal to their doctor. 82% said YES! 14% said NO. Out of that 82%, 65% said they remained loyal because their doctor listened to them and treated their needs. The remaining 17% said they felt their doctor was well informed, up to date and cared about their general health. The 14% that said NO told us that they were unhappy and disloyal based on reasons such as the doctor’s office was too busy, and they had to wait too long which made them feel unimportant.

BIG Medicine Magazine asked 100 patients: Is a doctor’s website important to you? 85% YES

15% NO

Is a doctor’s staff important to you? 88% YES

12% NO

Is a doctor’s surgical and academic training important to you? 100% YES

0% NO

Is a doctor’s office décor and level of comfort important to you? 91% YES

9% NO

Is a doctor’s reputation important to you? 99% YES

1% NO

Are you more likely to book a consultation with a doctor you see in a TV interview? 78% YES

22% NO

Next time somebody asks what is unique about you, your answer might simply be “I care about my patients”. However, to learn more about finding out how truly “unique” you REALLY are then take our Unique YOU Quiz. Go to www.bigmedicinemagazine.com/uniquequiz.

FIRE YOURSELF TODAY!

Regardless of how long you have been in practice, the moment you step back and fire yourself and become an OWNER rather than an employee, or the doctor, is the day when you will take full ownership of YOUR future. Start by choosing your date of termination from being an operator to an owner. Make it official and shift your thinking. You will be amazed at what you can begin to create when you have an owner’s mindset.

All work and no play makes for a DULL doctor!

What to STOP and START Sales and Marketing are number one in the big world of business. However, not all marketing is equal. Regardless of your medical skills and practice reputation, sales and marketing is the POWER that drives a medical practice. Before engaging in any kind of marketing, or hiring a firm to help you, you must first determine WHAT it is you are creating

When Was The Last Time You Played Charades?

and WHY you are creating it. What Do You Need To STOP doing? •

STOP wasting time and money hiring the wrong people.

•

STOP thinking you can save money by doing your own marketing.

•

STOP relying on only one aspect of marketing.

10 Top Ways To Have MEDI-FUN!

•

STOP thinking that if you do what somebody else did, it

• Play miniature golf

•

START thinking like a BUSINESS OWNER, not a doctor.

• Sky dive

•

START to organize a more cohesive, LONG and SHORT term marketing plan.

• Go bowling

•

START to be the practice LEADER.

• Eat something delicious and OFF diet

•

START avoiding (or stay away from) the pessimists.

•

START to do MORE of everything – promos, parties, networking, creating, training, motivating.

will work for you too. What do YOU need to START doing?

• Watch a funny movie

• Try paddle boarding • Take up painting • Participate in a Mud Run • Fly a kite • Play Charades

Who WhoAre AreThe The Power PowerPublicists? Publicists? OK. So we’re biased. BIG Medicine Magazine™

OK. So we’re biased. BIG Medicine Magazine awards Angela O’Mara and the team at The awards Angela O’Mara and the team at The Professional Image, Inc. with the BEST medical Professional Image, Inc. with the BEST medical publicist’s award. Besides the fact that Angela publicist’s award. Besides the fact that Angela is Editor-in-Chief of this magazine, here are the is Editor of this magazine, here are the reasons reasons we vote her agency and the TPI team as we vote her agency and the TPI team as TOP TOP POWER PUBLICISTS! POWER PUBLICISTS!

• In 1988, TPI was the First PR Agency to meet with Women’s • In 1988, TPI was the First PR Agency to meet with Women’s Magazines editors and New York media to discuss consumer Magazines editors and New York media to discuss consumer interest in aesthetic surgery interest in aesthetic surgery. • First PR agency to represent individual surgeons to the • First PR agency to represent individual surgeons to the media media. • First PR agency to work with hit shows ABC’s Extreme Makeover, E! Dr. 90210 as well as a host of other TV networks • First PR agency to work with hit shows ABC’s Extreme and news shows worldwide Makeover, E! Dr. 90210 as well as a host of other TV networks and news shows worldwide. • First agency to be invited to speak at medical industry events to explain the benefits of PR and Marketing to • First agency to be invited to speak at medical industry doctors events to explain the benefits of PR and Marketing to • doctors. First agency to help medical departments of major Universities host successful commercially sponsored • First agency to help medical departments of major educational and surgical post-graduate paid events for Universities host successful commercially sponsored doctors educational and surgical post-graduate paid events • for doctors. First agency to put together the aesthetic industry’s largest multi-disciplinary medical teaching event • First agency to put together the aesthetic industry’s largest • First agency to write a guide book on The POWER of PR for multi-disciplinary medical teaching event. medical doctors • • First agency to write a guide book on The POWER of PR for Most personable, qualified and creative staff medical doctors. • The best genuine British accents • Most personable, qualified and creative staff. • The best genuine British accents.

Ten Ways To Effectively Manage Your Day

Start Early and Plan Ahead!

Starting your day 15 minutes earlier each day, can add an extra 30 more minutes of productivity to your day. Also, if you spend the last 10 minutes of today planning for tomorrow, you will be off to an immediate fresh and focused start each day!

Make Lists and Take Notes!

No one has a perfect memory, so the best way to remember what needs to be done is to make “to do” lists. One of the biggest time wasters is trying to remember what you have to do. Writing your task down takes only seconds as opposed to the countless minutes it will take to recall what needs to be done.

Don’t Wait On Waiting Time

Time spent waiting doesn’t have to mean lost time! Many of us find ourselves arriving too early for an appointment, or waiting on someone who is late for an appointment. Use this waiting time effectively by doing small tasks such as sorting through mail, writing tomorrow’s “to do” list, writing down new ideas, returning calls, checking email, etc. Just because you have to wait doesn’t mean you can’t be productive.

There is an effective shortcut for almost every task you do. Finding these shortcuts and putting them to work can save you time on a daily basis! Is there a shorter route to work with less traffic? Use it! There are many ways you can maximize your time by using effective shortcuts. Just make sure they do not negatively impact the end result.

Handle The Small Tasks First

If you think a task is going to take less than two minutes to get through, do it as soon as possible! It will make you feel that you are getting through your “to do” list faster and the day will seem less overwhelming.

Group Similar Tasks Together

If you have a list of calls to do today, group them all together. The same goes for medical file reporting, new business proposals, patient reports, bill paying, etc. Switching between different tasks can be distracting as it takes a moment or two (or more) to get focused on the task at hand. By grouping similar activities together, you will save valuable time, be more organized, efficient and very productive.

Use Shortcuts Effectively.

Get Rid of Distractions!

The modern world is full of constant distractions, cell phones, email, staff, patients and even other doctors can distract you from your day. Scheduling all of these distractions at a set time is one of the best and most effective ways of getting the job done in a shorter amount of time.

Stock Up On The Basics

How many times have your run out of necessary surgical supplies or even simple things like copy paper just as you have needed to print a report? Doing a weekly inventory of your office and surgical supplies will ensure that you never run out of the basic necessities. Having to make a mad dash to stock up on daily items adds unnecessary stress to the day and wastes time.

Set A Pattern For Your Day

Most of us have certain responsibilities and activities that take place daily or weekly. By setting a distinct pattern for when you tend to these activities and responsibilities will help you organize and manage your time better. Ask yourself: should I book all surgeries in the morning? When should I attend to staff and sales calls? Where do new patient consults and post-op appointments fit in? When should I handle administrative duties and paperwork?

Organize! Organize! Organize!

How much time is wasted on looking for misplaced items? Make sure to keep your business and living areas organized at all times. It will save you a significant amount of time. And remember, saving time equals making money!

Where There’s Money There’s MISCHIEF!

For one doctor it started with medical vendors thanking him for paying them twice in one month. For another doctor it started with a few missing checks. For both of them, they were seeing a shrinking profit margin, higher overhead, unnecessary purchases and undocumented bonuses. Busy with patients, staff requirements and insurance outlay, the doctors rarely took time to review their accounts, trusting that their finances were in the hands of a loyal and dedicated employee. Employee embezzlement has reached epic proportions, costing U.S. businesses some $652 billion annually, according to the Association of Certified Fraud Examiners. www.acfe.com. Medical groups are particularly vulnerable, especially those in private practice. Many physicians grant exclusive bookkeeping authority to one person. Some even give that person power of attorney over the practice. Both of these are fatal mistakes. According to experts there are classic mistakes doctors make. • They don’t review their credit card statements • They don’t always sign their own checks • They do not keep track of insurance billing and reimbursement • They don’t review in-house bookkeeping records or patient payment schedules • They don’t monitor bank deposits or know when a reimbursement check was received, or when cash was used as payment • They don’t compare regularly (if ever) the in-house bookkeeping record against the bank statements Becoming familiar with employee theft and embezzlement schemes can help you formulate protective strategies. Many thefts occur at the front desk, where employees simply pocket the cash paid for copays and other fees. The office checkbook is another popular method for misappropriating funds. The person committing fraud simply writes a practice check for personal use and then records it in the check register as a practice expense. Dishonest employees in smaller practices (who handle most if not all of the accounting responsibilities) have been known to open a second account in the practice’s name, deposit money into it using a signature stamp, and treat it as their own. The physician never knows the account exists. Patient refunds are another favorite among petty thieves. Larger practices process hundreds of refunds a month, so it’s easy to process five or six fictitious ones using a patient’s name (or an invented one). The employee then takes the falsified refund checks and deposits them into their own account using an automated teller machine (ATM) and they almost always get away with it.

There are many ways to catch a thief, and many more ways for a thief to ruin you. Be on your guard!

Can Spelling Mistakes Cause A Loss In Revenue? According to a recent article published by the BBC (British Broadcasting Company), poor spelling can cost millions of dollars in lost revenue for internet businesses. Entrepreneur Charles Duncombe says an analysis of website figures shows a single spelling mistake can cut online sales in half. Sales figures suggest misspellings put off consumers who could have concerns about a website’s credibility. Poor spelling is a serious problem for the online economy, he says. Most medical practices now have an on-line presence, be it a website, blog or social media page. However, when a patient contacts your office asking questions via email, the questions to ask yourself is “who is answering these emails,” and “can they spell correctly?” Remember, 99% of the time, on-line communication is done using the written word. Even college graduates are using text speak in their communication. As time consuming as it seems, you might want to review all document templates used by staff members, and monitor outgoing emails to make sure that spelling mistakes are not costing you money.

Who’s Looking After

Your Parent’s Money? Like everyone else, physicians have aging parents with personal and financial needs. But who will take the reins when your parents are no longer able to do so? What if the stress of managing your parents and their finances becomes a burden to you, or worse, causes fall outs within the family unit. BIG Medicine Magazine™ talked to Herb Cohen, of Fiduciary Plus. Herb has worked with many physicians in this regard.

My father-in-law was well into his 90’s when he was hospitalized and began a quick descent, health wise. His situation was further complicated by living some 3,000 miles from my wife and me, the only people willing and able to help with medical decision-making, residence choices, and management of financial affairs. This was a difficult learning experience and one that made me think about who would be there to help if family is not available, or family dynamics rule out one or more relatives. The answer turned out to be licensed private professional fiduciaries who, by court appointment, serve as guardians, conservators and personal representatives of estates. They also serve by agreement as trustees, representative payees, or as agents under powers of attorney. Additional information is available on the Professional Fiduciary Association of California website [www.pfac-pro.org]. Outside of California go to www.guardianship.org. After this situation with my family I decided to use my prior legal and financial experience to become a private professional fiduciary. I serve my clients in one or more of the above capacities. A typical client is between 75-100 years of age with no children; or the children are otherwise engaged; or there is conflict, and possibly litigation, among family members; or the parent passes away without an estate plan. A professional fiduciary can help ease the pain among family members by acting as an unbiased liaison and expert decision maker during this difficult time. A memorable case is where an MD client with a family and busy practice came to know that his adult sibling was stealing from their elderly mother’s trust and brought suit against the sibling. The forensic accounting that I produced documented the theft with the information used to remove the sibling as trustee and bring charges against him. None of us want to think that this type of thing happens in families but, unfortunately, it does. Most physicians, or parents of physicians, probably have planned their future by preparing an estate plan in consultation with legal and financial advisors. They may even have periodically amended the Plan to reflect changing circumstances. But the weak link often is implementation at a stage in life when one is least able to take care of financial choices. Often times, when this situation is finally realized by other family members it can be a mess to sort out. What to do? The chart below will identify the primary alternatives of who or what is able to assist you, and the up and down side to each. Family Member or Good Friend to serve as power of attorney, successor trustee, or executor

UP SIDE: high level of trust; little or no cost

Financial Institution – Trust Banks or non-profit entity

UP SIDE: professionals; no concern for succession; large staffs

DOWN SIDE: nominee not capable of dealing with complexities nor available when the need arises; distrust within family

DOWN SIDE: expensive; bureaucratic; inflexible. Focus is on managing finances not personal or health matters Licensed Private Professional Fiduciary

UP SIDE: licensed by a State Agency with public disclosure; bondable; moderate expense; personal service DOWN SIDE: potential succession issues; geographical reach is limited

As physicians, you make medical determinations about the competency of your patients and address insurance matters, HIPPA rules, and the concerns of your patients’ families. A licensed fiduciary can do that too. You pay bills, including taxes, and spend time with investment advisors. As do I in my capacity as power of attorney, successor trustee, conservator and/or estate administrator. Just as physicians have a professional but intimate relationship with their patients, so do licensed private professional fiduciaries. The relationship starts with one or more meetings and the fiduciary’s review of the documents which govern their responsibility and liability to the client and his/her family. The critical element is trust and confidence, as it is in a medical practice. The fiduciary has the legal and ethical responsibility to carry out his clients’ wishes, and the client has to have trust and confidence in the fiduciary to do so.

Keeping a family happy is important. Keeping an aged parent safe, secure and living within the means they planned for is imperative.

The Year of The Entrepreneur 2014 will be a year of many big ideas, because it will be the year of the entrepreneur. This year has seen the growing trend of entrepreneurship being embraced as a positive way to create the jobs of the present and the future. From being a dirty word in the past, now entrepreneurship is increasingly being celebrated and encouraged - as it should be.

There has been a surge in the excitement surrounding start-ups, from Silicon Valley to Silicon Roundabout and beyond. Many internet start-ups came to fruition, and big businesses went public, creating enormous wealth for their founders. That generation are now setting up new businesses, helping to create more jobs and stimulate more innovation. Jack Dorsey from Twitter didnâ&#x20AC;&#x2122;t rest on his laurels after launching Twitter, he is now taking Square from strength to strength and I expect to see more entrepreneurial ideas from Jack and his peers in the coming year. I believe 2014 will be the year of the entrepreneur more than just in California. When visiting Africa, Australia, Europe, South America and the US this year, there was a real appetite for entrepreneurship wherever we went. We launched Virgin StartUp in the UK, and are receiving lots of applications from new businesses hungry to succeed. In South Africa and the Caribbean the Branson Centres of Entrepreneurship are overflowing with talented individuals eager to unleash their ideas onto the world. With the right support (financial and otherwise) they can and will. The entrepreneurs who will succeed in 2014 will need to focus upon having a purpose beyond profit for their business. A great example of this in the British Virgin Islands is an entrepreneur named Gumption, who we gave a

loan to start a glass-bottom boat company. He has paid back his entrepreneurial loan in full, and is now focusing upon his company becoming a force for good, helping protect turtles as well as entertain tourists. Technology is helping every business, large and small to move forwards, which will only increase in the coming year. Now, entrepreneurs can build companies at a fraction of the cost in the past. All of the little things that used to add up to big headaches for new businesses, from accounting to website development, are now available to small businesses, giving them the same capabilities as large enterprises at a cost they can afford. Because of this, new entrepreneurs have more time to think about the bigger picture and work out how to grow their

business, rather than fretting about every detail. Donâ&#x20AC;&#x2122;t get me wrong, there are still a thousand and one things for every entrepreneur to focus upon, and you need a great team of people around you and good delegation skills to utilise them. But now new businesses have more of a fighting chance. So, what is your big idea for 2014? Why not decide to set up the business you have always wanted? Screw it, just do it!

This article is part of a series in which LinkedIn Influencers picked one big idea that will shape 2014. Other contributors were: Jim Kim President at The World Bank Trish Regan Anchor and Editor-at-Large at Bloomberg Television Tom Gardner, Co-Founder at The Motley Fool Michael Andrew Global Chairman and CEO at KPMG Steve Tappin CEO Xinfu, Host of BBC CEO Guru & Founder, WorldOfCEOs.com Bill McComb Chief Executive Officer at Fifth & Pacific Companies, Inc. Walt Bettinger President & CEO at Charles Schwab to name a few. To read more go to www.linkedin.com.

A Media Mind Is A Terrible Thing To Waste We’ve all seen them. The press releases without a story. The publicist from hell who continues to relentlessly call a reporter or producer about the same product that has already been turned down more than…. five times! The ad copy that is borderline fraudulent. The overly exaggerated AFTER photo. Whether it’s a known fact or not, the truth is that people in the news are very busy people. Decline in advertising revenues in recent years has hurt the world of media at its very core – editorial – meaning that most major news outlets have suffered major cutbacks and staff layoffs and are operating with less seasoned writers, reporters and producers than ever. So, next time you are considering sending a news story to the media, or are hiring a publicist, please bare in mind that most reporters and producers these days have very little time to waste.

HOW TO GET THE MEDIA TO “LIKE” YOU • Make sure your news is “newsworthy.” The purpose of a press release is to inform the media of who you are, where you are and what your news story is. A press release should never be intended to make a “sale”. • Use a catchy headline. Start out strong. Your headline and first paragraph should tell the story, without giving it all away. • Writing for the Media. Your press release must be well written. In traditional media a press release will motivate a journalist or producer to consider doing an interview with you. • Not everything is news! Be careful not to gauge a story by your own personal level of excitement, or your own agenda. • Paint a picture. Illustrate with words your point of view and story idea as much as you can. • Get the facts. When dealing with the media (or with anyone for that matter) it is always better to tell the truth. Avoid fluff, embellishments and exaggerations or simply saying things to fill space. • Have a good angle. Every press release has to have a “News” angle. Without one it is not news. • Be brief, yet persuasive. A press release should be double-spaced and no longer than two pages in length. One page or one and a half pages are best. • Be brief. Fewer words are better. If you can use two words instead of four and still sound articulate and to the point, do it. • Avoid using clichés, slang or jargon. While you definitely want your press release to sound catchy and newsworthy, be careful of using slang, hype, clichés and jargon. • Don’t assume that the reader understands complex medical procedures. Write so that a person without medical training can easily understand your point.

Order Your Copy Today! LIGHTS! CAMERA! ACTION! The POWER of PR www.TheProfessionalImage.com

Where The Real Money Is YOU AND YOUR HABITS!

Personal habits, relationships, value creation basics and support structure add up to one thing = The Largest Check You Can Handle. BIG Medicine Magazine™ talked with John Davidson, Executive Head Coach and CEO of High Level Performance about how YOU can apply these four areas to your practice to attain optimal success and, yes, make money. What do you think is the largest check you can earn with the current state of these areas in your life? If you were to increase that average transaction size by 30%, what adjustments do you think you would have to make in each of these areas? • Personal Habits • Personal Habits • Support Structure • Relationships • Relationships • Value Creation Basics Let’s articulate your “Largest Check” strategy and “The Biggest Check” concept. Over time, as a physician you’ve grown your medical practice by asking certain fees for the medical services you provide. Whether you receive checks from elective patient procedures or from insurance companies, most times you get what you ask for, sometimes you don’t. Your experience is the total sum of all these checks (asking instances) that have occurred since the inception of your career. One recurring characteristic among physicians (and business entrepreneurs) is that they are “locked in” at a certain size check they can obtain consistently. All of your work habits, relationships, support system and the level of value you give patients are equal to the size check you can consistently achieve today in the marketplace. But tomorrow you want a larger check, correct? More income… yes? Ok, let’s look closely at the 4 areas that can increase that check size: 1. Work Habits. 1. Work Habits. Critical personal behaviors are: a. Always keep your word b. Finish what you begin

c. Be punctual, even early d. Never promise more than you can deliver

2. Relationships: 2. Relationships: Key relationships required: a. You have patient consults/surgery scheduled that will provide income within 90 days? b. You have other pending sources that will provide income that are over 90 days out? i.e., patient consults/bookings in the future, past insurance or other payments that are owed to you c. Do you have a clear plan as to what your next influential step with each area is? d. How intimate are you with your patient’s aspirations, dangers, opportunities, and strengths currently in life? How much range do your conversations have? 3. Support to reach reach and and maintain maintain this this new new size size check? check. How 3. Support System: What systems need to be adjusted, optimized, or implemented to well do you orient your business (practice) around your personal gift (surgical/medical skill)? Is your team (staff) able to support you adequately so that you spend time on your personal gift (surgery/medical skill)? a. How much time are you able to spend on areas where you truly are uniquely skilled? b. How much of the last 7 days did you work in activities that gave you energy? c. What capacity is your support system limiting you to? d. Is your support system uniquely capable of handling all the items you perform excellently, competently, and incompetently? e. How often do you work on their capability to become better at those tasks? Is it hit or miss? Or do you have a set time weekly to devote your energies to build them up? i.e. staff meetings, staff training f. How systematic and consistent is your support system? Does your team have routine actions? g. Are the systems illustrated or written to eliminate questions in the future? h. Do you have staff accountability? 4. Value Creation Basics: How can you build more value with each patient experience and with other relationships that will make a 4. Value difference and increase your net income? a. Not all of your relationships are considered equal b. 5% are responsible for 50% of your current revenue c. What unique process or program do you give your 5%? d. Can they get this total ultimate patient pclient experience anywhere else? e. How much time is spent working ON your unique process? Are you reacting to a problem, or the outcome of a problem, that organizes your daily practice life? You can either remove problems, or create desired goals, it’s your choice. I can attest that once you begin proactively looking at the four areas described, your ability to become a higher earner will instantly be heightened. The first step is choosing to become the predominant creative force in your life. You’re just seconds from crossing that threshold into new ground, the REAL MONEY is in organizing action from what you love, not from what you need to remove.

Lights, Camera, Help.....!!

What YOU Can Learn From A Real Housewife! Most doctors and medical professionals spend their time and energy caring for patients and perfecting their skills, not perfecting themselves for the spotlight of a camera. Now, however, with the growth of reality TV shows, video presentations on YouTube and the world of HDTV – using High Definition Cameras - the lens is bound to end up pointed at you and you need to be ready. BIG Medicine Magazine™ asked leading hair stylist and make-up artist Coby Knight, who recently worked on The Real Housewife television show franchise, for tips on how to look great, without looking fake. Hair and make-up – male and female – has never been as important as it is today, especially for those doctors that spend any amount of time in front of the camera, be it on a TV show, or videos on-line highlighting their practice. They say the camera does not lie. And with the new version of High Definition TV, many of my clients feel that the camera gets a little too ‘up close and personal’. As a hair stylist and makeup artist in the Orange County and Los Angeles areas for the last 18 years I have been able to help many people look and feel their best in front of the camera. Whether you are a model, a bride or a doctor, the quality of your hair and skin on camera is important. Recently working with the cast of The Real Housewives of Orange County, I had the opportunity to work with the leading cast members, as well as the many guests, including doctors, that made the show. I would like to share with you a few simple pointers that can prepare you for your close up.

Tips For Women: Foundation and concealer should be HD Makeup. HD Makeup reflects the lights and creates a smooth surface for the magnification of the HD Cameras. HD Makeup can be found at Sephora or Ulta stores. Choose one feature that you want to accentuate - usually eyes are a good choice because they show a lot of expression on camera. Wearing too much makeup, or attempting to accentuate all of your facial features (eyes, lips, cheeks, and brows) can give you a clownish appearance. Apply individual fake eyelash sections to outer corners of lashes to make your eyes “pop” a little. This will be very subtle, but will make a BIG difference on screen. Hair should look clean and simple. If you have bangs or layers around your face make sure they are slightly pulled back or swept to the side… if bangs/hair are hanging over your eyes, it will create a shadow and could be distracting. Don’t wear too much lip gloss. A little neutral color (light peachy pink) with a little shine is good. Too much shimmer or high gloss will be magnified on camera.

Tips For Men: Using a small amount of HD Makeup (foundation or concealer) applied with a brush or a sponge to areas where you have dark spots or imperfections will work well for you. Remember the HD lens will show everything and magnify things even more. However, when it comes to makeup on men, remember less is more. Make sure your hair is clean and simple. Do not use too much hairspray or gel as it can look shiny or stiff on camera. While I don’t encourage men to wear lipstick (or false eyelashes), a little Chapstick can go a long way. The cherry Chapstick brand works wonders as it moisturizes the lips and has a hint of color that will make your lips look soft and healthy. A smile goes a long way. Check your teeth up close. Make sure they are clean, flossed and that your gums look healthy. If necessary, there are some good over-the-counter bleaching products that can give you a quick Hollywood Smile!

Five Top Tips To Starting A Successful Business At BIG Medicine Magazine™ we are BIG fans of Sir Richard Branson. We admire him for many reasons including his entrepreneurial skills and his philanthropic contributions. Another thing that we like is how easy he makes everything look. Perhaps creating a multi-billion dollar business and living a lifestyle that most people only dream of is easy. What do you think? Here are Sir Richard Branson’s Five Top Tips For Starting A Successful Business as was written on his LinkedIn page.

“As LinkedIn is a business that started in a living room, much like Virgin began in a basement, I thought my first blog on the site should be about how to simply start a successful business. Here are five top tips I’ve picked up over the years.” Sir Richard Branson. 1. Listen more than you talk We have two ears and one mouth, using them in proportion is not a bad idea! To be a good leader you have to be a great listener. Brilliant ideas can spring from the most unlikely places, so you should always keep your ears open for some shrewd advice. This can mean following online comments as closely as board meeting notes, or asking the frontline staff for their opinions as often as the CEOs. Get out there, listen to people, draw people out and learn from them.

2. Keep it simple You have to do something radically different to stand out in business. But nobody ever said different has to be complex. There are thousands of simple business solutions to problems out there, just waiting to be solved by the next big thing in business. Maintain a focus upon innovation, but don’t try to reinvent the wheel. A simple change for the better is far more effective than five complicated changes for the worse.

3. Take pride in your work Last week I enjoyed my favorite night of the year, the Virgin Stars of the Year Awards, where we celebrated some of those people who have gone the extra mile for us around the Virgin world. With so many different companies, nationalities and personalities represented under one roof, it was interesting to see what qualities they all have in common. One was pride in their work, and in the company they represent. Remember your staff is your biggest brand advocate, and focusing on helping them take pride will shine through in how they treat your customers.

4. Have fun, success will follow If you aren’t having fun, you are doing it wrong. If you feel like getting up in the morning to work on your business is a chore, then it’s time to try something else. If you are having a good time, there is a far greater chance a positive, innovative atmosphere will be nurtured and your business will flourish. A smile and a joke can go a long way, so be quick to see the lighter side of life.

5. Rip it up and start again If you are an entrepreneur and your first venture isn’t a success, welcome to the club! Every successful businessperson has experienced a few failures along the way – the important thing is how you learn from them. Don’t get disheartened by a setback or two, instead dust yourself off and work out what went wrong. Then you can find the positives, analyze where you can improve, rip it up and start again.

Getting Psyched! At some point in your medical career, you will (or may have already) find that you have an unstable patient in your practice. While this is not the end of the world, it is an area that needs special attention, and extra special handling. BIG Medicine Magazine asked Beverly Hills, CA licensed therapist Carla Lundblade, M.S., L.P.C., N.C.C., to share her insights with us.

Beware The Fish That Swim With The Boat!

As a therapist and one who is trained specifically to look for stable/unstable patients, there are three rules that I use in my initial appointments to ascertain the mental stability of a patient. These are my three litmus tests that every patient must pass successfully for me to make the determination that I have a stable patient working through tangible issues, or an unstable patient that is dealing with intangible issues, or is one that is manipulating you as a doctor.

Three pieces of advice: 1. “Never do more work than the patient.” A patient legitimately seeking assistance will appreciate that there is no “magic cure” to any medical problem and be agreeable to utilize an array of treatment options (physical therapy, home exercises, etc.) in conjunction with medications. A patient who is reluctant to try these combined therapies is probably not looking for improvement and is showing poor judgment in considering helping themselves. The physician should verify that the patient is willing to try a variety of approaches including lifestyle changes of contributing factors to their issues, some of which can be very straightforward to try. If the patient is not willing, that is a huge red flag that there may be other things at work and the patient is not being honest. In addition, patients who report allergic reactions to several narcotics with the exception of one are probably not being honest, which leads me to my next point. 2. “How do you know your patient is lying to you? - Their lips are moving.” Search for consistency in the exam. Faking the injury or medical problem or convincing you that a medical problem exists is a significantly complicated feat for most patients. This gets even more complicated for the patient if the physician utilizes distraction methods. The doctor should navigate smoothly between the different parts of the assessment without allowing the patient a long period of time to respond to each one. While the physician ought to check uninjured areas initially and steer clear of abrupt movement, both fundamental for patient rapport, the examination of the injured area should not be scripted and questions be spontaneously asked relative to your observations. This allows for questioning the patient in novel ways that may get you more truthful answers and illuminate inconsistencies. Conduct appropriate tests. A patient needs urine toxicology testing. This is one of the most successful tests for scrutinizing patient behavior, it is underused. 3. “The patients you are drawn to the most are more likely to be the unstable patients.” Recognize suspicious behavior. Patients often reveal the truth of their condition through their behavior. Unstable patients flatter you and make you feel indispensable to their presenting problems. They may also tend to be impatient or obsessive, making phone calls both throughout office hours and after hours. They find doctors’ home phone numbers and other personal ways to connect. They frequently are no-shows for follow-up appointments and then will call in for a pressing appointment. They may request medications. When they receive prescriptions, many unstable patients are very flattering. They may hug you and exclaim; “You are the best doctor I have ever had.” On the other hand, repeated requests for medications or other unrelated therapy choices will often abruptly stop, and the flattery will stop when the doctor clearly states the treatment plan. Most patients who are making up a story or manipulating you sense when you are indecisive and so they press on to get what they want from you which may not be in their best interests.

Let’s Make It A CAUSE One of the more recent and popular forms of marketing is Cause Related Marketing. Many times, joining forces with a charity or cause that you feel passionate about can lead to a shared marketing campaign that benefits both parties. BIG Medicine Magazine asked Don Kilday, President of Crown Laboratories how his company uses this specialized niche of marketing to shed light on a big issue. The deadliest form of skin cancer is melanoma which, as we all know, is mostly preventable. One of our signature products, Blue Lizard Sun Screen, if worn daily and appropriately, can protect a person’s skin from devastating cancer causing sun rays. Over the years we have developed more and more ways to educate the public on the benefits of wearing sun screen and we have sponsored a variety of charitable causes that fit our company mission of providing sun protection to everybody, be it a sponsored walk for the American Cancer Society, or providing sun screen to local youth soccer teams. We see mutual value in Cause Related Marketing as it puts the best product (Blue Lizard) in the hands of doctors, cancer centers, and/or patients that truly have a REAL CAUSE IN PREVENTING SKIN CANCER. Several years ago, we were approached by a melanoma cancer survivor who was planning to walk 70 miles in five days to mark her fifth year anniversary of being diagnosed with stage IV melanoma cancer and to celebrate the gift of living a healthy, vibrant and cancer-free life! She was joined by her father. They started their walk in Napa, California and ended the walk in San Francisco. To help maintain a melanoma-free life, she wore SPF 30+ Blue Lizard Sunscreen for the duration of her walk. This symbolic saunter began on May 1st with the conclusion of her cancer-free journey on Monday, May 5th which was nationally recognized as “Melanoma Monday.” The final stage and 5th day of the walk featured her and her father crossing the Golden Gate Bridge and delivering a bottle of champagne (and a bottle of Blue Lizard Sunscreen) to her Oncologist. We supported the walk with many samples of Blue Lizard sunscreen for her to hand to other people as she walked, and our marketing team assisted her with obtaining media opportunities in the San Francisco area. This proved successful to our company and to the skin cancer survivor as she was volunteering for a variety of skin cancer charities that all benefitted from the media exposure our team garnered. This is just an example, there are many ways we combine efforts to initiate Cause Related Marketing campaigns in our company.

BIG Medicine Big CAUSE

This Issue’s Spotlight Alzheimer’s Research & Prevention Foundation www.alzheimersprevention.org

Each issue, BIG Medicine Magazine™ shines the spotlight on a non-profit organization that is making a difference. This issue we have selected The Alzheimer’s Research & Prevention Foundation, a 501(c)(3) charitable organization that since 1993 has been investigating a method of controlling the onset of Alzheimer’s disease. The Alzheimer’s Research & Prevention Foundation is investigating a specific meditation called Kirtan Kriya - a practice of the Kundalini yoga tradition. This practice holds tremendous potential to bolster the effects of medication and other strategies used to slow or prevent Alzheimer’s disease. The foundation believes it may even hold the potential to reverse memory loss.

• Every 70 seconds someone is diagnosed with Alzheimer’s disease • Alzheimer’s is the 7th leading cause of death in the US • One out of every eight people over 65 has the disease • One out of every two people over 85 is at risk for Alzheimer’s • Current estimate is 5.4 million Americans affected by Alzheimer’s • By 2050, it is estimated that 16 million Americans will be affected by Alzheimer’s

Why BIG Medicine Magazine selected The Alzheimer’s Research & Prevention Foundation! The Alzheimer’s Research and Prevention Foundation (ARPF) has been working toward the prevention of memory loss through education and clinical research conducted by ARPF in concert with leading medical centers at UCLA, UCSF and the University of Pennsylvania. Studies on this research have been published in prestigious medical journals such as the International Journal of Geriatric Psychiatry and The Journal of Alzheimer’s Disease. As a result of the extraordinary findings of these studies, Kirtan Kriya has been endorsed by the ARPF as a way to prevent Alzheimer’s disease. The technique known as Kirtan Kriya researched by the Alzheimer’s Research & Prevention Foundation is based on an established ancient yoga technique. Clinical research has shown this technique reaches the same areas of the brain affected by Alzheimer’s. With a focus on an integrative approach to prevention, the foundation is dedicated to helping individuals maximize brain health and function, regardless of age or stage of life. At Big Medicine Magazine, we like The Alzheimer’s Research & Prevention Foundation proactive approach to treatment. We also like that this method is easily accessible to everybody and that the Kirtan Kriya technique, although not a cure, potentially controls and slows the onset of Alzheimer’s, and helps improve memory. Clinical studies have also shown that it has therapeutic benefits for people with depression.

So You Want To Be A Doctor?

HERE’S WHAT YOU REALLY NEED TO KNOW! Not that we doubt you are questioning your choice of career, however, at BIG Medicine Magazine™ we do get lots of questions from doctors asking how they can adjust to this economy we call medicine so we asked Dr. Gregory Buford, a plastic surgeon and author of Beauty and the Business, for suggestions that might help you put your best surgical foot forward.

At the ripe old age of 7, I told my parents to stop calling me Greg and begin referring to me as Dr. Bill. Strange you might think, especially for a boy that did not come from a family of doctors and who did not know anyone named Bill. That was then, this is now and after years of training and perseverance I can now call myself “doctor”. This title has brought with it frequent requests to encourage others about a career in medicine. But, as happy as I am in my decision, I need to make a small confession. I do not recommend this path to just anyone. So why would I not recommend a medical career? The answer is complex and the journey much different and more challenging. To better understand how medicine has changed, we need to consider three factors: Technology, Relationships, and Entrepreneurship.

Technology. As much as we love to embrace technological advancements, they bring added responsibility to maintain a learning curve that is increasing at a rapid pace. Many of these new procedures, devices, and products were never dreamed of when we were in medical school and suddenly they are available to us. The challenge lies in determining not only how best to use them, but ultimately understanding their real efficacy. And while a new device may be beneficial, there may simply not be room in the budget to incorporate it. Relationships. More to the point, the patient-physician relationship. The Internet has forever changed medicine by providing immediate information on every aspect of health care that empowers patients with information they can use to better their health, making the patient more pro-active. With that comes responsibility for both parties to interact in a new way. Physicians must listen to their patients and patients must exercise compliance with their provider’s advice. Entrepreneurship. Physicians are taught procedures and how to deal with disease. We were never taught how to run a business. In fact, many of us were told (point blank) in our training that “medicine is not a business”. It should come as no surprise that many physicians face tremendous frustration coming out of medical school leveraged with debt, trying to start a practice, but not knowing where to turn for solid advice. Add to this a political atmosphere where the easy solution for cutting health care expenditures is simply reducing physician reimbursement and you are looking at an incredibly hostile and scary environment. So why do I keep practicing medicine? Simple. Medicine has changed, but many of the aspects that challenge us can become the same tools with which we can actually take health care to a new exciting level.

CONSIDER THIS! Technology. Is the lifeblood that allows us to achieve increasingly more natural and more durable patient results. Many of the procedures and devices we use were not available during our formal training. Tremendous responsibility rests on our shoulders to not only educate ourselves to this brave new world but also to learn how to effectively harness it through the appropriate training channels. Relationships.

Communication is another component of medicine that has changed dramatically but is actually changing for the good. We never expected to reach potential patients through blog postings but today this is a reality. As a frequent writer, even though I am working harder and longer to distribute information online, I am also creating a client base that is far more engaged and proactive in the health care delivery process than ever before.

Entrepreneurship. This may be the biggest challenge. I recently had the honor of joining the world’s largest group of innovators, the Entrepreneur’s Organization (EO). I joined because I was frustrated at what I felt was my lack of business acumen. I quickly became aware that running a business is not the most important key to growing a medical practice—entrepreneurship is. The days of simply hanging a shingle and waiting for patients to come are over. Through my interactions with fellow EO members, I have changed how I view my practice. I now view it as a startup. My product is good results but my ultimate goal is to bundle these results in a positive and branded patient experience.

“My gut feeling is that the new age of medicine lies in this direction and that those of us who heed the challenges and embrace them as stepping stones to a higher level will take health care, and their practice, to a new level.” Dr Gregory Buford.

January 24 & 25, 2015 LOS ANGELES 2015

RITZ CARLTON HOTEL Marina Del Rey, CA

Chairman: Dr. Lawrence Moy

NON-SURGICAL REJUVENATION AND REGENERATIVE TECHNIQUES FOR THE FACE & BODY Join us at the beautiful Ritz Carlton Hotel in Marina Del Rey on January 24 & 25, 2015 as we discuss and demonstrate the newest advancements in non-surgical approaches to facial and body aging. New techniques and technology for skin tightening including lasers, RF technology and other ablative technologies will be featured. Facial fillers, skin topicals, and other rejuvenative and regenerative approaches to aging will also be included in our lectures. Several of the leading aesthetic manufacturers will participate in on-going workshops and breakout sessions. AACD Los Angeles 2015 will include faculty who are recognized and established leaders within their specialty, as well as those that actively participate in aesthetic treatments under study or clinical review. It is our hope that you will want to be part of what will be an important and influential aesthetic and cosmetic dermatology meeting recognized for its scientific and academic leadership. We look forward to seeing you in 2015!

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A Night To Remember! It was a hot and sultry night as we celebrated A Night of Beauty and the launch of Dana Elise Solutions exclusive Vocal Facial and Luxury Membership Program at the world famous hip and trendy House of Blues on Sunset Boulevard. Surrounded by rock stars, musicians, entertainers, actors and the behind-the-scenes beauty makers connected to Dana Elise, this was a night to remember! Dana Elise Solutions, a premier full-service skincare spa and leader in progressive skincare options and BIG Medicine Magazine™ assembled the best of the best in beauty to pamper guests as they mingled among recording artists, celebrities and media. In addition to enjoying shoulder massage, hand microdermabrasion and beauty makeovers, guests received complimentary gift bags and were registered to win raffle prizes as they nibbled on delicious hors d’oeuvres and sipped decadent cocktails! Dana Elise and her team are thrilled to settle into their new offices located at 11500 West Olympic Blvd, #315, Los Angeles, CA 90064.

A GREAT BIG THANK YOU TO: Beauty Bumps CND Solar Oil Nail Treatments Carmella Cardina, Chaos Films Luscious Lip Gloss by Dana Elise Solutions Elevation Fitness Frank Barron Hair Design iS Clinical Skincare Youth Eye Complex Jus De ‘amour By Mercedes Eau De Parfum K Chocolatier by Diane Kron Kelly Taylor Metropolitan West Ken Siporin, M.D. Laura Bradley Music Nelson J. Salon Nelson J. Argon Oil Hair Care Neova Squalene Osea Skincare Oxygenetix Concealing Makeup Prtty Peaushun Body Lotion Solar Tizo Sun Protection Tan Towel Wipes Wiliiam Dorfrman, DDS

Clients, friends, family and the famous having a night of fun at the world famous House of Blues on Sunset Strip in Hollywood celebrating Dana Elise Solutions. You can learn more about Dana Elise Solutions at www.danaelisesolutions.com, or by calling 310-550-5566.

Turning A Negative Into A Positive

DEALING WITH BODY DYSMORPHIC DISORDER There have been a lot of stories in the news recently about plastic surgery and patients with Body Dysmorphic Disorder. As the media reports that this is a disturbing and growing trend, BIG Medicine Magazine™ talked with Beverly Hills celebrity therapist Carla Lundblade to ask her how you can spot a patient with this disease before you perform surgery.

All of us have some kind of relationship with our bodies. Some of us love our body, others do not. Psychologically speaking we have either a normal or abnormal relationship with our body. While we say “to each his own”, there are signs you can look for to determine whether the patient standing in front of you is going to be a future problem due to their personal image of themselves. Most patients coming to you for surgery are generally complaining about some aspect of their face or body that they do not like. However, a patient suffering BDD absolutely hates that body part. There is a difference between “don’t like” and “hate”. These patients try to not to look at that body part, or attempt to hide it from others. When they glance at their reflection in your lobby mirror and make a face at what they see, this is an obvious sign of deeper troubles. How do you know what is normal and what can be harmful, and how do you get the truth from your patients so you may best help them? We can all experience embarrassment or frustration about our bodies, but what if these thoughts are all consuming, create significant fears, anxiety and panic, and stop your patients from living normal lives? What if you have a patient that is even considering suicide as a result? How would you help? Such problems are real for many men, women and children who experience body dysmorphic disorder. New findings have been uncovered and effective treatments have been developed for BDD and its emotional and neurological causes. Brain activity patterns appear to be different in people with BDD than in people without the disorder. It was reported that the dissimilarity showed up in areas of the brain involved in visual processing. The severity of symptoms seem to coincide with measurable brain activity of similar magnitude. BDD seems to possess a mixture of genetic, emotional and neurobiological factors, which can also show up in other family members. So evidence supports that this disorder may have real causes and may not be “just imagined” or a sign of a lack of will power or low self esteem. The good news is that management of symptoms is possible and found to help a large percentage of those who suffer, as long as their issues are uncovered and they can withstand their personal awkwardness around them long enough to follow through with your referral to a therapist. Trust me, you will need a therapist to assist you in this multi-pronged approach. The most effective treatment regime seems to be cognitive behavioral therapy, CBT, partnered with serotonin-enhancing drugs. In cognitive therapy, patients become skilled at improving their thinking, showing publicly their “defect” to others and seeing themselves as more whole emotional people rather than just focusing on their “defective” emotionless parts. And prepare yourselves, relief and positive change may take longer than 3 months to show up but it will show up to the tune of ½ to ¾ of patients experiencing improvement. What fails miserably to treat BDD is plastic surgery and other beauty enhancing procedures. Even if the surgery or procedure changes the identified defective body part, the individual’s brain and patterns of thinking are still likely to search out and find another perceived defect and so on, and so on, and so on. None of this leads to a better life and more happiness. But you can help this patient. As a doctor, it is important to identify this problem within your patients and not to give up on them, so they may experience the joy of effective treatment that significantly improves the quality of their lives, their families’ lives and may even be life saving! Questions for doctors to ask patients:

• How do feel about your body?

• When you look in the mirror, what do you see?

• Have you had or are considering having surgery or procedures to correct a perceived defect? How did that go?

• Are there things you avoid doing because of your concerns?

• Do you ask others their opinions about it and what do they say?

The reality in this day and age is for surgeons to realize that they cannot and should not attempt to psychologically screen patients and it’s even worse to leave the job to a staff member or a questionnaire. With growing concerns about the extent to which cosmetic surgery affects patients’ relationships, self-esteem and quality of life in the long-term, it makes more sense to add both pre- and post-surgical patient assessments as a primarily fail-safe and excellent standard of care. This will ensure 1) no harm is done, 2) improvement is achieved and 3) each patient feels well cared for, happy and will tell the world about their procedure, which in turn affects how your referral business and your professional reputation grows. As a side note, the pre- and post-screening are considered “therapy” and are generally covered by most insurance companies, unlike most cosmetic procedures. Of course all aesthetic surgery patients are coming to you because they are not happy with a particular aspect of their body. However, there is a difference between a healthy dislike and an unhealthy one. Key phrases like “I hate the way I look” vs. “I feel that my nose is too large for my face” are obvious sign of the psychological health of the patient. Also, patients that “hate” multiple aspects of their body, or want to look like another completely different looking person like a celebrity are other warning signs that you should pay close attention to. With great and genuine care from you, a patient suffering body dysmorphic disorder, can ultimately go on to have a successful procedure and a happy future, given that you know what you are dealing with in advance of performing surgery.

When drugs are your business, YOU REALLY NEED TO TAKE PRECAUTIONS! We live in a time where prescription drug use and addiction are at epidemic proportions. Physicians that practice pain management and addiction medicine have to protect themselves not only from manipulative patients but also from their own employees. BIG Medicine Magazine asked leading pain management expert and drug treatment specialist Gregory A. Smith, MD, QME, of Comprehensive Pain Relief Group in Los Angeles, to help us understand how to deal with this serious issue.

THE PAIN IN PRACTICING PAIN MANAGEMENT For some people working in a pain management office is like releasing a kid in a candy store. Prescription pads are more valuable than blank checks. I have had former employees forge my signature and sell my prescriptions for people to obtain OxyContin or for their own use. I have also caught a former employee using Heroin in the bathroom. The first person I ever hired 13 years ago was done with a face-to-face interview and a handshake, it was a time when you could still trust people. Oh how the world has changed in such a short time. Over the years I have become much more cautious regarding whom I hire. Trying to get a job at my practice now is like going to work for the FBI! Background checks and drug testing are now a routine part of the hiring process. Physicians in private practice have many challenges like over regulation from insurance companies in the face of shrinking reimbursements. However, the pain management physician has the added burdens of dealing with patients, and sometimes employees that are very polished actors and manipulators to get drugs for their own addiction or to sell on the street for large profit. So how do you protect yourself? The following are the essentials when dealing with patients that are on narcotics: • Sign up for CURES (Controlled Substance Utilization Review and Evaluation System) which is the California PDMP (Prescription Drug Monitoring Program). Every patient that has filled a controlled substance under your DEA number will be listed. Including the drug name, quantity dispensed and location where the prescription was filled. The first time I did this I was shocked to see how many patients were getting a narcotic from me and then another physician a few days later. Go to oag.ca.gov/cures-pdmp; to sign up. Run a CURES report on any patient that exhibits suspicious behavior. • Randomly urine drug screen ALL your patients. Even the ones that are not on any controlled drugs, the results will surprise you. Also screen for illicit drugs such as Meth, Cocaine and Heroin. • Have all patients sign a narcotic contract. The American Pain Society (ampainsoc.org) and other organizations have examples, but the bottom line is that a patient agrees to only get their narcotic prescription from one physician (or office if multiple pain physicians) and also fill the prescription at one specified pharmacy. • Do background checks and a pre-hire urine drug screen on all potential employees. Also have a provision in your employee handbook that the employer reserves the right to request a random drug screen on any employee for any suspicious or unusual behavior. They can refuse but the refusal itself may be an indication that the employee has something to hide. • Finally trust your gut; if something doesn’t seem right with a patient or an employee dig a little deeper and see if there is indeed something wrong.

Beware of Thieves!

Is Your Staff Stealing From YOU? No wonder his Botox® profits were down last year! When asked by his accountant why his cost on Botox® and Facial Fillers was significantly higher than his sales on the same products the previous year, the doctor did not have an answer. He assumed there must be an inventory somewhere that was lost, or had been misplaced. So he asked his office staff if they had any idea how that could have happened but nobody was able to give him an answer either. Stumped, he carried on with business as usual because he was too busy to worry about the discrepancy. His accountant, however, decided to keep a more watchful eye on purchasing and inventory over the next six months to see if he could make sense of it. Well, make sense of it he did. He also found criminal activity was taking place. As it turned out, the doctor’s nurse had a “moonlight” injection clinic on Tuesday nights after the other staff had gone home. She was using the doctor’s supplies, but pocketing the money! Unfortunately this type of scenario is all too common.

How Do You Prevent This From Happening To YOU? BIG Medicine Magazine sought the advice of internationally acclaimed Newport Beach, CA plastic surgeon, Dr. Lavinia Chong who runs a tight ship when it comes to medications and prescription supplies.

Keeping “honest” staff “honest” is a tough but necessary mandate. In my aesthetic practice we stock Botox, a full array of fillers and narcotics. All injectables are doubly locked and the narcotics triply locked; I hold the only key for the drug safe. Our per diem nurse and I double count the narcotics, at every procedure and sign a drug log. In compliance with the requirements imposed by our credentialing body, we have protocols for “missing” drugs. All drugs, including injectables, are “logged in” by the back office manager, verifying the lot numbers, expiration dates and integrity of the product with the “packing slips”, which in turn are checked by my accountant and any variances of utilization trigger a system error alert. Charting the usage of individual drugs is essential to protect not only the patient but the practice. Limiting access to drugs, relying on double and triple checks and offering staff incentives (aesthetic treatments) has proved successful in my practice.

Doctor Protect Yourself Protecting a personal brand or other innovation with a registered trademark, copyright or patent has become as necessary to medical practitioners as penicillin to a patient. But like other business practices, legal protection of a practice name, personal brand, product or procedure is not something taught at medical school. BIG Medicine Magazine asked international Trademark Attorney, Sylvia Mulholland, how a physician with great practice ideas can make sure somebody else doesn’t steal or otherwise exploit those ideas, and confuse prospective patients.

The court dockets are filled with cases where physician-related inventions and names have been ripped off for financial gain by others. However, we can look first to the pharmaceutical and medical device companies (a number of which I am pleased to count among my clients) for the importance of brand name and design (logo) protection. Take a look around your office at the array of Trademark and Copyright registration symbols on pill packages, and labels and brochures for equipment and medical supplies. But now, just for fun, let’s bring the point out of the practice and into the world of fashion news to take a look at what happened to Christian Louboutin’s recent trademark infringement suit against Yves St. Laurent. Female physicians reading this will know about the importance of these shoes. As for male readers who don’t, go and ask your significant other. These shoes have become iconic and the two fashion powerhouses went to war over them. As you will see, it was a narrow victory for Louboutin, and perhaps a pyrrhic one as well, since the famous designer came perilously close to losing his equally famous red sole registered trademark. In 2011, Christian Louboutin monochromatic red shoe, including the uppers and thing, but YSL’s use of red on he had obtained a U.S. soles. That unexpected consumers, propelling But the district court denied extent of holding that a color in the fashion industry, and marks, including Louboutin’s. Fortunately for Louboutin, the decision but “modified” Louboutin’s contrasts with the remainder of trademark rights. The appeals Louboutin had established trademark with the upper part of the shoe. While Louboutin avoided the decision represents a bittersweet victory, continue to make and sell the very shoes dispute. It remains to be seen whether appeal the court’s monochrome carvetrademark protection, or cut his losses designers in general, and companies like Tiffany & Co. (with its famous robin’s egg blue boxes) are breathing a huge sigh of relief that color trademarks still exist. At least, for the moment.

Of course, fashion footwear and medical innovations are very different things. Or are they?

launched a trademark infringement suit when YSL debuted a featuring the color red on all components of the shoe, sole (note: not the shoes pictured here). Red uppers are one the sole of the shoe was too much for Louboutin! In 2008, trademark registration for the color red as used on shoe splash of red was the feature that resonated with Louboutin’s footwear designs to international fame. Louboutin’s request for injunctive relief, going to the can never constitute an enforceable trademark calling into question the validity of such color Oops! appeals court reversed the district court’s trademark to “uses in which the red outsole the shoe,” in effect limiting Louboutin’s court based this ruling on a finding that rights ONLY where the red sole contrasts invalidation of his trademark, the considering that YSL is free to that gave rise to the Louboutin will out of his now. But

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All jokes aside, it can be tough to be a doctor and especially one who uses the media to further their brand. To be a doctor on TV, you must also back it up with academics, education and stellar patient results. To be a doctor on TV you must also remember to never take it all too seriously. Life is too short not to have fun.

BIG Medicine Magazineâ&#x201E;˘

Marcel Daniels, M.D. Plastic Surgeon Long Beach, CA

BIG Medicine Magazineâ&#x201E;˘

Are You A

REAL DOCTOR?

Those are the famous words of soap opera actor Peter Bergman when he did a 1986 commercial for Vick’s cough syrup. TV has made a lot of other doctors famous too. Real and imagined. Dr. Doug Ross has a Wikipedia page detailing his entire medical career. So does Dr. Gregory House. Neither of these men are real doctors. Dr. Ross was a character played by actor George Clooney on the TV show ER and Dr. Gregory House, better known as House, is played by British actor Hugh Laurie. Both ER and House have won Emmy’s and Golden Globes. Another highly popular medical TV show, Grey’s Anatomy, became the highest-rated drama in the key demographic – the 18-49 year old age group, and was among the overall top-ten rated TV shows in the United States. So what does this tell us? That America LOVES its doctors! Now many of you may have the opinion that there are real doctors on TV news shows and documentaries that are less qualified than you, or may have less experience than you and you are wondering “How the HECK did they get on TV?” For the moment though, let’s take a walk down medical memory lane and look at the “Who’s Who” in Medical TV history. Medical shows, comedic or dramatic, play a BIG part in the lives of the American consumer and some of these doctors have become the most loved and recognized TV characters of all time. Perhaps there are a few “pearls” to be gleaned from this line up.

Benjamin Franklin “Hawkeye” Pierce (Alan Alda, “M*A*S*H”)

Cliff Huxtable (Bill Cosby, “The Cosby Show”)

Adapted from Robert Altman’s 1970 film MASH, the long-running TV series was a gentler version of the original comedy about doctors in the Korean War. Alan Alda’s Hawkeye Pierce was the show’s anchor, using humor to deflect the tragedy around him.

Dr. Cliff Huxtable was the amiable and bemused father figure who was always ready to deliver advice, when he wasn’t delivering babies. Bill Cosby’s character helped the show run for eight seasons from 1984-1992, and it was one of the biggest shows of the 1980s.

Marcus Welby (Robert Young, “Marcus Welby, M.D.”)

Doogie Howser (Neil Patrick Harris, “Doogie Howser, M.D.”)

Robert Young played the friendly family doctor Marcus Welby who first appeared in a movie-of-the-week in 1969 and returned later that year to star in a series that ran through 1976. Although the theme may not fit current types, his character remains one of the most indelible TV doctors of the era.

Doogie Howser breezed through school to become a doctor at 16 (only on TV), which meant he had to tackle the trials of being a teenager while also dealing with the adult pressures of the medical world. The show made Neil Patrick Harris a household name and he remains in the spotlight today.

James Kildare (Richard Chamberlain, “Dr. Kildare”)

Doug Ross (George Clooney, “ER”)

Dr. James Kildare was a fictional doctor on radio, TV and in comic books dating from the 1930s, into the 1960’s and with a short lived TV series in the 1970s. The most memorable version of Dr. Kildare was played by Richard Chamberlain. The show quickly achieved success, encompassing 190 episodes and sparking a new generation of medical shows.

“ER” ran for 15 seasons and moved a large number of actors through its cast but initial star, George Clooney, was the show’s most defining presence then, and now. Clooney played Dr. Doug Ross a caring pediatrician willing to break the rules to help people; he left the show during its fifth season. America will never forget that George Clooney’s big break was in the “ER”.

NO!

I Just Play One On TV

Miranda Bailey (Chandra Wilson, “Grey’s Anatomy”)

Sean McNamara & ChristianTroy (Dylan Walsh & Sean McMahon “Nip/Tuck”)

“Grey’s Anatomy” has been popular since its 2005 debut, and a big part of that is the supporting work of Chandra Wilson as Dr. Miranda Bailey, whose tough persona helps shape the younger doctors. A first for female doctors, Miranda shows us how difficult the world of medicine can be.

They say truth is stranger than fiction. This show made plastic surgery even more popular due to its bizarre plots and even more bizarre procedures. Not to mention the fast cars, handsome doctors and gorgeous half naked models. The show earned 45 award nominations, winning a Golden Globe and an Emmy Award. According to the Internet, series creator Ryan Murphy says that the medical cases on the show are “100 percent based on fact”.

Julius Hibbert (Harry Shearer, “The Simpsons”) On a lighter note, we can’t forget about the cartoon doctors. Always chuckling and seemingly indifferent to the ups and downs of life in Springfield, Dr. Hibbert, a spoof of Cosby’s Huxtable, is one of the most enduring and hilarious characters on “The Simpsons.” Leonard “Bones” McCoy (DeForrest Kelley, “Star Trek”) Neither can we forget about space doctors. “He’s dead, Jim.” Leonard McCoy was a surgical staple of the original “Star Trek” TV series. Known for his dry humor and comic pessimism. Dr. McCoy was not quite the doctor to the stars, more like the doctor in the stars, pun intended. He even put in an appearance in the pilot episode of “Star Trek: The Next Generation.”

Gregory House (Hugh Laurie, “House”) Hugh Laurie was a well-known comedic actor in England before his performance as the ailing and grumpy Dr. House brought him widespread recognition in the U.S.A. House is a tough man, but not without compassion for his fellow doctors and patients, although sometimes it’s hard to see. The series has remained popular even after six years on the air. At one point House was among the top-ten rated shows in the USA, has been distributed to 66 countries, and has received five Emmy’s, two Golden Globe Awards, a Peabody Award and nine People’s Choice Awards.

So next time somebody asks if you want to be on TV, you might want to say YES!

We Asked The Doc What Do You LOVE About Being A Doctor?

Dr. Bacot

Dr. Fleming

Dr. Lee

Dr. Kapoor

Dr. Mayer

Dr. Pearlman

Dr. Chong

Dr. Frankel

“The satisfaction I get when I see that I’ve made a positive impact on someone’s life.” Marcel Daniels, M.D., F.A.C.S., Long Beach, CA “The chance of performing surgery to change peoples’ lives.” Brent Moelleken, M.D., F.A.C.S., Beverly Hills, CA “I love anything and everything about cosmetic surgery, talking about it, writing about it and doing it. My job is my passion. Retirement is for people that hate their jobs, I never plan to retire.” Joe Niamtu, III, D.M.D., Midlothian, VA. “Feeling good about helping people every day I work.” F.R. Noodleman, M.D, Campbell, CA “The independence of being able to control how and what I choose to do.” Anonymous. “Love the confidences and stories shared with the patients.” Dr. Lavinia Chong, M.D., F.A.C.S., Newport Beach, CA “As a facial plastic surgeon I can first hand, through the combination of science, art, and many techniques, surgically help improve the patient’s self-image by creating a pleasing aesthetic result; seeing the patients’ positive results and sharing in their excitement is very gratifying and justifies the great trust that patients place in me.” Russell W.H. Kridel, M.D., F.A.C.S., Houston, TX “I love being a doctor because I can make a difference in someone’s life, i.e. self-esteem, appearance, etc.” Harrison H. Lee, M.D., D.M.D., F.A.C.S., Beverly Hills, CA “The opportunity for positively influencing patients and my discipline of facial plastic and cosmetic laser surgery.” J David Holcomb, M.D. Sarasota, FL “The ability to change people’s lives.” Steven J. Pearlman, M.D., F.A.C.S., New York, NY

“I practice medicine with my heart, and it is an absolute joy and privilege to take care of my patients. I treat each like a loved family member with dignity, respect and compassion.” Kedy Jao. D.O., F.A.A.F.P, La Mirada, CA “I love most my interactions with my patients and the potential to do some good for other people. It can be most gratifying.” Andrew Frankel, M.D., F.A.C.S., Beverly Hills, CA “Caring for patients and improving the quality of their lives.” Michael J. Will, DDS, M.D., F.A.C.S., Ijamsville, MD “I enjoy making a positive change in people’s lives that also enhances their quality of life. Seeing changes in their self-esteem is a very rewarding experience for me personally.” Vishal Kapoor, M.D., Beverly Hills, CA “Love helping people, love making people happy. Love the challenge of my profession. Love the lifestyle this profession provides me (have many visitors from around the globe and I get to visit doctors from around the globe too).” Juris Bunkis, M.D., F.A.C.S., Rancho Santa Margarita, CA “I love helping people to feel better about themselves with body image issues.” Toby G. Mayer, M.D., F.A.C.S., Beverly Hills, CA “I love meeting people from all over the world and helping them achieve their goal.” Richard W. Fleming, M.D., F.A.C.S., Beverly Hills, CA “The thing that I love the most about being a doctor is the opportunities to interact with so many diverse individuals, whom otherwise I would never meet., and to be given the opportunity to use my knowledge and experience to solve medical challenges in their lives.” Brian Bacot, M.D., St. Thomas, VI ”By changing people’s appearance and having a positive impact on the lives of others.” Kevin Sadati, M.D., Newport Beach, CA

tors. They Told Us! What’s The BEST Thing You Changed In The Last 5 Years?

Dr. Noodleman Dr. Moelleken

Dr. Kridel

Dr. Jao

“I have changed my outlook on life and what I expect from it.” Marcel Daniels, M.D., F.A.C.S., Long Beach, CA “We have implemented new areas in the face that can be beautified with LiveFill, permanent live facial filler.” Brent Moelleken, M.D., F.A.C.S., Beverly Hills, CA “That is so hard to answer because I am constantly changing everything. Excellence is a journey and requires continual tinkering. I am always changing our forms, letterhead, cleaning service, patient consents, website, blog, marketing, etc. It drives some of my staff nuts, but you have to change to progress.” Dr. Joe Niamtu, M.D.,

Dr. Will

Dr. Sadati

Dr. Bunkis

Dr. Daniels

Dr. Niamtu

“I spend more time with each new patient to really get to know their goals and aspirations.” Steven J. Pearlman, M.D., F.A.C.S., New York, NY “I added Anti-Aging Medicine and Regenerative Medicine to the practice to keep patients healthier and younger.” Kedy Jao. D.O., F.A.A.F.P., La Mirada, CA “The way I select patients. I am more careful about who I operate on and less anxious to take on all newcomers. You cannot satisfy everyone!” Andrew Frankel, M.D., F.A.C.S., Beverly Hills, CA

“Becoming a vegetarian.” F.R. Noodleman, M.D., F.A.C.S., Newport Beach, CA

“Hired and developed a dedicated, caring and service-oriented staff with a common vision of the practice.” Michael J. Will, DDS, M.D., F.A.C.S., Ijamsville, MD

“Hiring another physician to work with me.” ~Anonymous

“Taking a risk and building out my surgery center.” Vishal Kapoor, M.D., Beverly Hills, CA

“Incorporating yoga into my daily routine, it compliments my professional and personal life.” Dr. Lavinia Chong, M.D., F.A.C.S., Newport Beach, CA

“Started our own skin care line, MD Performance® Professional Skin Care.” Juris Bunkis, M.D., F.A.C.S., Rancho Santa Margarita, CA

“I’ve empowered my staff to make decisions on their own when patient care or happiness can be improved by their timely action with the underlying philosophy to treat all patients as if they were family.” Russell W.H. Kridel, M.D., F.A.C.S., Houston, TX

“More advantages to tissue expansion for reconstruction and facial aesthetics.” Toby G. Mayer, M.D., F.A.C.S., Beverly Hills, CA

“After many years in practice, I finally realized the importance of personally seeing my postop patients frequently instead of delegating it to our nurses.” Harrison H. Lee, M.D., F.A.C.S., Houston, TX “Approach to facelift surgery - integrating both laser lipolysis assisted contouring of the lower face and neck and structural fat grafting have had a profound impact on initial outcomes and long term results. A close second would be “rebooting” the office computer infrastructure (to iMacs) and transitioning to Electronic Medical Records.” J David Holcomb, M.D. Sarasota, FL

“I have emphasized less involved procedures with preventative treatments such as skincare at a young age.” Richard W. Fleming, M.D., F.A.C.S., Beverly Hills, CA “The number one best thing I’ve changed in the last five years is the location of my practice from the Atlanta, GA area (which I loved ) to the United States Virgin Islands (which I love more) - no comparison!” Brian Bacot, M.D., St Thomas, VI “Taking a risk and building out my surgery center.” Juris Bunkis, M.D., F.A.C.S., Rancho Santa Margarita, CA “By diet and exercise, I have put myself into the best possible shape and form.” Kevin Sadati, M.D., Newport Beach, CA

We Asked The Doctors! They TOLD US! Dr. Diktaban

Dr. Rnucci

Dr. Collins

Dr. Evans

Dr. Marotta

Dr. Mendelsohn

Dr. Repta

Dr. Miller

Dr. Tepper

Dr. Simon

Dr. Nevin

What Positive Changes Have You Implemented Into Your Practice Recently? “Our new direction in the practice has been to offer patients’ options that will serve as a vehicle for self-improvement with the quickest recovery and with an emphasis on preventative maintenance, healthy living, dietary modification, etc. rather than implementing a surgical body contouring process as the first option. This creates a long term relationship that goes the distance with our patients.” Brian Evans, M.D., Beverly Hills, CA “After completing my residency, I wanted to start my own practice, however, due to the economic times I was unable to get a loan. So I had to get creative with educational seminars, creating patient rewards for referrals, and most importantly utilizing social media. Social media is key to my practice now.” Beth Collins, M.D., Guilford, CT “I learned to keep an open mind. During the last five years the most difficult aspect has been managing employee needs and personalities. It’s important to listen and try to meet your employee needs at least half way in order to keep a happy productive workforce and minimize turnover.” James C. Marotta, M.D., Smithtown, NY “My challenge during the recession was to further develop and strengthen the non-surgical disciplines in my office in order to accommodate those patients desiring less invasive techniques of restoration. It worked.” John Renucci, M.D., Grand Rapids, MI “The most difficult obstacle to overcome during the past recession was the realization that the time was not 2005 or 2007. I learned to be flexible and recognize that financial considerations weigh more heavily on patients in this economy. You can be flexible with pricing without cheapening your brand.” Jon E. Mendelsohn, M.D., Cincinnati, OH In response to the current medical and business climate, I paid renewed attention to the Pareto Principle (80/20 Rule), characterizing and limiting the patients and procedures responsible for the bulk of my stress and unproductive activities. Scott Miller, M.D., F.A.C.S., La Jolla, CA

“Early in the recession we realized that long term investment in the practice would need to start taking place accordingly to allow us to position ourselves favorably when the economy improved. The most difficult part of this process has been two-fold: 1) trust in the ability to grow the practice through providing great service and results, and 2) managing the growing pains associated with such growth in uncertain times. We managed both successfully.” Remus Repta, M.D., Phoenix, AZ “We diversified the practice, maintained flexibility with regards to the delivery of care and assortment of treatment, services and products to fit the needs of changing populations, and was more sensitive to the needs of patients, and to the concerns that they had over their own financial situations during a recession or economic downturn.” Rich Tepper, M.D., Westfield, NJ “For us, the amazing result of this cosmetic surgery slowdown was the discovery (or return) of quick, lunch time procedures with injectables such as Juvederm, Restylane, Radiesse, and Botox. This new demand to “look good now for less” generated very innovative ways for plastic surgeons to make people look younger and better. I have developed techniques to perform fat grafting in the office with the patient awake, and the results can be long lasting and superior to standard injectables or face lift surgery.” Timothy Neavin, M.D., Beverly Hills, CA We offer a variety of procedures at different price points so we are able to give patients options that fit into their new budgets. Then, as the economy improved and their budgets improved, those same patients opted to have additional procedures with us. Theodore Diktaban, M.D., New York, NY The general economy will always have ebbs and flows, and although this may require practices to spend more time, effort, and money on marketing, they should not diminish the value of their services. If you have a little extra free time (during a slow period) - use it wisely! Family time, improving fitness, hobbies you love that are relaxing and enjoyable. Sean Simon, M.D., Miami, FL

If you would like to participate in our “We Asked The Doctors They Told Us” section, write to us at www.bigmedicinemagazine.com.

Multidisciplinary Ski Meeting at the RESORT at Squaw Creek, in Lake Tahoe, California (Thursday-Sunday).

February 26 to March 1, 2015 Please join us at the beautiful Resort at Squaw Creek in Lake Tahoe, California for an educational update on the latest advances in Facial Plastic and Aesthetic Surgery. A multidisciplinary faculty of Plastic Surgeons, Facial Plastic Surgeons and Dermatologists come together once again to bring you the most advanced and interesting winter meeting. • Watch live demonstrations of Ulthera, Zeltiq, Liposonix • See new products and debates on energy based applications in Aesthetic Medicine • Take a live injection workshop on all fillers including Voluma • Great educational programs for your nurses, patient coordinators and assistants • Interactive panel discussions on topics including Fat Transfer, Fillers, Neuromodulators, Platelet Rich Plasma, Stem Cells, Energy Based Systems for Rejuvenation and Lipolysis, Rhinoplasty, Facelifting and Oculoplastic Surgery • Live patient injection workshop with advanced applications and techniques

19 Hours of CME Credits Co-Chairs: - James Newman, MD and Corey Maas, MD Register and make hotel accommodations at The Resort at Squaw Creek. Ask for the California Facial Plastic Surgery special rates. Please make reservations early as the hotel sells out consistently.

Special Thanks To Our Corporate Sponsors Allergan Zeltiq Merz Lumenis Alphaeon Ulthera Neograft Lasering USA Syneron The Professional Image, Inc. Valeant To Register Go To www.CSFPS.org

Enhancing

Employee Relations only known then, what I know now, my life would have been a lot easier”. I certainly don’t feign expertise in employee relations. However, based on the experience of many doctors I have worked with, and my own personal experience running a successful practice, I have developed pearls on hiring and firing.

Dr. Joseph Niamtu If you ask the average medical student what they anticipate as the five greatest challenges in their upcoming career you would, of course, get a list that would include national healthcare, malpractice, wrongful diagnosis, demanding lifestyle sacrifices, etc. If you ask the same question to these people after five years in practice, very high on this list will be a new category and that is employees. Any seasoned doctor (or business owner) will usually admit that employee relations are one of the biggest challenges of running a business. Of course here we are talking about the doctor’s office. However, no matter what business you are in, be it a carwash, doughnut shop or surgeon’s office, finding competent, dependable, energized, honest and loyal employees remains a challenge. A great employee can be an invaluable and cherished asset that can greatly enhance your life, whereas a poor, lackadaisical employee can suck the energy and efficiency away from your practice and life. Since most doctors generally do not obtain reallife, sophisticated training on staff hiring and firing during medical school, it basically boils down to hit or miss and learning by mistakes; for better or worse. Ask any 20 year veteran of a medical practice about their employee experiences and I guarantee they will tell you “If I would have

BIG Medicine Magazine™

The first and foremost requirement of having a successful practice with great employees is to have a distinct and clear vision. My vision was to limit my practice to cosmetic facial surgery and market myself as the local expert in cosmetic facial surgery. It also was to have an exemplary and accredited facility with employees committed to teamwork and to have fun at work. My vision included the highest level of patient care and communication. When I hire employees I make my vision clear to them so they understand what is expected. If a practice leader (the doctor) does not have a distinct vision, or if his or her staff is unaware of this vision then chaos results. It would be no different than a football team going to the line without a play. No player would know what to do. This is why teams have plays and practice them. A leader without a distinct vision is a journey without a map. I feel that there are eight attributes that make a perfect employee and I learned much of this 30 years ago when I worked closely with a consulting firm called Mercer Global Advisors. For the sake of measurement, we will refer to a perfect employee as a “10”. What we desire is to be able to screen for employees that are a “7” or above. The following attributes will greatly assist this evaluation process.

1. Competency and Presentation 2. Unconditionally Committed 3. Givers or Takers 4. Offensive or Defensive 5. Superstar or Team Player 6. Joyous 7. Self Managing 8. Learner

Competency and Presentation

Competency is the foremost attribute required in the consideration. Again in any service oriented business, customers or patients expect and seek a certain level of care and service. When a person goes to a nice restaurant, they know in advance that it will be expensive. For that expense they expect a high level of service, i.e. prompt seating, polite treatment, accurate ordering, fast service, and attention to detail. A waiter that cannot meet those expectations is incompetent. This incompetence will, across the board, cause unhappy customers and eventually harm the reputation of the owner regardless of how great the food was. What is frustrating here is that the restaurant owner may really have paid attention to detail. He may have a beautiful facility with ample parking. He may purchase only the finest ingredients and he may have hired the best chef in the area. Despite all the attention to detail, a single incompetent employee may shatter his dream of having a fine restaurant by negating his attention to detail. There is a difference between inexperience and incompetence. If our waiter had a badge stating “waiter in training” we may expect a lesser level of service. This employee may become an excellent waiter, but should not be turned loose on the public without someone supervising. Presentation is also a very important factor to consider in the medical business. This example applies to cosmetic surgery and general medical offices alike. The discipline of cosmetic surgery involves cosmetics, aesthetics, and health. One of your most powerful marketing principles is the appearance of the doctor and staff. Slovenly, out of shape staff with yellow teeth or fingers from smoking or excessive body piercings are not the image we are trying to convey. An obese employee that is bubbly and neat may be an asset, but someone with cellulite bulging from dingy polyester white scrubs does not assist your marketing efforts. Sorry to be so graphic and judgmental here, but I have honestly been in doctor’s offices with staff that look like the people I have described above. If we are in the health care industry, should we not be exemplifying health?

2. Unconditional Commitment

4. Offensive and Defensive Employees

Unconditionally committed is defined as commitment with the lack of conditions. The closest example I can find is a resident in a training program. As residents, we could not allow anything to take precedence over our work. None of us would have dreamed of telling our respective program chairman that we couldn’t meet a deadline because we ate lunch and didn’t have time. We were in an environment where lunch was not a priority, and our work took precedence. When we are called to the ER in the middle of the night, we can’t say “it’s late, call me in the morning.”

By this categorization we are referring to one’s ability to accept change. Positive change is energy. If you examine successful people and successful practices you will see that they thrive on change. Change should breed excitement, but for many people it breeds fear and insecurity. If a doctor is truly interested in approaching excellence, then they must continually change all aspects of their practice to increase efficiency and service. I challenge and reward my staff for changing. We look at our forms, our policies, our furnishings and so on and brainstorm, as a group, on how to improve every aspect of the practice.

Owners of a business have much more impetus to be unconditionally committed, because they reap more of the benefits or failures than the employees do. For this reason, it is rare to find this level of commitment in an employee. When you have a good leader, clear-cut goals and the correct employees, the ensuing is a beautiful machine. Doctors that have exceptional and profitable practices probably are good leaders and have exceptional employees with a well-defined common goal.

The above examples do not mean that one person should not have responsibility. The difference is in the person. While the superstar wanted other staff kept in the dark, the team player would have communicated the important responsibilities to the other staff so the office would function in his or her absence. Look for, hire and reward team players, they will make your life and practice less stressful.

An unconditionally committed employee will perform within reason to accomplish the task at hand. An applicant that won’t work overtime or on Saturdays or follow your rules of the game is only conditionally committed, and does not meet the criteria.

3. Givers vs. Takers Someone is either a giver or a taker. A giver is a loving compassionate person who truly enjoys giving of themselves. Givers understand the “win/win” concept and fully realize that the more they give, the more they will receive in return. A taker operates in the win/lose environment in that in order for them to win, someone else must look bad or lose. Any person that speaks negatively about anything in order to enhance their own identity is a taker. A giver would complement the other person on their efforts then focus on those of their own. Although it is impossible to screen for this attribute in an interview, this behavior must be identified and these people removed from your staff. One bad apple can spoil the whole bunch! Takers are the type of employees that gossip, and gossip can cripple a practice. If, as an employer, you ever come across the “what’s in it for me?” attitude, you must take action. If an employee must have someone lose for them to win, guess who will be losing? YOU, the other staff, and the patients.

situations so all the attention swirls around them. It is not about winning the game, it is about how many points they scored. The superstar feels that for their previous experience or superior intellect that they can “do better”. They feel a superiority and are often over protective of the doctor and the practice. Their attitude is that they must “save” the practice from the incompetent hands of the other employees. Superstars place themselves in situations that “no one else can do”. For instance, they are the only ones that can back up the computer, or the only ones that do the payroll, etc. They thrive on being needed for important functions. They frequently do this to become indispensable. Guess what, you can’t fire these employees because no one else can perform the vital functions like back up or payroll. The key to neutralizing superstar status is cross training. Give several staff responsibility for critical functions. This is good business sense and lessens the chance of fraud and embezzlement. Cross training prevents superstardom.

Some employees are intimated by change and take the “if it ain’t broke, don’t fix it” attitude. This is poison in a motivated practice. Employees that accept and encourage change are termed offensive, while those employees that fear and resist change are termed defensive. We all like change because it counters boredom. If we all wore the same clothes every day and ate the same food at every meal, life would not be as interesting. The same holds true in the workplace. A valid leader understands that all change may not be effective and must concede to their staff that a given plan was not working. It is alright to make mistakes and not to dwell on them, but rather to attempt to understand what went wrong, do all you can to not let it repeat itself and move forward and enhance the service to your patients. Successful practices have offensive players.

Although cosmetic surgery is not physically challenging, many doctors go home at night exhausted and stressed. They are not exhausted from doing surgery; they are exhausted from making constant attempts to steer a team to success while keeping peace. Superstars embezzle from the practice. They don’t steal money, they steal energy. They are like sponges and they steal the energy and excitement from the other staff or even patients. To counter this type of behavior in these “indispensable” staff, the doctor must constantly make attempts to skillfully influence situations. This is what becomes stressful and exhausting. Surround yourself with team players and you will be energized. Remember, we are most successful when we are doing what we love to do. My love is surgery. When I have more time to do surgery, I am happier and more energized for my family, my friends and for myself.

5. Superstars vs. Team Players

The term superstar is not a positive adjective in this sense. A superstar is that type of employee that can do it all. The superstar manipulates

Knowing that we spend a significant part of our time with our staff, it makes sense to seek enthusiastic, joyous and energetic people.

Enthusiasm, Joy and Energy

BIG Medicine Magazine™

Termination

Happiness and enthusiasm are contagious and are self-perpetuating. Friendly people with high energy levels are a welcome addition to any group of people anywhere. If you truly believe that there are no dress rehearsals in life then you should make the most out of every waking second. For a practice to approach excellence, there is no room for pessimism. Surround yourself with enthusiastic, joyous, energetic employees with the other previously mentioned attributes and your practice will prosper.

Self Managing

Once you have found staff with the positive attributes, you need to make sure that they are self-managing. There are employees that know just what to do, but will not perform unless directly supervised. This is a drain because you need two people to do the job of one. There is nothing wrong with the concept of a manager, but if you must literally stand over someone to ensure progress, you have an employee that is not self-managing. Self-managing employees are a pleasure to work with and take all the effort out of management.

Learners vs. Non-learners

It is always preferable to hire experienced employees, but often not possible. It is a joy to hire an employee that catches on quickly. It is stressful and regressive to have employees that need to be continually told how to do a task. Unfortunately, some employees never seem to catch on. Our practice has a three month training period where employees are given some slack on learning their job. If they require continual instruction on learning repetitive tasks, then they probably won’t remain on staff. Hire competent, unconditionally committed, offensive, givers that are self-managing, joyous learners and you will love your job.

BIG Medicine Magazine™

If there is a single entity that holds back progress and perpetuates turmoil it would be the hesitancy of doctors to terminate an employee. One must make a decision to run a practice or an employee repair service. There is no doubt that terminating an employee is a decision that is wrought with emotional and legal ramifications. Firing someone or being fired can provoke so many emotions in both parties, that many doctors procrastinate or endure years of unnecessary stress because they cannot bring themselves to “pull the trigger”. It is very traumatic for an employee to be terminated as it signifies failure and humiliation. It is even worse when the employee feels that they were unfairly terminated. If an employee is terminated for being tardy and has the retort that “Mary Ann is always late”, your credibility is lost and you may open yourself to a wrongful termination suit. The best way to avoid termination is to use correct hiring principles. This sounds so trite, but in most offices hiring is such a haphazard event that it becomes a roll of the dice. I am continually amazed by the lack of attention to basic human resource policy in medical practices. Time after time well established offices do not have written job descriptions, policy manuals, employee documentation files, and other basic information. Every office should have written policy on exactly what it takes to be an excellent employee and what it takes to be terminated. For all the above reasons, every practice needs a map and a compass. The map is the policy manual and the compass is the leader of the practice, the doctor. When the performance of an employee begins to falter, the leader must conscientiously ask themself if it is an employee or employer problem. If the employer feels that the employee is not catching on or is unsalvageable, then it is better to approach the inevitable as soon as possible. It is also important to document employee shortcomings and proof of counseling the employee. This is critical in terms of defending a wrongful discharge suit or an unemployment claim. Check with your local and state Labor Board for correct protocol. If the proper pre-termination steps have been carried out, the actual task of termination need not be complicated. The single most important point is to have the entire script well thought out and clear in your mind. This is not

the time to ad lib or fumble around, absolute clarity is essential. It is also important to realize that if you are unhappy with the performance of a staff member, they are probably aware of this and they are also probably unhappy and sometimes the termination of employment is actually a relief to both parties. We always terminate an employment relationship on a Friday afternoon, unless a significant infraction such as theft or substance abuse has transpired. It is important to have a private environment away from other employees and it is mandatory to have an employee, preferably of the opposite sex, present to document and witness. I simply tell the employee that the employment relationship is not working. I also tell the employee that I feel that they are a fine person, but that they are just not a good fit for the practice. I tell the employee that I have a certain vision and direction for the practice and that the employee is not moving towards the goals of the practice, and again it is not a good fit. I do not delve into specifics as it opens the door for argumentation or comparison to other employees. It is imperative not to insult the employee and important to leave them with self-esteem. If the situation is applicable, then we offer the employee the ability to resign with severance benefits or be terminated with no benefits. It is acceptable to have a manager do the actual termination, as long as the proper channels are followed. In fact it may be wise for the doctor to distance his or her self from these proceedings and stick to doctoring. It is an absolute necessity to obtain any keys, credit cards or any other practice possessions immediately. There are many cases of documented sabotage involving the violation of this procedure. An even greater temptation for sabotage is to terminate an employee with two weeks’ notice. This a perfect invitation for this person to be unproductive or diabolic within your office. A prudent employer will already have a replacement lined up to step right in the position. To have an all-star team, you have to be ready to play an all-star game.

Dr. Joseph Niamtu is a cosmetic surgeon who practices in Midlothian, VA

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Taking on the World Developing A “World Class” Medical Practice Angela O’Mara

As President of The Professional Image, Inc. and Editor-in-Chief of this magazine, I have had the privilege to work with many medical industry leaders who have over time developed a World Class Practice. Being World Class does not mean being known the world over. It means bringing a quality and value to your practice, your patients and your life that is unsurpassed anywhere else. The popular saying “Rome Was Not Built In A Day” applies here as developing a World Class Practice does not happen overnight either. It requires many things, including constant care and nurturing and, the least of which, recognizing opportunity. For over twenty-five years, I have worked with hundreds of physicians to help them build a “world class” medical practice and business through public relations, marketing and consulting. My clients and I have survived at least three recessions, including the most recent one, and understand that each one brings a new set of challenges, as well as opportunity. Focusing on the opportunity will lead to excellence in all areas of your life and business practice. In today’s fast-paced, high-stakes, competitive medical environment, looking at your practice from a “business” point of view will provide enormous benefit. At TPI, we have developed a 7 Step System that will help you gain clarity and equip you with skills to not only navigate this new economy, but proven skills that will help you build a “world class” practice that matches your level of surgical expertise.

By exploring various alternatives to your current methods, you will feel: • An increase in motivation • Have a higher degree of accountability within the practice • Find a greater focus with pinpoint clarity

• Surround yourself with a strong team that understands what you want to achieve • Develop a vision of your future • Assess your current reality

• Identify and enhance personal strengths

• Initiate new public relations and marketing programs

• Identify and eliminate/minimize practice weaknesses

• Learn how to maintain your success

• Have increased effectiveness and confidence

• Ultimately feel engagement, fulfillment and reward in your professional life

• See a higher level of organization and structure

• Develop a solid strategy

• Realize the ability for greater earning potential • Find time for personal pursuits, family and friends

“You can start by finding a moment of uninterrupted time so that you can sit down with a pen and paper and begin a brief analysis of yourself, your practice and where you want to take it. The sky’s the limit! And the time is right to let the world know just who you are.” Angela O’Mara.

Those that have traveled the London Underground will recognize this phrase. It is used to let travelers know that between the station platform and the train, there is a small but dangerous gap that must be crossed in order to step on the train and thereby reach your destination. The same is true of your practice. Between “what you have” and “what you want” is a gap. Between where you are now and that “world class” status is a gap. The first step towards practice success is to realize what this gap is and how to safely cross it. For most of us there is generally something lacking. This lack might be money, time, energy, quality staff, location, adequate space, technology, business plan, team spirit, to name a few. Start by doing a practice-assessment to find your gap (go to www. bigmedicinemagazine.com/bigstrategy for your FREE questionnaire.) questionnaire.

BIG BIGMedicine MedicineMagazine™ Magazine™

• To make a commitment to yourself and to your personal success

• Develop a clearer sense of direction

Mind The Gap

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To do this, you need:

When doing an assessment consider the following areas: • Personal Effectiveness • Practice Leadership • Staff Leadership • Marketing Needs List • Sales Programs • Team Ability • Time Spent on Superior Skill • How Supportive Is Your Environment • Organization • Finances • Personal Health and Well Being • Inter Office Communication

Envision Your Future While none of us need a crystal ball to tell us that things have changed, it will take some insight on your part to develop your own personal vision and determine how you are going to adapt to the changes, and develop the “world class” practice you deserve. As they say, what you see is what you get.

Take A Reality Check To begin, many of us are in denial about the current situation, are operating out of fear, or are too overwhelmed with daily minutiae to want to find the time to face the facts. However, in order to be successful and survive a failing (or failed) economy, to do your best and build a more secure financial future, you are going to have to take out that pen and write yourself a prescription for success. Generally, once you do this, things are not always as bad as they seem and you begin to see the opportunities that are placed in front of you every day. By doing the personal practice assessment first, it will help you have a clearer view of your current reality. When I have gone through this phase with a physician, it always amazes me to see how many open ended and incomplete projects they have that are holding them back. Once you do the analysis it helps you decide which of these projects are worthwhile (if any) and let go of the ones that are going nowhere. This gives you fresh ground to begin to build toward your success.

Prescription For Success Developing a strategy for your practice and implementing it is vital to your success. Your strategy should include long and short term goals, and daily action items. As well as including goals, your strategy should also include financial needs and financial growth opportunities, staffing needs, role designations, ideal marketing budgets and outlets and, of course, time off for you so you can regenerate. It’s easy to build surgery and consultation time into the weekly schedule, but not as easy to include time for business building, planning, implementation meetings, creativity, sales goals and other assessments (including a round of golf or other leisure activity) that are critical to the health and future success of the practice, and you.

Jumping In Until you implement a strategy, you don’t actually know if it’s going to work. Of course, you can follow the example of others, or copy things they have done, but don’t forget that this is YOUR vision that you are creating and there is not a one-size-fits-all rule here. The world class surgical skills you learned in school, residency, fellowship programs and your own practice did not happen overnight. And, guess what, your

skills will only continue to get better and mature with time. In order to achieve “world class” recognition you must be willing to devote the same time to it. Making fundamental choices to change your life can seem risky. Making grandiose ideas come to life seems risky too, but the payoff will be tremendously lucrative and will free you up to really enjoy life the way you “In my 25 years of working in the medical industry almost all want to. The riskiest thing you doctors tell me they are happiest when they are doing surgery.” can do is nothing. Inertia is NOT Angela O’Mara going to make it through in any economy – good or bad. Get Keeping Your Edge proactive about your practice success and you Just when James Bond takes that final leap will find that it will ignite excitement, not just in looking battered, tired and dusty, we think “this you, but in your staff too. must be it for him” but it never is because he never gives up. And he always comes out Public Relations and Marketing looking suave and debonair and ready for the There are no mysteries to solid, strategic PR next adventure. Like James, you also need and Marketing but in an economy like this you to learn how to keep the “edge.” To keep your have to stop wasting time and money on hiring name in lights, to keep your practice thriving, the wrong people or thinking that you can do to keep living your life the way you want, you everything for yourself. I tell my clients “You keep must be vigilant about your success. While this doing what you do best – surgery, and I will will not take as much of your time as your initial keep doing what I do best, PR and Marketing.” “gear up to success” has, it is still an area that It works too because all of my clients are should be constantly monitored in weekly staff holding steady with practice revenues and meetings where you can keep a close eye are continuing to see themselves on TV news on sales increases, budgets and spending, shows and are regularly interviewed by the ROI (return on investment), staff and attitudes, media. They are all considered “world class” leadership and the other many details that lead world authorities in their respective fields. With PR to total success and personal fulfillment. and Marketing you also have to do a separate strategy that is different from your practice building strategy. You also must surround yourself with people that can implement a highly creative campaign that gets attention. Public relations is still the most credible and cost-effective way to promote a practice. Appearances on TV and articles written about you in newspapers and magazines offer a third party endorsement that advertising and internet promotion cannot. This is a good time to evaluate everything from logo and stationery, to brochures and website, advertising, social media and branding, events and PR effectiveness.

Being “world class” can mean many things. In the current environment I would suggest that you attempt to be “world class” in all aspects of your practice and your personal life. Not only will you feel great about your creation, but your staff and patients will appreciate it too. And the payback to you will be incredible. Enjoy!

You have worked hard to get where you are. Isn’t it time you started enjoying it?

Note: To order your copy of “Lights! Camera! Action! The Plastic & Cosmetic Surgeon’s Guide to Obtaining Priceless TV, Magazine and Other Media Exposure” it is available at www.amazon.com and www.theprofessionalimage.com

BIG Medicine Magazine™

The Lega Most doctors agree that they need attorneys to help them with a variety of practice issues. But what do you do when one of your patients asks you for a referral to an attorney? Big Medicine Magazine asked leading personal injury attorney, Rick Lundblade who practices in Oregon and California, for his advice.

Recommending An Attorney To A Patient? PROTECT YOURSELF A patient enters your office for an examination relating to an injury. They tell you that they were involved in an accident and describe the resulting injuries to you. At that moment, you are likely (and understandably) concerned more about the injuries rather than wondering whether they will be making any legal claims related to the accident. However, upon conclusion of the exam, your patient unexpectedly asks you for a recommendation to an attorney regarding the accident. At this point, some doctors may choose to decline the request for a variety of reasons. Others may willingly suggest the name of an attorney-likely based on their own past experiences. In any event, the following are factors that you should at least consider if you do make an attorney recommendation to a patient. • Does the attorney specialize in personal injury claims? For the most part, gone are the days of the attorney who claimed to be a “general practitioner.” There is simply too much law out there and too many different practice specialties to be competent in all. (Does this sound familiar to the medical dilemma?) An attorney who specializes in personal injury claims or litigation will be vastly familiar with the legal aspects of such claims and, equally important, will have a sound understanding of the medical terminologies important to injuries common to such claims. • Does the attorney have sufficient experience and/or competency handling injury claims? This is not a suggestion that an attorney who is relatively inexperienced cannot competently handle injury claims. Many young attorneys will have that “knack” for doing their work at a level sustained by only much more experienced attorneys. That said, as a general rule, you should have at least some understanding as to the experience and competency levels of attorneys you recommend to your patients. • What is the attorney’s reputation in the community? Within the medical community, injury attorneys may be loved about as much as a root canal! Doctors should have some understanding of the general reputation of the attorney for providing good legal work before they recommend that attorney to their patient. Reputation can and often includes whether the attorney genuinely cares for the client or is more interested in the percentage of the settlement that will be received when the case is closed. • Does the attorney appear to be prepared? When you are asked to meet with an attorney to discuss your patient’s case, does the attorney show up on time? Do they appear to have read the medical records in advance, or do they show up without any understanding of what the injury involves? Does the attorney ask questions that lead you to conclude that they have, in fact, read the file and understand the case from a medical-legal context? Your time is valuable - nobody benefits if the attorney is late or unprepared for meetings. • Is the attorney thorough when working with the client’s doctor? There will be times when you will be asked to testify on behalf of your patient, either in court or by deposition. In my experience, most doctors do not relish the idea of having to provide testimony. Clearly, this interferes with your time working with patients. For some, it is just plain uncomfortable to be asked to do something that is not routine or typical. There may be a fear of possibly being embarrassed in court. All of these reasons are understandable. However, a good attorney will spend time in advance of trial or deposition to go over the medical history of the patient, consider (or rule out) any pre-accident medical history that may impact your opinion, review certain questions and your anticipated answers to those questions, as well as to discuss what you can expect from the opposing attorney when he or she cross-examines you. There are almost certainly many other factors that may be considered important. The above-listed ones are those that I have found to be very important as part of my interaction with doctors over the past 15 years. Hopefully, these will assist you in your dealings with your patients.

al Eagles Over the past few years the US economy has been at its worst. Each day the media reports on financial disaster and bankruptcy. The medical community is not immune. BIG Medicine Magazine spoke with leading bankruptcy attorney, Michael N. Nicastro, Esq., of Nicastro Piscopo, a Professional Law Corporation, Costa Mesa, CA about this state of affairs.

Financial Red Flags When examining patients and patient data, physicians routinely look for health related “red flags” to help patients avoid, or mitigate, prospective medical problems. This focus on early detection can save lives and reduce future medical costs. Practicing early detection is also critical in the realm of financial health. A financial problem that is anticipated or identified in the early stages can frequently be resolved through modest fiscal or operational adjustments. In contrast, once the problem has grown into a financial crisis, a “painful” procedure, such as bankruptcy, may be the only solution. Accordingly, just as it is appropriate for a healthy patient to have regular medical check-ups, wise management will subject the corporate body to regular financial examination. This past recession, which has been particularly devastating for professionals, confirms the merits of “early detection”. Many professionals who have historically had lucrative practices and believe they’ve done “all the right things” from a business perspective, are now finding that bankruptcy is the only cure available for their financial woes. Our physician clients are shocked to “discover” that their condition is sufficiently dire to justify this sometimes bitter medicine. It has been my experience that medical professionals are particularly vulnerable to financial problems during an economic downturn due to the nature of their profession and training, and due to the payment structures imposed upon them by outside forces. Medical professionals are trained to take care of their patients, not to take care of business, and yet financial survival in this field, with its plethora of insurance arrangements, is increasingly a task. Many medical professionals simply wait too long before reaching out to a trusted financial professional. This is a mistake. Take the time to examine your businesses’ financial health. Here are few financial “red flags” to look out for: • Failure to make maximum allowed contributions to your retirement plan. You are your most important creditor. Let me repeat this….YOU are your most important creditor. Each month you should pay yourself first and then begin to pay other creditors. If you are not able to put away money toward retirement, you are not moving in the right direction and have lost valuable time. • Inability to pay off your credit card balances each month. Carrying credit card debt is one of the worst financial situations in which to find yourself. Usually, credit card balances build slowly over a period of time so that you get “used to” carrying debt and making minimum payments. However, you are paying credit card companies anywhere from 15% to 29% on their debt when the current prime lending rate is around 3.25%. • Lending personal funds to your medical practice. Simply put, the flow of money should be FROM your business and not TO your business. • Borrowing money from your retirement plan. Qualified retirement plans are safe from creditors’ claims (except the IRS) and represent funds put away for your future, not trying to solve past financial issues. There is one exception for using retirement funds – life or death issues. If you have no other option to pay for that lifesaving surgery (which would prevent you from benefiting from your retirement plan otherwise), go ahead and use those funds. • Late payments on your home, car or credit cards. If you do not have funds on hand to meet your current obligations, this is an early sign that you may be insolvent. • Accessing funds in savings to pay for living expenses or installment purchases. Savings should be used for a “rainy day” and not for normal anticipated ongoing expenses. If you have one or more of these attributes, or are engaging in any of these courses of conduct, stop and get a financial check-up. Better yet, take the time to get a periodic financial check-up even when these red flags are not flying.

Do You Live In A SUE Happy World? Learn Here How To Prevent Lawsuits It is an unfortunate fact of life that all doctors and their practices are easy targets for lawsuits regardless of merit. It is also highly possible that during almost every doctor’s professional career they will at some point need to defend themselves against a lawsuit and, should they lose, may find that a judgment against them comes at a massive and devastating financial cost. Dan McNeff, CEO

Doctors are not powerless to defend themselves, as Dan McNeff, CEO of Legally Mine, a provider of personal and business lawsuit protection services and products based in Salt Lake City, Utah notes. It is possible for doctors to create the legal equivalent of a bullet proof vest that will help them reduce and minimize the impact and financial trauma of a legal attack on their business practice and personal assets. “It is important for a doctor to understand that all lawsuits have two critical elements,” said McNeff. “The first is cause and the second is motivation.” According to McNeff, the cause of a lawsuit can vary in both its nature and who is at fault. Due to the laws of vicarious responsibility, fault can be extended from a medical assistant to the owner of the practice who may or may not have had any contact with a patient or other litigant. The motivation for lawsuits is always valuable assets that can be obtained through the lawsuit. In other words, when a patient sues a physician it is generally for money or other valuables. However, in order for a lawsuit to be successful and meet its intended desires, both the cause and motivation must be in place. The causes of lawsuits often fall out of the control of the people being sued, but the motivation (i.e., personal assets) can and must be controlled if you want to terminate the lawsuit. No trial attorney wants to work for free, so before filing a lawsuit they will check to make sure any legal action they take on another’s behalf will provide achievable cash awards in the end. Since the cause of a lawsuit cannot be controlled, the real key to lawsuit protection is making sure that personal assets are protected and can never be taken in a lawsuit. This can be achieved with the proper use of both a Family Limited Partnership, (FLP), and Limited Liability Companies (LLC’s).

“It is essential to note that the strength of these entities varies from state to state, and the language used in the business entities themselves makes a tremendous difference in how the judge treats any ruling,” stated McNeff. “If used and created correctly, these tools can stop a judge from taking any assets, regardless of the ruling.” McNeff further stated that once a trial attorney recognizes that there are no means of obtaining assets from a judgment, the lawsuit becomes worthless and most likely will not be pursued. All assets can be either safe or risky, with the risky asset being able to create a lawsuit on its own, whereas a safe asset could not. A car is a great example of a risky asset because mechanical failures within the car can create an accident. A bank account cannot create a lawsuit without manipulation from its controller. All risky assets need to be housed in their own asset protection entities to ensure that if it creates a lawsuit, unrelated assets will not be involved in the suit. Safe assets can all be housed in one properly written entity. In recent years in the state of Maryland there have been numerous lawsuits filed for Lead Paint Poisoning. A landmark judgment was rendered against a landlord for ten million dollars. In this case the defendant had an LLC to protect his assets, but it used the wrong language, was set up in the wrong state, and was organized incorrectly, and all of his assets were organized in one LLC. Because of these mistakes not only was the judgment rendered, all the properties owned by the defendant were seized in the lawsuit. At the same time other lawsuits were initiated against other landlords. These lawsuits were terminated within days because the prosecuting attorneys found that

the LLC’s were owned in the right states, and were organized so the judge could not distribute assets out of the entities. The asset protection was organized so that no one asset could be held liable with another. “Most malpractice cases against surgeons are settled out of court by an insurance company, but a trial attorney may look at the personal assets owned by a surgeon and decide that pursuing a lawsuit will render more money than the insurance covers, or that the insurance company is offering,” stated McNeff. “ In these cases, the surgeon who has protected his or her assets in a properly organized LLC will find that they can force a settlement from the insurance company should the prosecuting attorney find that there will be no access to personal assets regardless of the judgment.” Simply placing assets in an LLC with no regard to language, or the state in which it is organized, will rarely result in successful asset protection. Simply placing your practice in a corporation is a guaranteed disaster waiting to happen because judges have the right to pierce most practice corporations and the result will almost always be the loss of personal assets. For most people, assets reflect a lifetime of effort and investment decisions, and you want to protect them from damage, loss of disgruntled patients. The key to any good lawsuit protection plan will include ways to maintain control of your assets without direct ownership, shielding you from legal attacks. Should you decide you wish to place your assets into an FLP, LLC or any other protected business entity, you must make sure that you are working with a highly reputable company that understands the laws in your home state. www.legallymineusa.com.

According to McNeff, the cause of a lawsuit can vary in both its nature and who is at fault. Due to the laws of vicarious responsibility, fault can be extended from a medical assistant to the owner of the practice who may or may not have had any contact with a patient or other litigant.

The Success Business of SKIN CARE Cherie Dobbs is well known in the aesthetic medical and med spa industry. For over twenty three years she has been a notable formulator, developer and educator on skin care. She is also the founder of Dermastart, Inc., a leading aesthetic skin care company that formulates the ClearChoice and Prana SpaCeuticals brands.

Cherie Dobbs, President

From the age of ten Cherie was influenced by her mother who worked in the beauty industry. As Cherie notes, “I grew up in Newport Beach, California with a mother who worked in the beauty industry and I was surrounded by a fantastic combination of exotic and international people who, in my eyes as a ten years old, were the most beautiful and breathtaking people you could imagine.” As a young girl, Cherie accepted that beauty just happened. She thought that everyone was born beautiful and it wasn’t until she reached her teen years that she realized that true outer beauty is a combination of maintaining what you have, avoiding over-exposure to the sun, combined with a little added help from high quality beauty products. This was the catalyst that inspired her to focus her career in the aesthetic beauty industry. Beginning in the sales of facial implants, laser technology and a variety of other aesthetic treatments, Cherie quickly realized that her passion was in the science of skin care and decided to train as a clinical aesthetician. She knew that was just the starting point and that she needed to be the most knowledgeable person in the room when it came to developing and distributing skin care products that were safe and effective. As she had developed an extensive network of aesthetic surgeons from her sales days, Cherie found she could draw upon the great wealth of knowledge these doctors held. She also found that many of them were not only

willing to allow her to “pick their brain” as she puts it, but also openly introduce her to some of the proven and newer product ingredients that were not yet commercially available. “When I first started Dermastart, I did not have the range of products that I do now,” said Cherie. “I realized from day one that the only way I could effectively compete against the larger, better resourced and established skin care companies, was by having a fanatical focus on detail and quality.” It is an old chestnut that ‘knowledge is power’, but one that always holds true even today. Cherie’s ability to take the time to learn about and understand ingredients and formulations has allowed her to better lead the scientific development of the DermaStart product and team, and to create unique and top selling skin care products. Now known for her development of a broad range of advanced skin care products that often include new to market clinical grade ingredients, Cherie notes that although counter intuitive, her success as one of the top US skincare companies is because she is fiercely and proudly old fashioned! “One of my guiding principals at Dermastart is that we only deliver products that work,” explained Cherie. “It’s easy to create a beautiful package with a liquid that feels and smells nice, but it is incredibly difficult to consistently develop and deliver truly effective products that customers love.”

It is a known fact that the whole aesthetic industry is currently beginning to feel the first tremors of massive and dynamically progressive change. Many skincare and other aesthetic manufacturers and vendors within the industry are being purchased and absorbed into the mega-medical companies, as well as non-traditional corporate America. By all appearances, the aesthetic industry might be seeing a return to the early years when only a few vendors controlled the market. Cherie is positioned well because her boutique skincare products sold under the ClearChoice, and Prana SpaCeuticals brands, as well as her rapidly growing private labeling capabilities, helps her customers keep their product mix select and exclusive, further defining their aesthetic medical spas and medical practices as unique, special and different. A great example of this is the recently launched peels that have a two- unit dosage. The usage guidelines make DermaStart peels easy to use and the patient results are impressive. Of equal importance to all med-spa and aesthetic medical practice customers, is that these are very profitable items. Another spectacular hit is the Sport Shield SPF, a product category in its own right that is now seen and accepted by all ClearChoice and Prana SpaCeuticals consumers as a must have item for all seasons.

As Cherie points out, skin care products if correctly managed by a practice or med spa, can be a very important and significant part of recurring residual income. It is also another reason for continuing patient engagement and interaction further helping develop better patient relations. “I know our success is in great part that we don’t treat our customers as a destination that we ‘just’

ship product to,” said Cherie. “If our customers allow us, we like to work as partners and help them manage product inventory, all the way up to educational events. Quite simply if our customers do well, so do we.” With the new educational program Cherie is rolling out called Face Detailing™, she is sure to keep customers very happy. Face Detailing™ aims to help esthetician’s understand how to

assess skin better… creating client loyalty and individual results driven goals. Dermastart, Inc., ClearChoice and Prana SpaCeuticals are headquartered in Winter Garden, Florida. www.dermastart.com

“One of my guiding principals at Dermastart is that we only deliver products that work,” explained Cherie.

Hello

Who’s Calling Please? THE TELEPHONE – A Patient’s First

Verbal Interaction With YOUR Practice

by Angela O’Mara The majority of prospective patients that call your office are generally well educated. They most likely have already researched you on the Internet, shopped around for information and pricing from other doctors (your competitors), have a good understanding of their procedure of choice and are looking for answers and solutions to their problem NOW. Not next week or next year. But right now while they are on the telephone with your receptionist. Do you realize you may never meet this patient if this call is not answered correctly? Do you realize this call could cost you thousands of dollars in lost revenue?

Prospective patients that call your office will become cash-paying customers who will not only be loyal to you, but will also refer their friends and family, if they are greeted by a caring, knowledgeable person who is able to bring them in for a consultation with YOU. While you should not expect the receptionist to up-sell your services, it is ultimately their responsibility to bring that patient in for a consultation with you. If your receptionist ends the call without booking a consultation, or even worse, no contact information or source of the caller, then they are seriously hurting your business and losing you money. You are not alone in this scenario. Countless other doctors experience the same losses, every day.

Do you have the right person answering the telephone? It has been my experience that many times the receptionist is the least paid and the least knowledgeable person in a medical office. Many times they act as “gate keeper” and don’t understand that they play a pivotal role in the success of YOUR practice. The receptionist is not just answering the phone. They are your first and immediate connection with the world outside. This person holds the power to either turn that caller into a paying patient, or lose them allowing them to go

elsewhere for a procedure that you could have performed. Also, consider the fact that we are not talking about just one procedure. That same patient may have returned to you for further procedures and referred you to their friends and family.

Patient Tracking Tips: 1. Name, address, phone number, email address 2. Telephone and email contact information 3. Areas of interest (type of surgery or procedure discussed) 4. Timeline for treatment (how soon do they want to do this?) 5. Referral source (newspaper, magazine, TV, Internet, friend, etc.) 6. Consultation date 7. Notes on interesting points made during conversation 8. Any concerns to be noted

A prospective patient will never have the chance to consult with you if they have a bad experience with your receptionist I have been in practices where the receptionist complains that the telephone is a nuisance. They complain that it is a distraction, an interruption and never stops “ringing off the hook.” The telephone is your gateway to success and a good receptionist should understand what their role as “gate keeper” truly means. It is the entry to your practice and the doorway to new patients and future practice growth. It is also the welcome mat for past patients to return when they are seeking more procedures from you. Your receptionist should always answer the phone with a smile on their face. How they greet a caller will set the tone for the rest of the conversation. Their role of “gate keeper” does not mean that they keep the gateway closed as many seem to think. It means that they stand at the gate as the greeter who welcomes visitors to your practice. Example: With a smile on their face, “Good Morning (afternoon), Dr. Miller’s office. Jessica speaking. How may I help you?”

Next is the actual conversation. However, before we go there let’s discuss a simple method that will help you track all new calls, so long as the receptionist complies. Compliance with a tracking system, however, should not be a choice. Every practice needs to track new patient calls, and it needs to obtain new caller information in order to grow. Your receptionist should be ready with pen poised to take down the details such as name, address, phone number, email address, referral source, etc. They should then be ready to engage in a dialogue with the intent of bringing that person in for a consultation. In any other organization these types of calls would be called sales leads. They need to be treated with importance. While your receptionist should be able to answer basic practice and treatment information, they should not try to play doctor on the phone. Booking the consult is the best thing they can do.

What is the cost of Surgery? Medicine is becoming more of a commodity than ever and in the aesthetic industry it is a buyer’s market where people will ask price over the telephone. However, we all know that they are not comparing apples to apples. Therefore, your receptionist should have at least three talking points about you that bring value. These talking points could be:

During The Conversation It is always good that your receptionist frequently refers to your area of expertise and credentials wherever possible during the conversation. They can even go as far as elaborating on your state-of-the-art medical office, cutting edge procedures, highly qualified staff, etc., as long as the conversation allows it and so long as everything they are saying IS TRUE. Many receptionists get off track with personal and idle chatter and they forget their true role. That role is to be your ambassador to the caller and make sure that they bring that patient in to meet you for a consultation.

When A Call Becomes A Consultation The whole goal of the receptionist is to turn a call into a consult. It is a learned skill so long as the receptionist wants to learn it. An experienced receptionist should know this, but even a “newbie” can learn this skill fast. The more excited and educated they are about you, the easier it will be for them to make this happen. Sometimes, the receptionist may have to ask several times if the caller wants to book a consult, therefore, they should remain light hearted in their conversation while still being firm and on task. Asking how “soon” they want to have surgery is a great way for the receptionist to understand what time frame they are working with. If the caller says “Oh, within the year,” then the receptionist will have to work a bit harder to get the caller in to see you. If they say, “in time for a wedding in two months”, the window has narrowed and they should be encouraged to come in sooner.

I Don’t Want To Book Surgery Now If the patient decides “to wait and call back to book a consultation,” rather than book one now, that is OK as long as the receptionist has obtained all the necessary call back information. At this point the receptionist is still left with choices. They can: 1. Ask the caller if they would like a call back in a week or so to check in with them

1. Length of time in practice

2. Invite them to an event or open house that you have scheduled

2. Areas of specialization

3. Add them to your e-newsletter list so they can be updated on the latest developments in the practice

3. Medical School or Ivy League education 4. Number of procedures performed 5. A training site for other doctors to learn firsthand from you

4. Add them to other future event invitation lists It is the job of your receptionist to develop relationships with the people that call in and ultimately book them for a consultation for surgery. A few simple steps can help them be successful in their job, and build you a more successful practice.

6. Advanced training in cutting edge procedures 7. A caring doctor with a world-class practice 8. Patient testimonials As much as economic advisors would like to tell us that price is what matters most to consumers, when it comes to medical care and surgery, it is not. Patients definitely want to get the most from their insurance premiums, but from their doctor they want value, total care, comfort and results. When asked “what is the cost” over the telephone, this is a key indicator of the importance of price. Health is not just an item to be sold. It is often a dream to be had and selling that dream over the phone can be challenging. Therefore, I suggest that the receptionist understand the value of what they are selling. And ultimately they are selling a consultation with YOU.

How much does a lost call cost in revenue?

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How To Be A Healthy Doctor

Minutes to

Less Stress

It’s five o’clock and you still have a waiting room full of patients to see before the office doors close for the day. As a practicing doctor, you know the demands of running an efficient, modern medical practice really means you are a long distance runner, moving from one task or patient to the next in a seemingly never ending race. That nagging feeling of always being behind in your schedule can lead to dangerous stress levels that jeopardize your work and threaten your own physical and mental wellbeing. The list of physical complaints from time-stressed doctors seems to grow longer by the year: anxiety, depression, high blood pressure, body aches and sleepless nights. Add in irritability and low energy levels and you have a perfect storm of symptoms that will take their toll on you if not addressed daily. For doctors, the real challenge is finding quick and easy ways to relieve stress, because unless you are packing it in for the islands, it is going to be with you. So when every minute counts, how do you find enough time in the day to stop and heal yourself? The answer is simpler and more enjoyable than you think: Yoga-like poses – on the go. Elyse Briggs, Nationally Certified in Therapeutic Massage and Bodywork and owner of Yoga at the Village in Glendale, California, created her latest Stretch in Time® DVD series (The Basics and Balance: Build Strength – Gain Confidence) on the idea that the simplest of exercises are often the ones that do the most good. “My motto is to keep exercise simple so you are more likely to continue it. And it works.” says Briggs, herself a bundle of yoga-induced energy. “If your work schedule doesn’t allow for a trip to the gym, just grab a chair from your waiting room and do these easy exercises in between patients. You’ll be refreshed and invigorated within minutes.” Although it does not appear that doctors’ harried schedules will change for the better any time soon, it is possible to limit the negative effects of high stress levels through incorporating these easy yoga-like exercises into your day. Working just one exercise an hour into your schedule means one less minute of stress, and many more of good health.

At BIG Medicine Magazine™ we love yoga. These fun and practical DVD’s are available at www.stretchintime.com

Briggs developed the following five exercises and stretches to relieve the physical and mental stress doctors experience on the job. You can feel better in as little as five minutes - and all without rolling out your yoga mat.

1 2 3 4 5

Downward Facing Dog with chair – Relieves tight shoulders, hamstrings and lower back pain. Position a stationary chair against a wall. Stand and hold onto front edges of seat. Inhale, and on an exhale step back, knees bent and hips lifted. Chest presses toward thighs, spine lengthens as you try to straighten your legs. Breathe for 30-60 seconds.

Backbend with chair – A reverse spine stretch for lower back fatigue. Sit near the edge of the chair with hands on the side edges. Walk your feet forward, lifting your hips and coming into reverse plank. Shoulders are over wrists, arms and legs are straight. On an inhale with feet planted, lift your hips toward the ceiling. On an exhale arch your back. Breathe. Hold for 30-60 seconds.

Twist – Relieves back pain, lower back tension and aids digestion. Sit in the chair with shoulders and hips aligned. Inhale, and then on an exhale, leading with your navel, slowly turn to the right, placing your hands onto the arms or back of the chair. Inhale and move back to the center for a few breaths. Inhale again and repeat to the left side. Hold each side 30-60 seconds.

Forward Fold – Releases neck tension, lower back and spine tension and pain. Sit near the edge of the chair, feet more than shoulder-width apart. Inhale and raise arms overhead, palms facing each other. On an exhale and with a long spine, hinge at the hips and slowly lower your body and let hands reach the floor. Breathe. Hold for 30-60 seconds. For more of a stretch, grab the two front legs of the chair and with feet planted, straighten your arms, lengthen your spine and lift up. Hold for 30-60 seconds. Breathe. Then relax back into the forward fold. Come up carefully, hands on knees, pushing back up to your original seated position.

Relax with legs up the wall – A restorative pose for aching legs and lower back pain. Lie with your back on the floor, bottom and hips as close to the wall as possible. Straighten legs up the wall. Lie with arms outstretched and palms facing up. Breathe and relax for five minutes or longer.

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The Operating Theatre and Herb Garrett of St. Thomas London, England

The oldest Operating Theatre existing in Europe is in the attic of St. Thomas Church in London and remains as a memory of the original site of St. Thomas’ Hospital. Prior to 1822, surgical operations on female patients at St. Thomas’ Hospital took place on the Dorcas Ward. Hospital Governors, displeased by this limitation, demanded that part of the nearby Herb Garrett be converted into a new purpose-built operating theatre primarily for female patients. By fitting a skylight into the old wooden Church roof, surgeons were provided with a well-lit teaching space. By the 18thth century, the United Guy’s and St. Thomas’ Hospitals had become important and prestigious teaching hospitals. An Operating Theatre provided the opportunity for apprentice surgeons to watch and learn from their tutors. Among them was famous surgeon and anatomist Sir Astley Paston Cooper.

Photo: Gareth Miles, museum officer, lecturing at The Operating Theatre and Herb Garrett of St. Thomas.

A Step Back In Time In 1862, when St. Thomas Hospital moved from its ancient site to its current location in Lambeth, London, The Operating Theatre was closed and the entrances from the Hospital into the Garret were blocked up. Although it was not completely forgotten, and there were references in academic publications in 1936 and again in 1954, and the skylight could still be seen from the eastern end of St. Thomas Street, it was certainly a case of “out of sight - out of mind” and for many years The Operating Theatre was left to deteriorate in silence. It lay undiscovered for almost 100 years until researcher Raymond Russell uncovered a reference to its church attic location in the hospital archives.

Russell discovered the Operating Theater in 1956. It was clear that the old theatre could not be left to perish in its state of dereliction and neglect. Full restoration rather than mere preservation was needed. Apart from the intrinsic interest within Guy’s and St Thomas’s hospitals, it was obvious that the restoration would be of considerable general appeal; both to the medical profession and the public at large. No other early 19th century operating theatre exists in Europe. As the restoration would be within the property of the Cathedral authorities, their permission and co-operation were needed. The Provost and Chapter gave this willingly and graciously and a small Restoration Committee was formed and careful restoration and reconstruction began in the 1960’s. Today the Old Operating Theater is open to the public and has a permanent lease for another 120 years. Along with the discovery of the medical amphitheater, The Garret contained surgical and obstetric instruments, human specimens, miscellaneous items from the hospitals, such as mugs, a nurses chatelaine, carboys and bell mortars, and other items from the apothecary. Many of these items are on display, along with numerous other antique surgical instruments, photography and medical equipment. The Old Operating Theater is situated in an old part of London that dates back to the Victorian era. Life during that time was tough for inhabitants of the neighborhood. Surrounded by hundreds of manufacturers, slums, high poverty, terrible child labor abuses, all levels of pollution and filth.

Doctors at the theater saw a serious increase in the need for medical care and emergency surgeries due to injury and infection. The patients were mainly poor people who were expected to contribute to their care if they could afford it. The patients at the Old Operating Theatre were mostly women and many of the operations performed were for amputation. Until 1847, surgeons had no recourse to anesthetics and depended on swift amputation technique (surgeons could perform an amputation in a minute or less), the mental preparation of the patient, and alcohol or opiates to dull the patient’s senses. It is said that several of the surgeons became “show men” and gathered audiences of not just medical students, but local people who wanted to see a little blood. This description of the students packing the Theatre to witness an operation was left in archives by a St. Thomas surgeon, John Flint South: “The first two rows ... were occupied by the other dressers, and behind

Patients put up with the audience to their distress because they received medical treatment from some of the best surgeons in the land, which otherwise they could not afford. Wealthy patients of the surgeons would have been operated on, by choice, at home, probably on the kitchen table. The risk of death at the hands of a surgeon was greatly increased by the lack of understanding of the causes of infection. Although cleanliness was a moral virtue, descriptions suggest that a surgeon was as likely to wash his hands after an operation as before. Or in other words, they might not have washed their hands before or after surgery. The frock coats worn by surgeons during operations were, according to historical notations, ‘stiff and stinking with pus and blood’. Beneath the table was a sawdust box for collecting blood. The death rate was further heightened by the shock of the operation and, because operations took place as a last resort, patients tended to have few reserves of strength and subsequently perished.

a second partition stood the pupils, packed like herrings in a barrel, but not so quiet, as those behind them were continually pressing on those before and were continually struggling to relieve themselves of it, and had not infrequently to be got out exhausted. There was also a continual calling out of “Heads, Heads” to those about the table whose heads interfered with the sightseers.”

Thankfully, medicine has come a long way since the Victorian era and while we still have many doctors who are show men, we are pleased to report that, for the most part, they are operating in clean, hygienic and sterilized areas with state-of-the-art surgical equipment and anesthesia. If you’re planning a trip to London this year, you can learn more about this fascinating piece of medical history at www. thegarret.org.uk.

Sir Astley Paston Cooper was born on August 23, 1768 in Brooke, Norfolk. At the age of sixteen he was sent to London and placed under Dr. Henry Cline (1750–1827), surgeon to St. Thomas Hospital. He devoted himself to the study of anatomy. In 1789 he was appointed demonstrator of anatomy at St. Thomas’ Hospital, where in 1791 he became joint lecturer with Cline in anatomy and surgery, and in 1800 he was appointed surgeon to Guy’s Hospital on the death of his uncle, William Cooper. In 1802 he received the Copley Medal for two papers read before the Royal Society of London on the destruction of the tympanic membrane; and in 1805 he was elected a Fellow of that society. In the same year he took an active part in the formation of the Medical and Chirurgical Society of London, and in 1804 he brought out the first (and in 1807 the second), part of his great work on hernias, which added so largely to his reputation that in 1813 his annual professional income rose to 21,000 pounds sterling. In the same year he was appointed professor of comparative anatomy to the Royal College of Surgeons and was very popular as a lecturer. In 1817 he performed his famous operation of tying the abdominal aorta for aneurism; and in 1820 he removed an infected sebaceous cyst from the head of King George IV. About six months afterwards he received a baronetcy which, as he had no son, was to descend to his nephew and adopted son, Astley Cooper. He was subsequently appointed sergeant surgeon to King George IV, King William IV and Queen Victoria. He died on February 12, 1841 in London, and was interred, by his own desire, beneath the chapel of Guy’s Hospital. Photos to the left are of actual exhibits and antiques on display at the museum.

Dr. Pierre Fournier

The Secret To Beauty

EXCLUSIVE Paris, France

By Angela O’Mara

“To understand beauty, first you must know how to properly drink a glass of champagne,” said plastic surgeon Pierre Fournier, M.D., as his lovely wife Michelle placed an exquisite silver ice bucket carrying a bottle of vintage Moët on the table in front of us. My first memory of meeting Dr. Pierre Fournier was in the 1980’s when he was a guest faculty member at the Foundation For Facial Plastic Surgery meeting, an annual event hosted by H. George Brennan, M.D., in Newport Beach, CA.

The FFPS as it was known then, started the first multi-specialty aesthetic meeting that joined the various medical disciplines together into one event. It was held every summer and that particular year was momentous as Dr. Fournier was among many famous international surgeons to discuss the development of liposuction, a relatively new technique to US surgeons at that time. Today liposuction is among the most popular aesthetic procedures in the USA and has become a multi-million dollar device manufacturing industry. Liposuction has literally changed the shape of America. On that beautiful morning I had the good fortune to be invited to meet with Dr. Fournier at his superb home in the 17th arrondissement in Paris. We discussed his many years as a plastic surgeon, his time in the French Army, the early days of plastic surgery, the fabulous life he created, and his continued advocacy and teaching of plastic surgery worldwide. We, of course, also discussed my recent trip to the Musée du Louvre, home of the Mona Lisa, as Dr. Fournier believes that to become a top rated plastic surgeon, one must first look to the paintings of the ancient masters to fully understand the human body and its beauty.

at the age of eighty-eight and a half he continues his teachings, traveling extensively throughout Europe, Asia and the USA. The day after my lesson in champagne etiquette, Dr. Fournier was leaving for Singapore to deliver his lecture “What Is Human Beauty” to a large group of aesthetic medical surgeons. According to Dr. Fournier, an aesthetic surgeon by definition must create or conserve beauty. Surgical techniques abound in the textbooks but, in his opinion, artistic teaching on beauty or human beauty is not enough. Beauty lies within the eyes of the beholder and the sooner plastic surgeons understand the psychology of beauty, the better they will become at aesthetic surgery. “Beauty is an ensemble of shapes and proportions, which bring pleasure and which we admire, but the concept varies according to different cultures,” said Dr. Fournier. “Beauty stimulates an aesthetic feeling within us, pleasing to the eye, a sense of admiration. Some say beauty is a visual pheromone. I say it is a work of art. Go to the Louvre, you will see what I mean.”

But, back to the champagne. “Champagne is a great celebratory drink. It sends bubbles up your nose and makes you giggle. It is a drink that makes people happy. Just like plastic surgery is the surgery of happiness,” explained Dr. Fournier. In international circles Dr. Fournier is attributed to be the founder of modern aesthetics and

Original liposuction equipment from the 1980’s. Owned by Dr. Pierre Fournier.

Much has been written on the psychology of plastic surgery when it comes to patients. Very little has been written on “surgical psychiatrists” a term Dr. Fournier feels is more appropriate for a plastic surgeon given that when a plastic surgeon changes the outside of the human body, they also change the inside because they almost always make the patient a happier person. Dr. Fournier continued to explain that in his mind, human beings do not merely want to live, they want to live in the best physical and mental condition. He is obviously taking a dose of his own medicine, and so is his wife. The two are fit, able, active and very sharp minded. The constant lecturing and traveling is keeping them young at heart, in body and mind. Traveling the world is obviously nothing new to Dr. Fournier whose clients have ranged from queens and dignitaries the world over, to local farmers and factory workers. He has acquired both fame and fortune over the years. Although he had humble beginnings, he has been able to reach the heights of success both personally and professionally. After World War II and graduating from medical school he had no more money than a pickpocket he says. However, a friend of his suggested he try aesthetic surgery as it was a growing trend in Paris. He did and he found it came quite naturally to him and eventually he opened a small clinic in the suburbs. By offering lower prices than the “city” docs, his practice soon grew and patients began to line up at his door. His big break came when he visited his friend and

How To Pour Champagne The French Way Champagne is a celebration in itself and here are tips from French Plastic Surgeon Dr. Pierre Fournier. • Chill the Champagne. The ideal temperature is approximately 45 F (7C). At this temperature the aroma and taste of the drink can be fully appreciated • Hold the bottle steady at a 45 degree angle away from people. Remove only enough foil to loosen the twisted wire top. It is a good idea to hold a cloth (or a finger or thumb) over the cork when removing the foil so that it does not pop spontaneously. Hold the cork and gently turn the bottle to quietly pop the cork • Use a long stemmed flute or tulip shaped glass as they enhance the flow of bubbles to the crown and concentrates the aroma of the champagne. Place them close by so you can pour directly once the champagne bottle has been opened

fellow physician Giorgio Fischer in Rome, Italy. Dr. Fischer was a gynecologist who had invented a machine to “suck the fat of Italian ladies” and wanted to build a factory to produce his invention. Another friend, Dr. Yves Gerard Illouz approached them with the idea of using a suction machine (that had been developed to perform abortions which were legal) that he thought would work better. Thus began the popularity of the traveling trio that led to an invitation to lecture at the American Congress of Plastic Surgery, and then….. the world. His principal tool for liposuction was always the syringe which he believed was as

powerful as any suction machine, although I am sure there are many laser and light companies that would beg to differ. Today, liposuction has become an option for weight loss over diet and exercise, especially in the US where instant gratification is the norm. Whatever way you want to put it, or suck it, pun intended, liposuction is here to stay and has made a lot of people very wealthy. Dr. Fournier stopped practicing surgery two years ago. His days are now spent studying art and beauty, lecturing and teaching other physicians on his plastic surgery principles and showing admirers like me how to properly enjoy a glass of sparkling champagne!

• Wipe the neck of the bottle with a cloth to make sure it’s clean • To pour, hold the bottle at the base with a thumb in the dimple, and fingers on the bottle itself, pour about one inch of champagne into each glass. Let the froth settle and then continue pouring, topping the glasses up to two thirds full • Champagne flutes have long stems which you should use so as not to warm the contents of the glass • Although champagne is an elegant drink and should be sipped slowly, it should be sipped in a way that the champagne hits the back of your throat first. This way you feel and taste the full vitality of the drink. If it hits your tongue first it will instantly become warm and lose its sparkle

“Remember, gentlemen, it’s not just France we are fighting for, it’s champagne!” Sir. Winston Churchill WWII

Dr. Pierre Fournier teaching Angela O’Mara how to strike a pose.

Dr. Mario Gonzalez Ulloa

A Visionary In Plastic Surgery

A Report From South Of The Border By Dr. Alfredo Ponce, Plastic Surgeon, Guadalajara, Mexico Don Mario, as we referred to him, was from another galaxy. Born into a wealthy family, he studied medicine and, like many people who wanted success in those days, took his dreams in a suitcase and began traveling around the world to meet the best surgeons. He traveled so he could learn surgical techniques from them, techniques that he ultimately brought back to Mexico to the benefit of patients and future surgeons alike. Don Mario, whose full name was Mario Gonzalez Ulloa, became one of the most prominent plastic surgeons in Mexico, not just because of his surgical skills and expertise but also due to his entrepreneurial spirit. Dr. Mario Gonzalez Ulloa

I, personally never received a single lesson in medical school about how to manage and administer the money earned at my medical practice, or that being a doctor in private practice is just the same as building a company. I even remember receiving the message from my professors that “doctors should be somewhat like a social worker for the well-being of humanity.” Over the years, I have met many physicians who, after a life of professional success practicing medicine were passing the last days of their lives in bad condition. Not from ill health, but with economic problems. As you say in the USA, they were bankrupt. I was afraid in the early years of my career that this might also be my fate. That was until my final years of residency in Plastic Surgery in Mexico City where I met a professor who was like a celebrity to me and to many of the other plastic surgery residents. It was at that time that Don Mario began to influence my life. Don Mario contributed more to my future success than anyone. Don Mario was a pioneer and was always creating something; a surgical technique, an instrument, a new textbook, a novel, an opera or a new building. He was always creating, developing and inventing. One day he performed surgery on one of the most important actresses in Mexico and she paid him with a bag of coins. He took the bag of money to the bank, and the banker told him, “don’t put this money in the bank, buy land for the future,” and he did. He later used that land to build

his first hospital which remains one of the most important hospitals in Mexico City, The Dalinde Medical Center located in the heart of the city. To this day, it is one of the busiest health centers in one of the most populated cities of the world. Born in Chihuahua, MX, Don Mario carried a special place in his heart for Mexico City. In the 1950s the governor of Mexico City decided to develop new and modern sections that the city needed, and for that purpose he would have to destroy some of the older areas of Mexico City. Don Mario was very concerned because a lot of the buildings had such beautiful architectural treatments that carried a lot of tradition in them. Upon awakening from a troubled night of sleep, Don Mario came up with the idea of buying the building fronts and transporting them to an area where he would build new houses with the facades. After the paperwork was signed, he created new development in the area of Tetelpan, and with this idea he was recognized by many world leaders for his foresight into historical preservation. In 1973 he bought an old farm that was once owned by Hernan Cortez, the conqueror of Mexico and he converted it into one of the best hotels in the city of Cuernavaca, which is known as the city of the eternal spring. He named it the “Ex Hacienda de Cortez”, innovating with this a new type of hospitality that we know now as “the boutique hotel”. Every Sunday he would have lunch with a group of intellectuals that

he sponsored in his “Foundation For The Study of Mankind”. Being asked to participate in this lunch was an honor and was an exciting and unique experience where writers, sculptors, painters and all kind of intellectuals would enter into philosophical discussions that always kept a flavor of being in contact with wisdom. He was a friend of all the important people of those times. Presidents, entrepreneurs, artists, philosophers, but he never left the needy. He was one of the first passionate surgeons to correct congenital defects in the poorest of families dealing with cleft lip, and he organized and funded his own campaigns. He used to keep in his desk an acuarela painted in an eggshell as one of the most important rewards that a child gave to him after a reconstruction surgery of a cleft lip. Don Mario was also a forward thinking plastic surgeon. He was the original creator of gluteus implants that he referred to as the “almond” implants because of the shape of them. He considered that beauty was not complete in a female if she does not have a good projection of the gluteal region. He held a conference that he titled “The Syndrome of the Sad Buttocks” and it was a complete success. Of course, this was decades before we ever heard of the Brazilian Butt. One of Don Mario’s many great plastic surgery accomplishments was founding the Mexican Society of Plastic Surgeons that he hosted for decades.

I knew him in the last years of his life. He died of respiratory complications surely because of his heavy addiction to smoking. I still remember walking by his side and he would take my arms and support his other arm with his eternal companion, his walking cane (he suffered sequelae of poliomyelitis) and he always had a cigarette in his mouth. Even though I did not have all of the time to share with him that I would have wished for, I learned from him the most important aspects of plastic surgery - the basics of investing from what we earn as a plastic surgeon, and I learned from him how to be an entrepreneur, as well as a successful plastic surgeon. But, the most important thing I learned from him was a philosophy of life, a way to become a person that seeks the best way to enjoy life, to be happy and find pride in what you do every day. Don Mario was the first and best entrepreneur that I ever met. He started his career as a Plastic Surgeon, but he had also the capacity to be a continual student of beauty, a great philosopher, an incredible speaker, an outstanding professor, and much more. In my esteem, he was also one of the best humans that life placed in front of me as a teacher and mentor. Today, I see that many doctors in the world are impacted by the recent worldwide financial crisis that we have all experienced, and they still lack the foresight to think beyond their surgical career. As doctors, we need more education in administration and finances because life has changed from when medicine was an apostolic life and we are now living in a very competitive world. We need the teaching experiences from people like Don Mario.

â&#x20AC;&#x153;Don Mario was a pioneer and was always creating something.â&#x20AC;?

Bell tower of the San Francisco Church in San Miguel de Allende Dr. Alfredo Ponce

Dr. Bruce Connell

The Prince of Plastic Surgery - An American Icon

By Angela O’Mara As rare a breed as the prince whose palace he was guarding, Xolo, the large Xoloitzcuintli dog (Mexican Hairless) sat and carefully observed me from his vantage point on the balcony which overlooked the vibrant blue Pacific Ocean with a panoramic view of Laguna Beach, CA. It is a Saturday afternoon and as I sip tea with world renowned plastic surgeon Dr. Bruce Connell, I can’t help but feel incredibly lucky. The name Dr. Bruce Connell is spoken by doctors who in their own right are considered successful and established leaders, they often refer to him with the reverence of a student for a great master. Chatting with him on a bright sunny California afternoon ranks as yet another “most delightful days of my career” moments.

A humble man from humble roots in Alabama, this gentle giant of plastic surgery still knows how best to use his Southern charm to make a point and to tell a story. “I just wanted to be a good physician,” said Dr. Connell with still of a hint of a Southern drawl, as we talked about his early days in medicine. “I learned quickly that a bad facelift was often the result of a rushed surgery so I decided to slow down so I could get it right.” While he may have slowed down his approach to surgery, his reputation took off faster than a California wildfire. Connell grew up poor as the only child of a divorced mother. His parents, a schoolteacher and a baker-turned-cattle rancher, separated when he was five years old during the Great Depression. Connell graduated top of his class and worked his way through a year at the University of Alabama before winning a scholarship to pharmacy school in Birmingham, AL. After a brief military tour in Italy at the end of World War II, he obtained a medical degree from the University of Buffalo where he was drawn to the challenge of cleft lips and maimed hands. He then took an internship at Los Angeles County General Hospital - now County - USC Medical Center - and a residency at the University of Buffalo in general surgery, finishing his final residency in plastic surgery at the Mayo Clinic. When he graduated, he returned to Southern California to start his practice because the climate he says, reminded him of his time in Italy. Setting up practice in California was a godsend and it became home to this man whose ideas of beauty extended far beyond the face and body, but also to his garden and his personal

surroundings. It is not a secret that Dr. Connell boasts one of the most beautiful gardens in all of ritzy Laguna Beach, and that his brilliant hands are as agile at cutting and splicing hybrid trees and vegetation, as they are at cutting and draping human tissue. Maybe not considered entirely humble as rumors abound about the size of his home in Laguna Beach, or the lavish life he lived racing around Las Vegas with the “in crowd” on whom he supposedly performed plastic surgery. As Dr. Connell recounted to me, his life and his love of plastic surgery with glee, what struck me most was how genuine and caring he is as a doctor and as a man, and how this man’s quick mind and wit is still more vibrant than most people I encounter. What is his secret? “At first, I used to look at patients and wonder what I should fix,” said Dr. Connell. “Then all of a sudden I stopped dwelling on what wasn’t beautiful. The real mystery is in what is beautiful.’” Ask any plastic surgeon what it’s like to know Dr. Bruce Connell and they will tell you - he is to plastic surgeons what the “Oracle” was to Keanu Reeves in the movie The Matrix. Ever knowing and ever seeing. Before meeting with Dr. Connell, I sat down with Long Beach, CA plastic surgeon and former Connell fellow, Marcel Daniels, M.D., to discuss this living legend. Dr. Daniels was one of the best resources to discuss this world class icon given the fact that he knew Dr. Connell before Dr. Connell taught him how to become a worldclass surgeon. “I first met Bruce when he was starting out and he would come to our house to practice French

with my mother,” reminisced Dr. Daniels. “Little did I know then that many years later I would be learning facial rejuvenation surgery from him.” According to Dr. Daniels, and to many other plastics surgeons we spoke to, Dr. Connell made him not want to be “a general surgeon who just uses tiny sutures!” Dr. Bruce Connell’s fellowship training program was very selective and he is known for constantly challenging the preconceived notions of his fellows. He has trained several generations of plastic surgeons and has had a huge impact on the field of facial rejuvenation. His critical eye and attention to detail were a great inspiration to Dr. Daniels who says that to this day the techniques he drummed into his fellows in face and brow lifting are the gold standard for natural, elegant results! Techniques that still apply today. “Even many years after my training, I would attend meetings where Bruce would be presenting and all of the attendees would be awe-struck by the quality of his results,” said Dr. Daniels. “His techniques for face and browlifting remain gold standard to this day and he has had a major influence on many surgeons, including myself!” Over the years, Dr. Connell quietly became one of the world’s premier face lift experts. As well as training decades of future surgeons, he was sought after at medical conferences and his training seminars were always sold-out. Details of Dr. Connell’s works and techniques have appeared in many medical textbooks and white papers worldwide. However, if you search for him on the Internet you will find little about

him, but rather hundreds of google pages listing websites of all the other doctors that either trained with him, or reference articles he has written or quotes he had made. Dr. Connell’s reputation has outgrown the USA, over the years he has treated patients from Egypt, Italy, Germany, Australia, New Zealand, England, Singapore and countless other countries. The same can be said for his travels and lectures. It is said that his former apprentices, known as Connell Fellows, gather regularly from around the globe as the collective Connell Society to learn from one another and their mentor. So what has Connell been teaching all these years? “Natural results, of course,” laughed Dr. Connell. “The majority of people want to look like a better version of their younger self. They don’t want to look like anybody else.” Connell’s facelift techniques emphasizes careful attention to detail and can take over 6 hours to complete. But in talking to other surgeons they say that Dr. Connell not only taught them what to do right, but also what NOT to do.

Reasons A Facelift Can Fail According to Dr Bruce Connell • A surgeon can quickly tighten the sides of the face with a slice along the front of the ear and into the hairline, or yank the loose skin with too tight stitches that pull back the hairline so that it sits too far back on the patient’s head. • That same quickie technique on a man might result in earlobes with whiskers growing out of them. • Even some of the best-known surgeons will neglect to preserve the look of the tragus, or will pull the earlobes forward and down and tack them onto the cheek like a “pixie ear,” a rush-job staple that will later have to be camouflaged with longer hair or, for women, wearing huge earrings that aren’t necessarily in style.

• Or they will make incisions along the front of the ear that stand out like chalk lines on people with ruddy complexions. • They make scalp incisions that create telltale bald spots. • Or they will lift just the delicate top layer of skin, rather than the more resilient muscle tissue beneath it, flattening the cheeks like a G-force simulator on a trainee at NASA. • They might also lift both layers and carelessly reattach them. • Sometimes, they just make a cut in front of the ears, undermine the skin, grab the deep sheet, pull to the ear, and voila - you’ve got that wind tunnel look!

Archaeological evidence shows that the Xoloitzcuintli dog has existed as a native to Mexico for more than 3,000 years. Their value in ancient cultures is evidenced by their frequent appearance in art and artifacts produced by the Colima, Aztec and Toltec civilizations in Mexico. They were considered sacred dogs by the Aztecs (and also Toltecs, Maya and some other groups) because they believed the dogs were needed by their masters’ souls and were useful companions. Some people in Mexico continue to believe this breed of dog has healing qualities.

Two words that sum up Dr. Bruce Connell are precision and artistry. Or, as quoted in a Los Angeles Times article in 2006 “What Michelangelo was to the Sistine ceiling,” said Dr. Richard D’Amico, then president-elect of the American Society of Plastic Surgeons “Bruce Connell is to facial aesthetic surgery.” And judging from what his friends, colleagues and internet websites say, this opinion is still shared by many. Xolo guarding his Prince’s Palace

Tired Of Seeing Doctors Less Qualified Than You On TV? The Seven Deadly Media Sins – Giles Raine Over the past 20 plus years or so, I have worked extensively coordinating media placements for members of the medical community. During that time, I have placed many physicians on television. Now, with the popularity of reality based TV shows, more physicians than ever are enjoying what Andy Warhol called the “15 minutes of fame” moment. However, when the media’s huge appetite for patient surgery stories is combined with surgeons who have been trained to perform surgery rather than stand in front of a camera and pretend to act, the results can sometimes be less than enjoyable – or expected - for the reporter or producer, and for the physician. These are real stories based on real-life incidents retold to me by members of the media about surgeons with whom they have worked. (Not surgeons that I have worked with.) I can hear you saying, “I would never do that!”-but these surgeons did. You probably don’t even know who these surgeons are - or do you?

Don’t change your surgical techniques midstream

Whereas learning new techniques and surgical skills is a must for any surgeon, practicing those new skills for the first time is generally daunting to most-and it is not something you want to do on national television. Luckily for Dr. X, this was something he learned during a taped interview rather than a live one. While filming a segment for a national television show, Dr. X - who was demonstrating a new facelift technique - commented while a patient was bleeding profusely, “I usually don’t do it this way. I just learned this technique last week.” The producer was ready to pack up his equipment right there and then!

Make sure your equipment works

This holds true for any new equipment purchases. Recently, a Chicago-based producer told me about a surgeon who had bragged about being the “only” surgeon in his area to obtain a new laser for liposuction. Of course, the producer wanted to have the surgeon on his show as soon as possible - but he didn’t expect that the surgeon would not have at least tried the laser a few times before going live on the morning news. It turned out to be a complete mess because the laser was not working properly, replacement fibers were not available, and the surgeon did not have any patient testimonials of his own yet. Not only did the surgeon look completely incompetent on the air, he also jeopardized the opportunity to ever be invited back on the television show again.

Mum’s the word. Don’t be a gossip!

Although I am glad to say that this is not something I hear often, I have heard and witnessed it firsthand. Don’t gossip about your competition to a reporter! Please remember that when a television crew or writer from a newspaper comes into your office to interview you, they are also (and always) on the look-out for other stories. As friendly and innocent as they appear this is still a business situation, and sometimes getting the “scoop” or “dirt” on another surgeon can make for a great future story. I’m a firm believer that what goes around comes around. So, as tempted as you may be to divulge a little tidbit of information that may make you appear to be “in the know,” remember that someone else might be just as tempted to reveal a little something about you.

Nod, nod, wink, wink- keep it to yourself When you invite a television crew into your office to film a procedure, remember that they will walk away with more than a glimpse into your life. Ensure that they leave with a true picture of you, your core values, and your professional expertise. That includes not flirting with the reporter. No matter how innocent a joke may seem, in this day and age it can easily be interpreted as a form of sexual harassment that might not necessarily land you in hot water, but will seriously harm your reputation. And trust me, on this front I have heard it all: From the producer of a national morning show who, after flying from New York, elected to permanently shelve a 4-hour facelift shoot and then added the surgeon’s name to an internal blacklist for others to see; to a female staff reporter for an internationally televised entertainment show who almost filed a lawsuit against the show after filming a breast implant story, during which the surgeon repeatedly made silly jokes and off-color remarks. Remember that no matter how casual and friendly members of the media seem, they are doing a job. It is always better to keep things professional.

Is the patient really a patient?

Marketing 101 teaches us to find out who our competitors are. In the realm of medical television shows, not only do your competitors know who you are, they also know who works for you. A successful Miami surgeon who was scrambling to find a patient for a story on fat injection to the hands for the local ABC affiliate innocently thought, “Oh well; we will just use Jane, our office manager. She’s a good candidate for this procedure.” And she was! Her hands looked fantastic afterward. However, when the story aired during a news program later that week; an extremely jealous competitor called the station manager questioning the surgeon’s integrity and stating that viewers should be made aware when a surgeon uses his or her own staff members rather than unbiased patients to show the results of his or her work. All I can say is that the surgeon was never invited back on that news program again.

Who’s the Diva now?

Popular TV Show Scrubs is a great parody of life in medicine. To have a real life medical career and a presence on TV as an expert you do have to be a bit more serious.

“Let me do that shoot again, please”

A rather handsome, suave, and debonair young surgeon has really been enjoying the media attention he has received since relocating to Beverly Hills, CA - so much so that he believes he is not only the “star” of the show on which he appears, but also it’s director. Recently, a producer friend of mine told me “that” was the last time she would work with this man. Apparently, the crew spent more time reshooting the surgeon at various angles so they could get his “good side” than they spent actually filming the patient and the procedure. While all of us want to look our best, especially because the camera is generally not kind, remember that the purpose of the shoot is to gain valuable media exposure for your practice regarding your surgical skills-which are shown through patient results. If you would prefer to spend more time telling notable movie producer Cecil B. DeMile that you are ready for your “close-up”-as actress Gloria Swanson did in the movie Sunset Boulevard – you might want to consider switching careers.

We all know who the divas of the television talk shows are. However, the aesthetic industry has a few divas of its own - men and women - who have upset quite a few reporters and show hosts in their time. One particular Dr. Diva always seems to think the show will wait for him. Believe me when I say it will not. You must make it to the show on time, and allow yourself ample time to find a parking spot, or to navigate the limousine drop-off area. Another Dr. Diva believes she has every right to share make-up artists and have the luxury of several wardrobe “try-ons” before sitting down for an interview. Nope. That is not the case. I encourage you to bring an extra shirt or blouse, or suit jacket, in case of accidental spills, but you should arrive in what you expect to wear on the show. And please do you best to act and look like a surgeon.

TR E N D S

Social Media Madness!

Simplifying Social Media by Angela O’Mara

Social Networking has become a powerful method of expanding your communication with new and future patients and customers. While other social networking sites have come and gone, Facebook appears to have held ground and expanded beyond anybody’s imagination. Social Networking is a great way to build business connections, promote products and events and find new patients. Facebook facilitates the possibility of making an association with prospective and future patients. Once a network of “friends” is developed, users can communicate using private messages just like email or by ‘writing on their wall’, which is a message that can be seen by everyone else who is connected to the user. Facebook brings together millions of people globally and has also become a platform for online marketing. If you wish to generate new leads you cannot afford to ignore Facebook in your social media strategy or as a part of your overall PR and Marketing plan. The latest statistics have revealed that the average Facebook user spends about an hour each day on Facebook and has 130 friends. More than half of its 1 billion users log onto Facebook on a daily basis.

social

madness!

Simplifying Social Media by Angela O’Mara

HOW TO CREATE A WINNING PROFILE

BUILDING YOUR NETWORK BY ADDING FRIENDS

HOW TO BUILD PROFITABLE RELATIONSHIPS

The Home page of your website is your store front “window to the world”. Your Facebook page is an opportunity for the viewer to have a personal appointment with you. Having an interesting, attractive and effective profile is extremely important if you are going to use Facebook as a marketing tool, which of course you are. A profile is information that you write in the “About Me” box to introduce yourself to your audience. While this profile should not be too lengthy, it should be descriptive, accurate and engaging.

Whether you want to connect with you referral sources, new patients, existing patients, business associates, old college friends or complete strangers who might become patients, you need to first add them to your friends list on Facebook

What is the point in having hundreds of friends on Facebook if you are not able to convert them into paying customers? In social media as in other Internet media, customers, or patients, are acquired by building relationships with people in your target audience. In order to be a successful online marketer, you must get inside the head of your prospects and understand their needs, motivations and behavior.

Here are several other ways you can connect to people on Facebook to grow your network:

Your profile will be read by potential patients, existing patients, your target audience, other business associates, as well as your friends, colleagues and competitors. Your profile should create a positive first impression of who you are and what you do, and especially how you can be of benefit to others.

All forms of Social Media, including Facebook, are opportunities for branding. Your Facebook page should reflect the same branding as your website, collateral materials, etc. Using your name and/ or the name of your practice is important. Do not use a nick name or a pseudonym because you think you should be anonymous. Anonymity is not going to get you new patients. Use your practice name or actual name for your Facebook profile. Internet Entrepreneurs will attest that trust and credibility rely on personal brands based on the names of the individual, especially on line. There are two types of pages on Facebook, a personal page and a business page. Personal pages are easier to grow and it is easier to connect with old friends and new friends on a personal page. A business page is harder to grow because you have to get people to “LIKE” your page. This is a longer term process and may take a small amount of internet marketing or advertising to ultimately grow this page. However, you should consider having both a personal and a business page.

a. Search for people from other social networking sites you are a member of and invite them to be your friend on Facebook b. If you have an email list, you can design a personalized newsletter with an invitation to become your friend or to LIKE you on Facebook c. Search for groups on Facebook related to the niche you are in, become a member and send friend requests to all the group’s members. You could also search for general Internet groups and send friend requests to their members d. You can also use your mobile telephone. Facebook can find a friend through their phone numbers e. Send a friend request to the friends of your friends. Since you have the friend in common, you have a better chance of getting them to accept your friend request f. Add a Facebook icon on your website or blog which invites visitors to request you as a friend

Remember that people DO NOT browse the Internet to search for products and then buy them. Instead people browse the Internet to search for information that would help to solve their problems. If you have a product or a service that solves a problem, you must supply useful information online which will attract people to you and not just advertise your product. The core principle of Attraction Marketing is not to sell but to attract your prospects. This is done primarily by positioning yourself as an expert, an authority or a specialist in your niche. If you understand the above point, no one can stop you from becoming a star Internet marketer. The next question is how to position YOU as an expert? You become an expert in the eyes of others by sharing useful information with them. For instance, if you share factual information about your industry or help someone to understand the concepts of your subject or share the latest news and updates in your niche, you will soon be able to develop a perception of being an expert in your field. You will start attracting people to your site or blog on a regular basis. Many of them may choose to subscribe to your mailing list, if you have one. All these people are potential customers. If, and when, you offer a product, you can be sure to get a good response from them because you have already developed trust and credibility. While the position of expertise is an excellent way to attract customers to your website or blog, the same strategy cannot be solely applied directly on Facebook.

As mentioned earlier, your website is your “window to the world”. Your Facebook page is where you begin to actually have a conversation with the person who has stepped into your practice. Generally speaking, Facebook is a platform for building friendships and not for soliciting business. However, most people are using Facebook for two reasons – to be social and to grow their business. With Facebook the goal is to get as many people looking at your page and using it to update them on the services that you offer. You don’t have to over sell or promote your business directly, rather you will carefully craft your messages so that your viewer has a very clear idea of what it is you offer. The idea being that if you develop good friendships with people on Facebook, they will look at your profile and then go to your website, and then either ask questions or schedule a consultation to see you. Making friends on Facebook is just the same as making friends in the real world. I compare Facebook to a networking event or a cocktail party. At any of these events or parties you only have a limited amount of time to: a. b. c. d.

Make a first impression Strike up a conversation Explain what it is you do Understand how you can benefit the person you just met e. Determine if you can do business together f. Exchange contact information g. Cultivate a lasting relationship Here are several ways you can expand and keep your new friends on Facebook: a. b. c. d. e.

Send a personalized friend request Write a brief message on their wall Create interactions Develop the relationship Comment on their wall post if you find it interesting f. Write something that will get you noticed g. If you comment frequently on your page, other people will definitely notice you h. Tag people you know in notes, videos and pictures

HOW TO MARKET USING FACEBOOK Advertising While Facebook is tremendously powerful for building relationships, it also offers very effective applications for advertising - over 1 billion users is a market place that you cannot ignore. One of the most valuable things about Facebook is that

SOCIAL MADNESS

COMMENT, SHARE, LIKE you can target your advertising and marketing to a specific group of people based on age, location and other demographic criteria that is important to you. Advertisers can also track the performance of their ads in real time and make relevant optimization. You can also choose how you pay for your ad. You can use a pay per click (CPC) method or pay per 1000 impressions (CPM). I would recommend starting with a CPC method. That way you are only paying if someone actually shows interest and clicks on your ad. Facebook Groups Groups on Facebook have a great potential. They help you to find and attract fans for your pages or simply to find friends. Search for groups related to your niche or area of expertise and become a member, then contribute

USEFUL TIPS: Plan your Facebook and Social Media Campaign and Marketing Strategy before you begin any activities. Give Facebook and Social Media Marketing minimum of four months to gauge whether or not you are seeing a noticeable number of friends/fans for your Page. Remember that it takes time to position yourself as an expert in your niche. Take things step by step and add/set up the appropriate tabs (Events, Discussions, Videos, Groups, etc.) over a course of time so as to keep your content fresh.

quality information to the group and develop relationships with other members. It is especially useful if you can develop a relationship with the group administrator as they are in control of the whole group. Send a personal note to the administrator and ask if there are any areas of specific content they would like you to contribute. Once you develop a rapport with this person, you can also ask if they would like to post a link about their group to your Page, and vice versa; ask if you can post your page link on their group wall. Once you develop a relationship here, you can also ask if you can post your future events to their group. Starting Your Own Facebook Group You could even start your own Facebook group. It is a simple process. Click on groups in the navigation panel. On the next page, click on Create a New Group. Fill in the details and voila, you have created your own group. The difficult part is to get members for your group. If you choose to create a group with a well defined focus you will increase your chances of getting people interested in joining. It is best to invite your friends and fans or people from your email list to join your group. One of the most important things to remember with any form of Social Media Marketing is that you must be active. Blogs or Facebook pages that are not updated on a regular basis make it look as though you are not in the game. The same holds true of your group page. Keep it active. Publish information which is useful to the group members on a regular basis. Get the group members to participate by raising issues or asking questions. One of the downsides of Facebook or other Social Media Networks is that you and your staff can easily become distracted. While you do have to conduct a fair amount of time on adding friends and fans, and browsing other people’s walls to learn more about them, you must limit your activity. Otherwise, you will find that you have just lost two or three hours of time. However, if you are not disciplined in your Social Media Marketing efforts you will not see any results. Being disciplined means having a long term view of what Facebook can do for your practice, and not expecting quick results. NOTE: With Facebook, YOU MUST ADHERE TO THE SAME PRINCIPALS AND PATIENT CONFIDENTIALITY RULES THAT YOU DO IN YOUR DAY TO DAY MEDICAL PRACTICE.

Growing Your Facebook Presence

In Just 60 Minutes A Day!

Plan your Facebook and Social Media Campaign and Marketing Strategy before you begin any activities. Give Facebook and Social Media Marketing a minimum of four months to gauge whether or not you are seeing a noticeable number of friends/fans for your page. Remember that it takes time to position yourself as an expert in your niche. Take things step by step and add/set up the appropriate tabs (Events, Discussions, Videos, Groups, etc.) Over a course of time so as to keep your content fresh.

FACEBOOK IN 60 MINUTES A DAY MARKETING STRATGEY 0 – 2 Minutes: Login to Facebook and briefly look through the recent wall posts and get a feel for what people are discussing and sharing. 2 – 7 Minutes: Manage Friend Requests. Check whether you have any friend requests. Accept those requests that you want to, and write a brief personal note to each one Remember that developing personal relationships is the way to succeed on social media. 7 – 14 Minutes: Write personal comments on walls of 10 to 15 people in your network. Click the LIKE button or comment on posts that you are drawn to, as this form of relationship building is a continuous and crucial activity. 14 - 18 Minutes: Update your Status Update your status on the wall. The more visible you are, the more increase you will see in terms of practice, patients and branding. Write something interesting, inspirational or informative on your wall. 18 – 24 Minutes: Add more Friends and Fans to your Network. Increasing your network is as important as building relationships. Send out 50 new friend requests. Try to have a simple algorithm for sending out friend requests. You could send 20 requests to friends of friends, 10 requests to members of the groups you have joined and 20 requests using the friend adder software.

- Growing Your Facebook Presence In Just 60 Minutes A Day!

Add a video which you have previously uploaded to your Page. Upload an article in the Facebook Notes. Remember to put in your signature (website or blog link) at the end of the note. Update photos from an event. Browse through the threads on your Discussion Tab and answer questions and share your opinions and expert commentary. Monitor the performance of your Social Advertisements (if you have placed one) and optimize them as necessary. 38 – 54 Minutes: Develop Relationships with Groups and Joint Ventures such as: Contribute content on the groups you are a member of. Communicate with your joint venture partners and group administrators.

Share a link or a video you want others to see.

Simplifying Social Media

24 – 38 Minutes: Contribute Valuable Content such as:

Search for new groups or joint venture partners to associate with. 54 – 60 Minutes: Check On What Your Competitors are Doing: Do some research on what your competitors are up to. Browse through the Pages and review content on their wall to see what they are talking about and what interaction they are getting.

As you can see, by simply spending 60 minutes each day on Facebook, you can easily build a page and attract new friends and fans. Like other forms of marketing, Facebook and Social Media requires diligence, but once you start the process you will begin to build a momentum and the results might just surprise you!

Clever Thoughts!

Angela O’Mara, President The Professional Image, Inc.

Available at www.theprofessionalimage.com

Involve as many people as you can in your social media outreach! If you have the opportunity to tag or mention someone in your status update, DO IT! The tagging feature allows your photo or post to be featured on other profiles making it accessible to other people who have not LIKED your page.

Industry Transformer

The Robotic Hair Revolution is Here! With a celebrity following that is unsurpassed, Dr. Craig Ziering is a true leader in hair loss solutions for men and women, and he continues to pave the future of hair restoration with the addition of Robografts! Robografts are in high demand in Hollywood -- where A-Listers request Robografts over the long-standing mircrograft. You might wonder how a robotic system could contribute to such a delicate and individual treatment such as hair restoration, but the ARTAS System designed for Follicular Unit Extraction (FUE) and as used for the first time in California at Ziering Beverly Hills, is an interactive, FDA-cleared, and physician-controlled robotic system that makes hair restoration for both men and women even more effective and provides completely natural looking results. A Combination of Art and Science

A pioneer in the field of surgical hair restoration and this Follicular Unit Extraction (FUE) harvesting technique, Dr. Ziering combines art, science and the most advanced technology to create exceptional, natural looking results for his patients. His refined eye for aesthetics perfectly complements his advanced hair restoration surgical skills, allowing him to offer superior solutions to those who want to win the battle against hair loss and thinning hair. With more than 20 years of experience in the latest surgical techniques, Dr. Ziering has performed thousands of successful hair restoration surgeries at his clinics in Los Angeles, Newport Beach and Las Vegas. In addition to successful hair restoration surgeries, Dr. Ziering is an expert at creating permanent facial hair solutions in the areas of eyebrows, beards, sideburns, and moustaches, as well as restoring hair lost through trauma, burns or radiation.

Over 50 Million Men Are Affected By Hair Loss Recent surveys show that more than 50 million men in the United States alone are affected by male pattern baldness or androgenetic alopecia. By the age of 50, almost 50% of men will experience some degree of hair loss and one in four men will suffer some form of male pattern baldness (MPB), which has psychological, professional and social consequences for these men, such as:

• 68% of men feel helpless about their hair loss • 73% of balding men feel they are less attractive than they were when they had hair • 77% of balding men would feel very or somewhat concerned if they were in their 20’s, just starting their career and experiencing hair loss

Female Hair Loss Is On The Rise

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after 1 procedure, 1575 Grafts, 15 months Post Op.

Hair loss in women is also extremely common. Studies show that in the U.S. alone, there are 40 million women who suffer from hair loss. The causes of hair loss in women are often due to genetics, but there are other causes such as hormonal changes, trauma, traction (braids, tight pony tails, etc.), sudden changes in diet, medical conditions such as thyroid problems, general anesthesia, and stress. Some studies suggest that a majority of premenopausal women and a greater number of postmenopausal women will experience some degree of diffuse hair thinning as part of the natural aging process. As a result, their hair loss is very gradual and often cyclical. A medical exam, scalp biopsy and blood lab work may be required for the proper diagnosis of female hair loss.

For hair loss patients, there are prescription remedies, such as Propecia® (men only) and Rogaine® that offer some improvement to existing hair growth. However, surgical hair restoration is the only permanent solution for both men and women and one that can result in a natural, undetectable outcome.

The Robograft for Follicular Unit Extraction (FUE)

Other fields of medicine successfully use robotics for safe and effective surgical procedures such as heart valve and bypass surgeries, prostate surgery, and kidney transplantation. Now the technology is available for FUE hair restoration procedures. In recent years, FUE has gained greater popularity with patients looking for an even more minimally invasive approach to surgical hair restoration than the standard strip-excision harvest method. While it has always been considered less invasive than strip-excision procedures, manual FUE is a much more labor intensive procedure for the surgeon. Until now, the challenge has been that the surgeon spent a disproportionate amount of time extracting grafts from the donor area which left little time for the all-important overall artistic hair transplant design and creation of recipient sites to achieve the natural looking result that patient’s desire. The image-guided robotic arm, which is programmed with complex algorithms and sensors, enables the ARTAS System to bring great precision and speed in harvesting grafts at the ideal angle and direction, with the optimal distance between each extracted graft and at the proper depth of incision. This allows Dr. Ziering to focus on the artistic elements of creating natural age-appropriate hairlines and restoring a full head of hair for his patients who are battling hair loss. With the Ziering Robotic Hair Transplants, a patient can expect: • A minimally invasive approach to extracting individual follicular units • No linear incision with a scalpel or linear scarring • Precise, consistent FUE harvesting • Nearly undetectable treatment after only one week to ten days • A quick return to regular daily activities • Hair can be worn at any length or style with confidence • Only permanent solution for hair loss

Superior Surgical Skills

As always, it still takes the unmatched surgical skill and artistic talent that is unique to Dr. Craig Ziering. His ability to create a natural, full looking head of hair is unsurpassed, and it’s no surprise that Ziering Worldwide is one of the first in the hair restoration industry to combine revolutionary medical science and aesthetic art into one. The ARTAS System designed for Follicular Unit Extraction (FUE) and was used for the first time in California at Ziering Beverly Hills.

Industry Transformer Dr. Jon Garito At the age of 23, Industry Transformer Jon Garito, Ph.D., took over the family business. At that time, there was one product and eight employees. Over the course of 37 years, Dr. Garito transformed the Radiofrequency device and developed it into over 100 innovative surgical patents that would be used by physicians in 12 different medical specialties, and achieving worldwide sales in 70 countries, including the USA. By understanding and listening to the needs of the doctor, Dr. Garito not only transformed a small, family owned business into a multi-million dollar corporation, but also helped thousands of doctors improve their surgical outcomes by introducing them to the precise and bloodless field of radiosurgery. In 2008 Dr. Garito sold the company he transformed, Ellman International. He is now the founder and CEO of Life Sciences Technology, a company that helps doctors turn their ideas into innovative, marketable and patentable products. Dr. Garito shares with BIG Medicine Magazineâ&#x201E;˘ his trials and tribulations in the highly competitive field of medical device development.

THE EARLY DAYS

Dr. Garito began working at Ellman Dental Mfg. a Dental device company specializing in Radio Frequency (RF) technology in 1973 when he was in college. It was a small company owned by his father-in-law, Dr. Irving Ellman, and his wife Shirley Ellman. Dr. Ellman was a dentist (and an electrical engineer.) In 1974 Garito started law school, but found that he loved working at Ellman Dental Mfg., and continued to work there juggling law school and work. During the course of the next year Dr. Irving Ellman was diagnosed with cancer and consequently died. The family was devastated and, not knowing what to do with the company, thought first to sell it. Garito quickly stepped in and bravely told his family: “I can run the business,” he recalls. “I really believed that I could. I especially enjoyed the interaction with the Dentists.” At first it was overwhelming trying to manage the business and attend law school, so Garito decided to take a leave of absence from law school (although he did ultimately get a Ph.D. in Business in 1981) to devote all of his time to the company. Dr. Ellman’s youngest son Alan also joined the business. In the early days, the company was primarily in the dental field, but Garito Dr. Peter Raus, Oculoplastic Surgeon Brussels, Belgium and Dr. Jon Garito was eager to transfer the RF technology and, while helping a friend and veterinary surgeon, he realized that he could make minor adjustments to Ellman’s signature Dental radiofrequency device, the Dento-Surg, to help veterinary surgeons perform faster bloodless surgery on small animals. “It came easily to me. I worked closely with electronic engineers to increase the wattage to support small animal surgeries,” said Garito. “The higher powered RF devise was named Surgitron.” From there, the medical world was his oyster. Next it was dermatology. At a medical conference, Garito became friends with Dr. Sheldon Pollack a leading dermatologist who was Head of the Dermatology Clinic at Duke University. Garito and Pollack began research together realizing that the Surgitron was not only a novel device, but one that was highly effective at removing skin lesions, lessen pain, reduce healing time, and decrease scarring. “ Dr. Pollack had a tremendous amount of experience and credibility and was a very highly respected dermatologist,” stated Garito. “He was amazed by what the (RF) radiofrequency technology could do.” Dr. Pollack expanded the Dermatologic range of surgical procedures for the RF Surgitron while Garito developed RF accessories to support these new soft tissue applications.

THE IMPORTANCE OF TRAINING THE TEAM

Training on the use of the RF technology was already provided to dental surgeons at Universities and Dental Congresses. When Dr. Pollack said that he was interested in further training on the device the only option was to send him to a dental course. “At first I was somewhat embarrassed by the situation. Here we were with one of the most revered dermatologists in the country and without any peer training to support him,” recalls Garito. “As it turned out, it was a blessing in disguise. Dr. Pollack took Dr. Jeffrey Sherman’s dental course at the University of Connecticut and then became a lead trainer and developer of his own courses for the American Academy of Dermatology (AAD.) It was a win, win situation.” Garito quickly realized that he had a tiger by the tail and within a few short months began expanding the medical reach and capabilities of the Surgitron radiofrequency device, and developed training courses for the many doctors who saw the potential in these technologies. These lectures took off and so did the use of the radiofrequency unit. This was the tip of the iceberg. Training of the team was on the move.

CREATING INTELLECTUAL CAPITAL

Garito went on to develop strong relationships with high level luminaries in all surgical specialties. These relationships produced scores of new surgical procedures and numerous novel RF accessories for all kinds of soft tissue uses – eyelid lesions, rhinophyma, dermatology, ob/gyn procedures. He began driving the business from one medical specialty to the next transferring the RF technology and found that the company was highly successful in each and every specialty. The welcome reception from doctors was exciting. “Doctors would have different requirements,” said Garito. “Gynecologic surgeons were using a scalpel and scissors to trim labia and when one doctor asked if I could help him do this without excessive bleeding, I was able to shape the tip and diameter of the RF electrode to achieve what the doctor wanted.” The same held true in blepharoplasty when doctors were asking if he could help them make an incision in the eyelid and melt excess fatty tissue, thereby creating a new bloodless field for surgery, he was quick to adapt his technology for this purpose. Many doctors went from scalpel to laser, and then to radiofrequency. He quickly realized that he could create an RF electrode for almost any soft tissue or endoscopic surgical application. Doctors were drawn to Garito’s creative thinking, enthusiasm, energy and personality, including Dr. Constantin Stan an internationally renowned breast surgeon who practices in Romania. Dr. Stan’s close relationship with Garito contributed to the development of improved approaches to breast surgery with innovative customized RF tools. To protect this valuable asset, Garito set about getting patents on his inventions. Many noted multi-specialty surgeons published clinical articles in leading medical journals and textbooks on the RF Surgical device and its RF accessories. Over the course of his career Garito was granted over 100 patents on his inventions and, rumor has it, he’s not finished yet.

Note: Alan Ellman, a former executive and co-owner of Ellman International is listed as co-inventor on many of the patents referenced in this article.

FUN AND GAMES WITH THE FDA

In the USA, the official stamp of approval on any medical device is an FDA clearance. However, it’s very difficult in the USA to bring a product to market. Dealing with the FDA is difficult, costly and time consuming. Many large medical device companies in Europe and Latin America don’t even try to sell their products in the USA because of their lack of knowledge, or willingness to work with the complex FDA process. Garito learned firsthand the importance and the idiosyncrasies of dealing with the FDA. “First, you have to realize that when dealing with the FDA you are generally not involved with doctors, but rather engineers who have a completely different thought process and perspective,” said Garito. “It’s problematic and at times frustrating but you have to go through the regulatory system. While it might be construed that the FDA is inhibiting growth in new product development in the USA, for those that stick with the process and gain FDA clearance, the sky’s the limit.” Garito says he has a high level group of FDA and International regulatory experts now on board to help other inventors bring their medical product to market.

Dr. Despande and Dr. Vogt of Rome, Italy with Dr. Jon Garito

HERE COME THE BIG BOYS

Every entrepreneur and innovator dreams of the day when the big leader in the industry wants to buy their company. For Dr. Jon Garito that day came too soon. “Looking back people must have thought I was ‘insane’ when I turned down the first offer to purchase Ellman by a giant surgical company,” said Garito. “Here I was in my early 40’s when the President of this huge company approached me wanting to make a purchase. I was flattered, but I was not interested,” said Garito. He knew it wasn’t the money he was interested in, Ellman was already a success and he was making money, it was the challenge to continue growing and the camaraderie he had developed within the medical community. He was having too much fun. He was more passionate about helping doctors better serve their patients than he was in selling the company. The time wasn’t right. He continued developing new technology, creating more patents and penetrating more areas of medicine. He introduced the biggest advance in RF surgery the 4 MHZ Dual Frequency device. This new RF device was highly acclaimed and received both FDA clearance and a patent. There was still a lot of unchartered medical territory for him to explore, and thousands of doctors yet to convert to the superior and practical use of RF technology. At this time Garito started a second company Ellman Innovations (now Elliquence) with his partner, and they then entered the Spine and Neurosurgery fields.

TAKING THE WORLD MEDIA STAGE

“When Dr. Luis Rubio of Lima, Peru brought his patient Milagros Cerron to the Ellman offices in New York there wasn’t a dry eye in the room, including my own,” Garito reminisced. Young Milagro suffered “mermaid syndrome” or sirenomelia, a condition wherein the girl’s legs were joined, a condition which usually kills sufferers within days of birth. Dr. Rubio, with Garito’s guidance, had used the patented Radiowave 4 megahertz device to successfully separate the legs of this one year old girl. They had been invited by Oprah Winfrey to appear on her TV show and, after meeting with Oprah, Dr. Rubio insisted on bringing Milagro and her family from Chicago to Garito’s company in New York. Dr. Rubio had a special message for all of the staff at Ellman. He wanted each of them to know how important all of their jobs were, that without each and every one of them, this young girl might not have ever walked. One year later, a similar story broke the news. The first ever co-joined twins were separated without any neurological damage which the surgeon, Dr. James Goodrich, attributed to technology developed by Garito. All the eyes of the world watched this story. It was reported worldwide, from the BBC to the New York Times. When the CEO of Montifiore Hospital invited Garito to a black tie fund raising event, Dr. Goodrich talked to the entire attendees of the gala about the gravity of the surgery on the twins and the total success of the procedure. Then, unexpectedly, Garito was asked to stand up. In front of the entire group, and along with the president of Medtronics, Dr. Goodrich thanked the two of them for their critical roles in making this surgery such a huge success. Garito was shocked. “I was totally surprised to be included in this way. This was a critical turning point in my career.”

SELLING THE COMPANY

After 38 years Garito had travelled all over the world and the business became substantially bigger. He and his partner had expanded to over 125 employees, with over 100 medical patents under their belt, and operating in 70 countries. He hit a wall. “I realized I needed to start doing things for myself. Half my life had been dedicated to the business and it was time for a change,” explained Garito. “The internal management of the business and its structure was becoming overwhelming and I was spending so much time dealing with the internal stress of running such a large organization that I was no longer creating.” He knew this was the right time to sell, the right time to step back and let others take Ellman to the next level. As fate would have it, an offer came to the table and it was a good offer so he sold the company. Garito also sold his ownership in Ellman Innovations (now Elliquence). It was a good move. Many of the key players whom he mentored and worked alongside stayed with the two companies, as did his daughter who was one of Ellman’s best sales people.

Dr. Jon Garito demonstrating RF Technology at a St. Louis University Cadaver Workshop

Continued

WHAT’S NEXT for Dr. Jon Garito?

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Dr. Jon Garito cycling Southhampton, L.I., New York

About Dr. Jon Garito al patents. HeDr. grew Jonsales Garito in over developed 70 countries over 100 worldwide medical and patents. developed He grew medical sales in over 70 countries worldwide and developed medical ties including:technology in over twelve different specialties including: • Family practice • Dental

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• Otolaryngology • Dermatology

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• General Surgery • Ocular and Ophthalmic Surgery

• General Surgery

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• Spinal Surgery • Plastic and Reconstructive Surgery

• Spinal Surgery

• Oral Maxillofacial Surgery • Cosmetic Surgery

• Oral Maxillofacial Surgery

• Neurosurgery • Podiatry

• Neurosurgery

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Industry Transformer

Melasma

Changes in Hormonal Levels For Dr. John Shieh of RejuvaYou Medical Spa in South Pasadena, CA working with celebrities means that he works with those IN FRONT of the camera, and those BEHIND the camera, as in the case of Kerri Kasem a well-known radio and TV host. For Kerri even though she is known as the voice of radio, she still makes many public appearances and counts Dr. Shieh’s non-invasive approach to health and beauty among her celebrity secret weapons. Dr. Shieh has been a trail blazer in his approach to noninvasive anti-aging treatment, but where he really feels he is making a big difference is for those patients who suffer with melasma.

Dr. Shieh was excited when the FDA approved the LUTRONIC Dualpulsed Q-switched Nd: YAG SPECTRA™ laser for melasma and other skin conditions (including tattoo removal) as he was able to finally offer his patients a solution that worked and was safe. He quickly adopted this new technology and it is paying dividends in happy patients. “We have used bleaching creams and other topical skin treatments to treat melasma but it has always been a struggle to obtain a good result. The Lutronic SPECTRA™ is ground breaking technology and has proven to be a miracle worker in my practice,” said Dr. Shieh. Melasma is more prevalent in women than it is in men and also affects people with darker skin, such as those of Latin/Hispanic, North African, African-American, Asian, Indian, Middle Eastern, and Mediterranean descent. People who have a blood relative who had melasma are also much more likely to be at risk. Although causes of melasma are not yet clear, the AAD (American Academy of Dermatology) says that it likely occurs when the color-making cells in the skin (melanocytes) produce too much color. People with skin of color are more prone to melasma because they have more active melanocytes than those with light skin.

Common Causes of Melasma Sun Exposure: Ultraviolet (UV) light from the sun stimulates the melanocytes. Even a small amount of sun exposure can make melasma return after fading, which is worse in summer. It is also the main reason why it returns again and again. A Change In Hormones: Pregnant women often get melasma, which is also called chloasma or the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma.

In addition to treating melasma, Dr. Shieh says his individualized approach to skin rejuvenation in general is what keeps his celebrity patients in the public eye. “In many instances, cosmetic treatments have become “a la carte” depending upon which cosmetic counter you visit, rather than “personally individualized” as we offer at RejuvaYou,” stated Dr. Shieh. It’s no wonder that Dr. Shieh’s practice continues to be popular among a growing clientele. Using the right technologies with a comprehensive approach is a formula for success.;

Dr. Shieh offers the “RejuvaYou 5 Star” approach to getting camera ready: 1. Discoloration: remove/reduce brown spots, red capillaries, fine lines with appropriate lasers. 2. Laxity: loss of elasticity causes sagging. Restoring elasticity via laser, light, and radio-frequency energy treatment is vital. 3. Deeper Lines and Wrinkles: are removed with deeper peeling agents and laser treatments. 4. Volume: loss of volume ages the face. Volume is restored with fillers and/or fat transfer. 5. Prevention: Sunscreen and Botox® are used as preventatives to control future wrinkles and sun damage.

Cosmetics: Skin care products that irritate the skin may worsen melasma.

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Industry Transformer

Smile and The World Smiles With You Face Lift Dentistry® Treatment Preventing Premature Aging with Hi Tech Dentistry Dr. Sam Muslin We all know that a great smile can light up a room. But did you know that there is a new level of Hi Tech Dentistry that is providing better aesthetics for the entire face and profile while reversing the signs of aging? With a focus of transforming lives by not just creating a phenomenal smile, but also improving facial shapes and proportions even when you are not smiling, Santa Monica based Cosmetic Dentist Dr. Sam Muslin has developed a new paradigm in health and cosmetics. We all know that several cosmetic dentists promise us that perfect Hollywood Smile, but now the bar has been raised beyond just typical “smile dentistry”. We are moving into a whole new realm of anti-aging Face Lift Dentistry® that strives to improve facial shape and proportions that not only prevents premature aging, but also reverses the aging process.

The Face Lift Dentistry® procedure is the first dental treatment to idealize profile proportions, improve jaw position, and provide better support for the soft tissue of the face without surgery. Dr. Sam Muslin created the Face Lift Dentistry® procedure, a system of assessing and treating facial cosmetic issues that goes far beyond “Just the Smile”. Now we all know that to achieve the full effects of a real facelift surgery requires a skilled plastic surgeon, however, Dr. Muslin is finding that dental aesthetics can go hand-in-hand with plastic surgery and, as pioneer of the Face Lift Dentistry® treatment, he is paving the way for the future of true facial harmony. The Face Lift Dentistry® treatment actually permanently lengthens and re-shapes the face while idealizing the jaw position. Cosmetic Dentistry alone cannot offer this same result. Dr. Muslin is now teaming up with other physicians that specialize in plastic surgery of the face to bring patients a new option in age reversal. The Face Lift Dentistry® procedure makes the most of facial characteristics to naturally improve the smile, profile proportions, facial shape, jawline, and overall health of a patient. Thin lips can appear fuller without artificial fillers and implants because the newly improved teeth and jaw position better support them. The face is permanently lengthened to a more youthful shape to smooth out wrinkles and

minimize fine lines with his exclusive Face Lift Dentistry® bite correction method. The jawline is stronger and in better proportion to the rest of the face, so that a patient’s appearance is improved from every angle even when they are not smiling. This procedure improves the shape of the patients face in a way that is not possible with any other cosmetic treatment. Additionally Face Lift Dentistry® treatment has a huge health benefit by idealizing the jaw position. Dr. Muslin, who is a Master of the Academy of General Dentistry says, “the most important aspect of the non-surgical Face Lift Dentistry® procedure is the geometrical, functional and three-dimensional analysis that I develop for each patient.” According to Dr. Muslin, every single person needs something completely different to improve his or her face and profile. He uses a live motion camera so patients can observe themselves to see what he sees from all angles. Plus he takes over 50 different photos from various angles and expressions to develop the absolute best facial support and jaw position within biological limits.

The Best Cosmetic Dentist and More The Face Lift Dentistry® procedure requires highly specialized equipment, many years of experience, and the ability to think beyond standard cosmetic dentistry. In order to achieve the very best results for the patient, the dentist must have the vision of an artist along with the

technical capability to move accurately and quickly. Dr. Muslin has spent most of his postgraduate years perfecting his techniques and now caters to a select group of patients who fly from all corners of the world seeking the most advanced cosmetic dentistry so that they look younger and live healthier. Dr. Muslin says that each patient he sees presents a different set of health and aesthetic problems, and every patient wants a unique look. No Chiclet teeth here! With over 30 years of Hi Tech dentistry experience Dr. Muslin offers his patients the latest technology and personalized artistic skills for results that are natural looking and as functionally comfortable as possible. Whether the goals are purely cosmetic or there are significant TMJ health issues to resolve, in the end each person will have anti-aging results that will last.

Take A Bite Out Of This What most people do not realize is that their teeth and bite position directly impact the shape of their face and the support for their soft tissue. As we age our teeth become shorter every year from normal chewing and grinding. This tooth shortening leads to a loss of vertical dimension in our faces. Oval shaped faces become round and fat. Jawlines recede into weak chins. The distance between the tip of the nose and the bottom of the chin is literally getting smaller every year. Soft tissue

Industry Transformer

“Whether the goals are purely cosmetic or there are significant TMJ health issues to resolve, in the end each person will have anti-aging results that will last.” Dr. Sam Muslin.

sags and wrinkles, while lips become thin and compressed. Worst of all, while your chin moves north, your soft tissue succumbs to the force of gravity and moves south making you look old. Dr. Muslin will tell you that, people look old because they never had the best bite for their faces. The bad news is that the shape of a face and its bite position are formed between the ages of 6 and 13 without any precision. Very few of us had a perfect bite to begin with but over time even the slightest bite issue is exacerbated and the results show up on the face. Lips that were once full can look squished and thin. Soft tissue that once tracked the jawline begins to sag and wrinkle. All of these effects are exacerbated by a bite and jaw position that is not ideal. By optimizing the teeth for an ideal bite and jaw position, the aging face can appear naturally years younger. Patients who look older than their actual age, or even angry because of short and worn down teeth, can reverse these signs of aging while improving their health. Other patients of Dr. Muslin suffer significant bite issues like underbites, overbites, and cross bites. All of these conditions have significant health consequences and the cosmetics are not any better. Overbite conditions force the lower jaw back causing a weak chin, while underbite conditions push an oversized

lower jaw forward. Some people suffer with extensive TMJ pain, muscle tightness, and tension headaches that are in a large part attributed to their bite and jaw position. Too often this is not diagnosed before the pain is extensive and some damage is irreversible. Regardless of the bite condition the Face Lift Dentistry® procedure offers an effective over bite correction and under bite correction that improves the jaw position while dramatically improving the smile, facial shape, and profile.

Aesthetics Are Everything Sometimes the aesthetic goals of the patient require a dual approach. The bite and jaw position is idealized with the Face Lift Dentistry® procedure while the plastic surgeon improves the tissue appearance. Several of Dr. Muslin’s patients have undergone facelifts or implants both before and after Face Lift Dentistry® and the results are unprecedented. It is remarkable how a chin looks far better after the jaw is ideally positioned. Likewise a facelift appears even more impactful when the face is restored to a more youthful shape. There are certain changes that only a plastic surgeon can make and certain changes that only the Face Lift Dentistry® procedure can make so working together can be key. One of the best parts about the Face Lift Dentistry® procedure is that it is non-invasive. This means that grinding on healthy natural

teeth is not necessary. Any existing old fillings, crowns and decay are removed and natural healthy teeth are cleaned. Specialized porcelain veneers and porcelain Venlays™ are artistically crafted to function as an organized system to create the bite and jaw position needed. This system is three dimensionally designed by Dr. Muslin to support soft tissue, enhance the profile and optimize the facial shape for each person individually. Once the porcelain is bonded into place the results are immediate and there is no healing time.

Biological Compatible Materials With biologically compatible dental materials, and all infection removed from the mouth, the health of the patient is dramatically improved. There is no drilling on their healthy natural teeth so all of the benefits are without any compromises. For the first time in their lives, people have a bite and jaw position that is not only ideal from a health and function standpoint, but one that also looks phenomenal. The facial reshaping and jaw re-positioning results of the Face Lift Dentistry® procedure are unprecedented in the field of cosmetic dentistry. Perhaps more than anything it is the ability to improve your health while looking years younger naturally that is life changing for so many.

Dr. Sam Muslin is the Face Lift Dentist® in Santa Monica, CA.

Industry Transformer

Living In An Island Paradise Orthopedic Surgery Dr. Brian Bacot, M.D. In 2010 Brian Bacot, M.D. was one of the first orthopedic surgeons to arrive in earthquake ravaged Port-au-Prince to take care of residents injured during one of the most devastating earthquakes in history. It became a moment in time that changed Dr. Bacot’s life forever. His involvement with international healthcare services, including teaching local healthcare professionals in Costa Rica with the international organization Healthcare Volunteers Overseas was always gratifying to him. But there was something special and unique about helping to heal the people of Port-Au-Prince that inspired Dr. Bacot to deepen his commitment to medicine and to seek a new place to call home. Dr. Bacot now owns and operates one of the most advanced orthopedic medical centers in the US Virgin Islands. With a focus on orthopedic surgery, sports medicine, tendon and joint repair and arthritis surgery, Dr. Bacot has practices on St. Croix and St. Thomas, and is enjoying living the life of an island doctor traveling by sea plane or private boat around the islands. Prior to moving to St. Thomas, Dr. Bacot who is a fellowship-trained orthopedic surgeon and is well known for his highly developed skill in the treatment of arthritis, osteoporosis, trauma and other conditions, was the founder of a very successful practice in Atlanta, GA. With his pleasant and caring bedside manner, innovative, minimally invasive techniques, and emphasis on pain management – which all lead to rapid recovery and reduced pain – he became a surgeon of choice throughout the United States with a steady flow of patients who traveled from all over the world to see him. His philosophy of care towards his patients and his commitment to creating a physician-patient relationship that

enhances recovery is what set him apart. Dr. Bacot came to realize, however, that his goal was not simply to run the race, but to set the standard and provide the best in orthopedic health care, something he felt he could do better from an island destination, rather than an urban environment.

Making friends and reaching out to people from all walks of life is what has brought Dr. Bacot well deserved success in the US Virgin Islands. Never shy to smile at a stranger, or offer a friendly word, Dr. Bacot now counts local farmers and politicians among his friends and patients.

“Relocating a practice is not as easy as it sounds,” Dr. Bacot reminisces. “But for me, in the long run, it’s definitely been worth all the hard work.”

“Being civic minded has always come naturally to me,” said Dr. Bacot. “Therefore, getting COG deeply and actively involved with local school activities, and sponsoring sporting events and teams, as well as contributing to many local charities, has become very important to me. ”

This year Dr. Bacot put the finishing touches to construction of Comprehensive Orthopaedic Global (COG), a new state-of-the-art medical center which is located on the island of St. Thomas in the Virgin Islands. COG offers patients a wide range of diagnostic and treatment services for conditions of the hip, knee, shoulder, foot, ankle and more, and houses a comprehensive radiology department with facilities for: X-rays, CT scans, Ultrasound, MRI, bone scans, and interventional radiology. COG also has its own surgical suite and is developing a multi-specialty outpatient surgical center.

It’s also helped spread the word about Comprehensive Orthopaedic Global which has a second office location on the island of St. Croix, and consulting offices on the island of St. John, as well as on Tortola, the Capital of the British Virgin Islands. Dr. Bacot’s regular commute to the office each day goes far beyond jumping into the car and getting stuck in freeway traffic. On any given day Dr. Bacot might be seen hopping onto a local

Industry Transformer

“My experience in Haiti showed me how important life really is, and how fleeting it can be,” said Dr. Bacot. “I felt a need to be in an environment where I could really contribute to the community and where, on my time off, I could nurture my own spirit.”

Sea Plane if going between offices on St. Croix and St. Thomas, to steering his own boat over to the islands of St. John or Tortola where he will travel through international waters and be asked to show a passport. “My commute to work each day is varied and energizing to say the least,” laughed Dr. Bacot. “Varied because it could be by car, boat or plane, and energizing because I get to experience the true peace and beauty of the islands at different times of the day.” If it sounds to you that it might take the stamina of an Olympic athlete to keep pace with Dr. Brian Bacot you might just be right. Sports medicine is Bacot’s favorite area of work. A subspecialty of orthopedics, sports medicine deals with the prevention, diagnosis, treatment and rehabilitation of injuries suffered during athletic activity. The goal of treatment is to heal and rehabilitate the injury so patients can return to their favorite activities quickly, whether it’s Little League, recreational play or a high school, college or professional sport. Because of the frequent use, wear-and-

tear and risk of a fall or accident associated with sports activities, athletes are often susceptible to orthopedic injuries, including a stress fracture, chronic pain, or a tearing or stretching of internal structures. As with a sports team, there are many physicians who work together to help the patient regain maximum use of the injured limb or joint. “Players” on the team are typically the physician, orthopedic surgeon, rehabilitation specialist, athletic trainer and physical therapist - and, of course, the patient,” explained Dr. Bacot. “I also have specialized training in the diagnosis, treatment and prevention of sports injuries, and can help athletes return to their favorite activities as quickly as possible through the most advanced, minimally invasive treatments available.” It is for this reason that Dr. Bacot is now joining forces with the Iron Man contest that runs on the island of St. Croix each year. Not that he’s hoping for anyone to sustain an injury, but if they do, he will be there on hand to give them the best orthopedic care.

So what’s next for Dr. Bacot? “Well I have many ideas of ways to expand the practice in terms of branding, product development, more advanced physician communication and training opportunities and so on,” said Dr. Bacot. “But now that we have finished and perfected the COG Medical Center on St. Thomas, we will begin laying the stones for the new COG medical facility on St. Croix.”

Industry Transformer

Is It Nature or Nurture? What Makes A Great Surgeon? by Enna Ruiz

An Interview With

H. George Brennan, M.D. Newport Beach, CA

H. George Brennan, M.D. in his office in Newport Beach, CA

Surrounded by sculptures and paintings from a bygone era of classical luxury it was easy to relax in the big comfy leather couch as I listened to “I Could Have Danced All Night” a song from the famous movie and Broadway musical “My Fair Lady” which was delicately playing in the background. The song itself was apt for the occasion. I was waiting on an appointment with world-renowned cosmetic surgeon and former President of the American Academy of Facial Plastic and Reconstructive Surgery, H. George Brennan, M.D and the American Association of Cosmetic Surgery.

President of AAFPRS, and another 80 to become President of ASPS. It takes a special person to not only strive to the height of becoming President of an organization they feel passionate about, but also one that holds a great deal of personal accomplishment, practice success and the belief that they can make a difference. A belief that is shared by other members of those societies otherwise they would not have been voted President. So the question remains. Is it nature or nurture that makes a great surgeon? Or perhaps it’s a combination of both.

During his career Dr. Brennan has been known to turn ordinary faces into works of art with subtle changes to the nose, the eyes, the chin or whatever minor flaw was holding that face back from achieving full natural looking beauty. While Professor Henry Higgins wanted to change the accent and sophistication of poor young flower girl Eliza Doolitle, thereby making her more presentable into posh London society, Dr. Brennan uses his surgical talent to help patients feel better about themselves so that they can live more comfortably in a world of their choice.

Dr. Brennan decided to become a plastic surgeon when he was in medical school rotation. His older brother Lou was a plastic surgery senior resident while George was doing his rotations. Lou showed him before pictures of a young girl who had a rhinoplasty procedure that he performed. She was a cute girl other than the bump on her nose. And here was a doctor, a man, who was able to improve what nature had bestowed upon her. George wondered if maybe he was as gifted as Lou was. It was obvious from what he had witnessed during rotations that Lou had performed something on that girl that many of the other senior residents could not.

In the USA there are approximately 2800 board certified facial plastic surgeons, and around 5000 board certified plastic surgeons. The AAFPRS was founded in 1964. The ASPS was founded approximately in the 1940’s. Statistically speaking that means that only 50 doctors have had the privilege of becoming

Then as they went into the exam room, as they were taking bandages off the patient, George could not help but be amazed at the transformation that cosmetic surgery had made to the girl.

“At that moment, it became perfectly obvious to me what surgical path I should take,” said H. George Brennan, M.D. “I thought, ‘who wouldn’t rather practice aesthetic/cosmetic surgery that overall made people happy rather than medicine that would most likely deliver bad news… like neurosurgery.” To be clear, Dr. George Brennan knew immediately it was cosmetic and not reconstructive surgery where he would excel. “Reconstructive will never be perfect as it is an attempt at correcting a deformity,” continued Dr. Brennan. “Whereas cosmetic surgery is working on something that is already fine but can be improved and made better, even perfect, with surgery.” After medical school and residency, like many other young surgeons that had survived the cold weather states, Dr. Brennan packed his bags and headed west. “It was pretty easy to settle in Newport Beach,“ said Dr. Brennan. “I followed Nat King Cole’s directions and took “Route 66” and ended up originally in Santa Monica.” Both Louis Brennan, M.D. and H. George Brennan, M.D. continued to practice in California ever since that fateful day when George followed his brother. To this day, they agree that some things just can’t be taught in medical school. Performing any form of cosmetic/aesthetic surgery has to first come

Industry Transformer

“Most of all to be successful as a cosmetic surgeon a doctor must have an artistic eye, a good sense of judgment and impeccable training. This field is not a paint-by-numbers job.” - H. George Brennan, M.D., F.A.C.S.

from a natural born talent that is combined with the highest level of surgical academic training available.

Sharing his knowledge. He believes that the cardinal rule of medicine is to share information that will benefit a patient

Over the past 30 years, Dr. Brennan has seen, and contributed to, many surgical changes and the development of many techniques.

Artistry that goes hand-in- hand with technical skills that are improved with continuous education and personal self-growth.

“When I first started out the only type of implants that were available were for the chin,” laughed Dr. Brennan. “Now we have implants for the cheeks, nose, forehead, breast, arms, legs and even the buttocks.” Dr. Brennan himself developed the anatomic cheek implant and right now he is using an intra-nasal suction device for rhinoplasty that leaves a patient with zero pain, and packing is not necessary after nose surgery. With this device patients can breathe through their own nose during recovery. I watched a video showing an actual patient the day after surgery stating that they had minimal pain and hardly needed even over-the-counter pain relief medication. It’s a great boon for the patient as it means they can have optimal healing and still be active, eat a regular diet and sleep which are all necessary to a great recovery post nose surgery.

He also elaborated that today’s surgeons are so lucky that they can learn from the past. “Just look at liposuction now. Besides growing to be a procedure of choice worldwide, the technology we have now to perform this technique could not have been dreamed of 30 years ago,” he exclaimed. “Young doctors need to understand all the benefits they are receiving from knowledge of people who have created these new

I asked Dr. Brennan what were three things that contributed to his tenure as a cosmetic surgeon: 1.

Confidence and self- esteem. This comes with each successful surgery and the knowledge that he makes people happy from his work

Aesthetic Facial Surgery authored by Dr. Brennan

techniques and tools for aesthetic surgery. It is a tremendous advantage to them.” For Dr. Brennan his passion for cosmetic surgery comes from it being an innate knowledge to him. It is the epitome of art and science. He believes that surgeons are now better equipped on non-surgical things such as Practice Management, an area still not taught in medical school, but now most society meetings hold lectures on specific topics of practice management and marketing. In the past marketing was considered a stigma and unethical. With the sun setting on the Pacific Ocean and the last few notes of “My Fair Lady” playing overhead, I asked Dr. Brennan what he recommends a doctor do to insure his future success. 1.

Training programs. Get into the best training program possible

Don’t stop at one fellowship. In cosmetic surgery it is a must to do as many as possible.

Always stay on the cutting edge. While you must have what is new, you have to be smart. Don’t fall for the hocus pocus that the medical device companies want to sell to you.

“Most of all to be successful as a cosmetic surgeon a doctor must have an artistic eye, a good sense of judgment and impeccable training,” he continued.

Industry Transformer

A Lifetime of Smiles Laurence Rifkin, DDS Beverly Hills, CA For more than three decades, Dr. Laurence Rifkin has been bringing smiles to the people of Beverly Hills and beyond. What is the secret to this man’s never ending optimism and vibrancy? Is it expertise? Passion? A love of art? Or maybe it’s all three.

by Angela O’Mara Dr. Laurence Rifkin in his office in Beverly Hills, CA

When Laurence Rifkin, DDS says “we strive to deliver perfection in every smile and pleasure in every visit”, he’s not kidding. Dr. Laurence Rifkin has been practicing dentistry in Beverly Hills for close to four decades and continues to rank, if not lead, as one of the top cosmetic dentists in the world. From the moment you walk into his posh office on tony Bedford Drive in Beverly Hills where you are always greeted by a bouquet of the most exquisite and exotic flowers which stand poised in front of a sweeping panoramic view of Beverly Hills, Sunset Boulevard and the gorgeous Santa Monica mountain range, you know you have found a small slice of Nirvana. If you are lucky, Dr. Rifkn will give you a tour of Suite 1200, his private celebrity patient space on the other side of the building with views as opposite and diverse – vistas of the Hollywood sign and all the way to the sky scraper towers of Downtown Los Angeles – as his treatment center. Known through Hollywood circles and the Jet Set Who’s Who as one of dentistry’s most creative and private individuals, Dr. Rifkin is often seen on the sets of Hollywood movies creating special effects in movies such as The Hangover, and you might bump into an A List actor, European Princess or a genuine Rock Star on any given day at his office. But it’s not his social grace or easy charm that makes him so successful, although granted it helps a lot! It is his constant pursuit of perfection

in all aspects of his life and his work that makes him the crème de la crème. As a dental industry leader and advocate of true facial harmony, Laurence Rifkin, DDS has paved the way for aesthetic surgeons and aesthetic dentists to bring together the perfect balance of form and function ever before dreamed possible in the human face. “When I first reached out to the cosmetic surgery world I was welcomed because of my approach to patient care and cosmetic dentistry but was not immediately included as an integral part of a patient’s aesthetic health and well-being,” recalls Dr. Rifkin. “It took me lecturing on “form and function” at many aesthetic congresses worldwide, and arranging my own educational courses to help other doctors understand the importance of dentistry when it comes to facial support during facelifts and other forms of facial aesthetic surgery.” As such, many patients now visit Dr. Rifkin before visiting a plastic surgeon to make sure that their dental work is complete and ready to lay the framework for a facelift. 69,121 and counting… that’s the actual number of individual patients who have received care from Dr. Rifkin and, given his lust for life and natural high energy that number will continue to grow. Although trained as a dentist Dr. Rifkin’s complete understanding of the function of the head and neck goes far

beyond teeth and gums. He fully “gets” how the teeth and jaw support the soft tissue of the face, as well as how misaligned teeth can cause stress and tension on the face and neck that not only contribute to problems such as TMJ or TMD, but can also be responsible for premature aging of the face. The ability to achieve a natural-looking smile is considered the holy grail of aesthetic dentistry because it takes knowledge of the underlying skeletal form, the natural draping of soft tissue and the proportions of other facial features such as the nose, the eyes, the lips and the ears. It also takes a complete understanding of appearance and aesthetics to achieve superior results. Dr. Rifkin has surrounded himself with a team of skilled artists, professionals and the latest in technology and dental innovation to deftly capture the elusive beauty of nature which can be seen in the smile of every one of his patients. At the pinnacle of his career Dr. Rifkin is excited to share with others the secret to success. “Many people ask what the secret to my success is. To me, it’s no secret, I simply love what I do,” said Dr. Rifkin. “Every day I wake up excited to go to the office and see my patients. Every sunrise is a new opportunity for me to better someone’s life whether it’s by improving their dental health, or by improving their self-esteem.”

Success to Dr. Rifkin isn’t just about the end result for the patient, the entire journey is just as important and in his quest for perfection, he attends to every detail personally. “I start by involving my patients. I take the time to hear them. My initial consultation consists of asking questions, gathering details, taking lots of photographs and having conversations about what their needs are,” continued Dr. Rifkin. “I then create a computer presentation that identifies their conditions, confirms their personal goals and outlines my recommendations. There is a personalized design DNA in every patient’s smile and I use that to create the ultimate blueprint for each individual smile.” Doing a personal Power Point presentation for each and every patient can take a good deal of time, but it can also pay dividends in patient satisfaction. As we always say, an educated patient is a happy patient. You can see the same detail in other aspects of his practice. Each treatment room has a large HD screen TV and it’s not for watching cartoons. It’s so patients can see in detail any problems associated with their teeth. The TV’s are hooked up to the state-of-theart microscope Dr. Rifkin employs during his most intricate and precise procedures. Not only can he see a problem area through

the microscope, but he can magnify it to such a degree that there is little or no room for error. He can better diagnose decay, cracks and other pathologies that may escape detection without this form of magnification, and it also allows him to be gentle to the teeth and gum tissues, as well as providing an accurate restoration. In addition, Dr. Rifkin has his own lab and technicians that make dental restorations such as crowns and veneers on site, which is just another way to ensure that the patient receives the ultimate in care and service. Dr. Rifkin knows that patients come to see him because they consider him a master architect who is executing their vision. Surrounding himself with an expert team makes him unrivaled. Aside from being a master dentist, Dr. Rifkin is also an author, lecturer, educator and a professional sculptor with many of his pieces in private collections world-wide. This accomplished man has distinguished himself in one of the most competitive markets in the world – Beverly Hills, and all without the aid of advertising. By integrating his artistic background to create beautiful, natural smiles and his humble and modest personal nature of good will and good care, Dr. Rifkin brings to his patients and his practice an all-encompassing philosophy of absolute and on-going perfection.

A Warm Welcome Reception Area

A Room With A View Treatment Room

An Eye For Detail Microscopic Dentistry

Art Imitates Life Laurence Rifkin, DDS Sculpting

Dr. Rifkin showing a patient a brand new smile.

69,121 and counting… that’s the actual number of individual patients who have received care from Dr. Rifkin. It’s the attention to detail that keeps his patients coming back.

A Finished Masterpiece “Serenity”

Doctors That Make A Difference In a world economy that is under constant

Dr. Corey Maas

stress, world class

Specialty: Facial Plastic Surgeon Location: San Francisco, California Cause: Beauty For Books™

business leaders such as Bill Gates and Warren Buffett, among others, understand the true value of giving back. Giving back doesn’t necessarily mean giving away half of your wealth. It could mean a commitment of time, innovation or community involvement as is the case with the doctors featured here in “Doctors That Make A Difference.”

Dr. Corey Maas

Reading has always been high on my list of favorite things to do but it wasn’t until my children began to read that I realized the true joy of reading as a parent. As my children grew, I was able to watch them progress academically because they had access to great books. It became clear to me, however, that not all schools had funds to adequately provide enough books for their students and that many inner-city and rural libraries had a shortage of books. I have a strong commitment to literacy. Many successful people take for granted the availability of reading materials in the home and, after speaking to a number of patients that are teachers, I learned that many of the public schools don’t even have libraries let alone books for children to take home. After speaking with the charitable giving officers from the San Francisco Unified and Oakland Unified School Districts, I learned that many (if not most of the students) had no books at home at all.

At my practice, we began hosting Books for Botox parties which have been a huge success. Then in 2007, I formerly began Beauty for Books™ a California-based 501c3 non-profit organization serving under-funded primary and elementary schools in the United States. The goal of Beauty for Books™ is to generate books and reading materials for schools and children that are in need of reading materials at home. We also raise funds and collect donations for the purchase of books amongst schools. The organization now includes a group of licensed physicians, nurses (and other health care professionals working under the direction of participating physicians). Participating physicians identify needy schools and educational libraries in their communities that would specifically benefit from the program, and they then create an agreement to provide grade K-8 appropriate books and reading devices that are generated by donations from their respective communities in exchange for free aesthetic services and products provided by the participating physicians and their practices. Over the past few years the Beauty for Books™ program has collected and donated tens of thousands of books by offering complimentary skin and aesthetic

Dr. Corey Maas reading to students of a local San Francisco area school.

treatments with medical and aesthetic professionals in exchange for books and donations. My program is run annually, usually during the holiday season, at which time family, friends and patients of the respective practice will come together for a fun evening of aesthetic education and complimentary treatments in exchange for donations of selected books that are then given to the school or library that has been selected by the participating medical practice. We do some internal and external marketing to let patient attendees know that in exchange for the donation of five or more new or nearly new K-8 appropriate books, they have the opportunity to randomly draw from a bowl to gain a free service such as Botox or a Restylane injection treatment. This has now evolved thanks to choices of Botox, Dysport or Xeomin, also Juvederm, as well as our TMC skin care products and spa services. The first year, we garnered over 1000 books which not only excited me but, as we brought these books to the beneficiary schools, they became excited too. After discussion with some prominent contributors to other San Francisco charities, we decided to have a gala to celebrate and promote literacy and at the same time have a little fun and learn about beauty by inviting local successful beauty businesses, spas, salons, etc. to attend

the gala and set up booths so that party goers could get a small treatment such as nails, hair, facials, makeup, lashes, etc. The businesses loved the interface and the female attendees loved the spa treatments. The men, of course, came more to support (or meet) the great female supporters of the charity. Last yearâ&#x20AC;&#x2122;s gala had over 700 people and the W Hotel in San Francisco admirably donated the facility and helped us create a great event. I also have to give full credit to my wife, Kristin, who has really embraced the idea and turned it into a very worthwhile volunteer project that now has an outstanding board that is taking the Foundation to the next level. Our mission for literacy is now in its eighth year and while I am happy to say that more and more children have experienced the increased choice of available books and the delights of reading because of our program, the need of our Foundation has never been greater. More and more educational departments are experiencing massive budget cuts that are affecting the educational cornerstone that books provide, directly affecting the future of so many children from Kindergarten and on up. We have commitments to the San Francisco Unified School District, Oakland Unified School District and Marin City-

Sausalito School Districts, and estimate that well over 50,000 books have been donated since we started seven years ago. Our next big leap is to recruit more California aesthetic surgeons to join with us. To participate, physicians must identify geocentric school districts in need and agree to make it a 100% time and materials donation. Ultimately I would love to see this initiative go nationwide. The schools commonly invite me to come to their school and do a reading or talk about becoming a doctor. Itâ&#x20AC;&#x2122;s very gratifying to look at the eager faces of the children as I explain the important impact reading has made on my life and what fulfilling opportunities I have each year due to my access to books and reading. I tell doctors that are interested in participating in our program that the feeling you get when these kids surround you with appreciation and ambition is really quite fantastic. Iâ&#x20AC;&#x2122;m a firm believer in education and helping kids get excited about reading and giving them access to books keeps me connected with education in a way I never expected. www.maasclinic.com

Doctors That Make A Difference Dr. Babak Azizzadeh

Specialty: Facial Plastic Surgeon Location: Beverly Hills, California Cause: Facial Paralysis and Bell’s Palsy Foundation It began one day when my wife was watching TV and saw the story of Mary Jo Buttafuoco on the Oprah Winfrey Show. Mary Jo had been shot in the face and suffered facial paralysis as a result of the shooting. My wife called me and said, “Babak you can help her, I know you can.” One event led to another and it seemed that all of a sudden I was helping this wonderful and courageous human being regain her smile. Dr. Babak Azizzadeh with facial paralysis patient Gracie Doran preparing for The Doctors TV Show.

At that time there were no other organizations that focused on individuals suffering from life-altering facial deformities caused by nerve damage and Bell’s palsy. As a facial plastic surgeon my emphasis is on the head and neck and, over the years, specific nerve grafting techniques and procedures have been developed that allow these patients to regain movement in the face. The Facial Paralysis and Bell’s Palsy Foundation is a grass-roots organization that has grown due to the generous efforts of my patients, family, friends and strangers who really want to make a difference in these people’s lives. Our organization is unique because we have a strong focus on support groups. These routine meetings are on-going and are a way for people with various facial nerve disorders to get together to discuss living and coping with their situation. It’s a wonderful way to increase awareness and create a support structure. One of the great things to come out of this type of support has been the willingness of many patients and their families to be able to share their story. Some have even been brave enough to share their stories on TV shows such as Oprah and The Doctors. Facial reanimation surgery has been so gratifying to me. It also brings an amazing joy to my staff at work. It has helped us develop a better sense of team spirit due to its “give back” nature that is not necessarily felt with a 100% aesthetics only practice. One of the most gratifying moments is watching the look of joy on a patient’s face as they examine their face after surgery. When they look at me and smile and their face is no longer as crooked as it was before is deeply moving. www.facialparalysisinstitute.com.

For the past two decades, Dr. Azizzadeh has been actively engaged in clinical research helping to advance the field of facial plastic surgery. At UCLA, Dr. Azizzadeh collaborated with Nobel Laureate, Dr. Louis Ignarro, in evaluating the role of nitric oxide in facial plastic surgery. Currently, he is the principle investigator of a stem cell/facial nerve regeneration project at Cedars-Sinai’s Regenerative Medical Institute and Co-Director of the Multispecialty Aesthetic Clinical Research Organization (MACRO) where he has ongoing clinical trials in facial rejuvenation and rhinoplasty. Dr. Azizzadeh has published numerous textbooks and peer-reviewed articles, received many honors and awards as well as presented at the national and international level. He is the author of the best-selling consumer book Beverly Hills Beauty Secrets as well as the lead editor of four medical textbooks that are used by medical schools and residency programs to train upand-coming plastic surgeons (Master Techniques in Facial Rejuvenation, Master Techniques in Rhinoplasty, Master Techniques in Blepharoplasty, Facial Nerve).

Doctors That Make A Difference Dr. Juris Bunkis

Specialty: Plastic Surgeon Location: Newport Beach, California Cause: Honorary Consul - Republic of Latvia in California I am a plastic surgeon in Newport Beach, CA, a diplomat of the American Board of Plastic Surgery and a diplomat of another kind – the consul for the Republic of Latvia and a member of the Los Angeles Diplomatic Corps. Growing up I never dreamed that I would become a plastic surgeon, and I certainly did not think I would become consul for the Republic of Latvia. I was born of Latvian parents in a refugee camp in Germany after WWII. My parents immigrated to Canada, where I went to high school and completed college and medical school at the University of Toronto. After finishing my residencies in general surgery at Columbia University, and plastic surgery at Harvard University, I taught at the University of California, San Francisco prior to entering private practice in 1984. Throughout my professional career I have done a lot of volunteer work. It was never a conscious decision to be involved with the needs of others outside of my practice it was something that just became a part of my life. In the early days, I made many medical mission trips to Guatemala and elsewhere to work with other surgeons performing cleft palate repair surgeries in impoverished villages. I have organized multiple charity events, coached sports teams, sat on the Little League Board of Directors, and have been a volunteer deputy with the San Bernardino Sheriff’s Department for many years.

Dr. Juris and Tina Bunkis with President Berzins of Latvia.

My children were very involved with sports and we did not have much time to spend with the Latvian community. You can imagine my surprise when I received a call from the Latvian Embassy in Washington, DC in 2010 asking if I’d consider accepting a role as the honorary consul for Latvia in Los Angeles! Not knowing anything about the task, I requested information and received a diplomatic pouch containing applications and description of duties. My parents encouraged me to donate some of my efforts and time to the country of our origin and I accepted the challenge. I made trips to Washington, DC and Riga, Latvia for interviews and I was chosen for the position and received my diplomat ID from the US State Department, signed by Hillary Clinton! What does my position entail? Shortly after being appointed, I was notified by the foreign ministry in Riga that the Prime Minister would be traveling to LA with an entourage of ten politicians and some fifty business executives. It was my duty to arrange this visit, to the smallest detail. I was to coordinate all movements with the US Secret Service detail, to plan all the meetings and social events, to arrange transportation and meals – much of it on my dime! The meetings were a great success and during the time the Prime Minister was here, I promised to bring a trade delegation to Riga the following summer, which I did along with heads of corporations such as Boeing, Proctor and Gamble and Warner Brothers. We brought a large trade delegation to Riga of some 30 plus companies! I was able to arrange meetings with numerous government ministers, the Prime Minister and President, along with many very interesting social outings as well. I was interviewed on television and by print media multiple times. It was a nonstop whirlwind for five days.

Dr. Juris Bunkis being sworn in as Honorary Consul.

The consulate is located in my office in Newport Beach, CA. I have daily tasks to perform as the local consul. I receive inquiries daily about passports, visas and citizenship. We do not issue passports at my office but I do have to help people get the right information to the Latvian Embassy in Washington, DC. My role is very different from my role as a surgeon. I receive calls from Latvian citizens who have been robbed or put in jail, from relatives who want to know how to legally transport ashes back to Latvia, and a whole host of other unusual requests. Most of the inquiries I get pertain to business, including Latvian companies looking for markets or partners in the US, film makers wanting to place their films into festivals, and US small business owners inquiring about company or tax laws in Latvia. What I love the most about this position is the absolute intellectual rush. My wife, Tina and I receive invitations to monthly consular meetings in LA which always have fantastic speakers and venues. We get invited when important people visit LA (everything from professors giving talks to foreign dignitaries), and have been invited to many events in LA for national days, emperor’s birthday celebrations, mayoral inaugurations, meetings with Congressmen and Senators, tours of studios and meetings with CEO’s of various film companies. I have loved my plastic surgery profession; it has been very good to me. And now I am equally honored and blessed to be a diplomat of another kind. www.ocps.com.

Doctors That Make A Difference Dr. Joseph Niamtu, III

Specialty: Oral Maxillofacial Surgery/Cosmetic Surgeon Location: Richmond, Virginia Cause: GREATER RICHMOND ARC, SAFE HARBOR DOMESTIC VIOLENCE SHELTER

April and Dr. Joseph Niamtu with sons Evan and Joey.

As the father of two profoundly disabled sons many people wonder why (or how) I can offer a good deal of my time to helping others in need. My response is that I have always felt that all doctors have an ethical and moral requirement to give back. Since having two special needs children of my own, I have focused the majority of my pro bono efforts towards children in need.

Both of my boys, Joey and Evan, have severe cerebral palsy. When Joey was born he appeared to be a normal, healthy child for the first three months of his life. Then he began having seizures and missing milestones and, upon diagnosis, his doctors said he would never be able to walk, talk or develop mentally. He had numerous gastrointestinal problems and went through several surgeries in the first few years of his life. My wife April and I were not sure he would make it through some of these surgeries but he did. I come from a family that embraces the attitude of never “give up” or “quit”. A mantra I have maintained all my life. April and I decided to have another child as one of our primary concerns was who would look after Joey if we weren’t around. We both underwent significant genetic counseling and blood testing and were assured that Joey’s condition was a genetic mutation in early pregnancy that was extremely rare. We were told that the chance of us having another child with this condition were next to zero. We were elated when April became pregnant with our second child and did everything in our power to keep April healthy and to do the necessary testing for a safe pregnancy. While Evan appeared normal and healthy at birth, he didn’t roll, or crawl, which were all too familiar signs to us. Then at about three months he

began having seizures and the doctors told us that he had the same syndrome as my first son. He began having the same G.I. problems that Joey had and April and I spent so much time in the local hospital ER that it soon became a way of life. That was over fourteen years ago. I now live with the fact that neither of my children will ever walk or talk, are fed by a tube and can do nothing for themselves. It is not an easy fact to live with but one that we have chosen to accept and embrace completely. As a doctor and teacher it is hard to know that I can never teach my children. My children can only laugh and cry, so I make it my job to make them laugh as much as possible. April and I feel fortunate that we have been able to work together over the years to modify our home so we did not have to institutionalize our sons. This included adding a wing to our home along with wheel chair ramps, an elevator and around the clock nursing. I am fortunate that I am in a position to afford this type of care. However, we have also found that there are many families in worse situations than ours, families that are far less fortunate and we feel it our duty to help them. Over the years, April and I have worked feverishly with many charitable organization and I offer probono surgery wherever I can. We are also ardent

contributors to groups like the Greater Richmond ARC, which was established in 1954 by families for families. Since that time they have grown into a respected organization that each year helps over 1,400 individuals with intellectual and developmental disabilities. April and I are ongoing sponsors of ARC’s Annual Ladybug Wine Tasting event that benefits infant intervention. I am also a community spokesperson for Safe Harbor domestic violence shelter whose aim is to end the cycle of domestic violence. I often find myself treating facial injuries for shelter residents pro-bono and recently operated on a woman whose husband shot her in the head with a 40 caliber handgun while she was holding her infant. She lost vision in her left eye but I was able to treat her scars and facial damage. Additionally, we have been involved with the Richmond Branch of Operation Smile and have worked with many other charities including Connor’s Heroes, Noah’s Children and Heal the Children, which are groups that support children with cancer and other serious diseases. My wife and my staff and I now have a 30 year history of volunteering and giving back to the community. It’s been a part of my practice mission since day one. www.lovethatface.com.

INNOVATION IS YOUR COMPETITIVE EDGE TRADEMARK PROTECTION IS OURS Welcome to the Law Offices of Sylvia Mulholland. At Mulholland Law, we recognize that personal branding and innovation make up your competitive edge â&#x20AC;&#x201C; and that it needs protection. As a full-service intellectual property firm with more than two decades of experience, we provide regional, national, and international legal services in trademarks, copyrights, trade secrets, IP litigation, licensing and alternative dispute resolution. Contact a knowledgeable intellectual property attorney today TOLL FREE at 1-888-378-5551 or e-mail us at consult@mulholland-law.com to learn how we can provide powerful IP protection for your unique practice. Sylvia Mulholland

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Nurses That Rock! Medicine has changed a lot for nurses since the days of Florence Nightingale. According to the U.S. Department of Health and Human Services, Health Resources and Services Administration there are over 2.8 million RNs (including advanced practice RNs) and 690,000 LPNs in the nursing workforce. In recent years the nursing workforce grew substantially adding over 500,000 new RNâ&#x20AC;&#x2122;s to the labor pool. Not all nurses, however, continue tending to the sick and the poor under the guidance of a hospital or administrator. Many of todayâ&#x20AC;&#x2122;s nurses are entrepreneurs in their own right seeking out individual fulfilling, philanthropic and creative ways to practice their craft. Here are the stories of four such nurses.

Nurses That Rock! Maggie Lockridge, RN

R.A.W. - Rebuilding America’s Warriors Palm Springs, California Being one to always land on her feet, it didn’t take more than a few calls and within a few days Maggie was back in business. In 1994 Maggie Lockridge opened Shanteque at Le Meridien Hotel. Shanteque rapidly became the overnight recovery center of choice among many plastic and aesthetic surgeons operating in Beverly Hills and the surrounding cities. At Shanteque, Maggie employed 38 nurses, owned 3 luxury black town cars and catered to between 180 and 220 patient stays each month. Over the course of her seventeen year career owning and managing recovery centers in Beverly Hills, Maggie and her team oversaw the successful recovery of more than 40,000 plastic surgery patients. “Going to work at Shanteque was something I looked forward to every single day,” exclaimed Maggie. “We all knew just how lucky we were to work in such a wonderful setting and to take care of people in the luxurious and glamorous way we did. Shanteque was pure joy.” Maggie’s signature black town cars were well recognized in the back alleys of Beverly Hills where they would lie in wait to secretly whisk patients to the gorgeously appointed rooms of Shanteque. To this day, nobody knows better than Maggie Lockridge how to design a room so that it not only disguises vital medical equipment, but also make hospital beds actually look cozy and inviting. During its heyday, Maggie would arrive at Shanteque at 6.30 a.m. and often stay until 10.00 p.m. While most of Maggie’s patients recovered successfully and without any complication, Maggie says that occasionally she was more than grateful for her RN degree, especially when a patient suffered a hematoma and she would have to scrub in with the doctor late at night. Maggie Lockridge with wounded Army veteran and R.A.W. warrior Aaron Kimes. Aaron had a major abdominal scar revision.

During the Vietnam War era Maggie Lockridge served as a nurse in the U.S. Air Force Nursing Corps., caring for wounded soldiers stateside. The love of country and those that serve stayed with her throughout her life. Her nursing career eventually came full circle. Looking back on her much celebrated career Maggie says she is nothing but grateful for the incredible opportunities she has experienced as a result of her choice to become an RN. Born in Springfield, VT, Maggie attended nursing school in Boston, MA, worked for five years in various fields of nursing in New York City, raised

her children in Hawaii, and in 1987 a move to Beverly Hills found her in the position of Administrator of Le Petit Ermitage Hotel catering only to those who traveled from around the world to have plastic surgery by the surgeons to the stars. Unfortunately, within a short period of time, the owner experienced a foreclosure, and Le Petit Ermitage was dissolved. “The hotel recovery center was such a dream job,” said Maggie. “Then one day the owner decided to close the hotel and we were all out of work.“

Then, as quickly as Shanteque began, it ended. To Maggie’s complete surprise, two women walked in one day asking to buy Shanteque. Maggie threw out a price. They said yes. Shanteque was sold and Maggie spent the next two years writing memoirs and publishing a book, Facelift Hotel, which is still a best seller on Amazon. However, Maggie was not done. In 2007 she was watching journalist Bob Woodruff’s TV special on recuperating from traumatic brain injuries as he had sustained one while covering the war in Iraq. Bob was still recuperating from the explosion that literally rocked his world. At the same time the Walter Reed Veterans Hospital scandal was erupting in the media. Instantly, Maggie realized that although she could not

help these veterans psychologically, she could help them aesthetically. That night she wrote to thirty trusted doctors in Beverly Hills asking if they would join her in the Iraq Star Foundation that she was forming. Within a few days she received a call from Dr. Norman Leaf who offered to be the Medical Director of the Foundation, a position he continues to hold today. All 30 of the doctors she wrote to came on board. With a change of name since the war in Afghanistan, R.A.W. (Rebuilding America’s Warriors) now has 330 contributing surgeons nationwide. The surgeons at R.A.W. are made up of all specialties including plastic surgery, ocular surgery, neurosurgery, orthopedics, and pain

management to name a few. R.A.W. currently serves 49 U.S. States with its pro-bono surgery programs, and now is proud to say that it has added 10 different dental teams that work around the country with the support of the country’s largest dental implant manufacturers and the Beverly Hills Dental Lab that has donated crowns, bridges and other dental prosthetics. The Infinite Hero Foundation recently awarded R.A.W. a grant of $100,000.00 to provide aesthetic and reconstructive procedures and dental restoration to wounded and disfigured veterans. All donations to R.A.W. go directly towards the soldier’s transportation, hotel accommodations, food, surgical costs, medical supplies, hospitalization,

R.A.W. Medical Director Dr. Norman Leaf with wounded veteran Bobby Henline.

anesthesia, medications, and aftercare. Rebuilding America’s Warriors Foundation is a 501(c)3 charitable foundation. “Operating the Iraq Star Foundation and now R.A.W. has become a full time job that I never expected. Up to this point in my life I have to say it is the best job I have ever had,” said Maggie “To see the look of sheer happiness on the faces of the veteran and their family when the result of their surgery is revealed is unbelievable. To watch their confidence level soar as they begin to rebuild their life after surgery is tantamount to nothing I can ever describe.” www.rebuildingamericaswarriors.com.

Nurses That Rock!

Sylvia Silvestri, RN

Beverly Hills RN Beverly Hills, California

The traditional method for many nurses to find a job when starting their nursing career is either through a nursing employment agency, a hospital HR department or even the classified section of a trade journal. However, Sylvia Silvestri’s path to nursing entrepreneurship has an almost “true Hollywood story ” ring to it. But then luck is a combination of opportunity and preparation! Sylvia gained her RN degree at the Loma Linda Medical Center in Loma Linda, CA. Like many Los Angeles’ residents who live within sight of the Hollywood sign and are used to the frequent celebrity sightings at local restaurants, stores and coffee shops, Sylvia never considered that she would become an important part of this world. Upon graduation Sylvia literally met her future boss and mentor who would completely change the course of her professional career, after she moved into a new apartment in Los Angeles, CA, and happened to move in next door to a plastic surgeon. “I was very fortunate that I fell into the aesthetic industry by chance,” said Sylvia. “I moved in next door to Dr. Richard Ellenbogen, a plastic surgeon. We became instant friends and he and his nurse trained me on all aspects of plastic surgery.” That was seventeen years ago and since that time Sylvia has worked with many award winning TV shows and their featured doctors. TV cameras have since become a frequent part of Sylvia’s professional work life. A nurse is, of course, a vital and indispensable part of the surgical process, and Sylvia has helped with the enhancement, perfection and recovery of some of the most celebrated beauties of our time.

Working in the busiest and most exclusive operating rooms and recovery facilities throughout the Los Angeles area, from CedarsSinai Medical Center to private operating suites in Beverly Hills and beyond, Sylvia is now as sought after as the doctors for whom she has assisted. Her ability to work with the special requirements of Hollywood celebrity patients has placed her in the unique position of being the “go to” person when a media crew needs a real nurse for a TV shoot. Sylvia has worked with many of the top physicians including Dr. Jason Diamond, of E! TV Dr. 90210 fame, as well as other doctors featured on award winning TV shows and networks such as The Swan, MTV, VH1, Entertainment Tonight, CNN and many others. While she still greatly enjoys working in the operating room, her career path has grown to where she now also consults for several major aesthetic manufacturing companies, trains medical professionals in the administration of facial fillers and a variety of skin enhancing treatments, and assists in selecting surgeons for travel to Dubai and other foreign countries. “I also travel three or four times a year myself to New York and Nevada to teach and train other practitioners,” said Sylvia. “Having licenses in different states is very beneficial as I have connections all over the country and it allows me to visit and inject patients in other states, and offer training courses.” Being a nurse in Beverly Hills is very competitive according to Sylvia. Doctors and patients are used to the very best and can both be equally as demanding. While patient care and physician support is extremely important no matter where you live, it is often taken to a whole new level

In Beverly Hills, where face equals fortune, and nothing less than perfection is the expectation. “Beverly Hills was intimidating when I first started working there seventeen years ago as I was surrounded by so many amazing and talented doctors and people with fascinating lives. It took me over six months to feel comfortable,” says Sylvia. “Now I walk around in my scrubs just like the doctors do. I can hardly turn a corner without running into someone I know, or someone I have worked with. It’s a great feeling.” The unique nature of Sylvia’s work has placed her in the interesting position of being able to offer highly specialized patient centric services. As well as assisting where necessary with surgical procedures, Sylvia also consults and refers patients to doctors for surgery, and trains other physicians and nurses on injectables, microneedling techniques and platelet rich plasma treatments. She’s also adept at offering practice and marketing tips. Medicine always needs great nurses, and in Beverly Hills, Hollwood and Los Angeles, it seems the role of the modern day nurse is expanding far beyond the OR. www.beverlyhillsrn.com.

Nurses That Rock!

Cristina Chiappe, RN

South Bay Career Institute Los Angeles, California

For Cristina Chiappe nursing has been more than a career. It has been a vocation for most of her life. Born in Chili, after completing college, she moved to Los Angeles where she obtained her teaching credentials from the University of California Los Angeles (UCLA). Upon finishing UCLA, Cristina became a teacher at the Centinela Valley Adult School in Lawndale, CA where she worked for over twelve years. However, not too long ago, Cristina lost her job due to budget cuts and, as a result of a long period of unemployment, she also lost her home. As Cristina has always measured her own career success based on the success of her students, it was a deep and personal blow to not be able to continue making a difference in the lives of her students, many of whom had made great personal sacrifices to attend her classes. However, through sheer determination and a little bit of creativity, Cristina kept her commitment to her students and continued to teach them through a Medical Assistant program without a school or a salary. To help the leftover sixteen students from her class, Cristina set up a school in secret.

a state of shock,” said Chiappe. “Modesty aside, I ran a good program, and the medical community in my area recognized that my students were well-prepared.” Chiappe, a member of the board of neighboring Hawthorne School District, tried to fight the termination of her class. Her class was canceled anyway. Chiappe’s commitment to her students made her decide to keep teaching - without pay. It was a risky move. Even though Chiappe received a business license from Los Angeles County to run a nonprofit school, her application for a permit from the city of Lawndale was turned down due to inadequate parking. So she rented a space, and the class met in secret. “I didn’t want to leave my students with nothing. The school district cut the money back, but this was not at all about money. It was about education and a future for my students,” she said. “The students wanted to continue so I proposed that if we could open our own site…we’d be able to buy all the equipment so that they could have hands-on training. And we did it.”

This may sound like another Hollywood movie, but it is the true story of a woman who refused to take no for an answer. Profiled by CNN for her determination to see her students graduate from her initial program, Cristina has gone on to not only pull herself out of financial difficulties, but also to help young women and men, armed with Medical Assistant and LVN qualifications taught by her, move on to finding careers of their own in medical offices across Southern California.

Of her 20 original students, 16 stayed on. They used their tuition refund of $1,600. each to purchase over $15,000. worth of used medical equipment so they would have something to practice with. They bought sterilizers, machines to measure lung capacity, surgical instruments, a blood spinner, CPR dolls, a fake arm with a needle to practice drawing blood, books, an examining table, an electrocardiogram machine, instruments to test hearing and vision, and more.

“I never dreamed they would sacrifice my program, because it had helped so many people in the community. Honestly, I was in

Students met with Chiappe four days a week and finished the course with a graduation ceremony complete with caps and gowns. All 16

of Cristina’s graduates were placed in 160-hour “externships” in medical offices. (An externship is similar to an internship, generally offered by career college educational institutions to give students short practical experiences in their field of study.) By now, they have all been hired on full time as medical assistants. Since then, Chiappe has formed the South Bay Career Institute, a 501c3 non-profit organization that provides a variety of Medical Assistant and LVN programs primarily to under-privileged women and men. In addition, Cristina works full time as a teacher at Family First, a charter school for high risk young adults many of whom were previous high school drop outs. To date, Cristina has trained over 1600 students though her vocational training programs and says that this is just the beginning. “You do what you have to do,” says Chiappe. “And sometimes you have to show the world what is happening with the state of education especially in California. I have no regrets whatsoever. If anything, I’m more determined than ever to help these young people build a dream career in the medical commuity.” Charitable donations are welcome. For more information, Chiappe can be reached at cchiappe90250@yahoo.com or (310) 901-3704. www.southbaycareers.com.

Nurses That Rock!

Jill Tucker, RN Jill Tucker Nursing Services New York, New York

Jill Tucker has been a nurse for over twenty-five years, the majority of those years in the plastic surgery field in New York City. After receiving her Bachelor’s Degree in Nursing at DePaul University in Chicago, IL, Jill relocated to New York and began her career as an Operating Room Nurse with The Hospital for Special Surgery. She then moved on to a role as an Occupational Health Nurse, working in the medical departments of Fortune 500 corporations. During that period Jill was also part of a team that promoted and led blood donor drives for New York Blood Services. However, it was while working as a Private Duty Nurse on the Upper East Side of Manhattan that Jill gained valuable insight into the special needs of her patients—both in pre-surgery preparedness and consultation, and in post-surgical care and recovery. Using this knowledge, and networking with some of the city’s top nursing talent, Jill has now meticulously assembled a select staff of health care professionals that offer roundthe-clock nursing and care services to a broad spectrum of patients and medical specialties. “I’m a later-in-life entrepreneur,” says Jill. “My early work in medical facilities certainly prepared me for the work I do now. I never realized, however, how exciting being an entrepreneur could be.” Jill and her team of RN’s, LPN’s, CNA’s, Visiting Nurses, Aides, Medical Assistants, Home Companions and Therapists, can be scheduled to cover any area of medicine but they choose to specialize in pre- and post-operative plastic surgery care, orthopedic recovery, long-term

home care, IV antibiotic therapy at home, and operating room staffing. “Generally I am recommended by the plastic surgeon or orthopedic surgeon who has performed the operation on the patient,” continued Jill. “However, elective surgery is a small world and many patients refer me to their family and friends once they hear that they are also having surgery.” According to Jill, who now practices in New York City and Washington, DC, hiring a recovery nurse to come to the patient’s home is a fast growing business as hospital stays and over-night recovery facilities are becoming much more costly due to the changes in health insurance. For a patient, it is far more comfortable, as well as being convenient and cost-effective, to hire a nurse to stay overnight or attend to them daily with whatever medical after-care the procedure requires. As a concierge home care nursing service Jill offers the highest quality health care professionals to a very discerning clientele. Much like other exclusive and affluent communities, her patients in New York and Washington have done their homework when it comes to aesthetic surgery. Their expectations are often high and, as they are paying out of pocket for a treatment, they are also not willing to accept a hospital mentality when it comes to their personal care. Jill Tucker Nursing care is customized for each patient’s medical need. Conditions are assessed and options and procedures are discussed in advance as Jill is a firm believer that preoperative consultations not only better inform

the patient, but also help to reduce stress before surgery. She also discusses with the patient any preventative care and preparation for surgery, medical health history, medical facilities and any alternative care options. In addition, all aspects of health care coverage is carefully coordinated and overseen by Jill. As well as home health care services, Jill Tucker Nursing also provides services to international travelers and business professionals. Nursing Services are available to guests staying at the finest five-star hotels in Manhattan and Washington DC. So what keeps Jill Tucker in high demand? Concierge nursing has been quietly increasing across the nation. However, the significant increase in hospital care costs, as well as the concern among patients and doctors of the heightened risk of infections being found among patients at hospitals and surgery centers has made at-home nursing even more important. “All aspects of the patient’s health care after surgery is completely personalized by me,” said Jill. “Once a nurse always a nurse, the concerns and comfort of the patient are always placed first. That’s our team motto and what keeps my business thriving.” www.jilltuckernursing.com.

94% of the worldâ&#x20AC;&#x2122;s lawsuits are filed in the United States. Malpractice lawsuits are on the rise. Plastic Surgeons have the 3rd highest risk of being sued. The risk of being sued is directly correlated to the amount of money that would be attainable in a lawsuit. ARE YOU BURYING YOUR HEAD IN THE SAND? Is this your legal strategy for preventing and stoping lawsuits? Itâ&#x20AC;&#x2122;s time to rethink your plan... Did you know that less than 0.05% of attorneys have any education or experience in asset protection? Allow Legally Mine to eliminate the threat of being sued and learn from over 40 years of lawsuit prevention and tax education experience.

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Beauty From Within Is Crossing Borders! The true 21st Century Renaissance Man can be summed up by leading surgeons such as Cory Goldberg, M.D., F.R.C.S.C., F.A.C.S., a dual board certified Plastic and Craniofacial Surgeon who, in addition to running a successful practice in Toronto, Canada, also finds time to travel on surgical missions with Operation Smile to such far-away places as Egypt and Cambodia. He also travels the world teaching and will be lecturing in Israel later this year, before embarking on a more extensive speaking tour in the USA.

Dr. Cory Goldberg

As an established lecturer with Valeant Pharmaceuticals, Canada Dr. Goldberg is a recognized leader on a variety of subjects including Dysport, a prescription injection for temporary improvement in moderate to severe frown lines, and Selphyl, a Platelet Rich Fibrin Matrix (PRFM) technology. He also lectures on the many health benefits of nutricosmetics for both personal and patient use, a subject that is new to many of his physician counterparts outside of Canada and parts of Europe. With such dedication to medical science, it is clinically significant that Dr. Goldberg has not only become academically interested in GliSODin Skin Nutrients (GSN), a professional nutricosmetic oral supplement, he also uses them with dramatic results. GliSODin Skin Nutrients was designed for aesthetic practitioners and developed to deliver targeted skin healing benefits, as well as to maximize cosmetic surgery results. Consisting of the patented antioxidant enzyme GliSODin®

and therapeutic-grade nutraceuticals, GSN products help reduce the damaging effects of free radicals, which are said to be a major cause of skin aging, and provide the nutrients that are essential for beautiful, glowing skin. Dr. Goldberg first began using the GSN Pre & Post Formula in combination with facelift and other cosmetic procedures. However, when he personally lost over 40lbs of weight while using GSN Slimming and Detoxification Formulas he became an enthusiast and approached Corina Crysler, Executive Director, about becoming more involved with the company. Since then Dr. Goldberg says he uses GliSODin Skin Nutrients throughout his practice, has developed a variety of treatment protocols and is actively involved with the science and clinical study aspects of the company. “GliSODin® is the first patented technology which contains a bioactive form of superoxide dismutase (SOD) derived from the French melon, Cucumis melo, and is protected by a gliadin biopolymer

layer,” said Dr. Goldberg. “For this reason, SOD reaches the small intestine where it can be effective in the human body. Found in all living species, SOD is known as the ‘enzyme of life.’”

GliSODin® - No Longer A Secret

GliSODin Skin Nutrients has been quietly on the market in Canada, Mexico and Europe for some time. In 2001, François Vix, a former brand manager and senior executive for L’Oreal, Lancôme, and Johnson & Johnson, discovered an orally stable form of the antioxidant enzyme SOD, which was developed by two French immunologists. It was later trademarked GliSODin® and is derived from a French melon that contains 7x more SOD than regular melon. In 2007, François partnered with Corina Crysler, one of North America’s leading natural health product experts and the formulator behind GliSODin Skin Nutrients products. Prior to this, oral administration was highly ineffective due to the activity of the SOD molecule being destroyed by stomach acids.

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HEALTH BENEFITS OF NUTRICOSMETICS The anti-inflammatory and immune system modulating effects for the SOD-gliadin (GliSODin®) combination have shown in published studies that, while no such effects are observed with SOD or gliadin alone, the SODgliadin combination is very effective. Absorption of SOD in the human body has been shown to improve fine lines and wrinkles, increase natural photo-protection, assist in wound healing, and reduce inflammation.

Nutrients is the first product to market that brings beauty from the inside out. With massive growth in Canada and across Europe, (GliSODin® has sold more than 200 million daily doses and has been prescribed in over 30 countries), and based on world response to this product and the anticipated and massive growth of nutraceuticals in the USA, GliSODin Skin Nutrients could very well change the face of the aesthetic industry.

SOD and Aging

Dr. Goldberg is a Plastic Surgeon who is dual certified by both the Royal College of Physicians and Surgeons of Canada and the American Board of Plastic Surgeons. He is also a Fellow of the American College of Surgeons. After earning his MD degree from Queen’s University, Canada and completing his Plastic Surgery residency training at the University of Toronto, including a Master’s of Applied Science in Biomedical Engineering, he did sub-specialty fellowship training in Craniofacial Plastic Surgery at University of Southern California in Los Angeles, California. As such he brings a wealth of knowledge and expertise to reconstructive and cosmetic facial surgery. Dr Goldberg’s practice is a mix of reconstruction including craniofacial surgery, medical aesthetics, and cosmetic surgery, allowing for practice growth with GSN.

Oxygen is essential for life, however, it is also a very reactive molecule. Reactive oxygen species (ROS) are free radicals (O2°¯, H2O2, OH°) created from oxygen that are unstable and may cause cellular damage. The imbalance of ROS and available antioxidants to neutralize their harmful effects is defined as oxidative stress. Oxidative stress is linked to causing inflammation. Inflammation and oxidative stress can cause many degenerative diseases, and are the main causes of aging. “Under normal physiological conditions, a balance between these species and the body’s anti-oxidant defenses exists, however, certain conditions such as smoking, pollution, exposure to sunlight (UV radiation), metabolism of sugars related to high intensity exercise, the progression of aging, infection and the subsequent immune response, can increase the production of ROS like the superoxide ion (O2-) and the hydroxyl ion (OH-),” explained Dr. Goldberg. “This will disrupt the natural balance within the body and ultimately lead to oxidative stress, but with GliSODin® we have the ability to control oxidative stress internally.” Beauty from within is a new concept in the aesthetic industry. While physicians are offered a wide array of tools and technologies to help reverse the signs of aging and return youth to wrinkled skin tissue topically, GliSODin Skin

“At my practice the addition of the GliSODin Skin Nutrients line has been very well received by my patients,” said Dr. Goldberg. “Not only does it work in harmony to help patients heal better and faster after surgery or a cosmetic treatment, but it has also become a daily regimen for many, which brings them back into the practice regularly, keeping us connected and making us first in mind for future procedures.”

Lecturing in the USA

Dr. Goldberg will be speaking at a variety of aesthetic medical symposia in the USA in 2014 and 2015. Keep your eyes on the podium for this exciting lecturer.

Advanced Anti-Aging/Dermal Formula Formulated specifically to fortify the skin with the nutrients necessary to support its structure and function, this formula provides the skin with essential antioxidants to fight the signs of aging, and protect it from environmental factors. It is the fastest way to get the famous GliSODin® glow. A perfect daily supplement for age 35 and over. Advanced Skin Brightening Formula Promotes a bright, clear complexion, minimizing the damaging effects of sun exposure. It contains ingredients to increase the concentration of antioxidants, assists with evening out the skin tone, clears acne, provides photo-protection and nutrients to the dermis. Works best with skin 35 and younger, as well as for those with prolonged sun exposure. Advanced Detoxification/Cleansing Formula Designed to purge toxins through the eliminative pathways, without the use of harmful laxatives or diuretics. Many studies have shown that poor health and oxidative stress can lead to blemished, discolored and dull skin, and premature aging. Advanced Slimming Formula A complete system for healthy weight loss and management, this product is a safe and effective way to enhance the effects of body contouring and liposuction technologies. It helps to maintain weight loss goals and complements a healthy lifestyle, while providing beauty benefits such as an improved silhouette and a more toned physique. Advanced Lymphatic Formula Designed to assist lymphatic drainage and reduce swelling caused by fluid retention in the body. Contains ingredients such as burdock and artichoke and has purification properties that help to eliminate toxins from the body. Advanced Pre & Post Formula Recommended for use prior, during and after invasive aesthetic treatments including surgery. The specially designed formula prepares the body for cosmetic procedures to enhance recovery time. The Pre & Post Formula was formulated to address all levels of wound healing by helping in connective tissue formation and maintaining immune function. www.glisodinskin.com.

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Want A Perfect Size Breast Augmentation? ASK AN ARCHITECT Bringing BreastScale To Market in the USA For Carsten P. Walton having conversations about breast surgery was never unusual as his father is a leading plastic and reconstructive surgeon in South Africa. However, it was when a dinner conversation turned personal (Carsten was discussing a girlfriend with his father) that BreastScale, a revolutionary new idea in breast surgery perfection, was realized.

Patient expectation of surgery was a recurring theme of Carsten’s conversations with his father. Carsten mentioned that his girlfriend would like to arrange a consultation for a breast augmentation. “She wants to go up from an A cup to a C cup,” he said. “Sure. That’s somewhere between 280 to 330 CC,” was the reply from his father. Carsten, a trained architect who, together with his mother Hilke a master architect, jointly runs the architectural practice 7Circle, a company that focuses on luxury residential projects and boutique medical surgery centers around the globe, with projects in the USA, Australia and South Africa, was astonished at his father ’s answer. “You mean there isn’t an exact sizing system for a surgical breast procedure?” inquired Carsten who says to this day he is still shocked by this fact. “No, not really,” answered his father. “Breast implants come in volumes that are measured in CC’s, and as plastic surgeons we rely on training and experience.” As this conversation evolved, three questions about breast sizing came to light: 1. Surgeons speak in CC Volume, while patients speak in bra cup sizes - Why is there NO common language? 2. How is existing breast volume and asymmetry established to determine a starting point for proper calculations and a perfect bra fit? 3. How are changes in breast volume demonstrated ON the patient in 3D so they can be certain that the size they are being given is the actual size and weight that they want? As breast surgeons know, the implant decision is primarily guided by the surgeon who estimates the correct implant size based on individual skill and experience. Even the use of computer generated predictive software is not always enough to give a patient the true sense of how an implant will actually feel, weigh and look. Consequently patients are often disappointed

because the expectations of their surgical result can be dramatically different to the actual physical surgical result. Carsten used his experience in architectural design to create and develop a prototype that surgeons could use to simply and efficiently solve this problem. After bringing the prototype of BreastScale to his father and several of his plastic surgery colleagues for validation and testing, they encouraged Carsten to further develop the system. Although Carsten had chosen to pursue architecture, he was always inspired by the medical world due to his father being a plastic surgeon and his mother being a medical facility architect. The invention of BreastScale stands as a testament to this. Hilke has been involved in the architectural medical industry for over 40 years operating her own architectural practice, designing among others one of South Africa’s premier award winning private surgery centers, hosting 120 beds. Together they developed BreastScale, a new innovative system used to size and measure breasts so that patients can experience a near perfect breast surgery result. What makes BreastScale unique and different to any other sizing system are the colorful plastic breast volume measuring cups, which not only measure CC volume, but relate CC measurements to realistic and accurate international bra-cup sizes, allowing patients to better understand volume changes. Most surgeons would agree that patients think in bra-cup sizes and will ask their surgeon to augment them from one cup size to another – usually from a smaller A or B size, to a larger C or D size. Surgeons, however, work in CCs because that is how breast tissue is measured and how breast implants are manufactured. BreastScale easily translates this difference in size, mathematically allowing the patients to experience, test and have their new sizes demonstrated on their own body. BreastScale helps doctors simplify breast volume calculations which give patients a more

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predictable outcome – a more predictable outcome leads to a more satisfied patient result! BreastScale can be used with all types of breast procedures and is ideal for detecting breast asymmetry. The system is designed to compensate for the irregularity that exists within the bra manufacturing industry by making the cups adjustable to measure ‘three-tiers’ per bra cup size, all relating scientifically and mathematically back to CC volumes. The surgeon can then advise accordingly and select the necessary breast implant size, type and style from any of the leading breast implant manufacturers. “In today’s world, patients are informed, proactive and more engaged about their selected surgery, especially when it comes to breast sizing,” says Carsten. “Creating a system that allows surgeons who work in CC volumes, and patients who think in bra cup sizes, to communicate in a common language is vital as patients want to participate in selecting their new breast size.” While relying on the surgeon’s expertise and advice to guide patients through the available possibilities is obviously vital to the success of any surgery, utilizing a tool that can better captivate patient interaction is what has been lacking in the breast surgery market. A considerable amount of research has been involved in the development of the BreastScale system. While Carsten jokes that creating the cups started off as a fun day with a model who had a perfect C-Cup, and a lot of plaster, the ultimate intellectual property of the system came as a result of 3D scanning, consultation time with plastic surgeons and patients, meetings with bra manufacturers, plaster and clay molding, silicone molding, advanced computer modeling, vacuum forming, ratio models and calculations, industrial designing, 3D printing, field testing, injection molding, constant recalibration, more field testing and, after three years and a lot of start-up costs, BreastScale ultimately made it to market.

Carsten P. Walton and Hilke Potter

Part of the BreastScale research included a study of 1,200 women in Australia, South Africa and the USA who had recently undergone breast surgery procedures. The study concluded that 57% of patients were unhappy or dissatisfied with their post-operative breast size. Hilke explained that the surgeon or nurse can use BreastScale to demonstrate various volume changes on the patient, giving her the opportunity to test, feel and experience the breast implant sizes and options available. This process creates a more comprehensive consultation experience, improves communication, and allows for more realistic expectations after surgery. The BreastScale system has been adopted by surgeons in Europe, Australia, Japan, South Africa, and the USA. The BreastScale system debuted at the California Society of Plastic Surgeons (CSPS) Annual Meeting in California. Surgeons who are often early adopters of new technologies that ultimately become indispensable industry standards, were fascinated by the system and pleased with the solution that BreastScale can bring to their practice. Dr. RJ Walton, Professor of Post Graduate. Education - Aesthetic Plastic Surgery and Former National Secretary of the International Society of Aesthetic Plastic Surgery (ISAPS) South Africa for 18 years, has been the longest user of the BreastScale System and notes an increased 20% closure rate among new patient breast surgery consults.

“This greatly enhances the workflow within the practice,” says Dr. Walton. “My nurse loves interacting with the patients this way, it saves me time, and the added accuracy of taking the calculations and ‘trying-on’ of the new sizes makes the patient feel at ease, moving the final decision making process along faster.” BreastScale believes that surgeons using the system will offer an “enhanced consultation experience” as patients can better understand that there is a mathematical process to measuring existing volume and establishing their new volume and breast size so they obtain the perfect fit.

So what’s next for BreastScale? BreastScale has only recently entered the US market and has been met with an overwhelming level of interest from plastic and cosmetic surgeons, as well as medical manufacturers and distributors. Patients are loving it! “By creating a common language which both patient and doctor can understand, makes the patient feel confident about her selected surgery and choice of surgeon,” said Carsten. “I am proud to have developed this tool, and look forward to a time when the percentage of ‘satisfied’ patients more closely reaches onehundred percent.” www.breastscale.com.

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How One Good Deed Built A Multi-Million Dollar Company For Jim Parrott, the entrepreneurial spark has always been a part of his character. As a young boy growing up in a rural small town in central Ohio, Jim sold chickens to make extra pocket money. In his early teens he started a small repair shop on the family property where he would help locals with various machinery repairs. However, his first significant entrepreneurial venture was in graduate school in Dallas, Texas where he, and a small group of fellow MBA students, successfully formed a company called Diagnostic Aids which produced a self-administered pap test for women. Jim’s future was bright and after a number of years, and a variety of managerial positions with a large industrial company, Jim moved his family to the beautiful island paradise of Maui, Hawaii where he founded a full-services personnel agency called Aloha International Employment. This was during the mid-1980s where life in the Hawaiian Islands was not as commercial as it is today and Jim’s business grew rapidly. “As well as bringing employment opportunities to people on and off the island, I learned about the human resources side of running a business,” said Jim. “Little did I know that this experience would keep me in good stead for other business opportunities yet to come into my life.” Ultimately selling the business and moving his family back to the mainland, Jim returned to the medical industry working with a variety of healthcare companies including Homedco, Baylor Medical Center and Hoffman-La-Roche. Then, once again, the entrepreneurial spirit called and Jim formed Practicus, a healthcare consulting company that worked with medical startups including formation and launch of a national PPO. Practicus also worked with dozens of physicians and medical centers who were expanding their practices into new revenue streams such as capitated programs, research, clinical trials and travel medicine. As with most entrepreneurs driven by the desire to take on new challenges, Jim sold Practicus and went on to work with a start-up medical spa development company. In 2007 a group of investors recognized the potential of the company and bought it. However, as a result of the economic world meltdown that affected every industry including aesthetics, by 2008 the new owners had shut the business down in turn abandoning more than thirty newly-opened medical spas and leaving them without direction or support. “I had considered taking a hiatus from the business world after the sale of the medical spa

company,” laughed Jim, “but several of the spa owners needed my expertise and reached out to me asking for help.” As Jim explains it, the new owners had left the medspa owners high and dry and they needed help with everything from opening the medical spas they had purchased, as well as the day-today operations necessary to become profitable. At first, Jim felt a duty to help the spas that had been left to fend for themselves and worked pro-bono to help them stay open throughout the recession. As the recession ground on, with margins shrinking and costs increasing, the medspas began looking for every single opportunity to reduce costs. Prior to the sale of the medical spa development company, Jim had negotiated preferred vendor pricing and when one of the spa owners asked Jim if he could continue to get preferred pricing on the products, services and consumables that were needed in their med-spa, this was the entrepreneurial “Eureka” moment when the MedResults Network was envisioned. With a founding partner and using his close relationships with a few vendor partners who have since grown to become a cornerstone of MedResults Network, Jim was able to negotiate an extension of the discounts to each of the spas he worked with. After getting positive feedback from his group of nearly thirty spas that he was now helping, with the new company Med Results Network, he began to think that there were probably other spas looking for additional savings on the aesthetic products that he could offer through his partnerships. Jim felt this suggestion by the spa owner was nothing short of a stroke of luck and, like many other entrepreneurs before him, Jim decided to take on the challenge and move forward with the new company MedResults Network.

Jim and his partner invested heavily in the new venture and for the next two years working from home, Jim was able to grow the network to nearly 250 members and added several new vendor partners and additional new benefits for the group. By 2010 Jim Parrott had created yet another solid business concept that was now providing significant cost savings to over 250 medical spas, and was increasing sales to industry vendors that was surpassing many of their individual sales team’s efforts. It was a winwin for all. As some of the MedResults Network vendors held contracts which overlapped into the broader aesthetic industry, Jim decided it was time to expand into this arena. At the same time, Jim’s daughter Jamie had entered the last year of her MBA program at Pepperdine University. One of her assignments during the MBA Program was to perform a company business assessment with her classmates and Jim and his partner were delighted to let her use MedResults Network for the project. Although Jamie had a general understanding of the network, she really didn’t understand the full value and growth potential of what her father had helped create with MedResults Network. Neither did Jim. Not until he received the piercing analysis and scrutiny that only a team of young, eager and brilliant ”soon to be” MBA’s could deliver. The result of this major strategic analysis of the company led Jamie and her team to realize that a well- managed group buying system was highly sustainable because vendors would want to participate due to the increased sales volume. In turn, members would want to join because of the competitive pricing for the same quality products (from the same vendors) that many of them were currently buying. The biggest flaw in the company, however, was that Jim was a one-man show, and had little experience with the new technologies necessary for future growth. Jim decided it was time to hire someone, and it was obvious that the best candidate was his own daughter.

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After graduation from Pepperdine University, Jamie took on this role in 2010. In the four years since, Jamie and Jim have grown the MedResults Network to over 2000 members and 40 key vendors. “When I came on board, I spent the first six months learning every aspect of the business (GPO/buying network) and the aesthetic industry products, services, procedures, physicians, etc.,” said Jamie. “Our reporting systems needed broader and faster capabilities. I remember Jim did most of the financial calculations by hand and member contact was limited as would be expected from one man running the company.” She spent the next three years (and still) developing and adding new technologies to MRN that could support growth and assist in providing the best customer service to its members. She also initiated regular email campaigns and communications to the group as well as engaging in annual surveys to garner feedback. Since 2010, MRN has significantly updated its website, is able to digitally communicate regularly with members, has added a CRM system, developed intuitive reporting programs within CRM, and hired more staff, all to enable them to manage their existing member base and provide information to members, vendors and affiliates. “Currently, we have over 2000 members and are working with 40 significant industry vendors and growing daily,” explained Jamie. “Our criteria for accepting new vendors is stringent, we’ve actually turned down over 100 companies that do not fit within our requirements.” Jamie says she spent a good part of her first two years with MRN getting to know existing vendors and members. The better she got to know members, the more feedback they’d provide and they were always willing to put her in touch with the vendors they liked the most! As her relationships with vendors grew, she worked very hard to get to know each of their sales representatives on a personal basis, a major portion of their membership has grown due to vendor referrals. To this day, she still receives calls from reps that have moved companies and want MRN to work with their new company. Jim and Jamie constantly tell all of their new and prospective vendors that the key foundation to the success of the MedResults Network is based on their cautious and highly selective approach to accepting a vendor. Selection is made by conducting thorough research into reputation, industry leadership, degree of national coverage and willingness to support network members with product education. “The most important thing a vendor brings to MRN is a good reputation, they also have to be leaders in their industry category and have national coverage that will provide a benefit to our members,” commented Jim Parrott, “If through our membership we can bring some volume to them, they pay a small fee to us.” Jim further explained that before they select a vendor they may have several conversations with their executive team and reach out to several of their physician members for feedback. In some

Jaime Parrott and Jim Parrott of MedResults Network.

cases (where products can be tested), MRN has paid to purchase products and have their plastic surgeons and dermatologist members test them out first. Members are obviously concerned with results, so if a product doesn’t work, MRN will not offer it. Should MRN receive negative feedback from more than two or three members about a vendor, they will politely put the vendor on notice and have, in a few cases, dropped a vendor for poor service. “We’re always measuring feedback from our members so that we can guarantee that our vendors are performing as they have agreed to,” continued Jamie. “In addition, our commitment to vendors is that we’ll remain exclusive for the duration of the agreement—knowing that we’ll only be offering one brand for each product or service makes our selection process even more important for both parties.” So what’s next for MedResults Network? Digital communication is Ms. Parrott’s strength and she has now begun the aesthetic industry’s first true social business network – move over Facebook - MedResults Network Plus is growing rapidly. With the mindset that aesthetic businesses need to have excellent business managers, and provide the proper education and training for their businesses to succeed —MRN+ is rapidly becoming the one-stop-shop for MRN members.

we’ve seen this on LinkedIn, Aesthetic Everything, etc. In a sense with Plus, MRN is creating more of a ‘crowd sourcing environment’ by accumulating knowledge and educational content for the benefit of its members. MRN Plus is a comprehensive platform where members of the medical spa and aesthetic community can not only share ideas and create discussions, they can also access valuable content, find solutions to their business problems, and work directly with leaders in the industry who can help them grow. “We’ve done our due-diligence so that we offer all of these services in one place. As this is an online platform, the opportunity for Plus is endless, especially since most aesthetic practices are online or moving in that direction,” said Jamie “There is a lot of ‘noise’ on the Internet, but having an online presence is becoming a ‘non-negotiable’ in this industry.” www.medresultsnetwork.com.

The value of Plus is not necessarily in the aesthetic networking opportunities it provides—

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BIG Medicine Magazine Shines TM

THE SPOT LIGHT! on the MedResults Network

PAYMENTS

Skin Sol

INTERNATIONAL

Platinum Services Group

Where Science Me

While all doctors want to reduce their credit card processing fees, most are happy with gaining just a few points. Doctors that work with EVO Platinum Services Group enjoy a reduction of their credit card processing fees by 15% or more? Many doctors and practices have turned to EVO to reduce their payment processing fees and improve their bottom line. Doctors are saving on average $272. a month ($3,264. Annual), with an average cost reduction of 27%. Other EVO benefits include:

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Lowest Fixed Interchange Plus rate Low, Fixed Transaction Fee

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New State-of-the-Art processing methods 24/7, 365 Customer Service/Technical Support

Contact: Mark Morgan 949-678-5878 www.goepsg.com

AestheticLinkTM is the leading patient engagement cloud and mobile technology for aesthetic practices, dermatologists, and med spas. Developed in Silicon Valley, California, AestheticLink augments EMRs and helps aesthetic physicians satisfy stringent new HIPAA requirements related to patient security.

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Improve patient loyalty and retention Use innovative revenue generating opportunities Increase volume of patients and patient satisfaction

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Improve your practice efficiency View up-to-date industry trends Avoid HIPAA fines up to $1.5M / year

Grow your community of patients

With AestheticLink physicians extend the reach of their practice, offer a differentiating concierge experience to patients while providing private and secure consultations to both new and follow-up patients from anywhere anytime. AestheticLink is approved and recommended by leading malpractice insurance companies for doctors. Contact: Victor Gane, PhD. 650-485-2606 www.aestheticlink.com

AQ Skin Solutions is an innovative topical anti-aging cosmeceutical line that utilizes Growth Factors (GF) technology. It was both developed and patented (U.S. Pat. 8,518,879) by Dr. Ahmed Al-Qahtani. Dr. AQ used his background in immunology to create a GFtechnology with an advanced method of producing growth factors and cytokines. Growth factors (GF) occur naturally in many different cell types within the human body, which play a role in cell division, angiogenesis, as well as collagen and elastin production. In the cosmeceutical field, GFs have proven beneficial in wound healing and epidermal remodeling. Consequently, GFs have been used to reverse the visible effects of aging skin, with amazing results. Contact: AQ Skin Solutions 949-698-9649 info@aqskinsolutions.com www.AQSkinSolutions.com

Merz, an established market leader in anti- aging products has teamed up with the Med Results Network as part of its ongoing product education strategy. Med Results Network is key in helping Merz create doctor awareness with innovative products such as Belotero Balance an advanced dermal filler that plumps the face and smoothens facial lines and wrinkles. A product such as Belotero Balance is known worldwide for its great science and is noted for its clinical results in the highly competitive aesthetic medical practice/med spa industry making it a perfect partner for the MedResults Network. Products such as this are becoming increasingly important and sought after as key items that help build medical practices and med spas as repeat patient destinations. Contact: Jamie Parrott 1-844-799-2384 www.medresultsnetwork.com

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The MedResu has over 40 lea that bring volu aesthetic

MediWaste Disposal is a full-service medical waste disposal company that provides nationwide services to all MedResults Members and offers EXTREME discounts on various service packages.

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• 35 years experience in waste management service • Full integrated waste management needs • In constant pursuit of customer service perfection

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• Business practices that respect the environment Contact: Eric Barnes (855) 449-MEDI (6334) www.medi-waste.com

• True remedy for the skin, AQ Skin Solutions products enable the body to heal itself • AQ Skin Solutions offers real results, not quick fixes • The rejuvenation obtained with AQ skincare will always look natural and healthy • With a variety of products available, patients will be able to complement the physician’s efforts from home • The ingredients of AQ Skin Solutions products are not toxic. They supplement the naturally occurring components of youthful skin. • AQ Skin Solutions offers topof-the-line results. The best for your patient is the best for you! • AQ Skin Solutions is exclusively for physician dispense only and are medical-grade skincare products

ults Network ading vendors ume savings to surgeons.

Community Compounding Pharmacy is a pharmacist owned and operated organization. Committed to providing the highest quality products and customer service, they specialize in patient-specific formulas ranging from topical pain creams to hormone replacement therapy. They are pioneers in the highly competitive compounding industry. Catering to the needs of doctors and patients, the staff of Community Compounding Pharmacy is continuously conducting research to ensure that they are on the cutting edge of compounding technology. Their topical formulas include products that have been shown to renew and revitalize skin, even pigmentation, reduce inflammation, reduce scars and keloids, and relieve pain.

• • •

Most medications are ready to ship in 24-48 hours Pharmacists available during business hours Official pharmacy for MedResults Networks

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Licensed in 28 states and still growing Free shipping for most prescriptions Open Saturday

Contact: James Bui, Pharmacist 855-770-2070 www.communitycmpd.com



INTERSTATE HEALTHCARE

Specializing in insuring healthcare risks for over 42 years, Interstate Healthcare has become a national market leader. Whether you’re a physician performing cosmetic procedures, or a Medical Spa focusing on procedures that can safely be performed in Spa settings or in clean rooms, Interstate Health also provides compliance information that relates to an aesthetic practice. How do we set ourselves apart from other agencies? We:

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Keep abreast of changes in laws, board decisions and other governing bodies Testify before committees of state legislatures, licensing boards, and other governing bodies about the aesthetic profession Review Informed Consent documents to assure they meet risk management standards Review and catalogue training certificates of employees/contractors to assure ongoing training deadlines are met Provide the Interstate Solution so you can focus on your practice. Contact: Kathy Morosan-McKinney 800-419-5999 www.medmalquotes.com

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Industry Transformer

Infinite Beauty! Combination Therapies That Work - Featuring Skinfinity RF In today’s advancing world of aesthetic medicine stand-alone treatments are becoming obsolete and are being replaced with combination therapies due to patient demand. Many aesthetic practitioners are relying on multiple modalities to provide a more complete non-surgical solution for their patients’ anti-aging needs. Prior to this phenomenon, a single modality such as a laser would be offered up as a patient’s best solution. Today’s modern approach involves treating the skin at each layer with modalities that complement each other. Eclipse SkinFinity RF™ fractional technology has emerged as the ideal complement to this combination approach. As a color-blind microablative RF procedure, Skinfinity produces great outcomes for wrinkles and acne scars with minimal down time. This balances the efficacy of the traditional ablative modalities with the recovery experience that is similar to the non-ablative procedures. Traditional ablative devices like CO2 resurfacing often came with great risk, while the non-ablative lasers either fell short or simply did not work at all. By combining this revolutionary device with other proven modalities, Eclipse customers have found a more predictable path to superior clinical outcomes. The idea is to stimulate collagen growth by causing level 1 collagen formation (heat trauma) via radio frequency to the dermis while simultaneously ablating the epidermis for improved textural outcomes. This lays down the foundation for new collagen synthesis and serves as the primary stimulus on which the other modalities will build. Combination approaches can now be added to enhance the outcome. Eclipse MicroPen™ can also be used to help induce additional level 1 collagen formation by creating thousands of mechanical microinjuries via micro-needling (CIT). This simultaneously creates micro- channels which allow for deeper penetration and a higher percentage of absorption

of small molecule peptides and autologous growth factors. Utilizing the patient’s own growth factors to improve healing time and enhance the production of Collagen III & IV (non-trauma related Collagen) provides an advantage to the process that native levels of platelets and growth factors cannot match. One dermatologist that is experiencing tremendous success with the combination of SkinFinityRF™, Eclipse Micropen™ and Eclipse PRP™ is Southern California’s Tess Mauricio, M.D. who practices in San Diego. Dr. Mauricio has discovered how to successfully orchestrate the combination approach into her practice by customizing the Eclipse products as well as other select technologies. Dr. Mauricio has created the well-known Time Machine by Dr. Tess™, which utilizes a customized treatment regimen designed to meet the needs of each specific patient. Doctor Mauricio has received significant media attention with her age defying Time Machine By Dr. Tess™ combination therapy techniques.

“Often times I can delay or even avoid the need for a face lift! More importantly my practice has been able to turn back the clock on my patients’ aging process as much as a decade or more without surgery. The Time Machine by Dr. Tess™ is about taking the patient back in time by using a combination of specifically designed techniques merged with leading edge technology. The Time Machine by Dr. Tess™ is a way of assessing the skin as a global unit and not just simply addressing an isolated age related defect. Upon proper patient assessment a selected customized regimen is designed to correct and enhance the overall appearance of the patient in an optimal way. By applying sound medical knowledge with technology, we can do things to help our patients which may not have been possible 10 years ago. SkinFinity RF by Eclipse, and their other aforementioned products are used in my practice on a daily basis with great success and high patient satisfaction,” says Dr. Mauricio.

Beforeand andafter afterfollowing following treatment treatment. Courtesy Mauricio. Before CourtesyofofDr.Dr.Tess Tess Mauricio

Eclipse will be announcing training workshops in the very near future describing successful approaches which can improve the signs of aging with these combination techniques and technologies. Please go to www.eclipseaesthetics.com Learn more at www.eclipseaesthetics.com, www.skinfinity.com; www.eclipsemicropen.com

Industry Transformer

What’s The Next BIG Thing In Cosmetic Treatments That’s Affordable? Let “The Doctors” TV Show Tell Us! As science merges with aesthetic applications the battle to stay beautiful and youthful continues to advance. In today’s highly competitive marketplace appearances on TV shows such as The Doctors is always good for both the patient and the doctor as it helps raise awareness of new available treatments. Dr. Sandra Lee, a board certified dermatologist who practices in Upland, CA was recently interviewed on The Doctors where she discussed the new Eclipse MicroPen™ which is rapidly becoming one of the hottest aesthetic procedures to sweep the U.S.

The Eclipse MicroPen™ is a new micro-needling device which is utilized to apply a clinical concept known as Collagen Induction Therapy (CIT). Dr. Lee demonstrated how the pen itself has 12 tiny needles that are applied across the surface of the skin to create thousands of micro channels or micro wounds to stimulate collagen and elastin formation. It’s no big secret either that this technique is a new “must have” among Hollywood celebrities and no surprise that the Eclipse MicroPen itself has been sold to thousands of medical practices nationwide since its recent introduction to the US aesthetic market. “Finding ways to maintain or recapture lost collagen is considered part of the front line in the battle against aging,” said Tom O’Brien, Founder and CEO of Eclipse Aesthetics, LLC. “The Eclipse MicroPen delivers a means to improve the skin’s appearance in a more effective way that creates an improved youthful appearance.” Although the idea of micro needling of the skin sounds somewhat unnerving, it is actually quite tolerable. So what exactly is Micro-Needling? Automated Micro-Needling (also known as Collagen Induction Therapy or CIT) is a new treatment that reduces fine lines, acne scars and improves the skin’s overall appearance. During this procedure, tiny needles are used to create controlled micro-injuries to the skin in order to produce collagen and elastin. The skin’s repair process results in a thicker dermis with the appearance

of softer wrinkles. The MicroPen also creates superficial micro-channels which allow topical gels, creams and serums to be absorbed more effectively into the skin. This treatment can also create a positive effect on hyper-pigmentation as well as on hypopigmentation, acne scars, traumatic scars and stretch marks and other parts of the body including the face, neck, décolleté, arms, hands, legs, abdomen and back. It works by attaching a sterile needle-tip containing 12 tiny micro-needles to the Eclipse Micropen. A thin layer of topical gel is applied to the skin and the technician selects the appropriate treatment depth based on the individual needs of the patient. Next, in a single motion, the pen is gently pressed against the skin while simultaneously gliding in one direction until the entire treatment area has been covered. While it feels similar to light sandpaper being gently moved across the skin,

some areas are more sensitive than others but by applying a hydrating gel the process can be made more comfortable. The procedure takes approximately 15 – 30 minutes and the patient will notice a bright redness to the skin which may last for 2 – 4 days, although some patients heal within 24 hours. Visible changes to the skin develop over the course of several days and weeks and results continue to improve up to 6 months after treatment as collagen production continues. “Showcasing this treatment on The Doctors TV Show was a great way to educate the public,” said Tom O’Brien “As this is a treatment that is suitable for almost all patients, everyone can benefit in some way from the MicroPen.” The Eclipse MicroPen is now selling the device worldwide. For more information about the Eclipse MicroPen go to: www.eclipseaesthetics or www.eclipsemicropen.com.

Editor’s Note: TV shows such as The Doctors, Dr. Oz and even The View, The Talk and many others offer viewers the chance to see firsthand what new health and beauty treatments are available at the doctor’s office. At BIG Medicine Magazine we are firm believers in patient education and are always excited to see national news shows demonstrate new techniques and technology. The Eclipse Micropen was demonstrated on The Doctors TV Show.

Industry Transformer

A Small

Slice Of Heaven

Dana Elise Solutions in Beverly Hills has been delivering exceptional skin care to Hollywood’s “who’s who” for almost 30 years. With signature treatments such as the Electro-Luxe Facial and the Hollywood Hair Line, Dana has garnered a great reputation among top dermatologists and plastic surgeons because of her depth of knowledge when it comes to skin health, and her understanding on how to keep skin optimal both Pre- and Post- Surgery. She is also known widely throughout the entertainment and film industry as the “go to” skin care expert at many red carpet events. As a leader in the art of skincare and the science of hair removal, as well as a carefully-chosen selection of other aesthetic services, Dana offers safe, effective solutions for troublesome skin, and a unique fusion of health, beauty and science in an all-inclusive approach that promotes inner health, outer beauty and greater self-confidence.

The Electro-Luxe Facial

The Elextro-Luxe Facial combines expertise in Skincare and Electrolysis. The two are brought together into one amazing skincare treatment that is non-invasive, pain free, thorough and results oriented. It begins with a double cleanse and a Diamond Tip Microdermabrasion to slough off dead skin cells. Then a Galvanic current (Anaphoresis) with Scaling Fluid produces a process called Saponification, which softens and opens the pores to prepare them for a deep clean and extractions. The true gift of this treatment is the application of Electrolysis, making this combination completely unique and effective. There are 3500 hairs per square inch and, as you can imagine, the follicles get clogged creating Acne, Mila (whiteheads) and blackheads. Dana’s expert hands steadily guide a sterile-micro-insulated probe into the existing follicle which applies a gentle current to heat the Mila, Acne or clogged follicle. The heat of the current sterilizes the base of the follicle and reduces bacteria. The skin is then gently cleansed once more and a second Galvanic current, this time with positive pole energy called Cataphoresis, is used to deliver Hyaluronic Serum into the skin for complete hydration and to close the pores. Finally the use of High Frequency, a germicidal technique that rids the skin of any remaining bacteria, is applied across the entire face, and the use of LED light therapy for varying skin conditions is available. Now for the luxury…… massage of the décolleté, shoulders, forearms and hands for complete upper body relaxation and hydration… this is when we say, “Please don’t make me get up -this is a little slice of heaven!”

Hollywood Hairlines for Men & Women

Skincare for Pre and Post Facial Surgery

Hairline help is not necessarily just about natural hair loss and balding. Some people may have too much hair in areas of their face and body that they would prefer not to have, while others lose hair as a result of hormones and natural occurrences, injury or surgery. Dana Elise has been restoring a natural side burn hairline and helping many men after facial-lift surgery where the beard hair has been pulled behind the ear. Dana works closely with many Plastic Surgeons, Endocrinologists and Dermatologists on other interesting and demanding cases -- women that suffer Polycystic Ovaries (PCOS) and excessive hair growth from the imbalance of female hormones have gone to Dana for help. She also works closely with the Transgendered community in the removal of entire beards through Accelerated Electrology, where two Electrologists work simultaneously to clear an entire area, head to toe, beards, backs and bikinis. Even unsightly Ear Hair does not stand a chance with Dana around. With a team of professional and seasoned Electrologists, their expertise results in Hairless Bliss!

Glowing, youthful skin is a must have in Hollywood and beyond, and Dana Elise and her team of Estheticians have tailored several skincare treatments with IS Clinical, Specialty Peels, O2 Oxygen Facials and Cosmelan Peels specifically for people of color and clients with hydrating needs, as well as other specialty treatments to get their skin into fantastic shape prior to facial surgery. Many patients have the need for microdermabrasion, extractions, hydration, and correction of discoloration or Hyperpigmentation that needs to be attended to before and after surgery. If a clients is having a Rhinoplasty for example, and has blackheads that need removal, this must be done prior to surgery as you will not want to disturb or press against the nose for 6 months to a year after surgery. Dana works closely with surgeons to prepare the skin prior to cosmetic surgery so that the overall appearance is youthful, refreshed and even toned. Dana Elise Solutions offers each skin care client a thorough and detailed private consultation, and develops a custom program designed with home care products for ultimate effective results. Dana believes in beauty from the inside out and looking and feeling your best. A True Fusion of Health, Beauty and Science.

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Delivering exceptional skin care to Hollywood’s “who’s who” for almost 30 years. before

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Industry Transformer

RIDING THE WAVE Advancements In Skin Tightening The use of radiofrequency in medicine has been around for over 70 years, but Florida based facial plastic surgeon Steven F. Weiner, M.D. is among the first doctors in the US to use the new INFINI Micro-Needling RF device for skin tightening. Dr. Weiner told BIG Medicine Magazine™ that he is usually not an early adopter of new technology but in the case of INFINI, the science just made sense.

Over the last decade or more, there has been an array of aesthetic RF devices introduced to the aesthetic market. While much of the technology seems similar in nature, the results to the patient are not. Some yield good results, while others cannot stand behind their marketing claims. According to Dr. Weiner, when he was first introduced to the Lutronic INFINI, his decision to adopt it into his practice was immediate. “I just had to jump on this one,” he exclaimed. “The science was what convinced me, as well as the potential of this being a piece of technology that had a broader use base among my patients.” Research has shown that heating the dermis to a certain temperature will cause collagen stimulation and can result in skin contraction. Damaging the skin with heat triggers the natural healing process to generate new collagen. Heating the skin to temperatures high enough to melt or coagulate collagen first produces a contraction and then a rebuilding as new collagen replaces the old. The problem, however, lies in the control of the temperature keeping it safe enough for the skin surface. While we all know that more energy equates to more visible results, the price to the patient of this uncertainty was just too much for Dr. Weiner. Also, as Dr. Weiner states, the devices rely on the tissues to carry the energy to the right level and with differences in skin thickness, levels of skin hydration and the composition of the collagen and fat that approach can lead to

a placement of energy at unknown or variable depths. If the energy is placed too deep you can get fat necrosis. Likewise if the device doesn’t reach the critical temperatures, there is no collagen stimulation. “With the Lutronic INFINI RF microneedles the superficial layer of skin can be bypassed and the tissue can be penetrated to the level that you want to heat,” said Dr. Weiner. “With this technique the deeper tissue can be heated at a much higher level leading to greater collagen remodeling, collagen contraction and stimulation. According to Dr. Weiner, going deeper into the skin tissue allows for some treatment opportunities which haven’t been effective in the past with RF devices: Acne treatment (attacking the sebaceous glands, acne or other scarring (particularly darker skin types), sweating (attacking the sweat glands) and stretch marks1. He also uses it for fine lines and wrinkles and due to the RF’s ability to bypass melanocytes, he can safely offer this treatment to patients of color without being overly concerned about hyperpigmentation or increased melasma. With the evolution of RF energy delivery from external electrodes to interstitial needle electrodes heat delivery has been further refined by the use of insulated microneedles which have only the very tip of the needles as the active part of the electrodes. In addition, the insulated needles do not all punch into the tissue at the same time, but are inserted serially

Before and After Photos Courtesy of Steven F. Weiner, M.D.

in rows known as ComfortFlow Technology™. This minimizes pain, aids a more gentle insertion of the needles and helps to eliminate the bounce effect in thinner skin over bony areas of the face. With each RF pulse of INFINI, the array of needles is first quickly inserted into the skin in a 100ms mechanical pulse. After insertion the RF energy at the designated pulse duration is delivered followed by quick retraction of the needles. Because of the very fast and slight offset from row to row of the very fine needles, the needle penetration itself is virtually painless and minor pin-point bleeding. Because the shaft of the needles is insulated, there is no electrothermal damage at the epidermis, so skin cooling is not required: there is of course some micro-damage from the mechanical needling effect, but that has actually been shown to be beneficial. Dr. Weiner says that this technology certainly fills a void in his practice and that with every day use he is able to treat a wider array of patient concerns. His typical patient age is 40 – 65 for skin tightening, fine lines and wrinkles and with INFINI patients can return to work almost immediately with less downtime. In 35 – 40 minutes he can perform a full face and neck procedure. Like other RF treatments, collagen stimulation takes place over weeks and months and results will only continue to improve. His patients are seeing a visible result in 3 – 4 weeks and Dr. Weiner shows them their before photos so they can see the results for themself. To say the least, Dr. Weiner has a very happy patient base.

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“I’m committed to making your plastic surgery procedure a positive experience. Read my 10 Golden Rules First. You will be happy that you did.” Michele Garber

Michele Garber, the NipTuck Coach, is a leading expert in the plastic surgery and beauty industry, and is nationally recognized as the “go to” person when considering plastic or cosmetic surgery. Why Hire a Cosmetic Surgery Coach • Michele ONLY refers to the BEST qualified Board Certified Plastic Surgeons who hold the safest track records • She saves you Hundreds of Dollars in Time and Consultation fees • Michele works independently. She is not paid by doctors, medical organizations or manufacturers

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While researching the various options for skin care, cosmetic procedures and the related issues of safety and recovery times, I was overwhelmed by the amount of conflicting information available. I needed an objective resource that has deep experience in the variety of options available and it wouldn’t hurt if that person actually appeared to care about me vs. just seeing the fees I bring them. Michele brings all of this and more. Anyone considering a cosmetic procedure would benefit greatly from working with Michele. Dan, San Francisco, CA

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Ready For Your CLOSE UP? Can Video Create A PERSONAL WEB CONNECTION? By now, we all know that every practice and business should have a web presence. But if you haven’t upgraded your site to include video or social media, you may be limiting your practice and excluding prospective valuable patients. The internet is now our main tool for researching everything. When we need a doctor, we want to find one with a useful, up-to-date website. But now, in the age of social media, a plain website isn’t enough. When your practice has video associated with its content, you are much more likely to show up on the first page of that all-important Google search, automatically placing you ahead of the rest. Imagine smartphone and tablet users pulling up your videos and sharing them. Imagine creating your own YouTube channel featuring your practice and having viewers Tweet about it to their families. This can be your practice and it doesn’t have to be difficult to achieve. In fact, it can be the most fun part of your marketing strategy. But what about producing a video? It is difficult to know what to do first if there isn’t a Cameron or Coppola in the family. As a result many practices are tempted to self-produce videos to minimize cost. Jim Sanders, of Reel Ideas, a Pasadena-based production company advises doctors and business owners to exercise caution when deciding to go ahead on their own. “You can always give video a go yourself and take a look at the finished piece to determine whether you want to use it. But remember, your video might be the only glance that prospective patients give your practice. It should reflect the very best quality possible. This is your reputation and your life’s work, after all,” stated Sanders. If you are not deterred, Sanders offers a few quick tips: • Start by creating an outline. Identify your target audience and list your specific objectives. • Take an inventory of information you may want to include, such as photographs, awards, newspaper and magazine articles and mentions. And, of course, testimonies from colleagues and patients are invaluable. • Making good quality video is usually accomplished by experienced people. It is not only a complex technological process, it is also an art. Professionals know how to simplify the process and get great results with fewer headaches. There are now over 1 billion users on Facebook. By the end of this year there will be 22 million Twitter users. YouTube has hundreds of millions of users and uploads 48 hours of content every minute. If you think that social media is not for you or your practice, think again. Videos are a crucial extension of your medical practice on the internet. This is where your patients are. Ignoring it means ignoring your practice and your business, as well as its healthy future.

Trail Blazer

Dr. Jeffrey Klein “Prior to 1986, all liposuction surgeries were done under general anesthesia and were associated with significant surgical blood loss, as well as prolonged post-operative recovery of two or more weeks,” states Dr. Jeffrey Klein, a dermatologic surgeon who practices in San Juan Capistrano, CA and is the inventor of Tumescent Liposuction. “When my patients started asking me about liposuction, I felt there was too much risk involved with the standards at that time and began to research how I could develop a faster and safer technique, with more predictable results.” With that in mind, Dr. Klein went on to develop what is now commonly referred to as the Tumescent Liposuction Technique and so began what is now considered the gold standard of liposuction performed totally by local anesthesia, and with virtually no blood loss. Within a few years tumescent liposuction became the worldwide standard of care. If you do a google search for “Jeffrey Klein Liposuction” you will encounter over 10,000 listings. More than 800 surgeons from around the world have traveled to San Juan Capistrano to attend Dr. Klein’s tumescent training course known as Liposuction 101. www.loposuction.com. Many people ask: “How did he think of that?” Dr. Klein tells us that like many industry leaders and trail blazers he saw a problem and sought a solution. “There was a real need and desire on the part of the patient to look physically better and liposuction was their answer. As a medical doctor, my priority was to provide a safe and effective environment for the patient. The solution I came up with has now become a world-wide phenomenon and an application that has developed into other areas of medicine.” Dr. Klein has developed his single technique into a multitude of business opportunities, blazing the trail for both himself, and other doctors he has trained worldwide. Klein created HK Surgical, a company that distributes specially designed liposuction equipment and cannulas, as well as aspirators, positioning pillows, absorbent pads, post-care garments and OR accessories. Dr. Klein continues to blaze the trail and is active in research and teaching at the University of California, Irvine and Riverside campuses. Safety and comfort are Dr. Klein’s highest priorities and it is the mandate that all of his medical products are modeled on.

Trail Blazer Barry Knapp

For aesthetic physicians one of the most difficult obstacles to overcome is the downtime associated with a cosmetic procedure. Many female patients are afraid of being seen in public after undergoing an elective cosmetic treatment, or missing time from work. Barry Knapp, Founder and CEO of Oxygenetix Breathable Foundation, a breakthrough medical grade foundation make-up that covers, heals and helps minimalize surgical scars, found the solution to this problem by developing a make-up foundation that completely conceals any obvious signs of a chemical peel or surgical procedure, and allows the skin to breathe thereby enhancing healing time. “The skin needs air and water,” said Knapp. “Most skin care products, especially foundation make-up, create an occlusive barrier between the skin and the air causing the skin to go into an open active rebellion.” According to Knapp, Oxygentix contains a specific product he developed and patented called Ceravitae. This supercharged oxygenating complex formulation proliferates collagen cell connective tissue growth in aging or wounded skin. Knapp began his career as a young make-up artist in Hollywood where the sight of a pimple was enough to make any young starlet burst into tears. However, using topical makeup to hide that pimple could create havoc on sensitive skin. Knapp knew he had to either find or develop a make-up line that could conceal even the worst acne blemishes and skin problems, without looking false or causing further skin irritation. After much travel and research working alongside a chemist, Knapp developed new products and took several of these ingredients to create a chemically breathable matrix that was tested by world renowned skin product compounding expert, Dr. Peter Pugliese. Dr. Pugliese performed a breathability test proving that the formula worked at 85% air permeability. Today Oxygenetix Breathable Foundation can be found in over 1500 physicians’ offices in North America, as well as 16 countries worldwide. It is developed at the Oxygenetix, FDA cleared laboratory in Los Angeles, CA.

Trail Blazer

Dr. Melanie Palm When Melanie Palm, M.D., M.B.A. moved to San Diego, CA helping people who suffered with a variety of skin conditions was her first passion, becoming a leader in laser dermatology came as an unexpected and gratifying calling. Nominated as “Woman of the Year” by San Diego Magazine, Dr. Palm is an international speaker on laser and light technology. She is also an Assistant Clinical Professor at the University of Southern California San Diego and founding Director of Art of Skin MD in Solana Beach. “Helping people obtain a better skin condition is always my first approach, whether I am treating acne or wrinkles,” said Dr. Palm. “I have found that one of my favorite devices is the LUTRONIC® SPECTRA™. I love the Spectra--it’s a very versatile machine that allows me to treat pigmentary issues, blood vessels, enlarged pores, skin texture, and unwanted tattoos of ALL colors with one device.” According to Dr. Palm the Spectra has been an excellent and innovative device in her practice especially for the treatment of melasma, a frustrating condition for many women. In Dr. Palm’s experience the Spectra gently removes the excess pigment related to melasma over a 12 week treatment period. Her patients have noted that their pigment issues have cleared, their complexion is glowing, pores are minimized, and they use less make-up to camouflage the pigmented area. Dr. Palm teaches on the use of a variety of laser and light technologies including the Lutronic eCO2™ system, the newest, high-end CO2 laser device for laser resurfacing cases. Laser resurfacing has become the gold standard for treatment of facial wrinkles and loss of skin tone related to sun exposure. Fractionated laser resurfacing can significantly improve the appearance of sun damage and wrinkling of the skin. It is also often the treatment of choice for acne scarring. Vertical lip lines around the mouth, crow’s feet, surgical or burn scars, and brown spots related to sun exposure can all be greatly improved with laser resurfacing. And in her spare time. Dr. Palm is an avid supporter of Angel Faces, a not-for-profit organization charged with providing support for adolescent girls that have sustained traumatic burn injuries. Her office recently raised over $4000. for the organization.

Trail Blazer

Dr. John Fisher When Dr. John Bradford Fisher was Chief of Plastic Surgery at the United States Navy National Medical Center, he was required to reconstruct facial injuries, correct facial disfigurement and serve the needs of those who interacted with the President at that time, Ronald Reagan. ‘President Ronald Reagan came from an acting background where “good looks” were important,” said Dr. Fisher. “I had the dual responsibility of correcting both the ravages of war and keeping high-ranking naval personnel looking “fit for duty.“ Fisher, then Lt. Commander Fisher, developed the first use of facial implants that he carved from blocks of silicone. The results provided dramatic enhancement of the facial foundation. Close to that time Implantech, a leading implant manufacturer, began working on facial implant design and succeeded in designing anatomical shapes for the mid-face and chin, gaining FDA clearance to market these with the 3D Accuscan product in 1992. Today Dr. Fisher, of Body By Fisher® uses this experience to give patients a “Presidential” preview of what can be achieved with facial implants. “Today’s patients want to look younger. To look as they did in their early to mid-twenties,” said Dr. Fisher. “Many of them have bone loss and need more definition in their face. Simply tightening skin is often not enough.” But how does a doctor demonstrate how a patient will look with more definition? How can one show a patient how they will look with facial implants? While various 3-D programs are available, Dr. Fisher says nothing is more real, or more convincing, than actually proving it. He regularly uses a saline injection test he developed to simulate a chin implant, cheek implants, mandibular implant and to demonstrate midface projection. “My patients love it,” said Dr. Fisher. “They want to look younger, correct diminished features or simply obtain a “brighter” look. This injection technique helps them test the result before surgery.” According to national statistics facial implant procedures are on the rise. The news media has reported that the Social Media and Skype trend has contributed to this growth because people are now seeing how they look on camera and they are not happy with what they see. Dr. Fisher says that many doctors agree that the key to the “fountain of youth” begins with replacement of lost facial volume. “Three dimensional surgery is here to stay and I help patients see it first.”

POWER SHOTS!

Is Your Body Language Holding You Back?

Model: Brandon Murphy Barnes

What message are you sending with your body language? According to research performed by Harvard Business School professor Amy Cuddy, with body language we can change a person’s perception of us – and our own body chemistry - simply by changing body positions. Amy Cuddy gave a great talk available on the popular website TED (www.TED.com) about how small changes in your body language can radically change your job performance and career. Certain “power poses” immediately change your body chemistry, Professor Cuddy says. “And these changes help or hurt the way other people perceive you and, importantly, affect the way you actually perform. The full video is 21 minutes long and definitely worth watching.

Superman Pose

Game Changer Pose

Relaxed Power Pose

High Power Pose

Pride Pose

Relaxed Control Pose

How To Say QUESO! Smile For The Camera “Are you ready for your close-up?” said Cecil B. Demille to Norma Desmond aka Gloria Swanson in the famous Hollywood classic movie Sunset Boulevard. Of course she was ready. She had prepared for hours, even her whole life, for this moment. But taking a great picture can require more than hours of preparation. Finding somebody who can handle a camera is imperative to the outcome of your headshot. BIG Medicine Magazine™ asked photographer Mehri Modini, for some tips.

How do you see yourself? Successful? Strong? Interesting? Credible? Now, how do others see you? Driven? Responsible? Cutting Edge? Trustworthy? ARE YOU SURE? We’ve all heard that a first impression lasts a lifetime. As a medical professional you strive to be on the top of your game constantly and should know that first “meeting” you have with a patient (or anyone) is a make or break moment. But in this world of viral technology, is that meeting their ‘first” impression of you? Or has someone already “sized” you up before you’ve ever set eyes on them…. because they have seen you in web site and social media photos. Enter the age of the fabulous headshot. In today’s on-line world, it is even more important for everyone, especially medical professionals, to put their best face forward. More than just a “pretty face”, an outstanding headshot can showcase your positive attributes and, most importantly, leave a lasting impression so you are remembered well. But taking a terrific headshot is not as easy as it looks! We all know a picture is worth a thousand words, (hopefully not a thousand ‘notso-good words’).

Here are critical planning tips to make sure your headshot is spectacular: •

is pretty obvious but if you had to pull an allnighter, this just isn’t happening….reschedule •

make you look overly tired •

Don’t have a facial or skin treatment the day before a shoot, but do use a scrub, mask or light exfoliator the night before and apply night time moisturizer

•

Bring a wardrobe for the photographer to choose from and, better yet, if possible find someone who can tell you what colors flatter your face. Or hire a stylist

Second, look at headshots. Did the photograph stir your emotions? Do you have a warm, giddy feeling inside to meet this person or just….next?

•

Finally, notice the unique. Did the photographer take the time to really highlight your uniqueness…. which may not necessary be your face, but the pose, lighting, any props…etc.

•

Once you’ve found that special photographer with an “eye” for you, put your best face forward.

No alcohol the night before a big shoot. It bloats your face, dehydrates you and can

So how do you find a photographer as fabulous as you? First, look to the stars. In the entertainment world, an awesome headshot is beyond critical. For them, the headshot IS the first impression and with the intense competition, it better be knock-down, dragout, fantastic!

Get a good night’s sleep. You might think this

Leave the giant jewelry for Mr. T, just pick simple pieces that don’t take away from the real you If possible, have your make-up and hair professionally done…and yes, the men too

•

Determine if any props would make sense depending on your specialty

An amazing headshot is only the start of a lasting first impression you will develop with your patients or clients, but in today’s world of on-line marketing it is one of the most valuable items in your toolbox.

•

Remember: Good Enough is NOT Good Enough for YOU!

•

Don’t rush your appointment. Make sure your schedule is open so that you can relax and enjoy the moment Get your mojo on! Walk in and be ready to have fun and let the camera capture the spirit of you

•

“A great friendly headshot of YOU in your marketing materials is vital.”

Relax; remember as a professional your headshot should wreak of credibility

Scrubs Are

Nurses were the first to wear uniforms, before doctors wore scrubs. In the earlier part of the twentieth century the identifiable mark of a busy and successful surgeon was the amount of blood on his clothes. Yes. The surgeon wore his own clothes during a medical operation, sometimes covered by a butcher’s apron to prevent blood staining them. Back then, doctors performed surgery with bare hands and non-sterile instruments and supplies, obtaining needles and suture material from the local market. It’s hard to imagine in these days where the norm is a five star surgical center that functions with ‘positive flow’ ventilation and air conditioning, as well as back up from its own electrical generators, that doctors used to perform surgery in such a ‘barbaric’ way. Thank goodness for scrubs. That’s where the real story of modern medicine begins. Doctors wearing scrubs brought more to patients than McDreamy and McSteamy from the hit ABC TV Show Grey’s Anatomy will ever be able to. It was The Spanish Flu pandemic of 1918 and the growing medical interest in Lister’s Antiseptic that brought some doctors to begin wearing cotton gauze masks in surgery. This was not to protect the patient from intra-operative infection, but rather to protect the surgeon from contracting the patient’s diseases. Around the same time, OR staff began wearing heavy rubber gloves to protect their hands from the solutions used to clean the room and equipment, a practice surgeons adopted, albeit rather grudgingly. Over time, gauze masks and gloves became widely accepted and then gowns worn by OR personnel when “scrubbing in” for surgery, became standard procedure. By the 1940s, advances in surgical antisepsis and the research and science behind wound infection led to the adoption of antiseptic drapes and gowns for the OR. Originally, OR attire was white to signify cleanliness. However, the combination of bright OR lights and an all-white environment led to eye strain for the surgeon and staff. By the 1950s and 1960s, most hospitals had abandoned white OR apparel in favor of various shades of green and blue, which provides less eye fatigue. By the 1970s, scrubs had largely evolved into their current state: a short-sleeve V-necked shirt and draw string pants. And we now see a happy variety of colors and styles (some pediatricians feature cartoon characters on their scrubs to the delight of many a child), as well as scrub caps that have evolved from a means to protect patients from hair contaminants to signature styles for many a groovy doctor.

“In the earlier part of the twentieth century the identifiable mark of a busy and successful surgeon was the amount of blood on his clothes.”

Is your logo working for YOU? Scrubs and Lab Coats are a great place to advertise your logo and practice name, furthering your brand. Did you know a good logo can easily be embroidered onto the pocket and become a simple, subtle and effective marketing tool?

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A Final Word

How To Be Interviewed On TV! Let’s Hear It From Giles Raine

“America’s FAVORITE PUBLICIST” As a publicist that places doctors on many well-known TV shows I am frequently asked by doctors how and why other doctors who, in their opinion, are less qualified, less established and even less skilled, have been interviewed on the news or have been guests on major TV shows!

When pitching an idea to a producer, you need to be knowledgeable about their show. Spend time watching shows you would like to be invited on. Pay special attention to show segments of interviews that have similarity to you, your techniques and/ or the technologies that you use.

The answer is surprisingly very simple. Regardless of how academically qualified or successful a doctor and his practice are, the primary interest and agenda for a TV show producer, is to create an interesting show that will entertain its audience.

Regardless of how innovative your technique, technology or procedure is, the TV shows audience is not clinically trained. The scientific importance and relevance is best explained and illustrated by following a patient who is experiencing the treatment or surgical procedure. The more visually obvious and unusual the patients problem, surgical procedure and or treatment is, the easier it is for a producer to select you and your patient as a guest. Producers are always looking for dramatic interest!

If you want to be on TV, then these are the steps that you will need to take in order for a TV producer or journalist to consider you as a candidate for a TV show or other media interview. Every TV show, magazine, internet site or other media outlet has its own specific format. It is important to understand the format of a show that you feel would be interested in you. For example; a talk show that has an older female audience demographic with hosts and guests who discuss lifestyle and relationships, may, not consider a surgical procedure story a good fit within their format. However, the same show may find that the same doctor or patient that has a topic relevant lifestyle or relationship that fits the shows format might be the perfect guest.

The many years of clinical training deliberately teaches doctors to think and make carefully measured and conservative statements when asked a question. For many doctors who are pre-interviewed by a producer considering them for a TV show, this is not the type of response they are looking for. It is important to explain and summarize why your surgical procedure, treatment or technology is interesting and exciting within 20 – 30 seconds. It is also critical that you do this with energy and excitement!

Old fashioned, consistent and persistent follow up with the media delivers results. Most producers are very busy and unlikely to return your call no matter how academically respected you are. Producers are hit daily with phone calls and e-mails from many people (especially publicists) who also think they have the best and greatest story. Typically it can often take from several weeks to several months of consistent follow up phone calls and e-mails before the media will respond to you. I hope to see you on TV soon, and as they say in Hollywood ‘break a leg’! www.theprofessionalimage.com

As a medical media specialist at TPI, Giles is an expert in explaining complex scientific and medical concepts that will enable producers and editors to accurately and clearly ‘tell your story’ to readers and viewers nationwide. With over 30 years of PR and Branding experience Giles knows how to give the media what they need to produce a great show, interview or news story. This experience has made him an important resource for many producers, writers and editors worldwide.

The Professional Image, Inc.

PUBLIC RELATIONS • CONSULTING • MARKETING

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