E 111 Cosmetic Laser Dermatology Kachiu Lee MD

a doctors perspective e 111 kachiu lee md dermatology cosmetic laser
Dr. Kachiu Lee, MD talks to Dr. Justin Trosclair DC on A Doctor's Perspective Podcast

Learn about ultrapulse CO2 lasers, Bellafil, vaxolaser, sclerotherapy and more cosmetic dermatology procedures from Dr. Kachiu Lee MD. Considerations in non-white skin, affordability, and how cosmetic surgery has become more acceptable in culture.

We hear her why to not only specialize in dermatology but more of the cosmetic side of dermatology. It’s a story of family, self-confidence and making an impact that is truly palpable to the patient.

How have people and other doctors come around to having a positive and almost boastful attitude to cosmetic surgery when in the past it was hidden?

Quality of Life research has shown improvements in social, physical, and mental functioning after cosmetic procedures.

The Ultrapulse fractionated CO2 laser is effective for treatment of scars, wrinkles, and other signs of photodamage. It is her favorite go to Powerhouse laser even for keloid type scars and really bad teenage acne scars.

When treating African American or Asian skin, what precautions must be made so hypopigmentation does not occur?

What are non-ablative lasers (vaxolaser), chemical peels and Bellafil?

Bellafil is the only FDA approved collagen rejuvenator for acne scars.

Can makeup cover up facial texture issues?

If you can’t afford 10 laser sessions, does she recommend doing just 2 or should you try a different option all together?

What is sclerotherapy for leg veins?  Think varicose veins (how do you get those). This is an injection that can coagulate the vein and the body resorbs it. It sounds wild to me, so I asked her for more details. What are some ways to prevent varicose veins from forming in the first place (plus who is at risk)?

What are her go to marketing ideas?

Did you know freckles and redness in the face could be removed (Fraxil procedure)?

What does she do in the waiting room, staff training etc to give patients that WOW experience?

What has been more of a concern in training and patient interaction with some patients, her race or her gender?

How do you determine if you should go into dermatology instead of another specialty?

What does she look for in hiring staff and once hired what is a tale tell sign they will stick around?

https://www.kachiuleemd.com/

Kachiu Lee MD is board-certified and cosmetic fellowship trained dermatologist with a specialty in laser treatments.   She practices dermatology in Nantucket, RI.


Show notes can be found at www.adoctorsperspective.net/111 here you can also find links to things mentioned and the full transcript.

Full Transcript of the Interview (probably has some grammatical errors). Just Click to expand

Justin Trosclair 0:06
Episode 111 cosmetic laser dermatology. I'm your host, Dr. Justin trust Claire. And today, we're Dr. Zhu Li perspective to in 2017 and 2018 podcast Awards Nominated host as we get behind the curtain look at all types of doctors and guests specialties. Let's hear a doctor's perspective.

Okay, so this interview is full of some wild technology and scheduling. So when I first did the interview, I was in China, and I was trying out a new system to record However, during the interview, we actually lost connection, and then it would connect again. So even though we had a good hour, there was less that was actually covered. And so we were planning to redo it when I went to America, like a week or two later. Well, I'm telling you, I got the time zones mixed up, didn't schedule it didn't make the interview. And then the next time we had some issues with Skype, it was just kind of a mess, to be quite honest. So there was a few things more that we could have covered that we wanted to cover. But we decided to just take what we have, it's still really good interview, we just kind of missed a few pieces, like what she offers versus a mid levels and nurses one of those differences and then some family life questions. So needless to say from from past interviews, there is a difference. It's all the intimate knowledge of what you're using, what not to use the right doses, there's so many things that makes a difference. So enjoy the interview. They're still jam packed full of good information, like we're going to talk about a lot of like, say ultra pulse fraction data, co2 laser. What's that good for when you're looking at minority skin? What What else matters? They're non ablative lasers, chemical pills, Bella Phil, what is sclerotherapy? What's it used for any marketing ideas? What do you do about like staff training, also patient interaction, all those types of things for dermatologist and sitter, so that's gonna be great interview. Thanks, listen. And when it ends kind of abruptly, you know why we just ran out of time. I just want to say one more time, sorry to Dr. Lee, very unusual to have so many issues in one episode. But I still hope that you are able to use this episode for marketing or social proof or whatever it is that you want. And like I said, to the audience, you'll definitely learn a whole bunch about lasers in a cosmetic dermatology setting. By the way, you know, I've said this before that I pre record some episodes. And sometimes I record the intro like this earlier than they actually come out. Because, you know, when I went to America, I didn't want to have to do this on my vacation. So as we speak right now, my parents and I are all in China, my family, we're having a good time, they are experiencing life, how I live it and exploring new food and the new culture. And you know, it's going good, definitely follow Instagram and Facebook, and you'll be able to see and keep up with everything that is going on with the last month. It's officially Chinese New Year right now. So it's going to get a little wild and crazy. Okay, all the show notes can be found at a doctor's perspective, net slash 111. Let's go hashtag behind the curtain.

Live from China, and Nantucket Island. We have a great guest today. She is a board certified and cosmetic fellowship trained dermatologist with heavy specialization in laser therapy. It's definitely something that I'm curious about. And I don't know much about please welcome the show. Dr. Lee, thank you. Well, it's a pleasure to have you on you were actually recommended from another guest in the past. And he's like, Oh, you should definitely call her and she's going to be a wealth of good information for you sounds like Well, that's fantastic. One things we'd love to do just to get a basic background of all the things you could have done, it shows medicine, and then you chose one of the hardest things to get into dermatology, you're still background, how'd that happen.

Unknown 3:49
So I absolutely love the skin. I have two older sisters, and being the third and youngest trial to know that you get chucked around to all your sisters appointments and sports and everything in between. So my oldest sister had a lot of skin issues. And one of the things that I did a lot with her when I was little was I went to a dermatologist appointment. And I really saw the difference in how she acted and carried herself before she went to the dermatologist when she had really really awful and bad acne. And I saw her transformation over a few years after she started going to the dermatologist and really regained her confidence because her skin was now cleared. And I just thought that was the most amazing thing that you could do for someone to really give them their self confidence or self esteem back simply by treating their skin. And so that was one of the motivating reasons for why I went into dermatology because I want to be able to help those people regain their confidence regain their life, you know, make friends in high school and be themself just by purely treating their skin. Mm hmm.

Justin Trosclair 4:55
Well, kids are mean so I can definitely understand wanting to to help with that. That's for sure. Okay, so dermatology, the ones I've had in the past, they're more about cancers and bowls surgery and I guess when a call like life threatening potential, the type of Route and then are you more in the cosmetic side of Dermatology instead?

Unknown 5:15
Yes, so I am a laser and cosmetic trained dermatologist, which means that in addition to doing dermatology fellowship, I did a specialty. Or in addition to doing dermatology residency, I did a specialty fellowship, specifically in lasers and cosmetics up at Massachusetts General Hospital, affiliated with Harvard Medical School. So my goal is to help people become their ideal version of themselves and to help reading their confidence and regain their self esteem.

Justin Trosclair 5:47
Now, I've already know sometimes you guys get a good jab the little bit by your colleagues for being skin doctors. Is it even worse when you're dealing with like the the specialty that you're doing right now? Or do you know what I mean?

Unknown 6:00
Yeah, so there's definitely some people who don't see the value of what I do. But really, I think that with the way that our society is evolving, and what social media with, you know, me, TV and the internet being so popular, I think the value of cosmetics is definitely becoming more mainstream than even it was what it was 10 years ago. If you even think about five years ago, it was hard to find someone who would admit that they did something. And now not only do people admit it, but they proudly declare it and probably talk about what they've done to become their ideal version of themselves. So I think because it's become more mainstream and more accepted, it's definitely made it a lot easier for other specialists or other physicians to understand the importance of what we do. I also think very importantly, there's a lot more actual evidence based quality of life research that is out there. Now. The quality of life research has shown the immense improvements people have in their social, physical and mental functioning after having done cosmetic procedures. So it's not just a procedure for beauty anymore. It's really a procedure that people do to improve their overall health. And the evidence is out there to show that that's what that's what's going on.

Justin Trosclair 7:23
Yeah, that's really great. I think we forget about that. And when we see it, it makes a huge difference in somebody's personality, like sitting in your sister, the confidence, and you don't have to live especially don't have to live with it. You know, y'all thought I would have to always look like this or feel this way. Like No, actually, we can just do a probably a simple procedure. lasers are, you know, they they go home, I guess, the same day, right?

Unknown 7:43
Definitely, most of our procedures have no downtime. So a lot of times I call them the lunchtime procedure. You come in you do your procedure, lunchtime, go back to work, and feel fabulous about yourself. Alright,

Justin Trosclair 7:57
we're going to play what is this game? Because

some of these things, I don't know what some of the stuff that you do is, but I looked on your website like okay, that's interesting to me. That's interesting. And that's the fun part about I think this podcast is we get to learn something if you're a physical therapy or chiropractor podiatrist. Hmm. Let's learn something new today. You ready for this? Course. Okay, the ultra pulse fraction aided co2 laser. What is that? And are there other options available?

Unknown 8:24
That is my favorite powerhouse laser. And when I say powerhouse, it is a powerhouse. And I use that laser have to treat scars. When I'm talking about scars, I'm talking about what you're really thick kind of key loyal scarring. So what you from really bad acne scarring on your chest and back. What you get from bad burns are really just bad keyboards, guards, the laser can penetrate very deep, which is why it's good for deep scars. I use other devices that are not as deeply penetrating for things like acne. So on your face. I think he Lloyd scarring and acne scarring is one of the long term supply of our teenagers, for those unfortunate enough to have had really bad acne. And for people who have that acne scarring, this is one of the best options out there to help soften those scars and to help minimize the appearance of those scars.

Justin Trosclair 9:21
Now does this work for African Americans who get those big key Lloyd's

Unknown 9:26
definitely, and that's probably a large proportion of my population. So for African Americans who have a lot of the big key loads, especially on their chest, this is an amazing treatment to help with softening and reducing the size of those scars. And people of color it can, there's a higher risk of it causing dis pigmentation like hyper or hypo pigmentation. So the laser still works, it's just that we use slightly lower settings and do more treatments instead of using high settings and doing fewer treatments. But in my opinion, it's better to have a result where there is it any does pigmentation and just take a little longer getting there then to try to rush and get there from the beginning, but then be left with a result we're not happy with

Justin Trosclair 10:08
what they look like little languish are more like this, like, like on white scar tissue instead.

Unknown 10:13
So ideally, after you treat the scar, it's just going to look more like her normal skin, but there's just maybe a small area that's raised up, maybe it'll be, you know, 90% better, and you still can tell that there's a scar there. But you won't have to for people with the scars and visible area, they won't have to put makeup on it anymore to try to hide it, or others won't remark on Oh, why do you have that huge bump on your chest or that huge bump on your shoulder? So it's gonna make the texture better? And ideally, it won't. It won't cause any skin discoloration.

Justin Trosclair 10:49
Okay, very nice. That could be good to like, if you're in a frat or something. And you've got a big brand on your army like yeah, that was a part of me. I don't want anymore. Yeah, it's a way to help take care of that.

Unknown 11:00
A good, that would be a good use of your laser.

Unknown 11:04
Okay,

Justin Trosclair 11:04
the acne scars, we watch movies, and we see these old guys sometimes and this 4k world you like Wow, you really are full of acne scars, and you're still a superstar. I don't really know how that worked. But someone like that that's a good representation of something that you could use with the face setting to smooth it out.

Unknown 11:22
Yeah, so there's a lot of other non ablative lasers as well as things like substitution or chemical peels that you can use to smooth out the acne scars and I do all of that. And many cosmetic dermatologists do all of those types of treatments. But I think the people especially those old school actors who have a lot of that like ice pick scarring, those Yeah, indentations and their skins. Those are the people who could really use some acne scar resurfacing, whether with our non ablative laser like the fractional laser or what or whether it was some decision or a filler like Bella fill. My goal is for this next generation to not have anyone that has that type of deep pitted acne scarring.

Justin Trosclair 12:07
Do you put a nova cane or some kind of pain relief before you go through this because I've heard the tattoo removal are brutal.

Unknown 12:14
Definitely. So I either use topical numbing medicine so like a topical version of Novocain except it's topical light again, a compounded make sure everything works really well. Or for people that are very pain adverse or short on time. I can do injectable line of Cain that can

Unknown 12:34
use the pain

Justin Trosclair 12:34
that was intense.

Unknown 12:37
Just Shoot Me. Okay. All right here we go.

Justin Trosclair 12:41
crankier up, we're gonna treatments are we talking about I guess it all depends, of course, how big something is. But can we assume two or three visits, we're looking more like 10 for some cases,

Unknown 12:51
depends on how bad your score. So for some of my patients, two or three is enough. But for a lot of my patients who have really bigger, thicker key Lloyd scars, probably six to 10. If your skin of color I need to be I'll use lower settings, but a lot more treatments. And so those will definitely require a lot more treatments, even, you know, 10 or in excess of 10. But I always tell people that, you know, with each treatment, you'll definitely see the result, it's incremental. So you'll see it happen slowly. But really, when you compare the before and the after all the treatments, you're just going to see a miraculous transformation. And it's going to really help to improve that person's self esteem, it's going to just change their life. You know, for a lot of my patients putting makeup on to cover their scars, they don't have to wear makeup on their chest anymore. They don't have to wear makeup, you know, thick foundation anymore on their face, because they don't have to be trying to cover up that texture. Makeup is great for covering color, like if your faces really read. But it's awful for covering texture, because to cover texture, you really need to be applying like Hollywood studio level of makeup to really smooth out the texture. Wow.

Justin Trosclair 14:02
Do you find that some people come in, they're really they're really excited. And then they find out how much it costs into like, I'm all right there is there an option where they can get injected with a lot of Cain and just do one or two sessions because that's all they can afford, versus doing something more like five or six at a normal setting.

Unknown 14:19
Yeah, so they, we definitely work with patients in their budget. So if they can't afford the entire series, we may go with a less expensive option. Or instead of using a laser, maybe we'll do a chemical peel or substitution. My biggest my biggest hesitation is to do laser like once or twice on someone that really needs it 10 times, because they really need 10 laser treatments and they're spending all their money on to laser treatments, they're just not going to be able to get the results they want. And I'd rather redirect them financially to do something that will get them the results that are maybe temporary, but will make them happy. So whether that's using dollar fill to fill their acne scars or whether that's using chemical peels for resurfacing, it'll get them at least a better result that may not last permanently, but at least they'll be happy with what they got.

Justin Trosclair 15:13
You're not gonna like you went through got half a tattoo and you just couldn't take the pain and you quit like it'll still look like okay, is that that analogy makes sense?

Unknown 15:22
Yeah, it does make sense. So it also look okay, it'll still look better, but I but it may not fit with the person's goals of how much better they want to be.

Unknown 15:32
Okay, all right. We're just hitting would hate to start and be like, yeah, you really going to need to finish six guys. I like for real?

Unknown 15:39
Yeah, definitely.

Justin Trosclair 15:40
And what was this battlefield? Is it long lasting permanent

Unknown 15:44
fellow fellow is actually the only FDA approved filler for acne scars, we use a lot of things off label. So other than Bella fell we also use, you know, Truvada or wrestling or other other products. But Bella Phil's one of the oldest actual FDA approved treatments for Aqua scar, and it works by stimulating your own collagen growth, which is why it's a good option for kind of more permanent correction.

Justin Trosclair 16:14
Interesting. Now, what is this a square therapy leg, leg pain issues, what goes on

Unknown 16:20
there. So I have tons of patients that have such beautiful legs, they work out all the time to tone their body and tone their muscles. But then I asked them why they aren't showing those beautiful legs off and all of their hard work off. And they told me it's because of their veins. And that's where we come in. If you're putting in the work hitting the gym, I'm here to help you get rid of some of those varicose veins or get rid of some of those superficial veins. A lot of times people have varicose veins or other particular veins just because of genetics or mom has really bad beans or dad has really bad veins or they work at a job where they're standing for 24 hours or standing for a very long time like waitressing in medicine, if they're working in like a in surgery or something like that. And sclerotherapy is where I use an injectable medication I injected directly into the veins. And after I injected directly into the vein, the medicine basically causes that vessel to coagulate, and clothes off and so it disappears from the surface of your skin. All of these veins you see on the surface, right underneath or right underneath the surface of the skin are superficial. So with them for life or for survival. So closing them off and getting rid of getting rid of leads to a great cosmetic result.

Justin Trosclair 17:40
Oh, so you can it's kind of yucky clip. It's not clipping but you know, it's chemically clipping the court on one in and the other so it stops getting the blood flow said stop swelling, it doesn't

Unknown 17:51
kill it.

Unknown 17:53
It will look so the your I'm injecting the medicine directly into the vein. So it's coagulated and killing the vein itself.

Justin Trosclair 18:00
Wow. And then what happens to the vein

Unknown 18:02
inside you? Your body reserves that what? Yeah, so it's basically not there anymore.

Justin Trosclair 18:08
That's wild, right? You just okay, that's pretty wild to me, because I'm thinking Normally, you would cut them out early, that's the old school way,

Unknown 18:15
you can still cut out like the really, really deep means. But really, I think if you can use a non invasive method, there's a lot of new technologies that help us prevent having to go under the knife for me. And I'm

Justin Trosclair 18:27
assuming the way you do it, it stops it from I guess leaking the wrong way or going through a major vein that you're actually needed. All those are.

Unknown 18:36
So all of the major means that you actually need a pretty deep underneath the skin. So you really don't those ones as much. So all of the ones that are superficial on top of the skin are basically superficial tributaries that you don't really need.

Justin Trosclair 18:50
Wow, people get nervous about that when you when you tell them what you can do.

Unknown 18:54
I think people are just so excited at the prospect that they can get rid of their veins and we're skirts or show off their legs again, that they they are willing to go undergo that type of treatment. So I mean, it's really amazing the results you can get because people come in and they have all these like knobbly veins that they really don't like and after we do the sclerotherapy within a month, their legs are a much smoother, we may not have gotten all the veins but if you don't get all the veins, you can always treat them again. And it really does such a it does such a good job at getting rid of those unwanted varicose veins that I think anyone who is having issues with things should really consider getting it done. And it's also a medically necessary procedure for some people. Some people have a lot of pain or discomfort because of all the various studies. And so for those patients, it's not just about cosmetics, it's actually a medical procedure that can be done and can be potentially covered by insurance.

Justin Trosclair 19:55
Is there anything we can do? Can we were supportive stockings if you know your that job where you stand for Pete the 12 hours a day?

Unknown 20:02
Definitely. So compression stockings are the number one thing that I recommend to all my patients who are starting to get veins or who have had veins and just caught treated with a sclerotherapy. But if you're in one of those jobs, like in the service industry, where you're standing all day or in medicine, where you're standing all day, wearing compression can really help to prevent some of those veins from coming out.

Justin Trosclair 20:26
Cool. Who would have thought you would have to be so proactive, but it's a good thought if you especially if you see your family with it, right?

Unknown 20:33
Definitely my mother has very bad varicoceles and was having a lot of pain. And so after she was treated, it really changed her life. So she could actually walk more than five blocks without having to put her feet up, which is amazing. And she could actually go to sleep at night without her legs throbbing and feeling really sore. So that's a great example of a medical indication for sclerotherapy. And for Venus, we call it also Venus ablation for bigger beans, completion.

Justin Trosclair 21:08
Let's see what's another good one that we can cover? Is there anything we didn't cover that you were like? Well, this is a really cool procedure that we're starting to do or anything like that? Um,

Unknown 21:16
no, I did not want any of those cosmetic topic things I do all of them and, and everything in between. Okay,

Justin Trosclair 21:24
good, good. When it comes to say marketing, do you have to do any of that? Or do you get referrals from all the doctors in the area? Like what do you do?

Unknown 21:31
So I really think that cosmetics is just like any other field where the best marketing is word of mouth. So definitely marketing on social media marketing, through referrals from other dermatologists or plastic surgeons are hairdressers, obese. But really word of mouth is the best marketing I've had so far. And if you give someone a great result, all their friends are going to notice and all their friends are going to ask, you know, we're What did you do? Who did you go to what was the procedure like and if you can really provide a quality outcome for low cost and for low downtime, then those people are going to become your customers and all their friends are going to become your customers for life.

Justin Trosclair 22:15
Do you have any internal procedures to give that patient the wow factor when they are in your office,

Unknown 22:20
I love doing laser for removal of brown spots like freckles or doing laser for removing redness in the face because lasers are so effective for those two conditions that it really causes this while feeling when all those are freckles peel off after fractal procedure or after a Q switch laser procedure. And patients are so happy when they see that their nose or their cheeks are no longer read or studied with all these broken blood vessels and they can actually see their natural skin color it is really a such an amazing result that people are really just watching that was so effective. So low cost, low downtime, low pain or low discomfort that that's probably my number one procedure that those are probably my number one procedures that people

Justin Trosclair 23:13
do you do any trying to think patient walks in there in your lobby, give your lobby setup or your your your staff trained a certain way to make people feel more welcome, or they just like a high end clinic or anything like that.

Unknown 23:26
So our clinic space is very clean and very streamlined and brand new. So it gives people a very warm and welcoming impression. I also have a separate waiting area for my cosmetic procedure, procedure patient so that they can have privacy. If say they're doing numbing medicine for a little while and they need somewhere to sit. So they're not just sitting out in the waiting room with everyone else checking in. We also have very tastefully placed, informational brochures, a look book of before and after pictures in the waiting area for patients to leave through while they're waiting for their

Justin Trosclair 24:07
Have you had to you know you're a woman doctor and not white. Did you ever have to overcome any struggles or anything like that, while you were going through school, going through medical school as well with the patients as well as any of that ever come up where they're like, Oh, I don't know about you type of stuff.

Unknown 24:24
I think being a non white, young female all work against me compared to being older, wiser looking white male, I think that my skin color and background draw a very unique population, I see a lot of patients who are skin of color who have ethnic skin. And it really helps actually to bring in those types of patients because they know that I have the same skin color and the same skin tone and the same issues that they do. And those patients have told me before, like I have all those redness on my face, and I want to another doctor and they couldn't see it. But when I saw them, I could clearly see the redness. And that's just because some doctors just weren't used to looking at their skin tone and recognizing that that was red or that that was brown underneath are not natural skin tone. So if anything, I think that has helped me with certain patient populations. I think being a young female has been more difficult in terms of credibility. I think just being a young physician, people are always asking more questions about my training to make sure that I have experience, versus someone who looks a little bit more women and may have you know more years under their belt. But once I talk with them and do the console, they can tell that I know what I'm talking about. Once they look through the look book and see how many patients I've treated, they're usually pretty confident in my skills.

Justin Trosclair 25:53
People don't realize for like six years extra, you're a seasoned vet, by the time you're finally quote, ready to start on your own.

Unknown 26:00
Yeah, it's quite a lot of extra training. So after you know, four years of medical school, there's one year of internship three years of Dermatology, one to two years of fellowship in cosmetics and dermatology. Obviously, there's the boards that are administered by the American Board of Dermatology. So passing that test itself is no cakewalk. So by the time someone is out of practice, they've already got about six years of training under their belt, depending on what route they talk. And so they've seen a good number of patients and really do have a lot of expertise in their field before they're even allowed to sit the board for the boards and to pass the boards. That's really the ultimate stamp of approval and their skills

Justin Trosclair 26:45
that you were talking about the redness and the skin and working and living in Asia in China, you know, something I didn't really notice when I was first here and what people drink some of the guys that drink, their face will turn really red. And at first I never I didn't really notice that. And then once you know you're here for a while you like oh, yeah, this person can't tolerate alcohol very well. But she likes to drink and you can quickly see it in their face. Yeah, that's red, still yellowish, but it's red.

Unknown 27:10
Yeah. And that's by the, by the time it's that bright red, but it's screaming to, it's pretty obvious. So my goal is to treat things before they get so bright red.

Justin Trosclair 27:21
Alright, cool, very nice. Someone starting out, we can go two ways with this question. They're in college or trying to figure out what they want to do. Maybe they've been out of practice, maybe just like a general term or for a couple years. What should they look for? As far as they go year round? Should they try a different type of Dermatology? What are some of the pluses and minuses that they should think of?

Unknown 27:40
Well, I think someone who's considering dermatology, really should make sure that they absolutely love the skin and everything about the skin because even if they don't become a cosmetic dermatologist like myself, if they become a medical dermatologist, or most surgeon like a surgical dermatologist, they're going to be working with the skin all day, every day, and a lot of my colleagues in med school would do a skin check and say, Oh my god, that's so boring. All I'm doing is looking at the skin all day, I really want something more. And so if that's you, or if that's the medical student, then obviously the skin is not for you. But people who go into dermatology just so passionate about this, again, I could talk about the skin and the nuances and the you know different layers of the skin for hours. And if if that's really kind of what gets you excited, and dermatology is definitely the right route. And after you go into dermatology residency, you're exposed to so many different fields of Dermatology, whether it's most for the dramatic pathology, pediatric dermatology losers and cosmetics just complex midterm general term that that exposure will help that will that exposure will help you define which route you want to go into throughout the field of Dermatology,

Justin Trosclair 28:52
you got staff, did you have to hire everybody? Did you hire a manager to take care of that? And how do you train someone to be what you one,

Unknown 29:00
that's probably one of the hardest things to do. So I definitely have a HR person that helps with the hiring, I interview all the people that we hire that's that works directly under me or that works with me, for training the staff, I really look for people who are energized by what I'm doing, who are coming to work early, because they're so excited about what we're doing and staying late with procedures that they want, because they're just excited about seeing the transformation that these procedures have on people. But finding someone that has that enthusiasm is probably the first step. And once they have that enthusiasm, you can train anyone because if they have that enthusiasm, they're truly there to learn. But it is very difficult to kind of weed out the people who are genuinely passionate and excited versus the people that are not, but people usually declare their interest within the initial, you know, three months of working with you or even in the initial three weeks of working with you. And so if they're not doing a great job, then they're not the right person for our team. Would you say that people who see the job placement dermatology clinic looking for whatever right there would weed out some people are enough people apply where there's like knowledge needed money, and you see the job. So whatever breeding the job description helps to weed out a lot of people because we're so procedural. For a lot of dermatologists, they do a lot of skin surgery where you know, there's blood everywhere, or you know, the staff or the assistant is actively helping out with a excision or a surgical procedure. So I think that helps a weed out people if they know that they don't like doing hands on things like that are doing hands on procedural things like that, then that automatically weeds out a lot of the people and when I interview the people, you can tell right away if they have the personality, if they're excited, if they're cheery, if if there's someone that I would want to see walking in the front door of a cosmetic dermatology clinic of their kind of gloomy, you're just there to be there, then it's pretty evident from the beginning

Justin Trosclair 31:02
staff, they if they see blood, if they read the description on the ad, they probably wouldn't even apply.

Unknown 31:08
Yeah, there's also a lot of stuff that just are not interested in cosmetics or in lasers or in any type of aesthetic procedure and let itself without a lot of people I think the people who make the best staff members are people who have either had cosmetic procedures themselves, or who know people who have who have done it and really understand the quality of life impact a cosmetic procedures can have and how it can really help to transform a patient. Those are the people who really understand because they've been through it before and they really make the best staff people because they are the best ambassadors, brand ambassadors for the office because they're so enthusiastic and really do believe in the laser treatment or the filler treatment or the sclerotherapy treatment because they've had it themselves or they've seen family and close friends who have had it

Justin Trosclair 32:00
well well. Well, the abrupt ending I was referring to like always say listen, learn and implement. Thank you again, audience and Dr. Lee for your patience. Stay tuned for a quick add, you'll have a great week.

That wraps up another episode want to remind everybody that we have some great affiliate links available if you're into instrument assisted soft tissue manipulation, we've got the edge tool, and we got the hot grips, sage about 10%. Also with the edge, you've got the like blood pressure cuff restrictions system, you got the G sweet, inexpensive and more in case you'd like to in cash practice. If you want to know what hosting us for podcasting, blueberry, pure VPN, it's one of those ones I use to help keep my payments secure as well as access the internet more safely. You've got the primal paleo grass fed protein bone broth style, save 10% on that no sugar, allergy free, gluten free, dairy free all those types of things mentor box get taught by the office, we got set preset for those floss bands. And you may have heard about on one of the episodes really like those in the Amazon products that you might want. Click the link in the show notes pages. And of course, I got my own electric acupuncture pin to go with the needle acupuncture book and you know have a bundle set, bring them all together for a great price. also have the free downloads at a doctor's perspective, net slash blueprints. And what lately I've been doing is substituting a fifth one like I've done a neat and depend on the guest, I might do a different type. So check back there. So all those resources can be found a doctor's perspective, net slash resources. There's also t shirts at.net slash t shirts, put up some new designs from time to time, like Megan lemons out of lemonade, shrimp po boy plus all the Chiropractic and podcast swag that you could want. If you have any ideas for guests, please send an email Justin at a doctor's perspective. NET I'd love to hear who you think would be good or a profession that you may not have heard yet. If you can send me review that's dot net slash subscribe Apple, Google stitcher Android devices, you just click that that button it'll take exactly that a page you need to you can write a review, hopefully a five star review. I said it does help for other people to discover what we're doing here. And we've got over 100 episodes is gonna be like our third year super excited. We're going a little mini series like we've been doing, which has been fun. I hope you've enjoyed them as well that's that's the feedback I've gotten. And one thing I haven't really talking about too much is the doctor's perspective. NET slash support page. If you're about to host a cup of coffee, go for it. If you want to pledge a little higher fee there's buttons for that does even monthly recurring for those who feel like wow, this is like the cheapest mentor coach program I've ever seen because you interview so many different kinds of doctors and and have been able to implement things that I've heard and it works. So monthly recurring payments, which also you can get you my books for free t shirts for free. The first book, you know that deals with health and exercise, getting on a diet, getting your financial health and order as well. things I learned in China, you know that books is available as well. And one thing that I don't have I don't have like a full blown page about coaching and things but there's a little button there. I've had people request Hey, doctors and non doctors asking me can I do more than just answer a couple of questions or could you be my coach for a little while and I say yeah, we can do that. So something I haven't really advertised but it's something that I can do and do whether it's marketing strategies for new patients growth, those types of topics. If you're interested just email me Justin at a doctor's perspective. net. As always, listen, critically think and implement. Have a great week.

We just went hashtag behind the curtain. I hope you will listen and integrate with some of these guests have said by all means please share across the social media. write a review and you go to the show notes page. You can find all the references for today's guest even listening to Dr. Justin trust Claire giving you a doctor's perspective.

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