Will Kirby, DO, FAOCD, Talks With Kian Karimi, MD, FACS

Kian Karimi MD, FACS, is a world-renowned facial plastic surgeon and head and neck surgeon, double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology – Head & Neck Surgery. He is considered one of the nation’s top facial plastic surgeons and an innovator in advanced surgical and non-surgical treatments. Kian maintains a thriving medical practice in Los Angeles that focuses on rhinoplasty, revision rhinoplasty, and face and neck lifting procedures. He has been featured in the media regularly on shows such as "The Doctors," "EXTRA!," and "Entertainment Tonight."

Kian Karimi MD, FAOCD

Dr. Karimi! Let’s jump right into it: What's the best piece of aesthetic career advice you have received?

That would be from my mentor, Peter Adamson, MD, FRCSC, FACS, during my fellowship in facial plastic reconstructive surgery. He told me that If I believe in myself with the interests of my patients and their aesthetic needs, and, above all else, I remain a safe, ethical, and humble practitioner, and a lifelong student, that I would enjoy a fulfilling career and life. He could not have been more correct.

Words to live by! What adversity did you have to overcome on your journey?

The biggest adversity, besides the constant competitive nature of getting into the best residency, the best fellowship, etc., was when I decided to move to Los Angeles to start my practice, despite not having connections, family, or job offers. I reached out to different practices in the community looking for opportunities. I was told by several doctors that I had made a mistake by coming out and “hanging a shingle” to start a private practice on my own and that it would be very unlikely that I would survive. Rather than let jaded surgeons dissuade me (herein referred to as “the haters”), I decided that I was going to make it happen and be successful.

I’m biased but I agree that Los Angeles is definitely ground zero for aesthetics and the best practitioners and practices are absolutely coming out of Los Angeles! What resources are the most effective in making your life in aesthetics easier?

That would be my amazing team at my medical center, located in Brentwood. I founded Rejuva Medical Aesthetics in 2015, and we started off with a team of 3. We are now 27 strong, and each individual in our organization is exceptional. Because I have strong support from my team, it enables me to do what I am good at, which is providing the top care and results in both surgical and nonsurgical aesthetics and plastic surgery.

I wholeheartedly agree, our teams are what keep us strong and 27 is an impressive number! What should aesthetic providers invest in right now?

Aesthetic providers should invest in themselves. What I mean by that is, if they want to do aesthetics, they really need to understand the full cycle that a prospective patient will go through before finding them. This includes their online presence with reputation, reviews, and social media sites. One does not need to spend a lot of money on marketing. They simply make sure that their online presence is diversified, creative, and representative of the work that they do and who they are. If you do a good job of this you will get the type of client that YOU want.

For the injector, I believe in training, education, and constant learning to stay on top of this rapidly changing field of aesthetics. This includes anatomy training, utilizing the training provided by companies, and independent trainings with providers that you respect and are good educators. Meetings can be a good way to pick up some pearls but don’t take the place of intimate, hands-on training opportunities.

Entrepreneurs don’t need an MBA to be successful – simply pay attention to details, ask questions from peers in the space that are doing it well, and frequently review your own metrics and ask “how do we cut down on costs and maximize our productivity while not sacrificing our commitment to safe and excellent patient care and results”?

Moving forward, what role do you feel, if any, that allied health care professionals (RNs, NPs, PAs,) play in aesthetics today and what roles will they fill in the future?

Natalia Guzman FN-P, joined me shortly after I established Rejuva Medical Aesthetics and together and we have shown what the surgeon/nurse team can achieve. She is now a world-renowned injector, an educator and is incredible at what she does, making sure that we continue to deliver the highest level of care and outcomes for our aesthetic patients. I find that when we empower our allied health care professionals, they only elevate us and make us better. This was part of my inspiration for founding the Los Angeles Multi Specialty Cosmetic Academy in 2018 as a forum for physicians and allied health care professionals from all specialties and backgrounds to educate each other in a four-day symposium. We will be holding our sixth annual meeting this coming March in Beverly Hills!

Congrats - Much like yourself I am a big proponent of incorporating allied health care professionals into our industry. Hopefully the subjugation of our allied health care colleagues by our physician peers will cease, and degree diversity will be embraced sooner rather than later. Now then, why do so many people feel that the aesthetic industry is ripe for disruption?

There are emerging technologies and therapies that are coming out, and both potential patients and practitioners are equally excited about the present and the future of aesthetics. The prospective aesthetic client is also capable of acquiring tremendous amounts of information and knowledge about aesthetic treatments. However, there are a lot of channels that put marketing over actual science, information and results. I believe that prospective patients are becoming very savvy in being able to identify things that will be useful versus treatments that are simply being “sold.” I think the companies are taking a risk by having “celebrity” spokespeople endorse their products – personally I don’t think it is wise marketing.

That is very interesting. To shift gears, attendance at aesthetic conferences has fallen dramatically and the dip can no longer be blamed on COVID-19. What went wrong? How do we fix it and/or should we even try?

Attendance at physician conferences has fallen but if go to any non-physician conferences, you will see record-breaking attendance.

Fair point! Allow me to clarify and restate that question: Why have we witnessed the rapid demise of the traditional physician conferences?

A lot of conferences utilize the same blueprint and are organized by the same people, which has become tiresome for many of the attendees. When I attend a conference, I want to see fresh content from bright minds, I want to see emerging technologies and techniques, and I want to learn practical tips that will be applicable to my own practice. As put so eloquently by my dear friend, Shino Bay Aguilera, DO, I want to interact and learn from givers and not takers. Sometimes it is hard to know whether something that we are watching, or learning, is commercially biased and to what degree. Also, I am weary of some of my colleagues simply presenting “show and tell” presentations that simply show their very best results without providing a framework for how those results are achieved.

You aren’t alone in your stance. Many other interviewees have also told me that the traditional conference organizers and speakers have lost credibility, and it’s clear that many of our colleagues no longer trust their endorsements and professional opinions. Some have argued that it’s embarrassing and that we need to lean on device and injectable manufacturers to stop enabling these individuals and events but that a discussion for another day. So, we know that reputable providers now are skipping the compromised conferences and shifting their focus to new events where they can still enjoy learning and teaching. And that’s just one healthy and meaningful way for clinicians to interact and contribute to our profession and to avoid professional burnout. What other advice do you have for people in the aesthetic space to avoid ‘burnout’?

Burnout is very common in health care, and I believe that we suffer burnout and aesthetic space partially because we are constantly surrounded and bombarded by what others are doing in their practices. We often forget that what we see on social media is the top 1% of results achieved by an aesthetic practitioner, whether it be a surgical outcome or nonsurgical outcome. Also, sometimes we will see practices that are successful at social media in terms of getting attention, but this may not resonate with our style or our standards of professionalism. My advice is to be authentic, to realize what you are good at and to highlight that and to celebrate that in your own practice. Also, it is important to take good care of your staff and good care of your patients. I have always believed in community over competition. I believe if you're good at what you do and that people like you, you will be successful. Everything else is simply noise.

With so much confusion in the industry, and with so few uncompromised voices, where do you personally go for trusted aesthetic information?

There is a lot of confusion in the industry, and I have the luxury of being able to speak with other practitioners that I know will give me honest answers. When it comes to actual aesthetic information, I still read scientific articles and try to find out information for myself rather than simply relying on a company or a representative of the company.

I know that my group saw unbelievable growth recently, is that true for your practice as well?

Like many practices, we enjoyed a tremendous growth after the COVID-19 shutdowns, and we have an incredible team that we have acquired over the last several years. This is a good problem to have. However, we want to always make sure that we provide our patients and clients with an individualistic experience.

What is your favorite quote (mantra, etc.) that is applicable to the aesthetic industry?

My favorite quote is that “good work is not seen.” We really adhere to this whether we are recommending surgical modalities like rhinoplasty or face and neck lifting procedures, or nonsurgical modalities like injectable fillers, polydioxanone threads or lasers.

What advice do you have for someone not in the industry who wants to enter the field of aesthetics but doesn't know where to start?

It’s important to find a mentor or practice that will help you learn the skills you need to learn, rather than simply put you in a factory to try and sell as many services as possible. I also highly recommend hands-on cadaver courses to really get comfortable with the anatomy of the face, which can be intimidating. Physicians Jonathan Sykes, Chris Surek, and Sebastian Cotofana have some of the best injection-related anatomy courses out there. I think finding one that gives as much “hands-on” experience as possible is key.

What will the aesthetic industry look like 10 years from now?

We will have an incredible selection of injectables and new technology to be able to inject these products with minimal complications. We will have biostimulators combined with hyaluronic acids. Threadlifts will be common and accepted. We will hopefully finally figure out stem cells and how they grow our hair back, produce grafts we need for surgeries (bone, cartilage, fat, muscle, skin) regenerate our damaged or lost tissue, and improve our aesthetic. We will have “smart” syringes that will not allow injection of filler into blood vessels when the needle or cannula is detected to be within a blood vessel of a large enough caliber to cause vascular occlusion. Cannabidiol will be used for many different aesthetic indications. Space age stuff but it’s coming.

What does your aesthetic legacy look like?

My legacy is the Multi-Specialty Cosmetic Academy (MCA) that I chair and cofounded in 2017. The MCA is a forum where doctors, nurses, and other aesthetic professionals get together every spring for several days in Beverly Hills to exchange ideas. As course chair, I do my best to put together a program that has as little bias as possible and to have proponents and opponents give balanced views on different topics in the aesthetic space. For example, one year I had a debate on PDO threadlifts, as this is a controversial topic, and I wanted both sides to be presented. I also have started an injector fellowship and a surgical fellowship focusing on rhinoplasty and facelifting procedures to give back to my society and to the younger generation.

Thank you so much for the honest and transparent insights, Dr. Karimi. You clearly have your fingers on the pulse of the industry. How can readers get more aesthetic expert information from you?

Find me on Instagram at @drkian, on my practice website: drkian.com, and please attend my educational meeting by signing up at www.cosmeticacademymeeting.org!