Meet the Aesthetic Expert with Dr Will Kirby: Azadeh Shirazi, MD

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.

Azadeh Shirazi, MD, is a board-certified dermatologist specializing in cosmetic dermatology.She completed her residency training in at the Mayo Clinic and the University of California San Diego. As founder of La Jolla Dermatology & Laser Surgery Center in San Diego, and AziMD Skincare, she embodies a strong passion for aesthetics and truly enjoys the art of cosmetic surgery. She also enjoys delivering valuable information on health, beauty, and wellness to consumers through her podcast, More than a Pretty Face, as well as other media outlets.

Kirby: Dr. Shirazi! Thanks so much for sitting down with me. Let’s jump right into it. What initially led you to an aesthetic career path?

Shirazi: My creativity married my love for science. So here I am! I love reconstruction, I have a great passion for helping people regain their confidence, and I love innovation; It’s what wakes me up in the morning. Also, cosmetic dermatology is very visual, and I’m drawn to it because it comes natural to me.

K: Can you please tell us a little about your career backstory?

S: When I finished my residency, I joined a large multi-specialty clinic and over the years I became increasingly frustrated with corporate medicine and the freedom to be innovative.There was so much bureaucracy and red tape. I felt trapped as an entrepreneur. Working there instilled a belief in me that big practices and corporate medicine is the future. Somehow, they made it seem like small practices were impossible to create and grow. Nevertheless, I decided it was time to venture out despite watching small practices being taken up by private equity (PE) and consolidating into bigger and bigger groups.

I definitely went against the trend. My friends, colleagues, and family thought I was crazy to leave this secure, high paying job and start my own private practice. I opened up shop in the coastal village of La Jolla where 20 dermatologists had left over a span of 5 years: consolidating with large groups or selling to PE-backed firms. It’s been the hardest and yet the greatest career decision I’ve ever made.

K: Let’s go back even further. Did you face adversity because of your gender? Your religion? Your creed? Your national origin?

S: I moved from Iran to Kentucky not knowing any English during a time when the Iranian government was holding American’s hostage. So, I definitely faced some adversity. Such that I changed my name to ‘Marie’ by the time I got to High School to hide my origin. So, if you went to high school with me, you didn’t know an Azadeh! Thankfully, I never legally changed it. It was a rough transition for me, but the experience taught me the importance of diversity, inclusivity, and compassion for all human beings regardless of their gender, background, or race.

K: Early adversity is often a benefit later in life and you certainly have succeeded professionally. Specifically, you are renowned for being an expert in the off-label treatment of the unbelievably frustrating area of tear troughs and specifically for treating dark circles. Please talk to me more about how you pioneered your own technique for addressing this unmet need in the aesthetic space.

S: Over years of practice, I found that adding support and structure to certain facial ligaments is the most effective method for lifting the under-eye unit. These ligaments, specifically the lateral portion of the tear trough ligament, the zygomatic cutaneous ligament, and the orbicularis retaining ligaments, get stretched out with age and sag. Adding support to them allows for the greatest, most natural lift. As such, I developed a patented technique called EyeGlow using a blend of fillers, (calcium hydroxyapatite and hyaluronic acid), to lift the under eyes, restore volume, and improve dark circles. The blend creates a white opaque material to help brighten the under eye. It’s not really a tear trough filler. Due to placement of the filler mix on bone and various other aspects of the technique, the results last for years, and I’ve found less incidents of migration.

K: What's the best piece of aesthetic career advice you have received?

S: Make mistakes and always do the right thing. I’m such a perfectionist, as are many doctors, so the thought of making a bad decision or failing is really tough. But that’s how you learn and grow. And it’s Ok. But at the end of the day, aesthetic medicine is medicine. It’s a profession where the patient’s interest and well-being should be our only interest.

K: What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?

S: Every demographic is the most coveted, depending on what services you offer and your practice focus. I find millennials as the fastest growing demographic in aesthetics. It’s largely driven by the increased acceptance of aesthetic procedures, social media, and the availability of safer, more effective, noninvasive treatments. People are seeking preventative cosmetic treatments at an earlier age and making it part of their lifestyle and their antiaging regimen.This concept of prejuvenation is catching on with the younger demographics. We can do so much more for patients when we catch them early in life and start them on the appropriate antiaging program earlier in life rather than later.

K: What aesthetic patient population is the most challenging to deal with and why?

S: The “patient on a mission” is someone who wants to pay as little as possible, expects the most incredible results, and isn’t afraid to threaten you with negative online reviews. This is the person you cannot help. They are extremely challenging to manage, and you will not be able to convince them otherwise. Documentation, before and after photos, and setting realistic expectations early on are all important.

K: Telehealth exploded during the pandemic. Is it here to stay? What role will it have in aesthetics moving forward?

S: It’s here to stay. Telehealth, along with social media, has expanded our reach to consumers in ways I never imagined. I see patients virtually from all over the US and, frankly, the world. Social media and telehealth platforms have allowed us to connect with anyone anywhere.

First, it’s so convenient and your overall time commitment is shorter and more efficient. Second, it makes people feel more comfortable because they feel less exposed. When they come into the office, I’m in the room staring at their faces or bodies within minutes of meeting them. In a virtual visit, I review their photos ahead of time and then we discuss their concerns over video or text, then come up with a treatment plan which they schedule accordingly. Third, it gives people the freedom to see whoever they want from their living room.

K: With so much confusion in the industry, where do you go for trusted aesthetic information?

S: I always learned a lot at aesthetic conferences, not lecture halls and listening to speakers necessarily, but just from talking to colleagues and people in the industry. I’m always interested to hear about their approach, different techniques, and protocols outside the conference arena as this really helps me fine tune my art and my practice to better serve my patients. I also read a lot. I look for objective studies in arenas I’m interested in to better serve my patients. I love learning about new emerging therapies I come across in a journal article or online. I’m always looking for the science, the data.

K: I’m glad you referenced conferences. Why are we witnessing decreasing interest in aesthetic conferences and a sharp drop in conference attendance? Is COVID-19 solely to blame?

S: Conferences were previously big businesses. When calculating the cost and the inconvenience of travel coupled with the loss of revenue from time out of the office, they’re expensive to attend for clinicians, however. So many practitioners have been more selective as of late, decreasing overall attendance at these events.

Additionally, many aesthetic meetings may have the same lectures presented by the same people, year after year, with the repetition negating evolution. I also wonder if the return on investment for companies that sponsor conferences is meaningful—they are likely assessing their sponsorships. Having said that, I personally have found some conferences incredibly valuable because of the ability to network in person. I suspect that we will see some current conferences disappear altogether while a select few meetings that offer more hands-on training, new voices, live demonstrations, and novel, truly valuable content will rise.

K: Great points. I can’t help but notice that aesthetic conferences champion ‘key opinion leaders’. Many purported ‘KOLs’ in the aesthetic space state that they support ‘advocacy’ but when you dive deeper, they seem to primarily advocate for their, and their friends, wallets. Where might one find true advocacy in aesthetics these days?

S: I just recently learned what ‘KOL’ stood for, but I’m still not sure I understand what it means. What makes them ‘key’? How are their ‘opinions’ quantified? Whom do they ‘lead’ actually? I think a true leader should deliver authentic valuable information that will help serve the greater good, our industry, our patients, and our practices—and that isn’t happening.

My motto is ‘be valuable and success will follow’. We all have unique talents and offer different insights and perspectives. It’s important to learn from each other without feeling more or less superior based on a label. We owe it to our specialties and patients to present authentic data.

K: I can’t help but notice that most industry ‘KOLs’ are men. That makes no sense to me as most aesthetic patients are women and well over half of aesthetic providers are female. How did this gender bias start? Are men and women treated differently in residency or in medicine?

S: There’s definitely labels, and judgement and it stems from leadership and culture in any given organization. Gender biases are deeply embedded in our society and that’s the reality.Yes, there are situations where a woman will be treated differently by a man due to their “femininity” and vice versa.

We’re all going to have our stories about the nice guy vs the inappropriate guy (or gal). I say we focus less on gender and more on character. Men and women are not equal. Women don’t have to prove that we can do everything men can do. Our strength is that we can do everything men can’t do. That’s our strength. All I can say is never make an important decision without a woman at the table.

K: Very well put. Moving on, what is your favorite aesthetic treatment to personally receive?

S: Botox Cosmetic! I can really tell when it starts to wear off. I also love a light fractionated laser resurfacing treatment with a little filler here and there a couple of times a year. And I’m hairy so laser hair removal is an absolute must!

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

S: ‘Don’t worry about your competition. Worry about yourself and your own business’. You will never be them and they will never be you. Allow your competition to inspire you without making you lose focus. The more you focus on your own career, the more you will achieve and the more successful you will be. And honestly the happier. I love collaborating with colleagues in the industry. I think that’s so important.

K: What advice would you give to your younger self?

S: Don’t rush and be patient. It takes time to build careers and businesses. They don’t come like Amazon Prime, and it doesn’t have to happen in X number of years and by age Y. It takes time, hard work, focus, and dedication with regular doses of fun. It’s important to know when you’re starting out to have fun every day. It’s a journey and you have to go through it to find your passion, your niche.

K: Thank you so much for your insight and candor. This has been a truly refreshing perspective. How can industry readers get more aesthetic expert information from you and how can patients come to see you to get treated?

S: I am on Instagram and officially a TikTok’er, both with the handle @skinbydrazi. I have a podcast called More than a Pretty Face, which is focused on beauty, health, and wellness with a pinch of entertainment. On the podcast, my nurse, Lacie, and I reveal our weekly beauty and blemishes; you’ll have to listen to know what that means!I also interview various guests who give great insight into their practices or fields and provide listeners with valuable information.And since that’s not enough, I’m also on YouTube as Skin by Dr. Azi.