Latest / Beyond the Needle: The Aesthetics Business Podcast / The Ultimate Blueprint to Becoming a Successful Aesthetics Injector with Dr. Harriet Turnbull

Transcript

The Ultimate Blueprint to Becoming a Successful Aesthetics Injector with Dr. Harriet Turnbull · Beyond the Needle: The Aesthetics Business Podcast

• 0:12
  SPEAKER_01: Welcome to Beyond the Needle, the Aesthetics Business Podcast.
• 0:15
  SPEAKER_01: Each week I'm here to share real, actionable strategies and bring on expert guests to help you level up, attract more patients, and build a standout brand.
• 0:24
  SPEAKER_01: Let's turn your passion into a thriving business together.
• 0:32
  SPEAKER_01: Real quick before we get started.
• 0:34
  SPEAKER_01: Now I know this from experience both as a business owner and as a former clinic manager.
• 0:39
  SPEAKER_01: The operation side never gets easier as a clinic grows.
• 0:43
  SPEAKER_01: Staff schedules, payments, marketing, all of it pulling attention away from the treatment room.
• 0:48
  SPEAKER_01: That is, unless you have Gloss Genius, the intelligent system that does all of that work for you, so you can focus on the work you love and watch your revenue grow.
• 0:56
  SPEAKER_01: GlossGenius is sponsoring this episode and is giving you an exclusive code.
• 1:01
  SPEAKER_01: Enter code Needle at glossgenius.com for 50% of your first two months of their MedSpa and aesthetic plans.
• 1:09
  SPEAKER_01: Available to US businesses only.
• 1:11
  SPEAKER_01: Okay, let's get into the episode.
• 1:18
  SPEAKER_01: Hi everyone and welcome back to Beyond the Needle.
• 1:20
  SPEAKER_01: Today I am so excited to be joined by Dr.
• 1:22
  SPEAKER_01: Harriet Turnbull, Global Chief Medical Officer and Head of Training at Derma Medical, and someone who has spent over a decade working across both general practice and aesthetic medicine.
• 1:32
  SPEAKER_01: Today we are talking about something I get asked about a lot, and that is how to actually get started in aesthetics.
• 1:38
  SPEAKER_01: Because the path of wanting to do it well is not always clear, and the training landscape can be very overwhelming.
• 1:44
  SPEAKER_01: There is a huge amount of choice out there, quality varies enormously, and it's not always obvious what good actually looks like until you've already paid for something.
• 1:52
  SPEAKER_01: Harriet trains practitioners across the country.
• 1:55
  SPEAKER_01: She has seen every level of experience walk through the door, and she's in a brilliant position to talk honestly about what the route into this industry should look like, what to look for in a training academy, what most people underestimate, and what separates someone who builds a genuinely strong career from someone who struggles to get traction after their first course.
• 2:14
  SPEAKER_01: We dive into all of that today, from choosing the right training and understanding what competence actually looks like through to patient safety, complications, and what the next six months after qualifying should really look like.
• 2:25
  SPEAKER_01: So whether you're thinking about getting into aesthetics, you are newly qualified in figuring out your next steps, or you're a little bit further along and want to make sure your foundations are solid, there is so much packed into this episode, and there will be something in here for everybody.
• 2:37
  SPEAKER_01: And as always, before we dive in, please do remember to subscribe to this podcast if you enjoy these episodes, and don't forget to leave me a little review as well.
• 2:44
  SPEAKER_01: I really do appreciate every single one of them.
• 2:46
  SPEAKER_01: Okay, let's get into it.
• 2:53
  SPEAKER_01: Thank you so much, Harriet, for coming on.
• 2:55
  SPEAKER_01: It's so good to have you here today.
• 2:57
  SPEAKER_01: Start by telling everyone a little bit about yourself and what you do.
• 3:00
  SPEAKER_02: No problem.
• 3:01
  SPEAKER_02: Thanks for having me.
• 3:02
  SPEAKER_02: So my name is Dr.
• 3:02
  SPEAKER_02: Harriet Turnbull.
• 3:03
  SPEAKER_02: I'm an NHS GP by background, but for the last two and a half years I've been actually doing full-time medical aesthetics.
• 3:09
  SPEAKER_02: I started my career into aesthetics ten years ago now, and have blended that in with a lot of training and teaching along the way and have my own private clinic in central London.
• 3:19
  SPEAKER_01: And how did you get into the training side of things?
• 3:22
  SPEAKER_01: Because you dedicate a lot of your time to training, don't you?
• 3:25
  SPEAKER_02: Yeah, I do now actually.
• 3:26
  SPEAKER_02: It's a funny story.
• 3:27
  SPEAKER_02: I, after my kind of initial training, which was actually with Derma Medical, who are the training academy that I work for now, I was just so blown away by the training from day one that I went there that it was kind of secretly a bit of an aspiration of mine to become a trainer myself.
• 3:43
  SPEAKER_02: And through the further training qualifications that I did, they ended up approaching me to ask.
• 3:48
  SPEAKER_02: I'd done a lot of teaching in my background, and so it all just happened very naturally over the course of a couple of years.
• 3:52
  SPEAKER_02: And so I've been there for probably over eight years now teaching as well.
• 3:57
  SPEAKER_01: Amazing.
• 3:58
  SPEAKER_01: And what are your kind of favourite parts about training other practitioners?
• 4:02
  SPEAKER_01: What do you think?
• 4:02
  SPEAKER_01: What makes it so rewarding for you?
• 4:04
  SPEAKER_02: For me, it's all about taking people from at the beginning of the day when they're so nervous, there's often shaky hands in the room, and they're thinking, How am I going to get over this initial step?
• 4:15
  SPEAKER_02: And seeing by the end of our kind of training packages the level of confidence, they're wanting to do the next injection, wanting to do the next treatment, seeing what's up next.
• 4:23
  SPEAKER_02: Oh, we're doing this next, fantastic, and just that transition of confidence from someone that often comes in not with very much at all to leaving, feeling a really confident injector and ready to just launch into that journey.
• 4:34
  SPEAKER_02: For me, that just has never gotten old.
• 4:36
  SPEAKER_01: Yeah, I can imagine.
• 4:38
  SPEAKER_01: I've wanted to do this episode for a really long time because I hear training come up so much in conversations with other practitioners, like a lot of people will say to me, like they're you know, an established practitioner now, and they'll say that you know, at the beginning of their journey they had a nightmare, they wasted a lot of money on training.
• 4:52
  SPEAKER_01: You know, someone said to me the other day that they I think they did four different core like introductory courses in dermal filler and Botox before they actually were confident enough to inject on their own.
• 5:03
  SPEAKER_01: And then I also think there's a side of it where people will do the training and then they'll leave feeling confident and then maybe they won't inject as much as they should after that, so their confidence kind of declines and then they feel like they're back at square one.
• 5:18
  SPEAKER_01: So I think this is a really important conversation.
• 5:20
  SPEAKER_01: There's lots of different things I want to ask you today, but if we start right back at the beginning, if somebody's listening to this and thinking about getting into aesthetics, what do you think is the best and safest route for them to kind of go down initially?
• 5:34
  SPEAKER_02: Yeah, I think it all starts from having really realistic expectations about what that journey is going to look like.
• 5:40
  SPEAKER_02: You're not going to become the injector you want to become overnight.
• 5:44
  SPEAKER_02: It's going to be a real stepped progression.
• 5:47
  SPEAKER_02: And the key is to understand that up front it is going to be an investment.
• 5:50
  SPEAKER_02: It's actually going to be your biggest investment.
• 5:52
  SPEAKER_02: The beautiful thing about aesthetics is that there is the financial reward there.
• 5:56
  SPEAKER_02: You can recoup on that investment really quickly if you get to it after your training, as you mentioned.
• 6:02
  SPEAKER_02: But you're going to need to find a really good starting point to make sure that it's not a wasted investment.
• 6:07
  SPEAKER_02: If you put all of this money into lots and lots of courses, but at the end of each one, you're feeling like you still don't have that confidence to inject solo.
• 6:15
  SPEAKER_02: You're just going to be going round in circles rather than genuinely progressing.
• 6:18
  SPEAKER_02: And the key is to find a training provider that can provide you with enough kind of hands-on experience, really, and I know we're going to talk about that later, but also enough aftercare and support following that.
• 6:29
  SPEAKER_02: Otherwise, as you mentioned, you're just never going to even get started.
• 6:32
  SPEAKER_02: Yeah.
• 6:32
  SPEAKER_01: So, what do you think, in your opinion, a good aesthetics training program or pathway should look like?
• 6:39
  SPEAKER_01: What should it include?
• 6:41
  SPEAKER_02: Yeah, absolutely.
• 6:41
  SPEAKER_02: So it needs to be a course that covers all of your fundamental treatments.
• 6:44
  SPEAKER_02: So things like your upper face Botox and introductory treatments to lip filler, the lower face, chins, cheeks.
• 6:52
  SPEAKER_02: But it needs to have enough hands-on experience, enough practice.
• 6:55
  SPEAKER_02: You need to have enough patience under your belt to have really got a sense and feedback of what good looks like and what are the signs that perhaps something hasn't gone as well as it should, has there been a complication?
• 7:06
  SPEAKER_02: And also it needs to address what are those next steps after training.
• 7:09
  SPEAKER_02: You need to have a really robust hands-on side and the educational side.
• 7:13
  SPEAKER_02: But if you don't understand what I am going to do after training, this is not the NHS, which can be a real transition for people.
• 7:18
  SPEAKER_02: There's not going to be a pathway laid out for you.
• 7:20
  SPEAKER_02: You need to understand what do I need to do from where I am today?
• 7:23
  SPEAKER_02: I've got all these amazing new skills.
• 7:25
  SPEAKER_02: How am I going to become that injector?
• 7:28
  SPEAKER_02: What are the steps that happen in between to get me there?
• 7:30
  SPEAKER_02: And it's not just the injecting.
• 7:31
  SPEAKER_02: Yeah.
• 7:32
  SPEAKER_01: Tell me about some of those other steps that people should be considering.
• 7:35
  SPEAKER_02: Yeah, I think it's about knowing where you're at in your life, what it is that you're looking for.
• 7:39
  SPEAKER_02: I would say most people, when they get started, they're looking for kind of a side hustle, something to kind of add alongside their existing work.
• 7:46
  SPEAKER_02: For most, that involves being their own boss and starting their own business, which is really exciting.
• 7:50
  SPEAKER_02: But what actually, what does it mean for that?
• 7:53
  SPEAKER_02: How do you set up a limited company?
• 7:55
  SPEAKER_02: Where am I going to practice?
• 7:56
  SPEAKER_02: What insurance coverage do I need to have?
• 7:58
  SPEAKER_02: And fundamentally, the hardest bit, how am I going to find patients to fill my clinic?
• 8:03
  SPEAKER_02: And that's the hardest question for a lot of people to answer.
• 8:05
  SPEAKER_02: Others will want to go down a route which I did as well, of getting a job in a bigger corporate clinic, which there's loads of pros and cons to as well.
• 8:13
  SPEAKER_02: But again, you're probably going to need some coaching to know how that happens.
• 8:16
  SPEAKER_01: How am I going to get that dream job?
• 8:18
  SPEAKER_01: Yeah.
• 8:19
  SPEAKER_01: So if somebody is listening to this and they haven't, you know, maybe they're exploring aesthetic courses.
• 8:24
  SPEAKER_01: I mean, there's so many providers out there now.
• 8:26
  SPEAKER_01: Like, I feel like in the last five years alone, it's like probably doubled or tripled, and a lot of independent clinics are setting up their own kind of training academies as well.
• 8:35
  SPEAKER_01: So it can be a bit of a mindful to know what the best kind of way to go is.
• 8:40
  SPEAKER_01: What are some red flags people should look out for with aesthetic training providers?
• 8:45
  SPEAKER_02: I think for me, the things that I notice is, and you're absolutely right, there has just been this explosion of training academies.
• 8:50
  SPEAKER_02: We kind of joke in the industry that everyone's a trainer now, everyone's a KOL, you know, all this sort of stuff.
• 8:56
  SPEAKER_02: I would really look out for those that can't provide their own models when they're saying sort of, oh, come to our training to do Litfilism, you know, bring your sister to model and things.
• 9:05
  SPEAKER_02: To me, that's a red flag.
• 9:06
  SPEAKER_02: That's not professional, that's not boundaries, they should be providing model patients.
• 9:11
  SPEAKER_02: That's a fundamental thing.
• 9:12
  SPEAKER_02: So you should be selected, exactly, from that aspect.
• 9:15
  SPEAKER_02: And also that they've just not got any credentials, there's no accreditation to their training.
• 9:19
  SPEAKER_02: And if they have, you know, they've not shown that historic evidence that people have come through that training.
• 9:24
  SPEAKER_02: We've trained thousands of people at at Derma Medical, and not just in the UK, but across the world, and we have a huge body of evidence to show that we can produce confident and competent injectors.
• 9:35
  SPEAKER_02: And if they don't have that evidence and they're just saying, Well, look at me, I did this, so I'm going to teach you now.
• 9:39
  SPEAKER_02: That's really not sufficient in terms of what you require as the one that needs the training.
• 9:44
  SPEAKER_02: It's a very different skill, a very different setup to running your own clinic.
• 9:47
  SPEAKER_01: Yeah, absolutely.
• 9:48
  SPEAKER_01: What what are some key like pieces of evidence that people can look for to understand actually what that training day is going to provide them with?
• 9:55
  SPEAKER_02: Especially if you're kind of newer to it, I would actually say word of mouth is always going to be the strongest referral, just actually quite similarly to clinic, also.
• 10:03
  SPEAKER_02: That's where a lot of our uh trainees will find us.
• 10:06
  SPEAKER_02: They will have said, you know, my they're a dentist, their colleague came to us and they said it was fantastic.
• 10:10
  SPEAKER_02: That's that's one of the strongest things for us.
• 10:12
  SPEAKER_02: And that can be anything from reviews as well.
• 10:14
  SPEAKER_02: But I would say if you do know someone that's gone through training and recommends it, that's gonna be a really strong indication that this could be the right academy for you.
• 10:22
  SPEAKER_02: But you've got to look into it yourself as well and think about what's their style, what do you want to be your focus, and is this gonna meet what you're looking for?
• 10:30
  SPEAKER_01: And when somebody has completed that training, what would you say then the first six months of their kind of career in aesthetics should look like in order to kind of build on what they've learned and you know keep growing their skills and their confidence, and also on the business side of things, because like you say, there's so much more to it than just the injecting that people don't actually learn about in the NHS or anything like that.
• 10:52
  SPEAKER_02: Yeah, I think the first step, and I I'm a bit more tight in terms of the the schedules that I'll suggest to people.
• 10:58
  SPEAKER_02: I believe that you have six weeks after training to inject independently, and if you don't, I think it's highly unlikely that you actually will because as soon as you finish training, your confidence, as you said, is right up here and it's just gonna start to just decline and decline and decline.
• 11:12
  SPEAKER_02: Hit six weeks, you're gonna feel rusty, nervous.
• 11:15
  SPEAKER_02: It's always gonna be nerve-wracking injecting for the first time.
• 11:19
  SPEAKER_02: So the first step is to inject solo, and that may often look like family, friends starting with your first treatment of Botox and getting through that once you've kind of done that initial step, you can do anything.
• 11:30
  SPEAKER_02: Once you've got over that, the rest is gonna just follow naturally as long as you just keep that pace and momentum.
• 11:36
  SPEAKER_02: The next stages really are gonna be making sure before that, ideally, that you've got your insurance in place, you've got a reptile pharmacy that you're gonna use, perhaps you've looked into some software, and then you need a suitable clinical venue basically to be able to deliver your treatments.
• 11:50
  SPEAKER_02: You've got quite a checklist of things to do as soon as you finish.
• 11:53
  SPEAKER_02: And it can feel quite overwhelming, which is why we offer a lot of support and mentorship for anyone that we train to keep that pace, to keep reminding them.
• 12:01
  SPEAKER_02: But actually, with to be honest, with AI now as well, you could really use that to help you make okay, this is where I want to be in six months or a year.
• 12:08
  SPEAKER_02: Input that what should what should my task list be?
• 12:10
  SPEAKER_02: Because I remember when I finished training, I did not have a clue, which is how I end up working for someone.
• 12:14
  SPEAKER_01: And like you say, there's so much, it's very overwhelming to even know where to start.
• 12:18
  SPEAKER_02: Yeah, and actually, medics I I'd say naturally we feel more comfortable with the injecting, with anatomy and things like this, but actually thinking about you know, what should my website look like?
• 12:27
  SPEAKER_02: What is SEO, all these types of things can be really, really daunting actually for us.
• 12:31
  SPEAKER_01: Yeah.
• 12:31
  SPEAKER_01: So the first key important thing would you say is to get some people in and start injecting them, whether that's friends or family.
• 12:39
  SPEAKER_00: Yeah.
• 12:39
  SPEAKER_01: What if somebody really feels nervous doing that on their own?
• 12:45
  SPEAKER_01: Would you say that they're that means that's a sign that they need to go and continue their training or not if they're not ready?
• 12:49
  SPEAKER_02: Okay.
• 12:50
  SPEAKER_02: I think being really nervous and things like that is natural.
• 12:52
  SPEAKER_02: I say to my you know, people that we train, you're not a psychopath, you care about people, you want great outcomes, you're just putting a lot of pressure on yourself to want to do well.
• 13:00
  SPEAKER_02: You kind of have to act in spite of feeling nervous.
• 13:03
  SPEAKER_02: There is a bit of a balance there.
• 13:04
  SPEAKER_02: I remember my first day as a junior doctor.
• 13:06
  SPEAKER_02: Was I ready?
• 13:07
  SPEAKER_02: Yeah.
• 13:07
  SPEAKER_02: Was I nervous?
• 13:08
  SPEAKER_02: Yeah.
• 13:08
  SPEAKER_01: And that's actually a good thing, isn't it?
• 13:10
  SPEAKER_01: Like you say, it means you care and you want to do a good job.
• 13:12
  SPEAKER_01: Absolutely, absolutely.
• 13:13
  SPEAKER_02: If you're finding it so overwhelming that you can't function, then sure, you know, that would be a very unusual for someone who's certainly completed our training.
• 13:19
  SPEAKER_02: Maybe that is a call to have more support, more training.
• 13:22
  SPEAKER_02: But we have enough in place, I think, that we can confidently say that you're going to be ready or as ready as you'll ever be after our training packages.
• 13:28
  SPEAKER_01: And what about, I mean, you did mention insurance a second ago, but those kinds of things like insurance, indemnity.
• 13:34
  SPEAKER_01: And also from a prescribing point of view as well.
• 13:36
  SPEAKER_01: If, for example, if you're a nurse but you're not necessarily a nurse prescriber, what are those kinds of things that people that should consider?
• 13:42
  SPEAKER_02: Yeah, so there's certainly some more challenges if you're not a prescriber, and what we're particularly talking about in the UK is treatments with botuline toxin, which is a prescription-only medication.
• 13:51
  SPEAKER_02: If you're not a prescriber, you need to think about what is the structure of your business going to look like.
• 13:56
  SPEAKER_02: Are you going to be ideally teaming up with someone who is a prescriber, whether they're a nurse, pharmacist, doctor, dentist?
• 14:02
  SPEAKER_02: That works really, really well.
• 14:04
  SPEAKER_02: So that's always good to kind of start with the end in mind.
• 14:06
  SPEAKER_02: What am I actually going to be doing at the end of this?
• 14:08
  SPEAKER_02: The other option is to think about working with a prescriber, which again is really, really common practice.
• 14:13
  SPEAKER_02: So you'd find someone in your local area to be able to facilitate your prescribing who is suitably qualified to do so.
• 14:21
  SPEAKER_02: And things have changed in the last decade.
• 14:23
  SPEAKER_02: Ten years ago, it was okay to do things like online calls, see people remotely, do the prescribing, which is not really acceptable practice anymore.
• 14:32
  SPEAKER_02: So they do need to be face to face.
• 14:33
  SPEAKER_02: So there's some other challenges there with the botulinum toxin.
• 14:36
  SPEAKER_02: But I say I've had friends and colleagues who are not prescribers who've had very successful businesses.
• 14:40
  SPEAKER_02: You could think about splitting out your business.
• 14:42
  SPEAKER_02: Actually, I'm going to focus on these areas, whether it's the dermal fillers, the skin boosters, and explore that side of things and get someone else in, really think with your business hat on.
• 14:51
  SPEAKER_02: I'm going to get this, the dentist that you know that's a a block away, get them to come and be my Botox person within my business.
• 14:57
  SPEAKER_02: There's so many things that you can do and lots of different ways to think about it.
• 15:01
  SPEAKER_01: Just in case there is anyone listening who is a nurse and they're not yet a prescriber, but they still want to get into aesthetics, just talk me through a few of those different routes that they could consider if that's kind of blocking.
• 15:10
  SPEAKER_01: Yeah, absolutely.
• 15:11
  SPEAKER_02: So the main routes, one, you could think about becoming a prescriber, and this is becoming more and more uh commonplace, ideally through your place of work, and then you can expand out your scope into aesthetics.
• 15:21
  SPEAKER_02: It's incredibly straightforward the prescribing of Botox.
• 15:23
  SPEAKER_02: It's not a challenge for someone of that level of qualification.
• 15:26
  SPEAKER_02: The second thing I would say the best route would be to network locally, um, to either find someone who can act as your prescriber or you would like to work with in a business sense.
• 15:35
  SPEAKER_02: So you want to team up to have a combined clinic.
• 15:38
  SPEAKER_02: Some people just love doing Botox, and that's all they want to do, and they would love to find someone that wanted to focus on skin and on fillers so that they could do that in conjunction.
• 15:47
  SPEAKER_02: There are options for search tools for prescribers.
• 15:51
  SPEAKER_02: So some of the big pharmacies now actually do often offer search my prescriber and things like that.
• 15:56
  SPEAKER_02: So you can actually help you find prescribers in your local area too.
• 15:59
  SPEAKER_02: But I think networking, to be honest, is going to be the best way for you to find someone locally who's a good fit for you.
• 16:04
  SPEAKER_02: But I say there are online search engines you can use to find a prescriber now as well.
• 16:08
  SPEAKER_01: So lots of different routes.
• 16:10
  SPEAKER_01: And then from a cost point of view, obviously, you say, and and when I first entered a subject 10 years ago, this was the the done thing is you'd have a prescriber and they'd they could see them virtually, but that's not really acceptable anymore.
• 16:22
  SPEAKER_01: What would you say is the best way to kind of work it from a cost point of view?
• 16:28
  SPEAKER_01: Yeah.
• 16:28
  SPEAKER_01: Would you say have your all of your Botox appointments in one day?
• 16:31
  SPEAKER_01: Yeah, absolutely.
• 16:32
  SPEAKER_01: And then you have the prescriber in that day too, so that you've not got a prescriber in five days of the week.
• 16:36
  SPEAKER_02: Yeah, exactly.
• 16:37
  SPEAKER_02: So people would have like a uh consultation session basically with their prescriber to be able to do the prescriptions for the Botox to come in for their appointment and then block them together, basically.
• 16:46
  SPEAKER_02: So you'd have fixed prescribing and botox delivery days.
• 16:49
  SPEAKER_02: But that's why thinking about it, it that does work well.
• 16:51
  SPEAKER_02: But longer term, I think it, you know, either working with someone else in-house, in your team, having a prescriber in your team is going to be a long-term goal.
• 16:59
  SPEAKER_02: In the first instance, using someone else, I think works really well.
• 17:02
  SPEAKER_02: But I think if you're serious about this longer term, it's worth considering other long-term options.
• 17:06
  SPEAKER_02: Absolutely.
• 17:07
  SPEAKER_02: Like while you get yourself off the ground, it might work for the short term.
• 17:10
  SPEAKER_02: Yeah, they will typically charge a flat rate per prescription, say£30 or something like this.
• 17:15
  SPEAKER_02: You have to, you know, factor that cost in and making sure you're not undercharging yourself, which is one of the biggest problems I see anyway with people that are starting out always undercharging themselves.
• 17:24
  SPEAKER_02: So yeah, it needs to be worked into your business model basically.
• 17:27
  SPEAKER_01: Let's talk about undercharging actually, because I was going to ask you what are some of the biggest mistakes people make, and I would agree, yes, undercharging is a big one.
• 17:34
  SPEAKER_01: How can people avoid that?
• 17:35
  SPEAKER_01: Why and why do they tend to do that?
• 17:37
  SPEAKER_02: I think people relate it to experience too much, so they have a natural instinct to think, well, I'm newer to this, I shouldn't be charging as much as you know, someone that's been doing it for five years down the road.
• 17:49
  SPEAKER_02: And actually that's incorrect.
• 17:50
  SPEAKER_02: If you've invested in your training and you've really focused on making sure that your patient journey, that your environment is good, all those sort of things, it needs to match your skill set rather than just experience.
• 18:01
  SPEAKER_02: Sure, you could increase your prices over time as well, but the problem is that if you go in thinking, right, I'm gonna be the cheapest person in my area, and that's how I'm going to attract new patients, which is really, really common pitfall, all you're gonna find are the patients that are deal hopping, that are always looking for the cheapest Botox locally, and you're not gonna be finding your, you know, your best customers, the people that are truly, truly loyal to you, and would would not matter to them if you increase your prices 20% tomorrow, 30% tomorrow, they're still gonna want to come and see you.
• 18:31
  SPEAKER_02: So you're really kind of shooting yourself in the foot if you're going in at those bottom-end prices, and particularly as a medical professional, what you're also selling is your trust, that expertise that you have from all of your years of experience, because all you've done is transition those existing skills into a slightly new area, and that has enormous value, in my opinion.
• 18:50
  SPEAKER_01: I agree.
• 18:51
  SPEAKER_01: I think it's much better to grow gradually with the right types of people.
• 18:56
  SPEAKER_01: So you might not get as many people who are willing to spend X amount on Botox, at least you're not getting, like you say, the deal hoppers who are probably never going to come back, and then you're going to find yourself constantly searching for new people.
• 19:07
  SPEAKER_01: Whereas if you find the right kinds of people over a longer period of time, then you grow a really loyal kind of database of patients.
• 19:14
  SPEAKER_02: Absolutely.
• 19:15
  SPEAKER_02: And the other thing is you might find that you, if you're charging very little, great, your revenue is going up and up and up, but there's there's no margin, there's no profit.
• 19:23
  SPEAKER_02: And actually, you think, what is this for?
• 19:24
  SPEAKER_02: Well, ultimately, it's a business and you need to you need to look at your costs uh versus how much money is coming in the door.
• 19:30
  SPEAKER_01: Yeah, absolutely.
• 19:31
  SPEAKER_01: What would you say are some of like key tips that you can give practitioners for pricing their services?
• 19:37
  SPEAKER_01: Would you say like looking at other people in the area what they're charging?
• 19:40
  SPEAKER_02: Yeah, we know there's there's variation across the country.
• 19:42
  SPEAKER_02: So if if you're with I'm based down in London, it's going to be more expensive probably than than prices are in Manchester, for example, even city to city.
• 19:50
  SPEAKER_02: So I would always advise looking at what is average within my sector, sort of people that you would, you know, wish to be like a business like you, how much do they charge?
• 20:00
  SPEAKER_02: And charging either similar or more, but never ever less than they are, essentially.
• 20:05
  SPEAKER_02: And that really it does vary, so you need to have an understanding of what that what that looks like.
• 20:08
  SPEAKER_02: What are your thoughts on discounts in aesthetic?
• 20:11
  SPEAKER_02: I really struggle with discounts.
• 20:14
  SPEAKER_02: There's some question, really, especially if it's around Botox, around what is is this best practice?
• 20:20
  SPEAKER_02: Are we really incentivising people to have what we I would consider you know medical procedures?
• 20:24
  SPEAKER_02: That's a little bit of a grey area.
• 20:26
  SPEAKER_02: I avoid it as much as possible.
• 20:29
  SPEAKER_02: You know, I've played with many different things over the year, and I will offer very small discounts, now actually only on my patients' birthdays, and it's a very small thing, but people, it's one of those things I find people really like.
• 20:40
  SPEAKER_02: They they always get an email from the case.
• 20:41
  SPEAKER_02: Yeah, just a little bit of a voucher type of thing, rather than that.
• 20:43
  SPEAKER_02: Exactly.
• 20:44
  SPEAKER_02: A small amount towards their treatment.
• 20:45
  SPEAKER_02: I used to even do uh referral, you'd refer someone and get this off your next treatment.
• 20:49
  SPEAKER_02: I actually just found over time that wasn't really necessary.
• 20:52
  SPEAKER_02: If people are happy with your work, they're gonna refer you either way.
• 20:55
  SPEAKER_02: And actually, I didn't really find that incentivising them didn't mean seemed to make that much difference.
• 20:59
  SPEAKER_02: So I would limit that where where possible again, because I just think it's a little bit of a kind of ethically grey area.
• 21:05
  SPEAKER_02: But actually, if your business model works really well, otherwise you shouldn't really need it.
• 21:09
  SPEAKER_02: And I wouldn't want my patients to get stuck in a kind of discount cycle of just waiting for the next discount, waiting for the next sale, waiting for Black Friday, whatever it is.
• 21:17
  SPEAKER_02: So I try to avoid it.
• 21:19
  SPEAKER_02: I've really limited down what I what I offer discount-wise.
• 21:22
  SPEAKER_01: Yeah, it's so true.
• 21:23
  SPEAKER_01: And I and actually I don't know of many medical clinics or practitioners who discount their services, but like you say, if you offer discounts a lot, people will just come to expect it and then wait for the next one.
• 21:34
  SPEAKER_01: And I yeah, I do have some quite strong opinions about Black Friday and aesthetics.
• 21:39
  SPEAKER_01: I just don't think the two go together at all.
• 21:41
  SPEAKER_02: No, it's really strange.
• 21:42
  SPEAKER_02: It's really strange.
• 21:42
  SPEAKER_02: People are very familiar now, I think, with the kind of discounting sale culture that we have kind of seasonally, but it has no place in in medicine because.
• 22:00
  SPEAKER_01: Do we really want to be doing like flash sales on filler?
• 22:02
  SPEAKER_02: That is peak aesthetic season.
• 22:05
  SPEAKER_02: You don't want any more patients at a certain point that time of year.
• 22:08
  SPEAKER_02: It's too much.
• 22:08
  SPEAKER_02: My hand is like, I can't even use it from so much injecting bike by the time it's end of November.
• 22:13
  SPEAKER_02: So yeah, that's not going to be something I'm going to be doing anytime soon.
• 22:16
  SPEAKER_01: I totally agree.
• 22:17
  SPEAKER_01: What are some things that you think people underestimate when going into aesthetics that they don't necessarily like consider or that shocks them or easy mistakes that they make?
• 22:26
  SPEAKER_02: I think that really not understanding that this is going to be a journey that's going to take years to really become the injector you want.
• 22:33
  SPEAKER_02: We're talking about we're not talking weeks to months.
• 22:36
  SPEAKER_02: This is going to be years.
• 22:37
  SPEAKER_02: It's going to be a couple of years probably where you're beginning to really see the rewards.
• 22:41
  SPEAKER_02: So there's a huge amount of patience and persistence required.
• 22:45
  SPEAKER_02: I say it's not like when you, you know, you get a training scheme and you know that by the end of this training scheme, I'm going to be a consultant or I'm going to be this nurse prescriber.
• 22:55
  SPEAKER_02: Everything is just self-perpetuating and self-fulfilling.
• 22:59
  SPEAKER_02: So if you want to get to the next stage, you want to, you know, grow your business.
• 23:02
  SPEAKER_02: And this is a journey, by the way, that never ends.
• 23:05
  SPEAKER_02: It doesn't matter how successful you're going to be, there is no end point.
• 23:09
  SPEAKER_02: At one point you'll be thinking, I want to grow it, and then you're thinking, I actually want to do less and I want to step away and have other people come in.
• 23:15
  SPEAKER_02: There's always going to be the next biggest challenge.
• 23:18
  SPEAKER_02: So unless you can really kind of build and strengthen the habit of just constant improvement, then you're not going to get anywhere.
• 23:27
  SPEAKER_02: So I think, you know, understanding this is going to be a never-ending journey is really important.
• 23:31
  SPEAKER_02: And if you're not someone that enjoys that ride, this is not going to be for you.
• 23:35
  SPEAKER_01: Yeah, I think a lot of people do kind of go into it and they might have heard success stories from other colleagues within the NHS who have left and they've gone and got this great career in aesthetics.
• 23:43
  SPEAKER_01: They don't necessarily consider that it's not going to look the same for everybody.
• 23:47
  SPEAKER_01: And it does take, you know, I mean I do know of some people who've grown very, very quickly and, you know, have a very, very successful business within a year or two, but then of other people it's taken five, six, seven years for them to get to a place where they're, you know, comfortable and they're making money and they're, you know, can afford to invest in a device or grow, you know, grow their team.
• 24:09
  SPEAKER_01: Like it's not been, it's not the same path for everybody.
• 24:12
  SPEAKER_02: It depends how much are you alone?
• 24:14
  SPEAKER_02: Have you?
• 24:14
  SPEAKER_02: I mean, I've seen great success for people, especially nurses actually, who've actually gone into this together.
• 24:21
  SPEAKER_02: Huge strength in having someone else to be accountable to say, come on, what are we doing next?
• 24:25
  SPEAKER_02: What are we doing next?
• 24:26
  SPEAKER_02: And then I've seen over the years this this constant cycle where people, you know, they start, they work together, they start in this little room, and then they've got their own space, and then suddenly they're thinking, Well, I'm making my NHS salary in two days now, what am I doing?
• 24:40
  SPEAKER_02: And then they take the jump, and I I love seeing that kind of progression because it's so so possible.
• 24:44
  SPEAKER_02: But I think your own personal accountability is probably going to be the biggest thing to hold you back, which is why I think in especially as the NHS, if that's your background, you're so used to working as a team.
• 24:54
  SPEAKER_02: Yeah.
• 24:54
  SPEAKER_02: I think for me as a GP, I've always been a little bit more comfortable being on my own.
• 24:59
  SPEAKER_02: And I think that has been a real strength for me going into the industry.
• 25:02
  SPEAKER_02: I'm used to the consultation style and the yeah, just having that kind of one-to-one relationship with the patient rather than being like, oh, I'm a member on a team, there's a consultant and the nurse and the resident doctors and all of this sort of thing.
• 25:15
  SPEAKER_02: So I think, yeah, having that accountability of a second person, and they could even be non-clinical, someone that's going to handle the business side, the marketing side.
• 25:23
  SPEAKER_02: Yeah.
• 25:23
  SPEAKER_01: It's a very, very strong way to get started.
• 25:25
  SPEAKER_01: Yeah, I like that idea.
• 25:26
  SPEAKER_01: So you've seen that before where people have teamed up with another, like a two nurses, for example, and have opened a clinic together.
• 25:32
  SPEAKER_01: Yeah.
• 25:33
  SPEAKER_02: And you'll find naturally you've got different strengths.
• 25:35
  SPEAKER_02: One of you is great with the injecting, and they take the lead on, they're the lead injector.
• 25:39
  SPEAKER_02: They take the more complex cases, they do this sort of stuff.
• 25:42
  SPEAKER_02: And then someone else is like, actually, I feel a little bit not so kind of confident and want to step up and do these things.
• 25:47
  SPEAKER_02: But actually, I'm really comfortable doing some of the skin treatments and the Botox, but they love the numbers, they love crunching the numbers, they love thinking about, you know, how can we improve the space?
• 25:55
  SPEAKER_02: I want this kind of couch, I want to do this, I want to try this.
• 25:58
  SPEAKER_02: So you just got to work to what your strengths are, and hopefully, you know, they're going to complement each other.
• 26:02
  SPEAKER_01: Yeah, well, that's it, isn't it?
• 26:03
  SPEAKER_01: Because there's so many hats that you have to wear in business, and we're not going to be good at everything, so it's finding, like you say, what our strengths are and then outsourcing the rest or teaming up with somebody who's, you know, good at the rest of it.
• 26:14
  SPEAKER_01: On that note, and you mentioned earlier about you know, training and then going off and and treating independently by yourself or going and working for a clinic.
• 26:24
  SPEAKER_01: How do you think people can figure out what the best route is for them?
• 26:27
  SPEAKER_02: I think it's almost a bit of a lifestyle choice initially.
• 26:30
  SPEAKER_02: For myself, I was a GP trainee when I got into aesthetics initially, working full-time in the NHS.
• 26:38
  SPEAKER_02: There wasn't an option back then to be able to reduce your the amount of hours you were doing for any other reason than childcare, basically, was complete no.
• 26:46
  SPEAKER_02: So had to work around that.
• 26:47
  SPEAKER_02: And I was in the middle of like exams, all of that stuff, and I was thinking, I have just about enough time to actually deliver some treatments.
• 26:56
  SPEAKER_02: When am I going to do the marketing, social media, all of this stuff?
• 27:00
  SPEAKER_02: I just realised that I didn't fundamentally have time.
• 27:02
  SPEAKER_02: I did start seeing a few patients always independently, but for me, I was just like, I my focus then, I really wasn't actually thinking about the financial side.
• 27:10
  SPEAKER_02: I was thinking about I want to do my first thousand procedures.
• 27:14
  SPEAKER_02: That's what I kind of had in my mind.
• 27:16
  SPEAKER_02: So for me, getting a job and I got a job at a big clinic on Harley Street a few months after my training, and again, I was newer, but I had really gone for it, got started, really understood the consultation side very quickly, and they knew as a clinic that is the secret source as being a good at consulting is the thing.
• 27:35
  SPEAKER_02: So I for me, I was like, actually, I can do my full week in the NHS, go to Harley Street on a Saturday, and I was treating 10 till 4 pm every Saturday, fully booked out, talking sometimes like 20, 25 patients a day.
• 27:48
  SPEAKER_02: I really got my reps in very, very quickly doing that, and that suited me well.
• 27:52
  SPEAKER_02: And actually, the financial benefit, I'd doubled my salary within three months of doing my training.
• 27:58
  SPEAKER_02: So it was hugely impactful.
• 27:59
  SPEAKER_02: Of course, if all of those patients were my own, it would have been a different story altogether, but that's not realistic.
• 28:04
  SPEAKER_02: I never would have got to that point so quickly.
• 28:06
  SPEAKER_02: So for me, it was a no-brainer, and some people realistically do just want that increased level of mentorship to have that support and someone in the other room when like when they're starting to inject.
• 28:15
  SPEAKER_02: So there's a lot of things that that do play in, but there aren't only limited seats and jobs available, especially if you're somewhere more rural, you're not city-based, it's going to be tricky to get a job.
• 28:24
  SPEAKER_01: Yeah, I was just about to say, how do people go about finding those kinds of positions?
• 28:29
  SPEAKER_01: Because I would imagine they're quite limited.
• 28:31
  SPEAKER_02: They are.
• 28:32
  SPEAKER_02: I think the best way to do it, there's a few specialist recruitment places that you can join.
• 28:36
  SPEAKER_02: You can upload your CV.
• 28:38
  SPEAKER_02: We say at Derma Medical offer a lot of support to people looking to get into that.
• 28:42
  SPEAKER_02: People send their CVs to me, and it sounds very critical, but they're usually terrible for aesthetics.
• 28:49
  SPEAKER_02: They they're telling me about all their publications and surgery and things like that.
• 28:53
  SPEAKER_02: I'm like, this is this is lovely, but this tells me nothing about what you're gonna be like as an injector from the patient point of view and things like that.
• 29:01
  SPEAKER_02: So helping them just really uh create, you know, a CV that's gonna really show what kind of injector they are, who they are, all of that sort of thing, and then prepping them for interview as well.
• 29:09
  SPEAKER_02: So when the right job job comes up, we've had a really good success rate in the last couple of years at getting our injectors in some of the biggest UK clinics, and it's it's all about smashing that interview because they're gonna have a lot of candidates.
• 29:20
  SPEAKER_01: I love that because I don't think that's something that many training academies offer or even think about, you know.
• 29:26
  SPEAKER_01: So tell me, what are some what are some things people should be thinking about with their CV and then also interviews as well?
• 29:31
  SPEAKER_01: What are some tips you can give them?
• 29:33
  SPEAKER_02: So the CV, I think people often make their minds when you're looking at a C V within a few seconds, and again, this is aesthetics, it's about things certainly superficially.
• 29:43
  SPEAKER_02: It's got to look good, you've got to look tidy and professional, all those sorts of things.
• 29:46
  SPEAKER_02: So I've got to look at it ideally, just in one maximum two pages.
• 29:49
  SPEAKER_02: I've got to get a really instant impression that this person is confident if I see their picture there, you know, in their scrubs looking at that.
• 29:57
  SPEAKER_02: I love that straight away.
• 29:58
  SPEAKER_02: I'm like, oh, this is Dr.
• 29:59
  SPEAKER_02: So and so.
• 30:00
  SPEAKER_02: And I see their picture and I think, oh, they look really nice, presentable, and it gives them, you know, it gives you a really good instant impression of that person.
• 30:07
  SPEAKER_02: And then just having it really focused, not full of fluff.
• 30:10
  SPEAKER_02: I don't want to know about their GCSE French, all this kind of stuff that you'd be surprised what people put on there, having it really, really focused.
• 30:17
  SPEAKER_02: If they want this extra information, they can ask you at interview.
• 30:20
  SPEAKER_02: But just having something that's going to reflect the job that shows that you can communicate well.
• 30:23
  SPEAKER_02: So that comes through your story or your covering letter has to be really succinct, explaining why you're the right person for this role, your relevant experience to show the training skills, qualifications.
• 30:32
  SPEAKER_02: You know, you can perhaps have a portfolio of work as well.
• 30:35
  SPEAKER_02: If you've got here's some before and afters that I've done, they might request that.
• 30:38
  SPEAKER_02: When I started, they weren't interested in that at all.
• 30:40
  SPEAKER_02: I had it all ready to go, but they weren't because they wanted to see what I was like.
• 30:43
  SPEAKER_02: So they get a good first impression, and that's usually enough to get your foot in the door for an interview, which is when you need to really bring it at that stage.
• 30:50
  SPEAKER_01: Yeah, and and how do you bring it?
• 30:52
  SPEAKER_02: You need to be able to show your company that you are personable so that you can be relaxed, come across confident in your skills, and just talk to people in a manner that makes them feel at ease with you very, very quickly, that you have a good knowledge base and you can share that kind of experience, even if you are a newer injective, you can confidently say, I would recommend this to this treatment to you.
• 31:16
  SPEAKER_02: These are the things that tell me as such.
• 31:18
  SPEAKER_02: And based on what you've said, I've really showing them that I've heard what you've said, and actually, I think these things, these treatments, would really help to meet your goals and expectations.
• 31:26
  SPEAKER_02: This is the time frame, and those are the key elements that people are looking for, and they will be testing you on scenarios and things like that at the interview.
• 31:32
  SPEAKER_02: You know, how would you handle a complaint?
• 31:34
  SPEAKER_02: What would you do if you how would you explain to someone that they weren't right for treatment?
• 31:38
  SPEAKER_02: These scenarios very, very quickly will tell an experienced clinic whether you're going to be a good fit because you've got to be able to handle the patients and the lists that you're given.
• 31:47
  SPEAKER_02: It's going to be a challenge getting started.
• 31:48
  SPEAKER_01: Yeah, I can imagine.
• 31:50
  SPEAKER_01: At what stage would a clinic ask you to like demonstrate your injection techniques?
• 31:56
  SPEAKER_01: Is that a normal thing for the clinic to ask?
• 31:58
  SPEAKER_02: Well, not necessarily.
• 32:00
  SPEAKER_02: They might ask for a portfolio, they might get you in for a period of shadowing.
• 32:04
  SPEAKER_02: A really good clinic, I would say would actually put you on more of a kind of mentorship scheme.
• 32:08
  SPEAKER_02: But this is a this is idealistic.
• 32:11
  SPEAKER_02: I know 10 years ago when I started on Harley Street, there was none of that.
• 32:15
  SPEAKER_02: It was you started, here you go, here's your list, get on with it.
• 32:19
  SPEAKER_02: I don't think that's necessarily the right way to do things, and I'm hoping things are generally a bit better now.
• 32:23
  SPEAKER_02: But actually getting in, shadowing their existing injector, saying this is the way we do it at this clinic, that's the ideal.
• 32:29
  SPEAKER_02: And then you start to take it over perhaps with someone else watching you, that would be perfect.
• 32:33
  SPEAKER_02: Does it always happen?
• 32:34
  SPEAKER_02: No, I don't think so in reality.
• 32:36
  SPEAKER_01: No, I mean I've definitely seen both sides of it throughout my career in aesthetics with yeah, when I've worked in clinics.
• 32:42
  SPEAKER_01: Going back to the consultation side of things, because you mentioned about how important consultation skills are earlier on.
• 32:48
  SPEAKER_01: What would you say makes a good consultation and what are some common mistakes that practitioners make with them?
• 32:53
  SPEAKER_02: Yeah, it is the most important skill, and I think there's always an assumption that if you are a medical professional that you're gonna have all of those skills, but it it it doesn't always translate that easily for people.
• 33:03
  SPEAKER_02: And I think the biggest thing is just making people feel heard.
• 33:06
  SPEAKER_02: They've come in to you about something personal, often a very specific problem.
• 33:11
  SPEAKER_02: And if you're offering a treatment to them that they don't get why it's meeting their needs, they've come in today and they really are bothered by their their chin.
• 33:20
  SPEAKER_02: They've got a chin that they feel is too small, it's recessed, they're bothered, they hate the side profile, for example, and all you're doing is banging on about how they need temple filler and their under-eye hollows, even if that was, you know, the best treatment from for them from a purely kind of objective point of view, you thought that was gonna get the best, biggest result, you haven't shown them that you've that you've listened.
• 33:41
  SPEAKER_02: So that is the absolute key is making sure you've got enough time to really listen to your patient to show them that you've taken on board what it is that's really bothering them and you've articulated it back to them so they they feel like they've been really, really hurt, and then you've presented them with choices, you're gonna make a decision together.
• 33:56
  SPEAKER_02: And the other aspect is making sure that you are boundaried.
• 33:59
  SPEAKER_02: So when people come in saying, you know, I've got to have this done, and you don't think they're a good candidate, whether it's just not required or if it'd be excessive, that you can confidently say when when the answer's gonna be no and you don't think this is the best treatment or it's not gonna solve what what it is that they're looking for, those are the absolute key pieces, I think.
• 34:17
  SPEAKER_01: What are some tips that you you would give someone who's worried about having a difficult patient who, you know, or you know, being able to pick up on maybe some signs of body dysmorphia or someone coming in and saying, you know, a few things that raise some red flags, like, you know, I've been to seven different injectors and none of them would have been able to solve my issue.
• 34:36
  SPEAKER_01: Like, how would you deal with those types of things?
• 34:38
  SPEAKER_02: Yeah, that's a classic red flag, and I never it always makes me smile a little bit when I hear it because it is just so consistent.
• 34:44
  SPEAKER_02: So the best way to prepare yourself is to actually practice saying no and actually run.
• 34:50
  SPEAKER_02: It feels kind of cheesy to do it, but actually run that scenario of imagine.
• 34:53
  SPEAKER_02: This patient said, I want this, I want that, and I wish I had done this because this literally happened to me on my first day on Harley Street.
• 35:00
  SPEAKER_02: This young lady came in and she had the biggest lips I have ever seen.
• 35:05
  SPEAKER_02: They look like they were about to burst, and she came in, she sat down, she said, I want two mils of filler in my lips, I want it today.
• 35:12
  SPEAKER_02: I'd never met her, never consulted her.
• 35:14
  SPEAKER_02: I tried to understand where where she thought this filler would actually go, and I explained a little bit.
• 35:20
  SPEAKER_02: I said, Oh, I don't, I don't normally do more than one mill in one sitting, and sort of was just being a little bit of a wimp and kind of skirting round the subject a little bit, and I said I was gonna examine her, and she was telling me, right, put the dental block in now, I want you to do this, etc.
• 35:32
  SPEAKER_02: etc.
• 35:32
  SPEAKER_02: And it took me, I was going around the houses for like 20 minutes with her, and then I just eventually said to her, I'm really sorry, but I don't think that you really need any more filler, and your lips are lovely and they're full, and she was really cross with me, and it's because I wasn't firm, I wasn't clear.
• 35:50
  SPEAKER_02: I'd obviously given her the impression that maybe I was going to proceed with a treatment, and she was really upset and she was cross with me and she said, I'd take in the afternoon off work, I can't believe this, I'm so I'm gonna go somewhere else down the road.
• 36:01
  SPEAKER_02: She left, and I felt dreadful.
• 36:03
  SPEAKER_02: I just felt like such a failure.
• 36:06
  SPEAKER_02: And the best piece of advice I could get give someone now is just to practice saying no.
• 36:10
  SPEAKER_02: So the top tip is when you've decided, which is usually doesn't take long that you're not gonna treat someone, you need to get in there quickly and don't mess around for half an hour sort of talking around the subject, very quickly get on it and be very, very clear and say, I'm not gonna be able to offer you a treatment that you're not that you're gonna be happy with ultimately, whether it's for medical reasons, psychological reasons, and just say that I'm not gonna be able to offer a treatment that you're gonna be happy with results.
• 36:33
  SPEAKER_02: And you can give them options of no treatment, you could suggest that you think you they might be able to see a colleague for a second opinion, and you can then give them the heads up about them and say, genuinely, I'd like your opinion on this, but you've got to say no and you've got to get in there quickly and be very, very clear, not leaving the door open.
• 36:47
  SPEAKER_02: Ultimately, you don't have to treat any patients.
• 36:50
  SPEAKER_02: This isn't the NHS where you're obligated to do so, and it's only ever the times that I've treated someone against my gut that I've then later regretted it.
• 36:57
  SPEAKER_01: Yeah, yeah.
• 36:58
  SPEAKER_01: I think it's all about speaking to them with confidence as well.
• 37:00
  SPEAKER_01: Like you said, you kind of skirted around the subject because you were scared of saying what you really wanted to say.
• 37:04
  SPEAKER_01: But if you'd just been confident and which obviously is a skill that you have to learn as well, then they probably wouldn't have got so I mean you will always get people there.
• 37:13
  SPEAKER_01: And maybe upset no matter what.
• 37:14
  SPEAKER_02: Maybe she would have been upset.
• 37:15
  SPEAKER_02: But again, now I've my level of resilience over a decade has grown so much that I I wouldn't feel great about it and think that didn't go well.
• 37:21
  SPEAKER_02: Sometimes it doesn't go well even now.
• 37:23
  SPEAKER_02: But I quickly bounce back and just think, okay, brush it off.
• 37:26
  SPEAKER_02: It's it's probably not personal, and you just you move on with it, you document really, really well, and that's it, and it's just yeah, on top of it.
• 37:32
  SPEAKER_01: And you would rather you know have that horrible feeling for a short term, but not have treated them than treat them and then really regret it down.
• 37:39
  SPEAKER_01: Absolutely.
• 37:39
  SPEAKER_02: You never want to get in a situation where you see that you know, that patient's name pop up on your list, you get an email from them and your heart just you know just sinks.
• 37:47
  SPEAKER_02: That's that's your gut telling you this isn't a good situation.
• 37:50
  SPEAKER_01: Yeah, what are some other red flags that you think people should be aware of when you know in those early days when they're not familiar with consulting and treating patients?
• 37:57
  SPEAKER_02: I would say definitely bad mouthing other c clinicians, lots of them, even if you and I've made this mistake before, I thought I can treat that, that's no problem.
• 38:05
  SPEAKER_02: And you treat them the first time and then they say you're the best, you're amazing, you're like, Yes, I am, this is me.
• 38:10
  SPEAKER_02: It's just they were just waiting to find the right clinician.
• 38:12
  SPEAKER_02: That might be the case for a little bit, but trust me, that bubble is always gonna burst.
• 38:15
  SPEAKER_02: So that's one to avoid.
• 38:17
  SPEAKER_02: People that are patients that are really vague about what it is they want, they're just chronically dissatisfied with the way they look, but they can't really say why.
• 38:27
  SPEAKER_02: Sometimes, as well, if there is an event, possibly something emotional, whether it's like a wedding or a big birthday, and it's just coming from a negative place, not saying, if they're saying I'm turning 40, I want to look my best.
• 38:41
  SPEAKER_02: I've got a big party at the end of the year, it's eight months away, but I want to I want to feel my absolute best, great, we can plan around that.
• 38:48
  SPEAKER_02: But if it's oh my god, I'm turning 40, I just feel awful, I look terrible, I can't even bear to look in the mirror.
• 38:55
  SPEAKER_02: I've tried this, I've tried that, but nothing's making what is it they want done?
• 38:59
  SPEAKER_02: I don't know, just fix it, you know, big red flags that actually this person, this is internal work that needs to be done rather before anything kind of external, if it's coming from a place of negativity.
• 39:08
  SPEAKER_02: So I think those are probably the the main ones, or ultimately patients that just really aren't hearing your no, listening to your advice.
• 39:15
  SPEAKER_02: If they if they don't trust you and your recommendations, you're just not going to be able to move forward together.
• 39:20
  SPEAKER_02: They they need to be able to put that trust in you when you say no more, or you know, to just be able to really collaborate on a plan together.
• 39:26
  SPEAKER_01: Yeah, or telling you where to treat, like that lady you described.
• 39:29
  SPEAKER_01: She came in and said, I want two mil filler in my lips and I want it now.
• 39:32
  SPEAKER_01: You know, at the end of the day, it's like you wouldn't go to, you know, a specialist in the NHS, a gynecologist and say, This is my problem and I need this treatment.
• 39:40
  SPEAKER_01: You would go and get a diagnosis and then take their advice on treatment pathway.
• 39:44
  SPEAKER_02: It gets worse than that as well.
• 39:45
  SPEAKER_02: If our patients come in saying, Oh, oh, don't you inject here for this, don't you do that.
• 39:49
  SPEAKER_02: I want this volume here, I want this many units here, I want, and it's just no, this is this this relationship is not.
• 39:54
  SPEAKER_02: You need to be able to trust me with the medical side and the procedural side, or this just isn't going to work.
• 39:59
  SPEAKER_02: Sometimes you don't know, unfortunately, until you're in it, and that's when the the unavoidable, you know, or until you're treating them and they're saying, actually, can you put bit here and can you put bit there?
• 40:08
  SPEAKER_02: Think, oh no.
• 40:08
  SPEAKER_02: I get it if results based.
• 40:10
  SPEAKER_02: They think, oh, is this side a little bit higher or do I need anything?
• 40:12
  SPEAKER_02: And I say, I agree or I don't agree, that's fine.
• 40:15
  SPEAKER_02: But the ones that are being really prescriptive about what to do, that's that's not good, not something's not quite right.
• 40:19
  SPEAKER_01: What about complications?
• 40:21
  SPEAKER_01: What can people do to fill or what should they have in place to be able to deal with complications effectively?
• 40:27
  SPEAKER_02: Number one, you need to have the right knowledge and training done.
• 40:30
  SPEAKER_02: That needs to be done and dusted.
• 40:32
  SPEAKER_02: Fillers and Botox are actually incredibly safe procedures to do.
• 40:35
  SPEAKER_02: They get they get a bit of a bad name.
• 40:36
  SPEAKER_02: I think people get a bit overobsessed about complications.
• 40:40
  SPEAKER_02: It's really important, but if you've got the right knowledge and the right protocols in place, you just you manage it.
• 40:45
  SPEAKER_02: And it's really, really rare that these things are going to actually arise.
• 40:49
  SPEAKER_02: So you need to make sure that you know how to recognise what is a vascular occlusion versus an infection versus you know something like a normal lump and bump and things like that.
• 40:57
  SPEAKER_02: And then to just have a really clear protocol in place, especially for emergencies which might be more time critical, like an occlusion.
• 41:05
  SPEAKER_02: You need to have a pathway ready to go for when you're in the moment, this has happened, you've you've already done all the right things, you've quickly detected it, picked up those signs and symptoms, you know, the pain, the discoloration, whatever it is that you've noticed, and you can refer back to a protocol because in that scenario, your logical thinking brain is just going to be out the window.
• 41:24
  SPEAKER_02: It's it's it's scary, especially when you're when you're practicing on your own.
• 41:28
  SPEAKER_02: So you need to have that in place and also think about your network.
• 41:31
  SPEAKER_02: So with Derma Medical, once you've done our training packages, you get added in, you know, to a support group so that you can ask people.
• 41:37
  SPEAKER_02: We are manning that 365 days a year.
• 41:40
  SPEAKER_02: So there's always someone there on the other end of a phone if you need it, basically.
• 41:44
  SPEAKER_02: So we offer that to people that train with us.
• 41:46
  SPEAKER_02: So you've also got that layer, and that's something now, even after 10 years, certain complications.
• 41:52
  SPEAKER_02: I would want to speak to my colleagues.
• 41:53
  SPEAKER_02: I would never just manage it alone.
• 41:54
  SPEAKER_02: I think actually that's when you do need to go back to your more traditional NHS structures.
• 41:59
  SPEAKER_02: And when it is you that's caused a complication in an elective setting, it it kind of hurts.
• 42:06
  SPEAKER_02: It doesn't feel good, it feels it feels bad.
• 42:08
  SPEAKER_02: And I think it's useful to have a second opinion of someone who's not feeling emotional about it and can just be objective, look at the facts and help guide you and just kind of sense check that you've done all the right things, or is there anything else that I should be thinking about missing or any escalations that that might need to happen?
• 42:23
  SPEAKER_01: Yeah, what would a good kind of complications protocol pathway look like?
• 42:29
  SPEAKER_02: So there's lots of different available we've kind of we offer suggested protocols to our trainees.
• 42:33
  SPEAKER_02: There's also things like groups like Ace that can offer you preset protocols, but wherever you train, they will recommend protocols for you.
• 42:41
  SPEAKER_02: It's really there's the protocols that need to be in place, and you need to make sure that you've got the right equipment, medications.
• 42:46
  SPEAKER_02: These things are really, really important so you've got access to them whenever you might need them because that complication, you never know when it's gonna arise.
• 42:53
  SPEAKER_02: It'll be a completely routine thing, probably one of the lower risk procedures, something like that, and then it'll just happen.
• 43:00
  SPEAKER_02: So you need to be ready for it at any time and checking that your kit bag is in date, you've got everything you need, and also just keeping up to date with guidelines because things will change.
• 43:08
  SPEAKER_02: You think, oh, it's been five years, I've not had this complication, I'll just forget about it.
• 43:11
  SPEAKER_02: I do this myself.
• 43:12
  SPEAKER_02: I'm thinking, you know, what is the latest on antibiotics for this?
• 43:15
  SPEAKER_02: What is the latest, you know, evidence for this type of lump?
• 43:18
  SPEAKER_02: Or you have to keep yourself up to date as well.
• 43:20
  SPEAKER_02: You can't just rely on information that's 10 years old.
• 43:22
  SPEAKER_01: I also think a lot of people are so scared of experiencing a complication, but you know, I've heard a lot of injectors say that you know, even the most experienced injectors will have a complication at some point in their career.
• 43:33
  SPEAKER_01: Like everyone, if you're injecting enough, you're you're gonna have one.
• 43:36
  SPEAKER_01: So it's not necessarily something to be scared of, you just need to have that.
• 43:40
  SPEAKER_02: Yeah, it's not personal.
• 43:41
  SPEAKER_02: Actually, what I've seen from colleagues over the years actually is that when you've kind of got your first complication out of the way, whether it is you know, people always worry a lot about vascular occlusions, but it could just be that really nasty bruise, a big hematoma, and things like that.
• 43:53
  SPEAKER_02: Once it's happened and you got through it and you see that everything is is okay on the other side, you managed it really well.
• 43:59
  SPEAKER_02: The patient.
• 44:00
  SPEAKER_02: Patients often, if you manage it in the right way, you're open, you're transparent, you really support them, you don't just ignore their emails for two days, all that stuff, they will actually come through the other side often being your most loyal patient who would never see anyone else.
• 44:11
  SPEAKER_02: It's amazing.
• 44:11
  SPEAKER_02: It's not always this relationship-ending thing that people think it's going to be if you manage it in the right way.
• 44:17
  SPEAKER_02: And again, that always comes down to the communication.
• 44:20
  SPEAKER_01: Yeah, I guess having that community around you, like you say, to kind of bounce off of you know and ask questions when these things occur is quite important because in those early days of being an injector, you I would imagine a lot of people panic at the slightest bruise.
• 44:35
  SPEAKER_01: And I mean, is there anything like what are the key things people should look out for to be able to determine what's just a bruise or bad swelling to an actual complication that they need to manage?
• 44:45
  SPEAKER_02: Yeah, yeah.
• 44:46
  SPEAKER_02: I think it's good actually in your mind to sort of first of all is stop thinking about it on this kind of like this is okay, a bruise, small bruise, okay, big bruise, bad complication.
• 44:56
  SPEAKER_02: This is all on just a big spectrum.
• 44:57
  SPEAKER_02: It's on a spectrum of side effects which are to be expected.
• 45:01
  SPEAKER_02: You will have sleepless nights.
• 45:03
  SPEAKER_02: The number of sleepless nights I had over a Botox bruise and things like that.
• 45:07
  SPEAKER_02: Like I remember in my early days of practice, and I've never had a bruise like this since.
• 45:11
  SPEAKER_02: I went too deep with one of my crow's feet injections for a patient, and it came up with an initial bruise.
• 45:17
  SPEAKER_02: I thought it doesn't look that bad, it's just a small area.
• 45:18
  SPEAKER_02: When she woke up the next day, it was it was a black eye, small black eye, but it had gone underneath, and you see it like in her tear trough because that's where it goes with gravity.
• 45:25
  SPEAKER_02: I was mortified, the patient was not happy.
• 45:28
  SPEAKER_02: She'd never had boat anything like that, you know.
• 45:30
  SPEAKER_02: But I was new and an experienced, and there was a look, I felt terrible about it, but it was a really good, it was learning for me, which is I took my eye off the ball, I wasn't really focused on the depth, and actually I've never had one like it.
• 45:39
  SPEAKER_02: But now it's really useful when I have consultations with new patients now, and we're going through in great detail the possible side effects.
• 45:46
  SPEAKER_02: I say, you know, usually it's a very small needle mark, sometimes a little bit of a bigger bruise.
• 45:50
  SPEAKER_02: The worst case scenario here is it's a bit of a black eye, and that happens extremely rarely, but that has happened to my patients before.
• 45:56
  SPEAKER_02: Actually, just owning that and explaining to your patients that rarely that can happen, it just makes things so much safer.
• 46:01
  SPEAKER_02: And if it does happen, they're gonna say, Yeah, you warn me about that.
• 46:04
  SPEAKER_02: And it just the expectations are managed rather than going and saying, I never bruise patients.
• 46:08
  SPEAKER_02: I've been to injectors before, and they they kind of go on about how they never give people bruises and stuff.
• 46:12
  SPEAKER_02: And I just know that can't be true.
• 46:13
  SPEAKER_02: If you're using needles or cannons, it doesn't matter, like they are gonna bruise people sometimes.
• 46:17
  SPEAKER_02: So that would be my kind of initial tips, but really you've just got to keep going.
• 46:22
  SPEAKER_02: And if you keep going through that cycle, you see enough bruises, bits of swelling and things like that.
• 46:26
  SPEAKER_02: You need that evidence that things are gonna be okay to continue to move through it, but it's all about not just quitting the first time you get a big bruise because no one would have made it through.
• 46:35
  SPEAKER_02: Otherwise, you have to just kind of push through that and build that resilience.
• 46:39
  SPEAKER_02: Learn from it what you can, and you've got to go again.
• 46:41
  SPEAKER_01: Yeah, like you say, you learn from it and now you know, and I think it's just about owning it and also setting those expectations with the patient beforehand so that it's not a big surprise.
• 46:51
  SPEAKER_01: I think if people know in the back of their minds that could happen, it's that they're not gonna get angry about it most of the time.
• 46:56
  SPEAKER_02: Yeah, they're much more likely to accept it, and obviously some procedures are much more high risk for for bruises than others, but sometimes they come out of nowhere, you didn't expect it, and they end up with a big bruise from from a Botox injection.
• 47:06
  SPEAKER_02: You think, what happened?
• 47:07
  SPEAKER_02: But it just it does, the human body is complicated.
• 47:09
  SPEAKER_01: It is, and it could be like you know, a really, really hot day, and all the you know, the little veins in their face are like dilated, makes that the right way.
• 47:17
  SPEAKER_02: Yeah, exactly.
• 47:18
  SPEAKER_02: So not always personal, but you just need to own it and get through it and just and you go again.
• 47:24
  SPEAKER_01: What are your thoughts on guided injections with ultrasound?
• 47:27
  SPEAKER_01: Because I'm seeing a lot more injectors use that.
• 47:30
  SPEAKER_02: Yeah, I think a lot of it unfortunately is a bit of a gimmick.
• 47:33
  SPEAKER_02: So people saying, uh, you know, we offer ultrasound.
• 47:36
  SPEAKER_02: Well, what does that mean?
• 47:37
  SPEAKER_02: Do you have an ultrasound probe in the cupboard that's there?
• 47:40
  SPEAKER_02: That's that's cool, that's good if you know how to use it for emergencies and things like that.
• 47:44
  SPEAKER_02: Ultrasound guidance under direct ultrasound, I think most of the time is not required.
• 47:50
  SPEAKER_02: So when you are injecting, I I don't uh inject under direct ultrasound guidance because my non-injecting hand for me is just as important as my injecting hand, how I hold the tissues, create support, balance, sometimes sort of leaning on my other hand.
• 48:06
  SPEAKER_02: I personally would find it very, very difficult technically to do that with an ultrasound.
• 48:10
  SPEAKER_02: Maybe it would be learning curve, but I'd find that quite challenging.
• 48:13
  SPEAKER_02: And the reality is, I think that you actually lose a lot of that artistry.
• 48:16
  SPEAKER_02: If you are blocking the area that you're treating with an ultrasound probe, you're losing a little bit of that.
• 48:22
  SPEAKER_02: And I like the proprioception of actually looking.
• 48:24
  SPEAKER_02: I do not take my eyes off the tissue when I'm injecting.
• 48:27
  SPEAKER_02: I've got the feel of my depth with my injecting hand, but I'm looking constantly with dermal fillers specifically at the skin colour, any bruising, any swelling, like an absolute hawk.
• 48:38
  SPEAKER_02: Looking at my patient, looking at their face as well.
• 48:40
  SPEAKER_02: Are they wincing?
• 48:42
  SPEAKER_02: Are they looking relaxed?
• 48:43
  SPEAKER_02: All of these things are giving me constant feedback.
• 48:46
  SPEAKER_02: And for me, clinically, at this stage of my career, I find that more useful than having my other hand busy with the probe and my vision directed to the screen.
• 48:55
  SPEAKER_02: I personally, for me, that's not best practice.
• 48:58
  SPEAKER_01: Yeah, I can imagine that could be quite overwhelming.
• 49:01
  SPEAKER_01: That suddenly goes from like you say, feeling the tissue and injecting, and you've over time developed the skills to be able to read all of those different things, to suddenly you need to be looking at the probe, looking at the screen, and there's a million things suddenly going on at once.
• 49:16
  SPEAKER_01: Do you think it's beneficial for some things like the nose, for example, that's a bit higher risk or the temples?
• 49:22
  SPEAKER_02: Yeah, I think certain key areas, I think it actually pre-scanning the anatomy, it's got lots of value.
• 49:26
  SPEAKER_02: You mentioned again the temp temporal area has got hugely variable anatomy.
• 49:31
  SPEAKER_02: And actually, if you wanted to map it, particularly to see where where the vessels are, for example, you could use things like the gunshot technique, which is going down to bone or intramuscular, people argue about the anatomy in this area, but to map it out to make sure the zone that you're going to inject does not have a vessel there.
• 49:46
  SPEAKER_02: That could be really useful.
• 49:48
  SPEAKER_02: But then you've checked it, you've mapped it, now you're going to come out and do your injection.
• 49:52
  SPEAKER_02: The nose is tricky, the nose is always going to be a high-risk area.
• 49:55
  SPEAKER_02: Keeping to kind of midline injections where it tends to be less vascular and safer is best practice.
• 50:01
  SPEAKER_02: Again, I don't know how much safer that's going to make you in an area like the nose.
• 50:05
  SPEAKER_02: It's always going to be, I think, high risk no matter what you do.
• 50:08
  SPEAKER_02: And actually, the vessels in that area tend to be quite predictable.
• 50:11
  SPEAKER_02: So I think it's a balance between what is the injector's actual ultrasound skill.
• 50:16
  SPEAKER_02: It's a completely different skill set and how you apply it.
• 50:19
  SPEAKER_02: I think it's very variable.
• 50:20
  SPEAKER_02: But as a patient, they wouldn't say, oh, they've got an ultrasound, that just means best practice, best safety.
• 50:25
  SPEAKER_02: I would say it's not quite as simple as that.
• 50:27
  SPEAKER_01: I do see a lot of practitioners now saying that they don't offer non-surgical rhinoparty and they don't offer tears of filler because they're quite scared of treating those areas.
• 50:36
  SPEAKER_01: What would you say to people like that who are kind of maybe levitating towards other treatments and disregarding others when maybe it's just a confidence or a technique thing that they need to learn?
• 50:45
  SPEAKER_02: Yeah, I would say, you know, there is no 100% safe procedure when it comes to dermal fillers, that's something to bear in mind.
• 50:50
  SPEAKER_02: The nose is for common areas distinctly higher risk, and I do think it should be treated as such.
• 50:57
  SPEAKER_02: So I didn't train in noses until I'd been doing fillers for a couple of years.
• 51:01
  SPEAKER_02: And I think that's probably appropriate.
• 51:03
  SPEAKER_02: Some people like to, it depends what you're like as a person.
• 51:06
  SPEAKER_02: I really like to do one thing, master it before I moved on.
• 51:08
  SPEAKER_02: And I think having that experience and that many procedures under your belt is best practice.
• 51:14
  SPEAKER_02: It is always a procedure that is going to carry higher risk.
• 51:18
  SPEAKER_02: So you'd also need to make sure that you felt completely comfortable in recognising complications.
• 51:23
  SPEAKER_02: Maybe you've managed complications before in other areas before proceeding to it.
• 51:27
  SPEAKER_02: I think that it's still versus a surgical rhinoplasty still a good option, and the risks are relatively low compared to that, the severity, but it needs to be taken very, very seriously as a medical procedure.
• 51:40
  SPEAKER_02: Tear trough is generally incredibly safe.
• 51:43
  SPEAKER_02: It's a kind of a different situation.
• 51:45
  SPEAKER_02: I do a lot of tear trough filler in my practice.
• 51:47
  SPEAKER_02: It has gotten a really bad name, I think often because of people using poor technique.
• 51:52
  SPEAKER_02: They use poor technique, they've got you know using the wrong product in the area, and that's not giving them good results.
• 51:57
  SPEAKER_02: They're getting complications.
• 51:58
  SPEAKER_02: For me now is an area that I get extremely few complications, causes me no concerns.
• 52:03
  SPEAKER_02: And it's through adopting different techniques over time and using incredibly small amounts of filler to get the result and a realistic result.
• 52:09
  SPEAKER_02: We're never trying to go for a hundred percent correction, has proved actually to be non-problematic.
• 52:13
  SPEAKER_02: So I get a lot of those patients coming to me.
• 52:15
  SPEAKER_02: So I don't think there's a you know a black and white thing.
• 52:18
  SPEAKER_02: I see a lot of online because it's easy to polarise, you know, nose filler good or nose filler bad, tear trophilla bad is uh currently, you know, and patients always say, Oh, I've heard such bad things about it, you know, and there's an education kind of piece there.
• 52:30
  SPEAKER_02: So I think again it's a combination of understanding where you are experience-wise, knowing your own limitations, and just taking your time.
• 52:38
  SPEAKER_02: You don't have to do tear trough filler when you've only been injecting for six months.
• 52:42
  SPEAKER_02: Just pace yourself, give yourself time to really, really understand and enough procedures before moving on to these more kind of advanced things.
• 52:50
  SPEAKER_02: Ultimately, if it's outside of your comfort zone, risk-wise and things like that, you also don't have to offer it.
• 52:55
  SPEAKER_02: You don't have to offer it ultimately, it is your choice clinically.
• 52:58
  SPEAKER_01: But so if someone is quite nervous, you know, what they could start off is, you know, they've got their foundations for their embotox course, they've passed that, they're starting to treat patients, they might master, you know, lip filler and maybe chin and jawline fill or mid-face filler is a great one, and that can help improve the under-eye as well.
• 53:15
  SPEAKER_01: And then as they get more confident, they can start to add in other things like they might start to treat the temples, or they might start to treat the nose, or the under-eye.
• 53:22
  SPEAKER_01: And would you suggest that they go and have a dedicated training day or do a dedicated training course specifically on those areas?
• 53:30
  SPEAKER_02: Yeah, so we at Done Medical we've got different pathways.
• 53:33
  SPEAKER_02: So for things like tear trough and drawline, we're really getting to grips with using a cannula, and the more experience you get, the better.
• 53:39
  SPEAKER_02: We combine that into our facial contouring masterclass, which works really, really well.
• 53:43
  SPEAKER_02: And then we have a separate dedicated rhinoplasty course, and that's a relatively new change for us, but we realise that it just needs it needs that dedicated time, attention, focus, a real deep dive in the anatomy to fully understand it.
• 53:55
  SPEAKER_02: But yeah, pacing it in that way, I think, is exactly the right way to do it, basically.
• 53:59
  SPEAKER_01: Needle versus cannula.
• 54:00
  SPEAKER_01: What are your thoughts on that?
• 54:01
  SPEAKER_01: I mean, I guess it depends on the area you're treating, but what areas would you say you would kind of use cannula for?
• 54:07
  SPEAKER_02: And yeah, for me, cannula is better in terms of a safety profile.
• 54:11
  SPEAKER_02: You know it's going to have a lower risk of occlusions, that's particularly what we're thinking about.
• 54:16
  SPEAKER_02: Tends to be less bruising, although you can get some nasty, I've seen some really bad bruises from people from their entry, entry point with the cannula, even, and then didn't really realise because it's kind of hidden once you put your cannula in.
• 54:25
  SPEAKER_02: For me, absolute must, the tear trough, although I've got colleagues that have done it beautifully with a needle, and I think, oh gosh, I can't, you know.
• 54:31
  SPEAKER_02: For me, that's tear trough is is cannula when it comes to this section of the tear trough anyway.
• 54:36
  SPEAKER_02: More later, sometimes I can use a needle, but absolutely the jawline as well, when you've got major sort of facial artery territory, it's got to be with it with a cannula.
• 54:45
  SPEAKER_02: I do my temples all with cannula now.
• 54:47
  SPEAKER_02: I used to use, as I mentioned, the gunshot technique, which is a needle going very deep in the temple, and for safety reasons I found that on balance I can get just as good results going with a cannula, so I tend to do that.
• 54:57
  SPEAKER_02: So for me, there's a few areas, but I really, really like using a needle as well.
• 55:02
  SPEAKER_02: I just think the precision is unbeatable for lips.
• 55:05
  SPEAKER_02: For the mid-face as well, you can use a cannula, but I like to go in with a needle so that I can just pinpoint exactly very direct where I where I want the um the filler onto bone, and I've had no real issues with that.
• 55:16
  SPEAKER_02: Yes, I get the occasional bruise, but I certainly don't think I've seen a bit of a trend as well saying I use cannula for everything.
• 55:22
  SPEAKER_02: I think that's fine, that's fine.
• 55:24
  SPEAKER_02: But for me, I'm always going to use a blend of both again, just balancing kind of safety versus results.
• 55:29
  SPEAKER_02: And lips is an interesting one, you can get great results with a cannula, and you know, some patients actually find a cannula very uncomfortable in the lips because they sort of say it's more comfortable.
• 55:38
  SPEAKER_02: I think that really depends on the patient and the injector.
• 55:41
  SPEAKER_02: But what you often don't see is practitioners who use a cannula for lips, they then sort of sneakily finish things with a needle and they go, I just want a little bit more height here, just want to do this to the cupus bow.
• 55:51
  SPEAKER_02: They are often actually doing a combination.
• 56:47
  SPEAKER_01: Yeah, I don't think I've ever seen lips injected with a cannula that's a lot.
• 56:49
  SPEAKER_01: Yeah, I didn't know that that that was a thing.
• 56:51
  SPEAKER_01: Yeah, yeah, you can do.
• 56:52
  SPEAKER_01: Yeah.
• 56:53
  SPEAKER_02: What about aspirating?
• 56:55
  SPEAKER_02: This this is probably teaching-wise the most common kind of question and divisive area that we that we get asked about.
• 57:03
  SPEAKER_02: So aspiration when you're injecting is a tool, it's one of many tools in your toolkit that you can you can utilise.
• 57:10
  SPEAKER_02: So there the main issue that I have with it, and I don't routinely aspirate in my practice, which again, some of the guidelines suggest that you should should always aspirate, but there's a f there's a few pitfalls that I think that make it not really, it's it make it's not really always a reliable tool.
• 57:26
  SPEAKER_02: So when you're aspirating, well, the main things is to do with the the pressure in the syringe.
• 57:30
  SPEAKER_02: So especially if you're injecting a really thick filler, when you're pulling back, so what we mean by aspiration is drawing back on the syringe, creating a pocket of air essentially, and seeing if you get a flashback of blood that could be arterial blood into your syringe.
• 57:43
  SPEAKER_02: And we're talking about really, really small vessels versus a syringe that's under a huge amount of pressure.
• 57:48
  SPEAKER_02: So, what are the what is the likelihood that that blood is even going to be able to get into the into the syringe under those kind of conditions is variable.
• 57:56
  SPEAKER_02: If you get a negative, so there's no blood going in, you could be just next to a vessel.
• 58:01
  SPEAKER_02: You moved your then tip of the needle by a millimeter or two.
• 58:05
  SPEAKER_02: You're in a completely different place in the face.
• 58:07
  SPEAKER_02: So the information that you gathered is just not really applicable.
• 58:10
  SPEAKER_02: So are you going to every one millimeter re-aspirate with your injection?
• 58:15
  SPEAKER_02: Again, some people will advocate for continually moving the needle or the cannula when you're all of these things.
• 58:20
  SPEAKER_02: I think there's nothing that reliable that you can use in the area.
• 58:24
  SPEAKER_02: And the thing that I've learned over time is that I'm yet to be convinced that aspirating consistently will actually reduce your risk of occlusions.
• 58:31
  SPEAKER_02: I don't think that's really been properly proven.
• 58:33
  SPEAKER_02: And the other side is that again, I don't want to be distracting, focusing on aspirating when I could be using my other tools, like supporting the tissues, knowing my anatomy, looking at the tissues as I'm injecting, looking at the patient's expression.
• 58:45
  SPEAKER_02: For me, all of these things are actually much more useful, reliable tools for something not being right.
• 58:50
  SPEAKER_02: Yeah.
• 58:50
  SPEAKER_01: I I think that makes total sense, but I do hear it from both sides.
• 58:54
  SPEAKER_01: Yeah, quite a lot.
• 58:56
  SPEAKER_02: Aspiration is unlikely to cause any harm.
• 58:59
  SPEAKER_02: If you wish to aspirate, that's absolutely no problem.
• 59:02
  SPEAKER_01: Do you always have to aspirate?
• 59:04
  SPEAKER_01: No.
• 59:04
  SPEAKER_01: And like you say, it takes away quite a lot from everything else that you should be doing.
• 59:08
  SPEAKER_01: I mean, you're very passionate about anatomy, aren't you?
• 59:10
  SPEAKER_01: What you know, if somebody really wants to know their anatomy?
• 59:13
  SPEAKER_01: Because if I mean if you're coming from, you know, a a role in the NHS where you're you know a GP, you don't know a lot about anatomy before you do anything.
• 59:20
  SPEAKER_01: Facial anatomy.
• 59:21
  SPEAKER_01: Yeah, facial anatomy before you do your first kind of dermal philicore.
• 59:24
  SPEAKER_01: So, how can people really start to understand the anatomy in in depth and and and learn it?
• 59:29
  SPEAKER_02: It's all about clinical rev relevance.
• 59:32
  SPEAKER_02: So you're not going to know all the anatomy.
• 59:34
  SPEAKER_02: I'll never know all the anatomy, you know, these things, it's head and neck anatomy, it's hugely complex.
• 59:38
  SPEAKER_02: You could do a master's degree in just head and neck anatomy.
• 59:40
  SPEAKER_02: You know, there's a lot, there's a lot to know.
• 59:42
  SPEAKER_02: So I think it's all about prioritising the most clinically relevant information.
• 59:46
  SPEAKER_02: So things like the vasculature, understanding the fat pads, understand the different layers in the face, these are the things that you'll start with.
• 59:52
  SPEAKER_02: But any good training provider is going to give you all of that background information in a manual.
• 59:57
  SPEAKER_02: So, top tip, just prepare for your course.
• 59:59
  SPEAKER_02: You need to have that background information solid.
• 1:00:02
  SPEAKER_02: So when you'll go into your course, all you're doing is really refreshing that information.
• 1:00:06
  SPEAKER_02: You know your muscles, you know the path of the you know, facial vessels, all of this stuff you can do in your own time before attending your training.
• 1:00:14
  SPEAKER_02: So that's really, really key.
• 1:00:15
  SPEAKER_02: But it's about mostly just knowing for the procedures that you're starting with, what do I need to know about that?
• 1:00:21
  SPEAKER_02: You can't just be like, right, I'm gonna learn the whole anatomy of the face in one sitting over a weekend.
• 1:00:24
  SPEAKER_02: That's not gonna happen.
• 1:00:25
  SPEAKER_02: You've just got to know when you're starting with your upper face Botox, I need to be able to rattle off these muscles, know exactly where they are, what the landmarks are, and what they actually do.
• 1:00:36
  SPEAKER_02: What does this muscle fundamentally do?
• 1:00:38
  SPEAKER_02: And what's gonna be the impact of relaxing it with Botox, what's gonna happen, and that's a really, really good place to just start.
• 1:00:43
  SPEAKER_01: Yeah, so taking it bit by bit and mastering one section at a time.
• 1:00:47
  SPEAKER_01: Like you say, it's a very comprehensive thing to kind of try and understand in one sitting.
• 1:00:52
  SPEAKER_01: What about a filler brands?
• 1:00:55
  SPEAKER_01: Like there's a lot of different products out there.
• 1:00:57
  SPEAKER_01: I think fillers, then you've got so many different skin boosters now, different types of polynucleotides.
• 1:01:02
  SPEAKER_01: I mean, where can people start with understanding what the best brands are for them to work with?
• 1:01:07
  SPEAKER_02: I would say that actually there's there's an over-emphasis for neural injectors, get obsessed with which product should I use.
• 1:01:14
  SPEAKER_02: And actually, if you're using the correct density, the right thickness of product for the right area of the face when you begin.
• 1:01:22
  SPEAKER_02: So you're not, you know, your cheek filler, you're using something that's going to be much thicker, much denser, for example, and you're not using that also in the lips.
• 1:01:29
  SPEAKER_02: If you're using the right product that's designed for that area of the face when you start, the technique, the volumes, all of that stuff is so much more important than the product at that stage.
• 1:01:40
  SPEAKER_02: I think it's really important to just try different products to always use ones that are, depending on where you are in the world, that are CE marked, for example, if that you're in the US, has to be FDA, all this sort of thing to make sure that they're they're safe.
• 1:01:53
  SPEAKER_02: I'd start with one of the bigger brands.
• 1:01:54
  SPEAKER_02: If you've never heard of this product and it's a new injector, don't use it.
• 1:01:57
  SPEAKER_02: Start with one of the big named brands that you can actually access lots of support on.
• 1:02:01
  SPEAKER_02: So they have reps and things like that that can help you.
• 1:02:03
  SPEAKER_02: I'm not quite sure is this better for an older lip or a younger person, which should I be using from your portfolio?
• 1:02:08
  SPEAKER_02: And they can be really, really helpful on that side of things.
• 1:02:11
  SPEAKER_02: So everyone has slightly different preferences.
• 1:02:13
  SPEAKER_02: People often draw the same conclusions, like certain products, as one that I use for the under eyes, that is specifically licensed for that, and I've had great results with it, so I feel very comfortable using that.
• 1:02:22
  SPEAKER_02: But you do have to try different things over time to really figure out what is product, what is best for each area, and which you like.
• 1:02:31
  SPEAKER_02: The syringes are different ergonomically, the needles are different, all sorts of things that you need you need to try.
• 1:02:36
  SPEAKER_02: But yeah, with the skin as well, it's all about trying and adding on different products, getting that experience, but just outsourcing that information where you can.
• 1:02:43
  SPEAKER_02: So speaking to the team about you know what's the best way to use this.
• 1:02:46
  SPEAKER_02: And they, I've really found that in the last decade, the companies that produce these products they're listening to clinicians so much more than ever.
• 1:02:53
  SPEAKER_02: So they found that actually this works really well with the cannula in this area.
• 1:02:56
  SPEAKER_02: We would recommend this.
• 1:02:57
  SPEAKER_02: They're listening really, really closely and can feed back to you, you know, so it can save you that kind of learning cycle of getting disappointing results and things like that, or thinking, of course that didn't help that patient, they're not the right candidate.
• 1:03:09
  SPEAKER_02: What can I really improve?
• 1:03:10
  SPEAKER_02: For me, as an injector, it's absolutely crucial that I can deliver really impactful results.
• 1:03:16
  SPEAKER_02: I think if you deliver results that are really kind of meh a lot of the time, your patient is just going to lose trust for you.
• 1:03:22
  SPEAKER_02: So you need to know matching really which product is gonna really help which patient is absolutely key.
• 1:03:28
  SPEAKER_02: And don't offer too much.
• 1:03:29
  SPEAKER_02: You don't have to offer everything just because your neighbour is offering that.
• 1:03:32
  SPEAKER_02: You can just focus in on the things that you think really work.
• 1:03:35
  SPEAKER_01: Yeah, and then build on that over time as you get better.
• 1:03:37
  SPEAKER_01: I think like with everything we talk about, it's starting off and not thinking you need to do everything at once and getting confident and then building on it.
• 1:03:43
  SPEAKER_01: What about?
• 1:03:44
  SPEAKER_01: I mean, a couple of questions here.
• 1:03:46
  SPEAKER_01: A lot of people are now saying, you know, dermal fillers are dead, which I don't agree with.
• 1:03:51
  SPEAKER_01: I don't, I think there's non-surgically, there's nothing else that compares to filler.
• 1:03:56
  SPEAKER_01: But also a lot of people now going down the biostimulator routes.
• 1:03:59
  SPEAKER_01: What do you think about that?
• 1:04:00
  SPEAKER_01: And do you think that that's worth people adding in early on in their career, or do you think they should master filler first and then kind of look at things like sculpt?
• 1:04:08
  SPEAKER_02: I think that they can add it on very quickly in your career now.
• 1:04:10
  SPEAKER_02: The the you know, I I don't think dermal fillers are dead either.
• 1:04:14
  SPEAKER_02: They are an irreplaceable, fantastic tool.
• 1:04:16
  SPEAKER_02: Patients need educating about how great they can be in the right areas, but I think it needs to kind of complement skin and biostimulation at the same time.
• 1:04:25
  SPEAKER_02: So I think actually those are two areas that you can really start very, very quickly and together.
• 1:04:31
  SPEAKER_02: When I look back to my kind of early days of injecting, skin was a complete afterthought when they didn't need anything else filled, they had the Botox.
• 1:04:39
  SPEAKER_02: What else can we do?
• 1:04:40
  SPEAKER_02: They'd you know, we think, oh, do you want some skin injectables?
• 1:04:43
  SPEAKER_02: What else can you?
• 1:04:44
  SPEAKER_02: Which now is just I think it's kind of flipped upside down, it's kind of skin first, then we think about other things.
• 1:04:48
  SPEAKER_02: So I think it's really important.
• 1:04:50
  SPEAKER_02: Patients are very, very interested in their kind of overall skin health in a way that they weren't before.
• 1:04:56
  SPEAKER_02: They understand that you've got to look after your your skin at home.
• 1:04:59
  SPEAKER_02: People always use the analogy of saying, you know, you can't just go to the dentist once a year and not brush your teeth in between.
• 1:05:04
  SPEAKER_02: You need to have the right products and things like that that are actually clinically effective.
• 1:05:08
  SPEAKER_02: So I think they complement each other really, really well.
• 1:05:10
  SPEAKER_02: And ideally, you need to have enough tools in your toolkit to be able to treat as many patients as you can well.
• 1:05:16
  SPEAKER_02: So if you're if you're only treating kind of 25-year-olds doing lip filler and stuff and you and noses and you like all that, that's great.
• 1:05:23
  SPEAKER_02: But your, you know, 45-year-old who really's got sort of global volume loss and some laxity and they would really benefit from sculpture, if that's not your perfect patient, then maybe you don't need to go down that route.
• 1:05:33
  SPEAKER_02: But it's understanding who are your patients and what treatments are they going to most benefit from.
• 1:05:38
  SPEAKER_01: Okay.
• 1:05:38
  SPEAKER_01: So understanding who you want to attract first and then thinking about what you're actually going to offer them.
• 1:05:43
  SPEAKER_01: Are there, I mean, a lot of people are still quite scared of biosimulators, I think.
• 1:05:46
  SPEAKER_01: I mean, obviously, I think sculpture has gone through a bit of a reformulation, so it's not like it was 10, 15 years ago.
• 1:05:54
  SPEAKER_01: But what would you say to people who are still a little bit wary of biosimulators?
• 1:05:57
  SPEAKER_02: Yeah, I I think newer injectors are actually less wary of them in a way that kind of like people that are because they've not seen it.
• 1:06:03
  SPEAKER_02: Yeah, they've not seen the problem.
• 1:06:04
  SPEAKER_02: So again, we're referring to the the nodules issue with sculpture, but they've changed their protocol, it's more dilute than it used to be, and it's become much less of an issue and can have really, really good results.
• 1:06:14
  SPEAKER_02: And there's newer, similar products, the PLLAs that are coming onto the market now and also gaining a bit of traction.
• 1:06:20
  SPEAKER_02: So I think newer injectors seem less concerned about this.
• 1:06:23
  SPEAKER_02: But again, I would just really get good at whatever tools that you're using.
• 1:06:27
  SPEAKER_02: If you're going to introduce polynucleotides and sculpture at the same time and just focus on one, focus on one, do enough procedures, get them done, do your first hundred polynucleotides, then think about adding in sculpture and things like that, just so you can get really, really proficient at one thing before moving on to your next kind of tool.
• 1:06:45
  SPEAKER_01: Level seven, that's something I really wanted to ask you about.
• 1:06:48
  SPEAKER_01: How important do you think level seven is for injectors to have?
• 1:06:51
  SPEAKER_01: I would say the it's unclear.
• 1:06:54
  SPEAKER_02: At the moment.
• 1:06:54
  SPEAKER_02: So level seven is essentially the highest standard that we have in the in sort of aesthetic medicine at the moment to show competency within your skill set.
• 1:07:06
  SPEAKER_02: I did my level seven many, many years ago.
• 1:07:08
  SPEAKER_02: It's hugely evolved since then, actually, in terms of how much better it is in terms of what what's required.
• 1:07:14
  SPEAKER_02: And I think it can be a really good tool for people if you're looking to delve into all aspects of aesthetic medicine.
• 1:07:21
  SPEAKER_02: So your injectables from the more scientific side, the evidence base.
• 1:07:24
  SPEAKER_02: It's a brilliant, really good way to kind of submerge yourself in that world world with a huge time commitment as well.
• 1:07:31
  SPEAKER_02: It's a massive qualification.
• 1:07:32
  SPEAKER_02: It takes a lot of time.
• 1:07:33
  SPEAKER_02: It requires other skills like critical reflection as well, which is really, really important.
• 1:07:38
  SPEAKER_02: So it's drawing on your previous experience as well.
• 1:07:41
  SPEAKER_02: It's not clear currently what the what the the place for level seven will be if regulation, proper regulation should occur.
• 1:07:51
  SPEAKER_02: And there was some talk that this is going to be the you know the only route and a must-have.
• 1:07:55
  SPEAKER_02: We're not sure about that at the moment.
• 1:07:57
  SPEAKER_02: And I don't think injectors that have been doing aesthetics for 25 years are necessarily going to be rushing out to do their level seven, for example.
• 1:08:05
  SPEAKER_02: So the jury's still out on that one at the moment.
• 1:08:08
  SPEAKER_02: We offer a fantastic uh level seven programme at Durham Medical.
• 1:08:12
  SPEAKER_02: We are JCCP approved.
• 1:08:14
  SPEAKER_02: We offer a curriculum developed by OTHM, our exam board, and it is a yeah, it's a very impressive uh award to go through and be given.
• 1:08:23
  SPEAKER_02: So it's it's great at the moment if you're looking to develop your skills, your learning, your confidence, and to really grow as a practitioner in that sense.
• 1:08:32
  SPEAKER_02: Patients aren't really aware of it, I would say.
• 1:08:34
  SPEAKER_02: They it's not something that I've ever been asked about, but nonetheless, I'm glad I did it at the time.
• 1:08:38
  SPEAKER_02: For me, it was the right way for me to get more practice, more support, and feel like I was just learning as much as I possibly could basically at that point in my career.
• 1:08:46
  SPEAKER_01: So for you it was worth it because you feel like you got a lot out of it on top of the other training that you had done.
• 1:08:51
  SPEAKER_02: Yeah, I wanted again at that time there was a lack of kind of mentoring support, and for me it kind of plugged the gaps there.
• 1:08:58
  SPEAKER_02: So it was, yeah, very, very much worth it.
• 1:08:59
  SPEAKER_01: You've got to do it for the right reasons, essentially.
• 1:09:02
  SPEAKER_01: Yeah.
• 1:09:02
  SPEAKER_01: I mean, for somebody who is maybe listening to this, considering doing the level seven, what does it kind of look like?
• 1:09:10
  SPEAKER_01: And like you say, it's a it's a it's quite time consuming.
• 1:09:13
  SPEAKER_01: I mean, what does it look like in terms of time commitment?
• 1:09:15
  SPEAKER_02: Yeah, I think really it depends on your speed of learning.
• 1:09:18
  SPEAKER_02: You I think would aim to kind of complete it in within within two years, certainly, but I think you're looking probably about a year of study, and that's if you're focused on getting it done.
• 1:09:27
  SPEAKER_02: You need to be, let's say, there's short answer questions that you need to be delving into, coursework in that way.
• 1:09:33
  SPEAKER_02: The expectation now is that you need to be injecting independently alongside of it as well to be able to perform you know critical reflections, which can be newer to some disciplines.
• 1:09:42
  SPEAKER_02: There's a huge body of work alongside all of the practical assessments that you need to be doing and preparing for as well.
• 1:09:47
  SPEAKER_02: So it's yeah, it's a massive undertaking, and you need to have if you're you know, you've got a hugely demanding schedule from your family life, your working life, you're trying to launch your new business as well, it needs to sit at the right time in your career to make sure that you've carved out enough time and space and headspace for it as well.
• 1:10:02
  SPEAKER_01: Yeah, and actually to get enough out of it.
• 1:10:04
  SPEAKER_02: Yeah, yeah, absolutely.
• 1:10:05
  SPEAKER_02: I wouldn't do it as a tick box exercise, it is certainly not that that it demands a lot more of you.
• 1:10:11
  SPEAKER_02: So, yeah, it needs to be carefully considered.
• 1:10:14
  SPEAKER_01: And again, finding a training provider for the level seven, and is it kind of the same wherever you go in terms of what you get?
• 1:10:20
  SPEAKER_02: We offer a huge amount of support.
• 1:10:23
  SPEAKER_02: You also get access to our fantastic online learning platform, Dermahub, which goes far beyond.
• 1:10:27
  SPEAKER_02: There's a dedicated area for level seven, but it goes way beyond the scope of level seven in terms of extremely advanced procedures.
• 1:10:34
  SPEAKER_02: There's, you know, there's a podcast on there, there's all sorts of other tools and resources, a community for support.
• 1:10:39
  SPEAKER_02: So we offer a lot of that alongside of all of our mentorship as well, which is really, really strong.
• 1:10:44
  SPEAKER_02: A lot of the core curriculum will be the same, and you're held to an external, you know, regulated list of proficiencies that you need to achieve.
• 1:10:51
  SPEAKER_02: So in that way, it's quite similar, but I think the how is probably quite different, and we're very realistic with you know students signing on about what it's going to take to get it to get it done.
• 1:11:00
  SPEAKER_01: I mean, tell me about Dermahub for a minute because I actually think Dermahub is an amazing tool for probably a lot of people listening, especially early on in in the career.
• 1:11:07
  SPEAKER_01: What kind of can they get out of that and what does it look like?
• 1:11:10
  SPEAKER_02: Yeah, so Dermahub is uh, as I mentioned, our online training platform, and it is an incredible and very, very extensive treatment library at its core.
• 1:11:19
  SPEAKER_02: So you can find anything you'd want from really foundation.
• 1:11:22
  SPEAKER_02: You're beginning, you're doing your first Botox, you can see everything like that from basic mapping out of cheek fillers.
• 1:11:27
  SPEAKER_02: There's a whole series on anatomy from one of our fantastic trainers who's a masculinofacial surgeon, so he's a fully qualified doctor and dentist, and he goes through the depths of all of the areas of the face broken into great detail.
• 1:11:39
  SPEAKER_02: There is everything, and there's things like um frown filler, for example, temples, there's really advanced treatments on there, through to really basic skin procedures as well, chemical peels, everything that you would ever kind of need, basically.
• 1:11:51
  SPEAKER_02: And I think particularly when you're starting out, seeing what it looks like before training, refreshing your knowledge after training is essential.
• 1:11:57
  SPEAKER_02: So I remember, you know, when I did tear trust the first time, for example, I wish I had had this sort of tool available now where I could have the night before just watched one of the trainers doing the procedure, reminding me of the landmarks, exactly what I'm doing, the things I need to be focusing in on would have been so, so helpful and would have made it all a lot less scary.
• 1:12:16
  SPEAKER_02: And we have a mobile app for it as well.
• 1:12:18
  SPEAKER_02: So you can literally you can watch it in your own time.
• 1:12:20
  SPEAKER_02: You've got you know dead time on the tube and things like that.
• 1:12:22
  SPEAKER_02: You can be watching it, downloading it offline.
• 1:12:24
  SPEAKER_01: Just constantly updating your skills, and yeah, if there's something new that you want to kind of implement into your practice or your knowledge, just going on and the content is a lot of it CPD accredited as well, so you can actually be putting things into your portfolio and things like that.
• 1:12:36
  SPEAKER_02: So it it's a great tool.
• 1:12:37
  SPEAKER_02: And again, some of the other things that I mentioned in the podcast.
• 1:12:40
  SPEAKER_01: Yeah, I mean, completely unsponsored by the way.
• 1:12:42
  SPEAKER_01: I just wanted to bring it up because I think it's yeah, it's like having your own little kind of aesthetics encyclopedia in your pocket, you know, whenever you need it.
• 1:12:51
  SPEAKER_01: So yeah, I think that's a great tool for you know everyone to check out.
• 1:12:54
  SPEAKER_01: Going back to initial kind of foundations training, I wanted to ask how much hands-on training should someone typically expect to get, or do you think someone should ideally get out of their training?
• 1:13:04
  SPEAKER_02: So we I think probably Dermomedical are really known for how much we focus on the hands-on training.
• 1:13:08
  SPEAKER_02: I just think nothing can replace that in terms of what you need on a training course.
• 1:13:13
  SPEAKER_02: So, you know, you can prepare your anatomy before you can learn the landmarks, but it's the hands-on bit and the consulting that are two things that you you know you need to have that in your course.
• 1:13:22
  SPEAKER_02: All of our courses have at least half of the day, with we've got model patients all provided for you.
• 1:13:27
  SPEAKER_02: So I would say at least half of the day, but it needs to be fully booked, multiple models.
• 1:13:31
  SPEAKER_02: And I know from our trainers, the way we do things is that our goal as quickly as possible is to get the syringe into our students' hands so that they are injecting as much as possible.
• 1:13:41
  SPEAKER_02: I've heard so many stories of I went to this training academy and the trainer wouldn't let me inject, and they just took over and it left me feeling rubbish and I had no confidence to go out and do it independently because they just took over and did it for me and said, no, no, no, this is how you do it.
• 1:13:53
  SPEAKER_02: I'm gonna show you.
• 1:13:54
  SPEAKER_02: Great.
• 1:13:54
  SPEAKER_02: I still don't know how to now.
• 1:13:56
  SPEAKER_02: Yeah, and what about group sizes and things like that?
• 1:13:59
  SPEAKER_02: So we we offer a variety of groups.
• 1:14:01
  SPEAKER_02: Typically, it'll be four maximum five learners to one expert trainer, but we do have options as well for one-to-one training that's become so popular, usually more for masterclasses or for people who are looking to refine their skills, get a portfolio together.
• 1:14:15
  SPEAKER_02: We can offer all sorts of things like that.
• 1:14:16
  SPEAKER_02: So someone's, you know, they've done the training, they want to just refine their skills, do whole patients by themselves, get fantastic before and afters.
• 1:14:23
  SPEAKER_02: We offer that sort of thing as well.
• 1:14:25
  SPEAKER_02: But I think actually having a group is really useful because you're kind of in it together.
• 1:14:28
  SPEAKER_02: I don't think I would have wanted to do it one-to-one from the start.
• 1:14:31
  SPEAKER_02: Actually, working with colleagues, typically in a group of four, is really useful actually.
• 1:14:35
  SPEAKER_02: But typically by the end of my courses, I'm saying, right, can you tell so and so I want you to check their work?
• 1:14:39
  SPEAKER_02: You're gonna mark up, you're gonna check it, da da da, and getting everyone involved in in all of the processes and actually critically kind of appraising each other as we go.
• 1:14:48
  SPEAKER_02: Yeah, I like that.
• 1:14:49
  SPEAKER_02: Are there any kind of group sizes that you think would be too big?
• 1:14:52
  SPEAKER_02: Yeah, I mean, I've heard you know horror stories of kind of ridiculous group volumes here in the UK and also in the US.
• 1:14:59
  SPEAKER_02: I mean, one of the big trainers there, you can expect to have like 25 people around a patient, which is just absolutely nuts.
• 1:15:06
  SPEAKER_02: Group sizes isn't everything, it depends how they kind of action it, but it certainly shouldn't be, I think, any more than probably five or six would be quite a large group because it's just quite overwhelming for the patient.
• 1:15:16
  SPEAKER_02: And you know, our model patients really understand they they love coming to see us, they actually like the whole experience and the learning and find it really interesting and understand that you know that had the importance of the learning process and actually for for injectors to be safe, we all had to learn, everyone had to start somewhere.
• 1:15:32
  SPEAKER_02: You feel like I think sometimes neuro injectors feel like they're not allowed to begin, and it's we're all beginners once, and that's completely fine.
• 1:15:37
  SPEAKER_02: But yeah, it depends on the experience of the trainer as well, as to I think how many uh students and learners they can actually manage as well.
• 1:15:44
  SPEAKER_02: It's really critical.
• 1:15:45
  SPEAKER_02: If they're very inexperienced, they're not going to be able to manage a group setting safely.
• 1:15:48
  SPEAKER_02: So there's a lot to consider in that.
• 1:15:50
  SPEAKER_01: If there's a lot, I mean you'd be stood at the back of a crowd trying to see what's going on with you.
• 1:15:54
  SPEAKER_02: Yeah, and that sort of setting is again bring your own model and all this sort of stuff, which I just think is not the best way it should be.
• 1:16:00
  SPEAKER_01: No, yeah, I agree.
• 1:16:01
  SPEAKER_01: Okay, I'm just going to fire off some kind of dilemmas, quickfire kind of scenarios at you just to get your thoughts on some specific things.
• 1:16:10
  SPEAKER_01: Okay, so I've seen foundation courses ranging from a few hundred pounds to several thousand.
• 1:16:15
  SPEAKER_01: How do I know what's actually worth paying for and what's just good marketing?
• 1:16:18
  SPEAKER_02: If a foundation course in aesthetics is costing a few hundreds of pounds, run, that's the first thing to say.
• 1:16:24
  SPEAKER_02: That that doesn't make any sense.
• 1:16:25
  SPEAKER_02: What products are they using?
• 1:16:26
  SPEAKER_02: What's the standard of the training?
• 1:16:27
  SPEAKER_02: The reality is in the UK, most training courses that are designed for medical professionals cost about the same, is the reality.
• 1:16:33
  SPEAKER_02: So I would really try not to be too price-driven focused.
• 1:16:37
  SPEAKER_02: There's small differences between them, and really focus on what is it that you're looking to get out of the training.
• 1:16:43
  SPEAKER_02: Do you want to c come out clinically proficient?
• 1:16:45
  SPEAKER_02: Are you looking for a qualification like the level seven and just focus in on the training academy you think is going to get you where you need to go?
• 1:16:53
  SPEAKER_01: I've done three different courses now, but I still don't feel confident injecting.
• 1:16:56
  SPEAKER_01: Am I under trained or am I falling into the trap of constantly booking more courses instead of actually practicing?
• 1:17:02
  SPEAKER_01: Yeah, that's a good question.
• 1:17:03
  SPEAKER_02: I I would say if you were one of our students, I would say unless there is some particular reason you're not feeling confident that we need to get into and we would be there to have that question with you, it's probably a case of you need to get on and start injecting, but fundamentally, if you really don't feel like you're safe to inject, then I think you'd have to go back and question the training that you had received because that is not typical of the training that we deliver.
• 1:17:28
  SPEAKER_01: I'm comparing two academies, one offers more theory and qualifications, the other offers more live model experience, which should matter more when you're starting out.
• 1:17:36
  SPEAKER_02: Honestly, you just need both.
• 1:17:39
  SPEAKER_02: I would focus personally on the academy that gave you better hands-on injecting experience at the time because the learning that you can do otherwise can much of it can now be done, for example, with Dermahub behind the scenes, you can do online learning, a lot of self-directed learning, which we use at medical school as well.
• 1:17:54
  SPEAKER_02: Prioritize the hands-on.
• 1:17:55
  SPEAKER_01: I finished my training, bought products, arranged insurance, and set up a room, but now I feel completely overwhelmed.
• 1:18:01
  SPEAKER_01: What should my first three months actually look like?
• 1:18:04
  SPEAKER_02: First of all, well done.
• 1:18:06
  SPEAKER_02: You've made a huge amount of progress, which is brilliant.
• 1:18:08
  SPEAKER_02: So I think you just need to just take a moment, actually congratulate yourself.
• 1:18:12
  SPEAKER_02: You have gone straight out the gate and got all these things done, that's brilliant.
• 1:18:16
  SPEAKER_02: Next steps is though, I would say, is to stop avoiding what you need to do, which is start injecting.
• 1:18:22
  SPEAKER_02: You need to get patients in ASAP.
• 1:18:25
  SPEAKER_02: You've done all of that stuff, that's fantastic, but you need to prioritize as quickly as possible of getting your first patient in friends and family, get their first Botox done.
• 1:18:33
  SPEAKER_02: Nothing else is going to get you over that fence.
• 1:18:36
  SPEAKER_02: You need to climb over yourself, and that is usually the biggest thing that people are are avoiding.
• 1:18:40
  SPEAKER_02: They'll do everything else, but you've just got to see your first patient and get it done.
• 1:18:43
  SPEAKER_01: Yeah.
• 1:18:44
  SPEAKER_01: Would you say that's the difference between a very, you know, why some injectors actually manage to grow quite quickly is because they they don't let that fear help them back.
• 1:18:53
  SPEAKER_01: You you will be nervous, you have to act in spite of that.
• 1:18:56
  SPEAKER_01: And I and as you say, it's just having the right kind of community around you and the right people around you.
• 1:19:00
  SPEAKER_01: Like with Derma Medical, you've got that group of people that you can go to if something goes wrong or if you have oestrogen.
• 1:19:07
  SPEAKER_01: Absolutely.
• 1:19:08
  SPEAKER_02: And there's nothing we all had to start.
• 1:19:10
  SPEAKER_02: We all had our first patient.
• 1:19:11
  SPEAKER_01: You have to remember that.
• 1:19:12
  SPEAKER_01: Absolutely.
• 1:19:13
  SPEAKER_01: Okay, I'm going to we're gonna finish the episode and wind down the episode on a quick fire round.
• 1:19:17
  SPEAKER_01: I've got quite a few questions I'd like to ask you.
• 1:19:19
  SPEAKER_01: So let's go.
• 1:19:20
  SPEAKER_01: One thing you wish somebody had told you before you started in aesthetics.
• 1:19:24
  SPEAKER_02: Your progress is going to be measured in years, not weeks and months.
• 1:19:27
  SPEAKER_01: The one treatment or skill every new injector should master before moving on to anything advanced.
• 1:19:32
  SPEAKER_01: You need to be able to learn to say no to patients.
• 1:19:35
  SPEAKER_01: Biggest red flag in a training academy.
• 1:19:37
  SPEAKER_02: Offering no credentials.
• 1:19:39
  SPEAKER_02: Expand on that, actually.
• 1:19:40
  SPEAKER_02: So not having any accreditation, unclear who is going to be delivering the training and having no proof of success for their students.
• 1:19:48
  SPEAKER_01: Most underrated skill for a new injector.
• 1:19:51
  SPEAKER_02: Learning to really consult and listen your patients with kindness.
• 1:19:55
  SPEAKER_02: The quality that separates a competent injector from a great one.
• 1:19:58
  SPEAKER_02: Knowing your unknowns.
• 1:20:00
  SPEAKER_02: You'll never know everything in aesthetics, but until you know what you don't know, you are not necessarily safe.
• 1:20:06
  SPEAKER_02: Agree.
• 1:20:07
  SPEAKER_02: One thing every practitioner should know about complications.
• 1:20:10
  SPEAKER_02: All you need to do is learn to recognise it.
• 1:20:13
  SPEAKER_02: If you can recognise it, everything else is going to be okay.
• 1:20:16
  SPEAKER_02: You can go through the steps of management, but if you don't pick it up and quickly, that's when the problems begin.
• 1:20:21
  SPEAKER_02: Biggest mistake people make when choosing their next course.
• 1:20:24
  SPEAKER_02: Getting too course happy and thinking that endless courses are going to suddenly make them feel confident when actually it's independence and showing yourself that you can do it that's going to genuinely make you feel ready.
• 1:20:35
  SPEAKER_02: Yeah.
• 1:20:35
  SPEAKER_02: Do you think people can do too many courses?
• 1:20:37
  SPEAKER_02: Yes, yes.
• 1:20:38
  SPEAKER_02: Some people do too many courses too quickly.
• 1:20:40
  SPEAKER_02: I probably still do about gosh, three to five courses a year.
• 1:20:44
  SPEAKER_02: So it is a journey that never ends.
• 1:20:46
  SPEAKER_02: But if you're just doing back to back to back-to-back courses and actually not doing anything independently, you're not really an injector, you're just kind of jumping from course to course, which is different.
• 1:20:54
  SPEAKER_01: Yeah, I agree.
• 1:20:55
  SPEAKER_01: Because I mean you can go from course to course learning things, but it's actually what's going to cement that knowledge into your brain is practicing the skill.
• 1:21:03
  SPEAKER_01: But if all you're focusing on is doing course after course, you're not actually putting the time in to execute those.
• 1:21:09
  SPEAKER_02: Yeah, which is a different, it is a different skill.
• 1:21:11
  SPEAKER_02: It's about taking on that, you've got to be ready to take on that responsibility and that accountability, which nothing's gonna prepare you for, you just need to do it.
• 1:21:18
  SPEAKER_02: Okay, next one.
• 1:21:19
  SPEAKER_02: Best piece of business advice you've ever received, best piece of business advice, don't be afraid to talk about your services confidently.
• 1:21:29
  SPEAKER_02: So I don't know what was really the issue, but when I started, I felt almost embarrassed to say, you know, oh, I do offer this.
• 1:21:37
  SPEAKER_02: Did you know you could have this skin booster or something?
• 1:21:40
  SPEAKER_02: You're not selling to your patient, all you can do is just educate people about the treatments that might benefit them, and then ultimately it's their decision.
• 1:21:47
  SPEAKER_02: And that doesn't feel salesy, that's the hardest thing when you're a medic by background, is is kind of learning the difference between that.
• 1:21:54
  SPEAKER_02: But my job as I see it is just to educate patients about what they can achieve with what treatments, yeah, giving them the options and then they make the final decision.
• 1:22:03
  SPEAKER_01: I do think that as well that that's something most people really struggle with.
• 1:22:06
  SPEAKER_01: Like you say, you're a medic by background.
• 1:22:08
  SPEAKER_01: When you're in the NHS, you're never like selling, and people do see aesthetics of selling because obviously that you're getting money in return directly from the patient, so it feels a little bit unnatural, I guess, at first.
• 1:22:17
  SPEAKER_01: It did for me until I flipped it and just thought I'm not selling to them, I'm just educating them.
• 1:22:21
  SPEAKER_01: You're educating them, they've come to you with a concern, they have come to you.
• 1:22:24
  SPEAKER_01: You haven't gone and pulled them off the street.
• 1:22:26
  SPEAKER_01: They want to know.
• 1:22:26
  SPEAKER_01: They want to know.
• 1:22:27
  SPEAKER_01: And you have said, This is why you're experiencing the issue, these are the options.
• 1:22:31
  SPEAKER_01: Yeah.
• 1:22:31
  SPEAKER_01: Which is just a medical model.
• 1:22:33
  SPEAKER_01: Yeah, exactly.
• 1:22:34
  SPEAKER_01: One resource you'd recommend to somebody at the beginning of their assesses career.
• 1:22:38
  SPEAKER_02: Obviously, I'm biased, but I would recommend thinking about Derma Hub, our online training platform.
• 1:22:42
  SPEAKER_02: It's just, it's there, you know, 10 pm at night, got your first tear trough tomorrow, and you can just do that quick recap to get you over that confidence hurdle rather than saying, oh no, I don't think you actually need it, you know, to the patient.
• 1:22:52
  SPEAKER_02: You know what you're doing, it gives you that final little bit of support you need just to go for it.
• 1:22:56
  SPEAKER_01: And if there's anything specific that you don't feel as confident on, there'll be something on there to help with you.
• 1:23:00
  SPEAKER_01: Absolutely.
• 1:23:00
  SPEAKER_01: Yeah.
• 1:23:01
  SPEAKER_01: If you could change one thing about the aesthetics industry right now, what would it be?
• 1:23:04
  SPEAKER_01: In a word, regulation.
• 1:23:06
  SPEAKER_02: The I've got a view of what I think regulation should look like, but the government just needs to do something.
• 1:23:14
  SPEAKER_02: This is a major patient safety issue at the moment.
• 1:23:17
  SPEAKER_02: It's really, really scary.
• 1:23:19
  SPEAKER_02: It is like in the UK, unlike anywhere else in the world, pretty much.
• 1:23:22
  SPEAKER_02: And something needs to change really, really rapidly to protect the general public.
• 1:23:26
  SPEAKER_02: Do you think it ever will?
• 1:23:28
  SPEAKER_02: I think we all get some degree of regulation.
• 1:23:30
  SPEAKER_02: I don't think it'll align with what most medical professionals would recommend, which is a real shame.
• 1:23:35
  SPEAKER_02: The government should have done this 25 years ago and it's not happened.
• 1:23:38
  SPEAKER_02: You know, everywhere else that we train the rest of the world is very clear about you know who should do these procedures and who should not, what supervision is required.
• 1:23:46
  SPEAKER_02: My view is that it should only be performed by regulated medical professionals, essentially, is the only way to protect patients, but we'll see.
• 1:23:54
  SPEAKER_01: And finally, where can people find out more about Derma Medical's training and connect with you if they want to ask you questions about your experience?
• 1:24:01
  SPEAKER_02: Absolutely.
• 1:24:02
  SPEAKER_02: So we've got a vast wealth of information on our website, www.dermamedical.co.uk.
• 1:24:08
  SPEAKER_02: So you can check out all our courses and packages options there.
• 1:24:10
  SPEAKER_02: And you can also uh drop us a message at our Instagram, derma underscore medical, where you can find out a little bit more just about how we train, the flavour that we give to training, and see some of the regular trainers and faces just to make you feel a bit more comfortable and at ease before starting training.
• 1:24:25
  SPEAKER_01: And you can always drop me a message as well at drharriot dr.harriet as well on Instagram, and I'll get back to you.
• 1:24:30
  SPEAKER_01: Amazing.
• 1:24:30
  SPEAKER_01: And there is lots of educational content as well on the Instagram that will help people.
• 1:24:34
  SPEAKER_01: Amazing.
• 1:24:34
  SPEAKER_01: Well, thank you so much for coming on.
• 1:24:35
  SPEAKER_01: It's been so useful.
• 1:24:36
  SPEAKER_01: I feel like it's been a bit of a blueprint for people getting started in aesthetics.
• 1:24:40
  SPEAKER_01: We've covered so much.
• 1:24:41
  SPEAKER_02: Hopefully, you know what?
• 1:24:42
  SPEAKER_02: Ultimately, I think if you're not sure about who to train with, see who you can have a chat to.
• 1:24:47
  SPEAKER_02: Speak to someone who's been through the process who knows it inside out, and I think that'll probably that'll give you a sense of everything you need to know if these are people that you trust to go with.
• 1:24:54
  SPEAKER_02: Trust your gut.
• 1:24:55
  SPEAKER_02: Great advice.
• 1:24:55
  SPEAKER_01: Thank you so much for coming on.
• 1:24:57
  SPEAKER_01: Thank you.