Navigating Tech and Trends in Plastic Surgery with Dr. Mark Epstein

Announcer (00:06):
You are listening to the Aesthetically Speaking podcast presented by Nextech.

Tyler Terry (00:11):
Hey guys. Welcome back to the Aesthetically Speaking podcast presented by Nextech. I'm your host, Tyler Terry, and we are coming to you live from beautiful Austin, Texas at the Aesthetic Meet, which is formerly known as asaps. Today I have a very special guest. His name is Dr. Mark Epstein. Dr. Epstein is a dual board certified plastic surgeon in Long Island, New York. Dr. Epstein, welcome to the podcast.

Dr. Epstein (00:40):
Thank you so much for having me, Tyler.

Tyler Terry (00:42):
Of course, of course. How has the show been so far?

Dr. Epstein (00:44):
Show's awesome. Show's awesome. I love the shows.

Tyler Terry (00:47):
Yeah. Yeah. This is one of the best, I would say, one of the best aesthetic meanings of the year, right?

Dr. Epstein (00:51):
Oh, absolutely.

Tyler Terry (00:53):
Yeah,

Dr. Epstein (00:53):
Absolutely. It's my favorite.

Tyler Terry (00:54):
Yeah, it seems like a lot of your colleagues are here. You get to hang out, catch up with everybody, which is great. So Dr. Epstein, tell us a little bit about yourself.

Dr. Epstein (01:03):
Well, I'm a dual board plastic surgeon. I've been in practice for just over 30 years.

Tyler Terry (01:08):
Wow.

Dr. Epstein (01:09):
We have a big focus on breast and body, but we also do face, we have not only the surgery side, but we have a fully equipped med spa with all the latest technologies and lasers and a wellness center, we can focus on weight control and sexual wellness.

Tyler Terry (01:26):
What are some of the things you're offering in that wellness side, or what are you seeing?

Dr. Epstein (01:29):
On the wellness side, the main things that people are interested in is weight control with the GLP one medications, and the other thing that is really big is sexual wellness. We are offering a hormone replacement and we don't do a turnkey method where you just subscribe to something and send a bunch of pills. We actually do a thorough analysis of your body's hormones and chemistries and then figure out how to put you back to an equivalent ideal state using a combination of testosterone, progesterone, and other medications. We also offer vaginal rejuvenation using radio frequency. We have O shots and P shots and clitoxin, which is a combination of neurotoxin like Botox and PRP and all these things work very well together to rejuvenate you sexually in terms of your mental state, your hormonal state, and we're going to be incorporating the new medication ADDIE in as well, which acts to adjust the dopamine serotonin balance in your brain and actually stimulates sexual desire as well as improving orgasm. Who doesn't want that?

Tyler Terry (02:45):
Yeah, no, that's amazing. Who doesn't want that? It sounds like you offer a vast array of services. You're tailoring the service to the patient because you're actually understanding what they need in terms of their chemistry and all the different things. What is that intake form like if a patient was to first come to your practice, what is that experience like?

Dr. Epstein (03:06):
Well, when the patient calls, if they're interested in the wellness component, then they come to the practice, they meet with my PA, Janet, who is absolutely amazing. She's also a phenomenal injector as well, and Janet will then direct an interview and find out exactly what their questions are, what their desires are, where they feel deficient, and what their goals are.

Tyler Terry (03:28):
Okay. Yeah, so it's very much in tune with what the patient needs and what their desires are to your point. So let's talk a little bit about cybersecurity. What are you seeing? Why is it so important to protect your practice and to be mindful of cybersecurity?

Dr. Epstein (03:44):
Well, everyone has data to protect. That goes without saying, but in the aesthetic space, we have very, very sensitive data. We have not only the usual name, social security number, address, that sort of thing, but we also have photographs. Photographs are highly sensitive data, and even though you should be taking your photos where you keep faces off bodies, there's no reason to combine the two.

(04:13):
A threat actor, if they get into your data, they can still figure out which photos go with who, and then take that data and publish it on a website and use it for ransom. So my mission is to educate my colleagues and those in this space about all the special precautions they need to take. Most of the precautions, it's really all about risk management, and if you do simple steps, even steps that don't cost much money, you can substantially lower your risk from being attacked. Some of the worst attacks were done by ignoring some very, very simple concepts in data protection.

Tyler Terry (04:55):
What are some of those essential precautions? If a practice is just starting out, they're listening to this and they're thinking, I don't even do this. Wow, I need to do this every day. What are some basic things they should be doing?

Dr. Epstein (05:07):
Looking at what are the most common causes of why there's a data breach? I can break this down to just a few categories. The first has to do with weak and stolen passwords. How many people out there are putting passwords on little stickies on their computers or under their keyboards? That's just common sense. You should have strong passwords and change them regulate. That doesn't cost any money. The next thing has to do with unpatched applications. If you are an aesthetic practice or a physician, hopefully your computers are being maintained by a managed service provider. The days of the IT guy is long gone. Having one guy who is there when you need to hook up a printer or you have a problem, you can't get into something that's antiquated and that's a setup for disaster. A managed service provider is someone who provides computer support, hopefully you get it 24 7, and they're there for different aspects of your IT infrastructure.

(06:06):
Data security is just one of them, and managed service providers have specialists on board who are data security experts in addition to people who manage setting up the architecture where your data is stored and debugging issues with computers and things like that. So your managed service provider is responsible for making sure that all your software is updated. One of the biggest breaches was the SolarWinds breach, and that breach was a supply chain attack because SolarWinds didn't update a certain piece of security software, the threat actor got into their network and SolarWinds distribute software to all its vendors. So all that software they distributed was now infected and they basically infected all their customers. So it's very important to patch your applications. Had they done that one patch, they would've never had that disaster. The malware itself is very, very cleverly designed to compromise systems. It gets in there and it sits undetected for these days, 200 days, while the threat actor is pulling your data off, looking at it, figuring out your business finances, whether or not you have cyber insurance, how much money you can afford to pay for an attack as a ransom, and they're pulling off your photos and your patient data and all of that.

Tyler Terry (07:23):
Wow.

Dr. Epstein (07:23):
Social engineering is another big way they do attacks. For instance, if they do an attack on the Aesthetic Society, they can go grab the Aesthetic Society database and not do anything further, not scramble their data, not threaten them, not ransom them because all they want is that data. And then what happens once they have the data, they now know all our identities and all our aesthetic society info. So you can get a spear phishing email that will have your name on it, your Aesthetic Society membership. It might have your current balance of your annual dues, and maybe there's a little button click to update and pay your due, and that is where you launch the malware.

(08:07):
So they're using the data taken from one place as a means to create a socially engineered attack on a large group of people. And then less commonly or physical attacks on the network or even insider attacks. Someone can come in to do a repair on your computers disguised as the computer or printer repair guy, and they stick a USB drive into a computer and now they've launched malware or it can be an actual insider, an employee who steals data. So those are the ways that these attacks occur. Now, my recommendations for a practice, the Medi Spa, whatever the business is, is you must have cyber insurance a minimum of a million dollars. The cyber insurance that your regular business insurance gives is simply not enough. Cloud migration I think is very important these days. I think everyone should have their data stored on the cloud. The cloud is not necessarily more secure than if you hosted your own server and put all the necessary software in, but what the cloud migration does is allows you to take that off your list of things you have to personally worry about maintaining and being responsible for. Regular assessment of your security status is very important. You do that with your managed service provider. You do an annual vulnerability assessment you see with recent attacks, and you should be able to be guided by your managed service provider what you might need to button up and make a little bit tighter. And again, as I said before, protecting your passwords, very, very important. Another thing that should be done, it's not always done, but penetration testing, you actually hire a third party, not your managed service provider to try and get into your network. If you have your managed service provider, that's kind of conflict of interest. So it's best that you hire an outside party to try and hack in.

Tyler Terry (10:04):
Yeah, because of course if they were to get into their own network, they don't want to tell you that.

Dr. Epstein (10:08):
And my last recommendation is some form of multifactor authentication. So for instance, when my users go to log onto the windows on their desktops, we use a product called duo and there's a lot of them out there that do this. So something pops up on their phone that's basically is making sure that that is the person who's trying to log in. So if someone has my username and my password, but they don't have my iPhone, they're not going to be able to get into my computer, at least not on the inside or remotely. So that's a very important thing. And I think any company that has web portals with data should have multifactor authentication. That's basically becoming a standard.

Tyler Terry (10:51):
Certainly. With your staff. How are you constantly maintaining training for cybersecurity? Is that something that you do a couple times a year when you have a new employee? I'm sure I could tell just by talking to you, this is of the utmost importance to you.

Dr. Epstein (11:05):
Well, you just beat me to the punch because what you need to do is engender a culture of cybersecurity. Everyone takes ownership in some of the worst attacks. I know it was a low level employee who got an email that turned out to have malware in it and launched the whole attack.

(11:23):
So what we do is we use a service, we use know before, but there are several of them out there. And what they do is they have a wonderful series. Know Before has about 80 videos, they take 30 seconds to watch and all the employees are required to watch the entire set, and we get a dashboard. So we know that they've watched all of them and it instructs you on all the different things that you can do to be cyber secure. And it's amazing. Every week I get emails from my staff and we have about 15 people and they'll forward me suspicious emails. They are constantly picking up, I would say 98% of the time the emails they forward me are actual malicious attacks on our servers. And the other thing that we do is our managed service provider that furnishes the know before will actually do fake attacks on my staff. So they'll get an email which is malicious except it's not really malicious, but it's not a real email. It if they fall for it, they then open up a video that explains, oh, you opened up this video. There's a problem. This is a simulated attack of this type.

(12:38):
And the staff get graded on their performance, and my staff pretty much pick up every one of 'em. They don't fall for any of these fake attacks, which means we are actually successful in engendering a culture of cybersecurity. All it takes is one bad click to destroy your entire business. And I have a colleague who lost one of the most successful aesthetic practices in the country. He had a lot of A list celebrity clients, you name it. And he is uninsurable after his attack, it cost him over a million dollars and a lot of grief and anguish, and it was all because one receptionist opened up an email that she shouldn't have.

Tyler Terry (13:22):
Wow. That is so sad to hear. Thank you for talking about know before. That's actually something that we do at Nextech as well. We use know before and we have to constantly learn and be trained and even have those simulated attacks where congratulations, thank you for reporting it. If you did it right and if you didn't do it right, you have to watch a video and your manager knows. And that's really, really important. This has been very buttoned up in terms of how you're protecting your practice.

Dr. Epstein (13:49):
And it's funny, if you want to get cyber insurance these days for the last couple of years, the carriers will send you a very detailed questionnaire that your IT people, your managed service provider needs to fill out and you have to be able to check all the boxes that you have, all these different features enabled or they're not going to give you insurance. And just to give you an idea of the cost of an attack, my attack in 2021, which resulted in no loss of data and no exfiltration, no one got my data, cost $114,000. I had a $10,000 deductible on my cyber policy, so it cost me 10 and they carry 104,000. The forensic evaluation alone, I believe was about $80,000 and it was another 10 or 15,000 for the IT people to mitigate the attack and reload the machines and restore backups. If you have to pay a ransom, it becomes a lot worse. The average cost of a breach right now in the world is about $5 million according to the IBM Panama Institute report. And in the United States, the average cost of a breach is twice that. Healthcare has been number one, highest cost of breach, 13 years running with a cost of about $10 million.

Tyler Terry (15:17):
Wow. Wow. Just that alone, I mean, that's reason enough to make sure you have all of these necessities in place.

Dr. Epstein (15:25):
So if you don't have insurance and you're in a position where you have to pay a ransom to keep your data, you stand a very good chance of losing your practice or losing a good substantial amount of money.

Tyler Terry (15:39):
Yeah. So let's shift gears a little bit and talk about a mini procedure. Can you tell us what a mini procedure is?

Dr. Epstein (15:49):
I hate the term mini procedure. To me, mini procedures mean mini results, but there are procedures that are micro invasive or mini invasive, less invasive that do produce significant results. I'll give you an example of what I'm thinking. People will come in and say, I want a mini facelift. Well, if you ask plastic surgeons what a mini facelift is or you go in the books, there's no such procedure. You have a certain amount of anatomical issues that you need to correct, and if you do anything less than that, you're going to get a substandard result.

(16:25):
So it's going to be a mini result. Now, if we're talking about a procedure such as breast augmentation, there are different ways to do breast augmentation and you can do it with standard incisions and cutting the muscle or going above the muscle, or there are some new procedures that have come out and will be available in the United States in a matter of months that will allow you to do the procedure with very small incisions, couple centimeters with a super fast recovery, less complications and better longstanding results.

Tyler Terry (17:05):
Really? That's incredible.

Dr. Epstein (17:07):
Stay tuned. There'll be more on that. I'm not permitted at this time to discuss.

Tyler Terry (17:11):
I was gonna say, Dr. Epstein, come on

Dr. Epstein (17:13):
Any more about the procedure, but if you follow me and you follow my Instagram, Dr. Mark Epstein, you will learn about these procedures when they come out. So stay tuned for the summer.

Tyler Terry (17:25):
And those who are listening to that, we'll be sure to include links to follow Dr. Epstein in the show notes. So what types of patients are most drawn to these types of, I don't want to call 'em many, but these types of procedures?

Dr. Epstein (17:39):
Well, I don't look at like patients being drawn to the procedures. Everyone wants less surgery and better results.

Tyler Terry (17:45):
Maximum results, right? Minimum downtime.

Dr. Epstein (17:48):
So everything do I try and do in that regard. Some things still require a bigger surgery, some things don't. But even when you go back 21 years ago when breast augmentation was a super painful procedure and not much has changed currently from back then I started doing a one day recovery breast augmentation, which still involved in incision, but the way the surgery was conducted, the pre-op preparation, the post-op care and just the overall process made it so that I can perform the surgery and have my patients out to dinner and shopping the day of surgery. And I've even had a patient who went to the gym the day of surgery.

Tyler Terry (18:29):
No way.

Dr. Epstein (18:31):
Way.

Tyler Terry (18:32):
That's incredible.

Dr. Epstein (18:33):
So there are ways to enhance recovery and of course no narcotic use goes without saying. So this has been the focus of my practice for over the last 20 years. So I'm always looking for a better way to deliver better results with less complications, less downtime, less pain, less risk.

Tyler Terry (18:53):
How can surgeons balance meeting patients' short-term desires with long-term aesthetic goals?

Dr. Epstein (19:01):
That's an interesting trick because you know the saying you want something good, you want something fast, and you want something cheap. Can have two, but you can't have all three. That's the problem sometimes. So I'll have a patient, I remember I had a very, very petite woman come in with no breast tissue to speak of, and she wanted to go from AA to a D, but she said, make it look natural. And she asked for a 450 cc implant. I said, I assume you just want one across the entire chest. No way I could fit a 450 in each breast. It's impossible. And a situation like that you can't do, or if you try and do it, you may get very good short-term results and then a matter of months later you create a disaster of complications and potentially create uncorrectable deformities.

Tyler Terry (19:58):
With these types of patients, how are you educating them? How are you studying the tone? Is that before they come in? Is that something that your staff does? Is that something that you're doing in that consultation?

Dr. Epstein (20:07):
Great question. Great question. My website has a tremendous amount of information and it's available in three forms on the website, depending how you like to learn. Every three years, I change my website for the last 20 some odd years. If you go on the website, there's written information and it reads like an online encyclopedia, but the advantage to the website is I can change it on the fly. I can add and remove text, add videos, illustrations, and we use all these things. The second place is the video gallery. The video gallery has a couple hundred videos I recorded with the Plastic surgery channel. I record about 20 to 30 videos a year with them.

Tyler Terry (20:46):
That's a lot. I've never heard somebody have that many videos. It's hard for me to get somebody to do 10 videos.

Dr. Epstein (20:51):
Oh, we have over 200. In fact, I recorded about 15 yesterday and I recorded videos for a procedure that I'm not going to be performing until this summer. So where in anticipation of all of that, and the third place is the photo gallery, we have almost 700 before and after cases of different procedures. So you can go on there and hopefully find someone similar to you that you can relate to and see what we can do with the surgery.

Tyler Terry (21:20):
Yeah, I love that you're feeding different mediums of content. I call this the Amazon like experience. You go to Amazon, Amazon's feeding us everything that we need to be more confident and comfortable to drop it into our cart. So on your website, you've got texts if you want to read it, get videos if you want to watch 'em, or you have before and afters if you want to look through them, whatever you want. Or maybe it's all of 'em, but it all there.

Dr. Epstein (21:40):
There's another opportunity that frequently is missed when the patient calls and makes an appointment to see you, there is a duration of time until they see you. The question is what are you doing with that duration of time? So we are using a partnership with Clarity Performance. And what Clarity Performance does is it allows me to leverage all the videos that I've made that are on my website and drip them to patients. What Clarity does right now is they have something called Journeys and Journey is like pick a procedure. You can have a breast aug journey, a lipo journey, a tummy tuck journey. So when the patient calls and makes an appointment, they with permission give their cell phone to my coordinator and my coordinator puts that into the Clarity website, and then they will be dripped videos based on the journey that they pick. The journeys and the videos are all very well done prerecorded videos, they are generic, but my patients say they've been quite good and they're happy with them. So I've taken it to the next level and I've created my own journeys using my own content. So in the next week or two, we're going to be launching all those journeys. So instead of hearing Katie, your host talking about breast aug, it's going to be Dr. Epstein talking about breast aug the way Dr. Epstein performs the surgery and what he feels that you need to know best. So the level of education is stepped up several fold.

Tyler Terry (23:09):
Wow, I've never heard of that before. Typically maybe watching one video if you're lucky to get the patient to do that, but the fact that you have journeys that are going to be tailored to the procedure on some type of cadence, I don't know if that's a weekly or every couple days or whatever it is. That's pretty next level. I'm very passionate about patient education and I love that.

Dr. Epstein (23:29):
The patients come in and they say, I feel like I know you. And when they come in for a consultation for say, a breast augmentation, which is a lot of information, it's a lot to know, if they take the time to learn the information before they come in, we take the discussion on a much higher level and the consult time is much better spent.

Tyler Terry (23:47):
You know that they're serious about what they're getting. They have better questions for you, right,

Dr. Epstein (23:50):
Better questions. And they're better empowered to make a decision that's right for them.

Tyler Terry (23:55):
I love that.

Dr. Epstein (23:55):
Because a lot of times there's options in surgery and this gives them a chance to learn more about the options and think about it and come in knowing what they think is best. And then we go through some questions and it's just a much better experience.

Tyler Terry (24:11):
Yeah, I love that you say that. So I've been with TouchMD all my career and then now Nextech, the last few years since the acquisition and TouchMD sales pitch has been, part of it has been, Hey, we're going to help you increase your conversion rates. And people would quiz me on that and say, well, what are you doing that's increasing the conversion rate? And it took me a while to figure out that it's the formula in which we're educating a patient and then a better educated patient has better questions for the surgeon and with better questions for the surgeon, the surgeon's going to be more teed up to get better answers. And he or she's obviously very professional in what they do, but they're going to be able to use that time to your point, that time with you during that consultation is more valued and they're going to be more empowered to make a better decision. And that's where the increased conversion rate happens because they're better educated and had a better consult.

Dr. Epstein (24:58):
Well, I got a great TouchMD story because

Tyler Terry (25:00):
I'd love to hear it

Dr. Epstein (25:01):
About maybe 10 years ago, no, actually more than 10 years ago, I was at the meeting and I met Carrie Smith and Jason Whitesides and looked at TouchMD and I said, wow, this is cool. I should get it. And I got it. But the problem was with every patient you enrolled, I had to manually enroll their name and their demographic info, which takes time during my consult, and it had an ability to mirror the data on an iPad to an Apple screen, but the technology was very poor, so the images weren't good,

(25:32):
It just wasn't working for me, and so I bailed. And I did without it for several years. Then I was back at the meeting and I run into Carrie and Jason again, and the pitching to me TouchMD, oh, I tried it. It didn't work. It wasn't any good for me. Oh, well lemme show you the new version. And I look at it, the ability to mirror using the Apple TV was phenomenal. The images were great. Now the data is integrating with Nextech through an API Active programming interface, which allows the data as soon as a new patient registers into Nextech, they're already in TouchMD, so I don't have to enter any demographic info.

(26:18):
And there's some other great features with it. TouchMD has probably got the best photo that I've ever seen, so how many patients know what their back looks like? But when I do body contouring, it's a 360 degree procedure. So I'll take pictures of the patient front back sides, and then we sit down and I say, listen, we are just two colleagues looking at discussing a case, and I can bring up the pictures and I can draw on the pictures and show them what I'm going to do. And then I can even put little text tags on like lipo here and tummy tuck there and whatever. So when they don't bring their significant other, they can go home and they have access to all the images I took and annotated, and they can basically look at the pictures and walk through it and explain to their significant other exactly what my surgical plan is. So it's an incredible tool during COVID, phenomenal for virtual consultations. And I get patients from all over the world, so when I do a virtual consultation, all their photos are uploaded to TouchMD. And the other thing is I'm one of the principal investigators in the US Motiva clinical trial, and we're about to start year seven in a couple months, and a lot of my patients have left the area and moved elsewhere. We can still do their follow-up using a virtual consult and they upload virtual images to TouchMD. So it's a really fantastic tool. I love it.

Tyler Terry (27:48):
I love that. I love that. Thank you for sharing that story. So talking about software a little bit, you mentioned Nextech and TouchMD, what are some ways in which you evaluate software? You mentioned that you rebrand your website every three years. How are you constantly investigating software, making sure that you're up to date with the latest and greatest you're at the show? Is that one of the ways? What are some of the ways to share with our audience that you evaluate?

Dr. Epstein (28:11):
Well, I've got a background in biomedical electrical engineering and computer science, and I've been writing software since I was in high school in the seventies. So I've written in basic and FORTRAN and Assembler and Machine and Visual Basic. And so I have an appreciation for what goes into software. And I've also learned to design and relational databases using Microsoft Access and creating my own front ends for data entry. So I got a good background in this, and way back around 1998, I actually coded my own rudimentary EMR, which I absolutely loved, and it worked very well for me. And then in 2011, Mr. Obama said, well, we should have everyone get EMRs. I'm going to pay for it. So I was like, Hey, if it's on your nickel, I'm in.

(29:00):
So I looked at Nextech and I looked at a program called Cosmetic Suite, and I like Nextech a lot more. Cosmetic Suite was good for my needs, but the price point of Nextech was triple Cosmetic Suite, and it was just for a single surgeon, and I was in practice at the time with a dermatologist. It was a good solution for us then. And then I was at the meeting maybe four or five years ago, and I was at the Nextech booth and I'm looking at the changes in the program and they said, now we're doing just cloud. And there were some definite improvements and I liked it. I said, well, what's the pricing? And they told me the pricing. I was like, that's what I'm paying now with Cosmetic Suite. When did things drop? So now it's

Tyler Terry (29:50):
You feel I'm getting so much more for the same. Yeah,

Dr. Epstein (29:52):
So now it's a total no brainer. So I looked at the Nextech, I looked at some other programs, competitive programs out there. While these programs may work better for some people, I needed something very robust. And for me, it's all about efficiency. So if you have a way to enter data in quickly, easily, and reliably, where the data, a lot of the data is taken by my medical assistants now. I can't rely on them. I can't even rely on myself to think of everything I need. But if you have a template that prompts you with all the important data points that you need, you're going to be very efficient at recording that data. Nextech comes with a lot of templates, but I found for my use, none of the templates were of any use, but it has a very important feature called a Global Template editor.

(30:46):
Which once you learn how to use it, it unlocks an incredible power of your ability to create templates the way you want very quickly and very powerfully. And it can even save data in certain elements. And then that data is then auto-populated into other templates when they're open, which is incredible feature. Now the Global Template editor, it's a little bit of a beast to conquer. You have to dedicate yourself to learn how to use it. But I worked with Heather Holland at Nextech and she was amazing, and it didn't take more than a few days for me to get comfortable with it. And alright, you could say, alright, I'm a computer geek, I can handle that sort of thing. But I had a nurse clinical manager who was working for me, and I showed her how to do a few rudimentary things with the templates and how to edit them. And she has no computer skills other than what anyone else has that's basic. And she was making changes in the templates on her own to update and suit our needs.

Tyler Terry (31:48):
Amazing.

Dr. Epstein (31:49):
And it's funny because I've had one colleague who had Nextech for many more years than I did, and we were talking one day and he said, how do you like Nextech? I said, oh, I like it a lot. I said, how are you doing with it? He goes, I'm just not getting benefit out of it. I go, let's do a Zoom session, show me what you're doing. And the mistake he made was he didn't create any custom templates. He was using what was out of the box. Now, I don't know any software application, anywhere that out of the box is going to solve all your needs.

(32:24):
But to give you an idea what we do with it, our MediSpa, we have probably 30 or 40 different procedural consents all templated into Nextech. My office-based surgery facility, all our forms, pre-op, instructional forms, medication forms, nursing intake forms or records, circulating records, recovery, overnight recovery, everything you can think of, there is a template for it. And all the data I need is captured. And if I find I need to add something or change something and my staff are good like this to say, okay, on this box here, can you change this and add this and take this away and auto-populate this somewhere else? And I do it and it takes 30 seconds. So I think Nextech is a total no-brainer for someone in the aesthetic industry.

Tyler Terry (33:15):
Yeah. Well, you shared so many great pearls there. I love when you said you're looking for something that helps you or allows you to get things done quickly, simply and reliably. Reliably is very key. Making sure that it's secure and

Dr. Epstein (33:30):
Absolutely

Tyler Terry (33:31):
All those different things. So shifting gears a little bit, so you mentioned you have a medi spa. Do you have any pearls that you can share with our listeners on how you're cross-selling your plastic surgery patients into becoming long-term MediSpa patients, focusing on that lifetime value of the patient, and then also your Medi Spa patients becoming aware that you offer plastic surgery services?

Dr. Epstein (33:55):
Well, one thing is having everything in one roof, one building makes it a lot easier. If I'm seeing a patient, I've done surgery on them, maybe they have some scars and I want to laser them, I can go grab my aesthetician real quick, bring her in the room and say, what do you think about doing these scars? That's one example. Or I'll be talking to a patient, she wants to lose some weight or it's just opening up the conversation. I spend a lot of time with my patients, I get to know them so they feel comfortably. The woman may be in her mid forties, I'll say, I'll start the conversation how things at home, you feeling kind of sluggish. You feel like you got your energy, or do you feel sexually you're deteriorating due to menopause or whatever. And they'll all be honest with me and they'll say, oh yeah. And I'll say, well, you got to see Janet. She's just doing amazing jobs with hormone replacement. And the patients love it and the results are great. And then on the med spa side, they'll see someone and they need something surgical and they just grab me and I come in and see it. So there's a lot of cross population that way.

Tyler Terry (34:59):
I love that because then you're under promise and over delivering instead of trying to over-promise and something nonsurgical, you can come in immediately and say, Hey, you know what? You're not going to get the results that you probably want there, but surgically I can help you. Let's again, shift gears a little bit. I'm very excited to ask you this question and to hear your take on it, and I think you're going to have a hot take for our audience. Let's talk about aAI What are you most excited about with AI that you can share with us today?

Dr. Epstein (35:28):
I'm a little bit new to AI, but then again, everyone else is. I will say AI is not the solution for cybersecurity, although the will make you think it is, it's not. But for everything else, it's incredibly impactful. I did presentations at this meeting and also at the Aesthetic Innovation Summit, and I created them using an app called Gamma. It's Gamma App Forward create, and you go on the web and it's an inexpensive program. You can get the pro subscription for $180 a year. Best money I ever spent because I made it back the first day in the time I saved creating a incredible PowerPoint presentation that I couldn't in a million years do if you gave me all the time in the world.

(36:12):
And it's really cool. You create these cards, which are sort of slides, but they're called cards and they have the text information you want, and that serves as a prompt for the ai. And then the AI goes to town and it creates all the graphics and it does varying types of graphics from one card to the next and creates AI images. And if you don't like the AI image, you create a prompt. And I had one where I wanted to show a woman thinking about what she'd look like with a breast aug. So I typed in the prompt, young, attractive woman being pensive, looking upwards, thinking about what her body would look like with a breast augmentation. And it produced the image in about 30 seconds, and I was just blown away by it.

Tyler Terry (37:03):
Wow, isn't that incredible? You didn't have to go find a website and try to buy the rights to it, or you didn't have to go hire a model to do it, to take a picture or any of those things like you were able to in real time, what? Probably less than a minute, get that image.

Dr. Epstein (37:15):
Yeah, I did the whole presentation in an hour, but when I first saw the app on my phone at 11 o'clock at night before I was going to bed, I said, all right, I'll do a little test in it. I said, give me a presentation on cybersecurity. And that's all I put in. And it created eight incredible slides because it went out to the internet and educated itself on what was important. And as someone who graduated the Harvard Program on cybersecurity a couple years ago, I looked at this, I said, wow, this is a great mini presentation.

Tyler Terry (37:48):
Yeah.

Dr. Epstein (37:50):
I did my breast aug presentation with Gamma, and I've since passed it on to other surgeons.

Tyler Terry (37:54):
And how nice is that when you can actually save time so you have more time to enjoy the show or enjoy your family or more time to do surgery, right?

Dr. Epstein (38:02):
Yeah.

Tyler Terry (38:02):
Instead of spending 20 hours building these slides for your talks here.

Dr. Epstein (38:06):
Yeah. I also had a podcast called Cosmetic Conversations on one of the local radio stations, and I did it with a woman who was from the aesthetic industry, and she would text me at six in the morning on the day we were recording at 10:00 AM and she'd say, what do you want to talk about? And of course, I've been so busy I hadn't thought about it. So I'd pick a topic, put it into chat, GPT, and it gave me all the talking points for the whole show. Amazing. And two minutes later, I said, this is what I want to talk about. I'd send it to her. And she's like, wow, when did you have time to do this?

Tyler Terry (38:39):
That's incredible. I love that. So I have a question. What are you seeing with patients, there used to be that joke of, oh, did you ask Dr. Google? Right now we have kind of Dr. AI or Dr. Chat, GPT, Dr. Grock, right? How are patients coming into your office now educating themselves, maybe unrealistically? Are you seeing a change where they're coming in and they're asking questions based on what they asked AI?

Dr. Epstein (39:03):
Great question. I'm going to answer it now. And when we reconvene for podcast in a year, I guarantee you I'm going to give a different answer.

Tyler Terry (39:10):
Yes.

Dr. Epstein (39:10):
Right now it's still Dr. Google, but the power of AI is that it can go and digest videos. So when I started my website over 25 years ago, I was dedicated to creating an online living book like encyclopedia.

(39:29):
So all my content was custom created in great detail. When you go on most plastic surgery websites, the amount of content is very minimal and very generic. In fact, sometimes you could just highlight it, put it into Google, and 50 websites will pop up with the exact same paragraph. So that's useless. So I've been dedicated to a robust content, and then for the last 10 years, a lot of video. So my website's over 200 pages and has probably a couple hundred videos on it. So the power of AI is, it can digest all that content and all that video, and my YouTube channel has a couple hundred videos on it. So again, all that content can now be digested by AI. Unlike Google, which can't digest the videos, AI can. So as people start going to AI as a means of doing a search rather than Google, I'm going to benefit from that effort, that whole idea of 25 years ago about putting so much content on my sites.

Tyler Terry (40:35):
Yeah, thank you for that answer and for that insight. I'm kind of getting towards the end now, Dr. Epstein, but I wanted to ask you if you have any final thoughts that you'd like to share with the audience?

Dr. Epstein (40:45):
I think it's a very, very exciting time in the aesthetic arena. New procedures, new techniques, results are better with the new Motiva implants. It's been a life-changing change in my practice. I've been in the study for seven years, so I have a lot of experience with it. And the new developments coming from Establishment Labs are absolutely incredible. And you're going to see very soon in this country, breast augmentation is going to be really turned upside down, inside out and around for the better for our patients.

Tyler Terry (41:12):
Dr. Epstein, I want to thank you again for taking time today to join me on the podcast. I have so much respect and admiration for you and what you've built with your practice and all the different things that you've accomplished. Appreciate you being a power user of our technology Nextech, and TouchMD, would love to have you again on the show. Maybe it's next year at this conference.

Dr. Epstein (41:31):
I would love it.

Tyler Terry (41:31):
Another time. But for those of you listening, be sure to check out the show notes to follow Dr. Epstein, maybe on LinkedIn, Instagram, all of the above. And until next time, Dr. Epstein would love to have you on the show.

Dr. Epstein (41:45):
Thank you so much.

Tyler Terry (41:45):
Thank you.

Dr. Epstein (41:46):
Take care.

Announcer (41:48):
Thanks for listening to Aesthetically Speaking, the podcast where beauty meets business, presented by Nextech. Follow and subscribe on Apple, Spotify, YouTube, or wherever you like to listen to podcasts. Links to the resources mentioned on this podcast or available in your show notes. For more information about Nextech, visit nextech.com. Or to learn more about TouchMD, go to touchmd.com. Aesthetically Speaking is a production of The Axis, theaxis.io.