In this month’s “Meet the Aesthetic Expert” column, Will Kirby, DO, FAOCD, talks with Alexander Zinovy Rivkin, MD, an aesthetic specialist and assistant clinical professor at the David Geffen School of Medicine at UCLA.
Welcome to “Meet the Aesthetic Expert,” where, each month, dermatologist Will Kirby, DO, FAOCD, of LaserAway, will connect with select industry leaders to get their expert opinion on the aesthetic specialty. With an emphasis on straightforward, candid questions, Kirby will focus on the best in aesthetics and get the experts’ frank thoughts on where the field is headed.
Alexander Zinovy Rivkin, MD, is an aesthetic specialist and Assistant Clinical Professor at the David Geffen School of Medicine at the University of California—Las Angeles. He received his undergraduate degree from Columbia University and his medical degree from the Yale University School of Medicine. His residency in Otolaryngology and head and neck surgery was at the University of California San Diego School of Medicine. His practice, Westside Aesthetics, is focused on developing and perfecting non-invasive, non-ablative cosmetic treatments. He is best known nationally for pioneering and popularizing the non-surgical rhinoplasty procedure. In 2020 he authored the largest statistically comprehensive study on non-surgical rhinoplasty in the medical literature. He has authored numerous peer-reviewed publications and chapters on non-surgical cosmetic treatments and serves as a lead investigator on FDA and National Institutes of Health (NIH) clinical trials on a regular basis. He frequently trains physicians from all over the world on optimizing advanced injection techniques and serves as an expert for national media, including the TODAY show, The Doctors, Good Morning America, Entertainment Tonight,and EXTRA. Rivkin divides his time between patient care, clinical research, physician education, media appearances, and lecturing at scientific conferences throughout the world.
Kirby: Hello Dr. Rivkin! Let’s jump in. Can you please tell us a little about your backstory?
Rivkin: My family and I came to this country in 1975 from Odessa, in the USSR. I was 7 years old. My grandmother survived World War II by doing clandestine beauty treatments and selling homemade beauty products as she and my mother fled from the Nazis. This was a particularly dangerous survival strategy because private commerce was punishable by the government.
By the time my mother grew up and went to beauty school, my grandfather, a pharmacist, had become involved in the family beauty business and under my grandmother’s direction, a steady stream of creams and products were flowing out of our apartment. My mother carried on the legacy and developed a devoted clientele for her secret facials and treatments in Odessa. Funny thing about my mother is that when she was a young esthetician she lived in Siberia for a while because my father got posted there for work. She was the only beauty practitioner for miles, so she was performing intense phenol peels on young women who wanted to improve their acne scarred skin. According to her, she had great success. “Their face turn black, like bottom of shoe, then 3 days later, black fall off, and they come back crying happy because skin look like baby skin!” she would say!
After we emigrated, my mother went legit and founded her own facial salon, called “The Skin Care Clinic.” She ran it for 25 years in Brookline, Massachusetts, where we settled. So, I guess I carried on the family tradition!
K: So, what initially led you to an aesthetic career path?
R: Prior to medical school, I was always drawn to the arts and literature. I admired the writers, thinkers, and artists that I encountered who filled the world with beauty. I longed to be the kind of person who could change the world, if even in a small way, by creating something unique. Needless to say, these aspirations were put on hold during medical school and residency, until I considered the aesthetic field. Aesthetic procedures made me remember how much I missed being creative. It was like a part of me that had been asleep for a very long time woke up.
K: What adversity did you have to overcome on your journey?
R: Because I chose to not practice as an ear, nose, and throat (ENT) physician, and I was not a dermatologist or a plastic surgeon, I have never had a seat at the table in society meetings or core conferences. I never had mentors and could not ask for help or advice launching my practice and career. Fortunately, this was such a new field that everyone was making it up as they went along, so, in terms of technique and best practices, I soon realized that my ideas were as good or better than what the thought leaders at the time were doing. I knew that without those affiliations, my name had little value to the dermatologists and plastic surgeons in the field, so if I wanted patients, I had to attract them myself. No one was going to refer to me. Striking out on my own was quite risky – I had no safety net and failure could have been financially devastating, but it was thrilling and it worked out very well in the end.
K: What is something interesting about you that you have never before publicly revealed or isn’t widely known?
R: I trained as a head and neck surgeon, but never actually practiced. My residency training experience was grueling and, although I was a good surgeon, I decided to jump into this brand-new field of non-surgical aesthetics as soon as I came out in 2002. I saw it as a chance to develop and refine procedures that had never been done before. To me, this was an opportunity to create beauty using brand new tools – fillers and neurotoxins – just approved by the FDA.
K: What resources are the most effective in making your life in aesthetics easier?
I try to delegate as much of the business and marketing side of the practice as possible, so my most valuable resource is human capital. Hiring talented, capable, motivated, and creative people is critical for the success of a business. I’m not someone who is going to sit down and crunch the financial numbers, or collate the results of an email campaign. I need people who can do this and help me make strategic decisions. I can tell you that I’ve made many more errors in hiring people than I have had success. Maybe it’s because Los Angeles is the land of make believe, but I have been fooled many times over the years. Thankfully, we have an outstanding team these days and, as a result, I’m very happy with the growth of the practice and our expansion into areas such as Beverly Hills!
K: What resources (technology, human resources, staff education, marketing, etc.) should aesthetic providers invest in right now?
R: There is a flood of aesthetic providers. Existing doctors and nurses are attracted to the independence and lifestyle of aesthetic medicine and new injectors are being minted every day. Providers must rise above the crowd to be noticed and the differentiation, for the most part, happens these days on social media. Instagram and Tik Tok literacy today is a pre-requisite for success in our field. You have to determine what your brand is online. What works for you and comes naturally and is appealing to an audience. The trick is to figure out a time balance because social media can take over your life, leaving you with no free time. You have to invest your time efficiently and do the research to understand what works and what doesn’t for you and your brand.
K: What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?
R: Young women, in their 20s and 30s, are a much bigger aesthetic patient demographic than ever before. Social media has propelled awareness and education about what we do and these patients want to take advantage of the procedures we offer. They understand the value of preventative procedures and do not want to wait until they look like their mothers to start treatment. They want to avoid looking like their mothers all together. They know that injections and devices can make them look better, not just younger so they come in to get tweaks and subtle changes. They are much more likely to be open about what they do, so word of mouth is quite important with them. Of course, they are also quite disloyal and a special or a Groupon can sway them to try another provider.
K: Telehealth exploded during the pandemic. Is it here to stay?
R: I think it’s here to stay and will be a great help for patients who want to fly in for treatment. They want to have the peace of mind of doing the consultation without being forced to commit to a plane ticket. Tele-consultations will not replace face to face aesthetic evaluation, but will certainly be useful as a screening tool for whether the patient is an appropriate candidate for the kinds of procedures the office offers.
K: What steps should the aesthetic industry take to increase overall market penetration?
R: Social media is the preferred vehicle for communication and information gathering these days. Cosmetic practitioners need to not only embrace it, but also understand it and become proficient in how to communicate through it. Social media provides us an unparalleled opportunity to connect with our patients, make them comfortable with us and allay their fears about the procedures we perform. If we can show them that it is possible to enhance and beautify without making people look unnatural, we can expand the number of people opting to come to our practices.
K: What role do allied healthcare professionals (RNs, NPs, PAs,) play in aesthetics?
The role of allied professionals in our field is massive and growing. Some of the best injectors out there are allied healthcare professionals and their skills are finally getting the recognition they deserve.
K: What is the biggest myth in the aesthetic industry?
The biggest myth is that what we do is governed by evidence based, scientific principles. Most aesthetic practitioners learn from their more experienced colleagues who themselves decide how to do things via trial and error, discussing with the peers they trust, and under the paid influence of industry. Much of the aesthetic literature consists of relatively low evidence quality research such as retrospective case reports, small uncontrolled prospective series, opinion pieces, and the like. The good blinded prospective studies are almost all funded by industry and are designed for FDA approval and marketing purposes. The reason for this is that academia is dismissive of aesthetic medicine and plastic surgery, there’s few government-funded research grants, so the research is being conducted in private clinics with industry money. This pattern will continue until more independent research funding materializes and our academic institutions can start generating good data.
K: What keeps you up at night?
R: I am always concerned about late presentation of ischemia in my injection patients, especially my non-surgical rhinoplasty patients. I’m less worried about the majority of cases that show signs while they are in the exam room – those I can treat and prevent progression. It is the rare cases where the skin looks fine in the chair, but then develops signs of ischemia later that night that progress, get mistaken for a skin infection by the Urgent Care doc and develops into full blown necrosis by the time they call me.
K: What can the aesthetic industry do to increase diversity and inclusion?
R: The industry needs to become more inclusive. For example, more people of color (POC) in ads, more representation in brochures, etc. This is starting to happen, it seems, as the industry has woken up to the fact that POC have money and are willing, theoretically, to spend it on aesthetic treatments. What has not happened is representation in the C (exceutive) suites. The power in the industry is still held, as it is in most other American industry, by older white men. That needs to change for diversity to really happen.
K: Why are we seeing decreasing interest in conferences and lower conference attendance?
R: The same talks are delivered by the same people paid for by the same companies. I think that conference attendees are also tired of seeing the same key opinion leaders (KOLs) deliver frothy talks full of superlatives about a company 1 year and its competitor the next because in the following year, the competitor outbid the original company for the KOL’s opinion. Attendees want to learn about how experienced people actually do things, not hear some KOL drone on, repeating company boilerplate about a product they never actually touch themselves.
K: What advice do you have for people in the aesthetic space to avoid ‘burnout’?
R: Don’t try to do it all. Seeing patients, handling the admin, doing your own Instagram page – it’s way too much for one person to handle and it will slow down your growth. Invest in a good team and focus on the things you are expert at doing and you will grow faster.
K: What is your current biggest personal operational hurdle and what could be done to fix it?
R: The availability of professional and capable staff. More reasonably priced staffing agencies would help, but also, better education at the level of the MA schools and nursing schools for people who want to go into the aesthetic industry. Some of these schools could run certification courses for front desk and back-office positions so that we don’t have to do all of the education post hiring.
K: What is your favorite aesthetic treatment to personally receive?
R: The one I have time for because I usually don’t have time for any!
K: With so much confusion in the industry, where do you personally go for trusted aesthetic information?
R: Colleagues I trust.
K: 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?
R: Get the necessary degrees, read as much as you can, and then go shadow as many people as will let you into their offices. Look not just at how they inject or what settings they set their lasers to, but how they handle patients, what the patient experience is, and how they deal with problems.
K: What advice would you give your younger self knowing what you know now?
R: The smart older people in that room mostly want you to succeed and not fail. They know that you don’t know everything. They know that they don’t know everything either. The others in that room don’t matter. Always prepare, always absorb as much as you can at every opportunity you can and never be embarrassed. Just like dating, self-confidence is magnetic and will get you very far, even if you’re actually faking it. Half the people on that stage are saying things they’re not totally sure about with so much confidence that you’re thinking they have a PhD in the subject when they don’t.
K: What will the aesthetic industry look like 10 years from now?
R: There will be more fierce competition for the status of “expert.” This competition will be mostly played out on social media. Also, lighting, make-up, and subtle head position tricks to enhance the before and after differences will become passe´ (I hope). The optimist in me wants to say that we will elevate those with real artistic talent and real ideas above the charlatans.
There will be more variety of fillers and toxins with more effective skin tightening technology. We may develop topical hair growth formulations. We may develop anti-aging treatments that are truly customized to the patient’s DNA profile. It will be exciting to see.
K: And what does your personal aesthetic legacy look like?
I pioneered and popularized non-surgical rhinoplasty. I hope to be remembered for championing evidence and common sense-based ways to perform the procedure with minimal risk and maximum results.
Thank you so much for this fascinating interview! How can readers get more aesthetic expert information from you?
@Dr.rivkin for my personal Instagram and @rivkin_aesthetics for the business Instagram.