Aesthetic Medicine Ambassador

By Linda W. Lewis

One of the pioneers in aesthetic medicine, Michael H. Gold, MD, now lectures internationally on a wide range of subjects from acne treatments to laser lipolysis. After completing his undergraduate degree at Tulane University in New Orleans and his doctorate in medicine at the University of Health Sciences, The Chicago Medical School, he served his internship in internal medicine at Emory University Hospital in Atlanta and his dermatology residency at Northwestern University School of Medicine in Chicago. He is founder and medical director of Gold Skin Care Center in Nashville, Tennessee, one of the lead- ing dermatology centers in the country, which includes The Laser & Rejuvenation Center, Advanced Aesthetics Medical Spa and the Tennessee Clinical Research Center. In early September, he talked with us about the growth of his businesses and how aesthetic medicine has developed over the years.

Nashville, Tennessee, may seem like an unlikely destination for a young man who grew up in Philadelphia, and studied and trained in cities like New Orleans, Chicago and Atlanta, but Dr. Gold married a Southern lady and had family in the South himself. When he finished his residency, it was a flourishing practice in Nashville that presented him with the best opportunity.

“It was a great combined medical/ cosmetic practice,” he explains. “All of us are a product of our experiences. I did my dermatology residency at North- western University, where I worked with Dr. Henry H. Roenigk, one of the true pioneers in cosmetic dermatology. The first day of residency, I did a hair transplant! Of course, I learned the dermatology basics as well, but by the end of the residency I was very comfortable doing sclerotherapy, collagen injections, liposuction, hair transplants and excision surgery with a cosmetic flair. I love dermatology but I also enjoy the cosmetic approach. It was natural that when I entered practice, cosmetic dermatology was part of it.”

Although he spent only a year there before opening his own Nashville prac- tice in 1990, Dr. Gold credits the experi- ence with helping him learn about running a practice and how to think on a bigger scale. His own practice started small. “There were only three of us: a receptionist and a nurse, both of whom had come with me from the other practice, and me,” Dr. Gold recalls. “We did everything from treatments to marketing to billing. A few patients followed us to the new location and we were able to build the practice quite rapidly. There wasn’t a lot of competition for the services I offered in Nashville, and the medical community there was quite open. I would hang out in the doctor’s lounge in the hospital, and as I got to know the local physicians, they became a great referral base.”

Big Business
The Gold Skin Care Center is very dif- ferent now. Its four divisions employ a total of 55 professionals. Gold Skin Care Center, which is the medical dermatology practice, includes Judy Y. Hu, MD, FAAD, several nurses, a physician assistant and other support staff. “We have 22 exam rooms, including four surgery suites,” says Dr. Gold. “The waiting room will hold 50 people. I’m not one who believes you have to have separate waiting rooms for medical dermatology patients and cosmetic patients, but we added the Laser and Rejuvenation Cen- ter because we ran out of space in the dermatology waiting room.”

The Laser and Rejuvenation Center, which was added in 2005, includes 10 treatment rooms and its own reception area. Drs. Gold and Hu oversee three nurse practioners and nine nurses, and the center offers every kind of filler, Botox Cosmetic (Allergan) and a wide vari- ety of laser and light procedures.

Dr. Gold has hired business specialists to oversee every aspect of his operation—a practice administrator, human resources director, accounting director, billing director and marketing director. “I’ve had help running my practice since I started,” he acknowledges. “My father ran several pharmaceutical companies so I saw the business side of medicine early on, and I’ve always had an aptitude for business. Years ago I actually got booed on stage for saying that I was a dermatologist and a businessperson. A few years later that same group invited me back to lecture on the business aspects of running a practice. Today, lots of us know that dermatology practices are businesses and you can make of them what you want. My philosophy has always been to hire knowledgeable businesspeople and give them the opportunity to succeed.

“I didn’t start out to build this kind of operation,” he continues. “It kind of grew organically. I added the Medical Spa early on because I think selling skin care to my patients is important. We sell about 500 products from more than a dozen brands.”

The Medical Spa employs three estheticians. In the past, there have been as many as seven employees, including massage therapists and nail technicians, but Dr. Gold has found that restricting the business to skin care makes the most sense. The estheticians perform facials, cellulite treatments, microdermabrasion and other cosmetic treatments such as spray tanning.

“I’m personally involved in the skincare products we sell. One of the reasons I started the Medical Spa was because an aunt said to me: ‘The dermatology offices I visit in New York always have things I can buy. It’s very helpful.’ Since Northwestern had a tight research rela- tionship with Estée Lauder, I set up a retail program with them, which lasted for years,” says Dr. Gold.

The close relationship between cosmetic skin care and dermatology is one of the reasons for Dr. Gold’s success. “I was one of the teens involved in the original Retin A trials, and acne treatments have continued to be a major interest of mine. There are not many acne patients who I can’t make better—and treating teens with acne is very good for business. When the kids’ acne clears, their moms come in for treatments they’ve learned about while sitting in the waiting room. Then they bring in their friends and relatives.”

The doctors at Gold Skin Care Center use a combination of topical medications and devices to treat acne, including tretinoin, retinoids, antibiotics, blue light, IPL and Isolaz (Aesthera). “I just published a report on Isolaz. Many patients get better after two to four Isolaz treatments, but I do use it in combination with medications. The Smoothbeam (Candela) is also showing good results. And, of course, I am a proponent of PDT for acne.”

Jessica Hayes, director of marketing at Gold Skin Care Center, confirms that 80% of their marketing targets existing patients, letting them know about additional services and setting up referral programs. “We publish a glossy magazine twice a year that includes lots of information about available services and concentrates on what’s new,” she says. “To attract new patients, we do some print advertising in local social and lifestyle magazines and we have an aggressive physician outreach program designed to generate physician refer- rals. There are 200 family practices in the area and we try to make presentations to each of them. We also have several events each year.”

Looking Back and Ahead
What sets Dr. Gold apart from many successful medical aesthetic practitioners is his involvement with research. How did that come about? “You need some luck,” says Dr. Gold, “and you need to enjoy working 12 hours a day to keep up with the writing and lecturing.”

His research operation began around 1994 when a friend of a friend called about a new IPL device for hair removal, the Epilight. “Publishing the research on that device put me in the spotlight and was a boon to my cosmetic business,” he says. “The second big research project was for Cica-Care (Smith & Nephew), topical silicone gel sheeting for the treatment of hypertrophic scars and keloids. It was originally used in burn centers but I found it could be used prophylactically to prevent scars of all kinds,” he says. “I was also lucky enough to be involved with the development of photodynamic therapy, working closely with DUSA on the development of Levulan.”

The Tennessee Clinical Research Center, a full-service clinical research organization, now has a staff of 12 and performs clinical trials for a variety of pharmaceutical and medical device companies. Over the years his research group has worked on acne medications, pharmaceuticals for eczema and psoriasis, and on dozens of devices used in dermatology and aesthetic medicine.

“We’ve come a long way from those early machines,” he notes. “In hair removal, for instance, there was a shift to longer wavelength lasers to treat darker skin more safely and then a shift back to improve efficacy. We now use a variety of devices—IPLs, alexandrite lasers and 1064 lasers for hair removal, depending on the patient. In the future home devices will definitely play a role. We already have two devices cleared for home use—one diode laser and one IPL. I don’t think these will completely replace professional hair removal pro- cedures but it would not be wise to ignore them.”

Where have we made the most progress? “Resurfacing has perhaps come the farthest,” he says. “We started with CO2 laser resurfacing and added erbium before shifting to nonablative lasers to answer patient requests for less down- time. Now we are back to fractional ablative CO2 and erbium, and the current results are amazing.”

What’s on the horizon? “The next big thing will be cellulite treatments and fat removal,” he continues. “We now have devices that can truly improve the ap- pearance of cellulite and I’m really ex- cited about laser lipolysis—especially its ability to tighten the skin along with fat removal. And there are perhaps even better devices with ultrasound coming down the pike.

“Another area that has a lot of growth potential is dermal fillers. We have only a handful now and there are dozens in Europe. I anticipate a lot of new prod- ucts in the next few years. And there will be some Botox Cosmetic competitors. We have had experience testing all four neurotoxins in our research facility,” he notes.

Roving Ambassador
Dr. Gold’s involvement with research has taken him around the world—several times. “In the laser business the hubs are Israel, Italy, Boston and California. I need to go visit the companies and work with their engineers. And, of course, a lot of the devices are manufactured in China. I travel a lot—3 and a half million air miles since I started my practice,” he acknowledges.

Dr. Gold is a member of the European Society for Laser Dermatology, the In- ternational Society of Dermatology and several other organizations in Europe and Asia. “I love being a part of the in- ternational dermatology community. I can go anywhere in the world and have friends join me for dinner. Since my kids are out of the house, my wife, Cindee, can travel with me and sometimes one of the kids will join us. And we constantly train doctors from other countries in our Nashville facilities. Dermatology is a global business.” By the time you read this, Dr. Gold will have attended the European Academy of Dermatology meet- ing in Paris, another meeting in Hong Kong and the International Society of Dermatology, which just happens to be in Las Vegas this year.

“You have to work hard to get to where you want to be,” he advises. “Nobody gave me my practice. Decide on your desired track and keep working on it. What I do, I do for personal satisfaction. I don’t make a ton of money writing and speaking around the world, but I enjoy it. I’m not concerned that other doctors will offer cosmetic dermatology procedures. Some patients will always find a place to get what they want cheaper. I want patients who appreciate what I have to offer—my credentials and education.”

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 Linda W. Lewis is editorial director for Medesthetics.