Will Kirby, DO, FAOCD, Talks With Karan Lal, DO, FAAD, MS

Karan Lal, DO, MS, FAAD

Originally from New York City, Karan Lal , DO, MS, FAAD, grew up in Queens and attended Hunter Science High School in Manhattan. He graduated summa cum laude from the New York Institute of Technology, where he completed a rigorous 7-year accelerated combined medical program. He was selected to be an academic medical scholar, during which he received a Master of Science in neuroscience,a scholarship for 3 years of medical school and graduate training and was elected to the Sigma Sigma Phi and Psi Sigma Alpha medical honor societies. Lal completed his internal medicine internship at the University of Connecticut Medical Center in Farmington, Connecticut where and was elected intern of the year. After completing a 3-year dermatology residency at the University of Massachusetts, where he was elected chief resident, he continued on at the University Massachusetts to complete a pediatric dermatology fellowship where he gained an interest in vascular anomalies, pediatric laser, and dermatologic surgery of pediatric patients. He also completed an ASDS cosmetic surgery fellowship and is currently the only double board certified and fellowship trained pediatric and cosmetic dermatologist in the country. He specializes in pediatric and adult dermatology, laser surgery, soft tissue filler augmentation, body sculpting, and pigmentary abnormalities of the skin and is director of pediatric dermatology and cosmetic dermatology at Affiliated Dermatology in Scottsdale, Arizona. He enjoys treating patients from birth onwards and building long-lasting relationships with families!

Hello, Dr. Lal. Congrats on your meteoric rise in the industry - In a very short period of time, you have really made a splash! Would you be so kind as to begin by telling us a little about your backstory please?

I was told I was going to be a doctor from a very young age. I loved my pediatrician and grew up thinking I was going to be a pediatrician. During college I also fell in love with acting and drama. I secretly told myself that if I didn’t do well on the MCAT I would drop everything and go to India and try out for Bollywood. (Spoiler alert, I did fine on the MCAT.) I started medical school and became enthralled with primary care (because it covered everything) but I stumbled upon dermatology in my first year of medical school and enjoyed the diagnostic conundrums. I was very lucky and was able to spend time with Dirk Elston at the Ackerman Academy during medical school.He is an exceptional mentor. I drank the dermpath Kool-Aid. Fast forward, I matched into dermatology at the University of Massachusetts. While dermpath was on my radar, I had a lot of pediatric dermatology exposure. Everyone finds pediatric dermatology difficult for a number of reasons. My program director Karen Wiss, is a world-renowned epidermolysis bullosa expert and she is the nicest human being in the world. She is also wicked smart and I wanted to be just like her. I stayed at the University of Massachusetts for my pediatric dermatology fellowship.

What initially led you to an aesthetic career path?

We had a lot of laser exposure during residency training, so I decided to moonlight during my pediatric fellowship and ended up doing a lot of cosmetic dermatology (on the parents of my pedi patients). It was then I had an epiphany- I could make a niche out of this! For me being an expert is associated with additional training. I didn’t want to just be a dermatologist that only offered cosmetics, I wanted to be the dermatologist that trained with the OG (original gangstas)! This inspired me to do an American Society for Dermatologic Surgery cosmetic surgery fellowship and I just finished my cosmetic surgery fellowship!

What's the best piece of (aesthetic) career advice you have received?

A consult is a consult. I think as young dermatologists we are hungry to learn and help people. However, I have learned it is best to discuss all of the options with patients and provide them with information to make a thorough informed decision and not rush into a procedure the same day as the consultation. Because these are not medically necessary procedures it is imperative that patients understand expectations, risks, and comparative results and in reality, no one can do all of that in 15 minutes.

You journey sounds like a relatively smooth ride but there is always adversity behind success. Why hurdles did you have to jump during your path?

The biggest adversity was being a DO. I was told day one by everyone around me that it would be a difficult battle. Fortunately for me, I enjoy challenges. I took that and decided I would not let others chose my fate. I was the first osteopathic medical student to match into dermatology at the University of Massachusetts. In the end this adversity separated me from the rest and now people seek me out because of who I am.

With the supreme success of so many osteopathic physician and surgeons in the aesthetic industry, the fact that a DO bias still exists surprises me but it's great that you overcame that issue! Now let’s dig even deeper; What is something interesting about you that you have never before publicly revealed?

People don’t know my weight loss journey. I was 300 pounds until I was 21 and then (as my interest in acting and drama grew) I decided I had to lose weight. I went to India and hired a personal trainer who worked with me 4 hours a day, 6 days a week for 3 months. I lost 90 pounds during this time. This weight loss triggered severe telogen effluvium that transitioned into male pattern baldness. I then lost another 90 pounds over a year. I am bald and full or stretch marks and I love it!

Wow. Good for you! You clearly invested in the right resource to assist you with the weight loss. What resources should aesthetic providers invest in right now to maximize their potential?

I think social media is underrated. It is so important, now more than ever to learn how to use social media to educate patients and advertise your expertise. With this comes, free publicity and marketing. Instagram has an amazing way of assessing engagement with followers and viewers. In terms of technologies, I think body contouring devices are overrated. I have seen many practices and providers start with body contouring devices and unfortunately the results for many muscle stimulation and fat melting procedures are temporary and hard to objectively track. I have noticed a lot of patient dissatisfaction.

Very fair points and I don’t disagree at all. What aesthetic patient population is the most challenging to deal with and why?

I don’t think it’s a specific group. I find all cosmetic patients challenging because everything is elective. I am very honest about expectations and risks. I have all patients repeat back to me the risks of filler: blindness, death of the skin, stroke, infection. I see their faces when I tell them and then most, if not all, say “how come my last injector never told me that.” Even one complication or adverse outcome is devastating.

Though rare, these potential adverse reactions are absolutely terrifying, and I agree wholeheartedly: Full disclosure is imperative. What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?

Patients of the LatinX community are the fastest growing cosmetic population. Over 50% of my patients are Latinx and they know what they want. They make a big portion of my skin of color population and have great melanin diversity. In addition, I notice younger patients (<30) seeking aesthetic care. Most people want to prevent rather than fix.

Telehealth exploded during the pandemic. Are you a fan? If so. how do you utilize it?

Telehealth is great for simple medical follow-ups, but I cannot do a cosmetic consultation via telehealth. Lighting, shadowing, texture, pigment, are all hard to assess over the camera.

That makes sense. Everyone agrees that telehealth is here to stay but how an individual dermatologist utilizes it varies widely. Knowing that telehealth is just one tool at our disposal is a great transition into my next question:What role do allied health care professionals (RNs, NPs, PAs,) play in aesthetics?

Let me preface my answer by saying I am biased. I know amazing NPs, PAs, and RNs that perform cosmetic procedures. Personally, as someone who has sought out a fellowship and dedicated a year to learning everything cosmetic with already a strong basis in anatomy, microbiology, pathology, pharmacology, I think many procedures should be in the hands of trained CORE physicians. In cosmetics, ignorance is not bliss. I think procedures like laser hair removal, superficial chemical peels, microneedling, and non-invasive body contouring devices can be delegated to the right person but injectables, IPL, etc. should be performed by the appropriate CORE physician. I don’t think it’s appropriate for non-CORE physicians to be performing aesthetic procedures either. I may feel comfortable in managing heart failure, but I know it would not be the right thing for me to do.

What is the biggest myth in the aesthetic industry?

Lasers are easy. You have to force yourself to think about the physics of each device and come up with your own parameters. I find so many people who think of lasers to be thoughtless due to platforms and devices that have algorithms and pre-set parameters.For almost every laser I use I make sure I know the physics (which I hate) and the endpoints. I now never use pre-set parameters; however, I have in the past and have had adverse outcomes.

What keeps you up at night?

Postinflammatory hyperpigmentation is my biggest fear. I treat so many skin of color patients and I know how to push my limits. PIH is very hard to treat, despite what people say or think. I have had my fair share of PIH nightmares and now I trust no device and their “colorblind” safety.

In many ways, the concept of a ‘key opinion leader’ seems to have become synonymous nepotism and greed.Why does our industry still tolerate antiquated ‘KOLs”?

I am tired of seeing the same people on the podium. For the past 10 years it has been the same people. People want authenticity and that is not what I find when I go to meetings and hear speakers who endorse everything.

So true. It’s clearly time to change the way meetings and conferences work. So, what can the aesthetic industry do to increase diversity and inclusion?

In my opinion we have too little of a presence of Asian, Latin, and LGBTQ+ physicians in the circuit. We need to find and seek out experts and rising leaders of these backgrounds and give them a chance to shine. The majority of my patients seek me out because of my background. It is sad when a patient says,“why is it so hard to find someone who looks and understands me?” I myself try to mentor as many medical students and residents as I can to pay it forward.Industry as well needs to sit at the table and create initiatives to promote rising stars.

Without using any names, tell us about an aesthetic adverse event suffered by a colleague of your that made you rethink your own practice.

We all have seen burns from IPL. I had a colleague that used conservative settings on a patient on the arms for treatment of lentigines. This patient was a skin type 1 and suffered significant burns in the treatment areas. This made me step back and re-evaluate treatment options for isolated lentigines and pigmented lesions off the face. I now prefer to use picosecond lasers to treat lentigines and macular seborrheic keratoses.

What advice do you have for people in the aesthetic space to avoid ‘burnout’?

Do medical dermatology. You need to have a mix. We went into dermatology to help people and solve problems. We are natural problem solvers. I find it so rewarding to clear a kid with severe atopic dermatitis and it makes it all the worthwhile. I just had a teenager tell me “For the first time in my life I am going to wear half sleeves because my arms look normal.” That is my burnout extinguisher.

If you weren’t an aesthetic expert, what would you do for a living?

I would probably be an actor. I love making people laugh and creating an ambiance for people. I am very shy, but I love public speaking and performing. I still would love to find my way to tv one day (my life would make a great tv show).

What is your favorite aesthetic treatment to personally receive?

I love me some radiofrequency skin tightening. It feels like a hot-stone massage, and I actually do think it works (with consistency).

What is you least favorite aesthetic treatment to receive?

Laser hair removal. It is painful regardless of topical numbing concentration and occlusion. I would prefer to be sedated for laser hair removal of my chest.

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

Ten years is a long time. Our industry is the fastest growing industry in medicine with new devices coming out every day. I hope we have safe longer lasting soft tissue fillers that are economically fit for our patients I believe we will have body contouring treatments for the chest (which we don’t have yet). I believe photobiomodulation will continue to grow and light-based therapies will skyrocket for various conditions (medical and cosmetic).

As an expert in the aesthetic industry in a powerful position, people are looking at you to lead. If you could inspire a movement in our industry, what would it be?

I would love to redirect attention to better cosmetic education of budding dermatologists. Most dermatology residency programs do not provide adequate cosmetic training. Patients are very aware and will seek these procedures (whether it be safe or not). If we don’t educate our residents to be competent in the most commonly sought-after procedures, there will be poor patient outcomes. My goal is to create a more standardized cosmetic curriculum for residents.

Name drop 3 individuals that represent the future of our industry and maybe they will be the subject of future interviews!

I look up to Omer Ibrahim MD. He has been my future leaders network mentor for the and is an excellent cosmetic dermatologist and stays true to himself. Natasha Mesinkovska MD, PhD is a hair expert who has been superbly involved in a lot of research. I can text her any time of the day and she will respond; she is the real deal. David Ciocon MD is an OG. He has supported me and taught me so much during my cosmetic surgery fellowship. He treats essentially a full skin of color population doing Mohs surgery and cosmetics. He spreads the word not by playing the podiums but by teaching all of the residents and fellows so they can go out and help people.

Dr. Lal, Thank you so much for the honest and transparent interview. I’m greatly looking forward to catching up with you in person soon.How can readers get more aesthetic expert information from you?

You can follow me on Instagram @sirdermzalot. I am very responsive and love chatting!