With more than 27 years of practice under his belt, Dermatologist Dr. Ron Shelton gives us an insight about his experiences and running his practice in New York City.
Name: Ron Shelton MD
Location: Manhattan, New York City
Brief Bio: An industrious, forward thinker, Dr. Ron Shelton, in 2001, brought together an accomplished group of surgeons to holistically address the needs of both cosmetically-minded patients and those needing Mohs surgery and reconstruction for skin cancer.
The New York Aesthetic Consultants included Cosmetic Dermatologic and Plastic Surgeons. It was one of the first medical spas in New York City. In July 2014, Dr. Shelton was invited to join the prestigious NYC laser practice, Laser and Skin Surgery Center of New York. Both Dr. Shelton’s and LSSC’s practices have benefited by this merger as the Midtown NYC cosmetic dermatology practice has more than 60 lasers and devices and a dedicated research division for the development of new laser technology.
Dr. Shelton has maintained his affiliation with the Mount Sinai Medical Center as an Assistant Professor, and he is responsible for teaching many residents, international cosmetic dermatologic surgeons who are being trained in fellowship and visiting physicians from around the world. He has lectured at The American Academy of Dermatology, The American Society for Dermatologic Surgery, The Dermatology Society of Greater New York, The American College of Mohs Micrographic Surgery and Cutaneous Oncology, The New York State Society of Dermatology, The New York Medical College Department of Dermatology on Liposuction and Fat Injections for facial volume restoration and Mohs Micrographic Surgery for skin cancer. He has published many articles in peer reviewed journals as well as having published chapters in medical textbooks and a chapter in an internet dermatology textbook. His books on Botox and Liposuction were published by Penguin-Putnam Publishers in 2002 and 2003 respectively. He has given many talks to community centers concerning his books.
Dr. Shelton has been entrusted by the American Academy of Dermatology to be a spokesperson for the media, as he retains an academic interest and is highly regarded by his peers as an ethical and knowledgeable physician. Dr. Shelton has been listed as one of New York Magazine’s Top Doctors, Castle Connolly’s “Best doctors in America” and Super Doctors for many years. Dr. Shelton has also received an award as Teacher of the Year at the Mount Sinai Medical Center, and from The Journal of Dermatologic surgery for original research.
Dr. Shelton’s philosophy in practice is that he and his staff provide the same care to his patients as they would to their families.
What inspired you to get into dermatology?
As a young child I was fascinated with using my hands to build and engineer home made games and devices for household use. I loved the science of the human body and after becoming interested in medicine I was attracted to the field of plastic surgery. As a medical student I “forced” myself to take an elective in dermatology as I thought it would be helpful if I became a plastic surgeon. I was so ignorant as to what dermatology involved that I became fascinated and overwhelmed by how much it had to offer. While a dermatology resident, I had the great privilege to study under Dr. Stuart Salasche, a leader in the field of dermatologic surgery. I pursued fellowship in this subspecialization and was lucky to be accepted in the prestigious fellowship of Dr. Richard Glogau, a renowned cosmetic dermatologic surgeon in San Francisco. This was the best academic year of my life! I knew I had picked the right field for me.
Could you give us a background about your practice?
Our practice has 8 full time dermatologists and several part time dermatologists and a plastic surgeon. We practice in Midtown Manhattan and Southamptom Long Island, but my full time practice is limited to our NYC practice, in which I see patients from 8 AM to 5 PM, Monday through Friday. We have many administrators including the executive practice administrator, COO, office manager, nursing manager, laser research manager, many RNs and a few medical assistants. I perform all laser and cosmetic device treatments for my patients. We do not have ancillary providers perform lasers in our practice. Half of my practice is cosmetic dermatology including laser resurfacing, laser treatment of discoloration (facial erythema, lentigines, tattoo removal), body sculpting / skin tightening with liposuction and minimally invasive (ThermiTight) and non invasive treatments (Thermage, Ultherapy, ThermiSmooth, CoolSculpting, UltraShape, SculpSure), volume augmentation with fat injections as well as many of the hyaluronic acid treatments (Voluma, Vollure, Volbella, Juvederm, Restylane, Belotero) and other fillers and Sculptra. Botox is very commonly performed. The other half of my practice deals with skin cancer treatment with excisions, and Mohs Micrographic Surgery and Reconstruction.
The practice has four floors in our building and a dedicated laser research division which allows me to stay current with advancing laser technology.
Most of my skin cancer patients are referred by their dermatologists, plastic surgeons or internists. I have seen many patients who have new skin cancers diagnosed and return for mohs surgery on these additional skin cancers since I started practice in NYC in 1993. My cosmetic patients are referred through friends, doctors and many come from searching on the internet.
What can you tell us about the process of hiring staff?
When I ran my own practice things changed but I never found employment agencies to help me as much as I thought they could. I also found them to be expensive and running a medical practice is not the same as a big corporation with a larger H.R. budget. In the beginning we ran ads through local papers, especially the NY Times, in print, and later as the internet evolved, on-line and then found Craig’s list to be helpful, Monster, etc. Linked-In and the current employment marketing sites were not as common then. I had a tiered application system. First the office manager sorted through all replies and only selected the top echelon of applicants. The manager then did a telephone interview with each applicant before selecting those who would be invited to come in for a personal interview. All who came to our practice also met with our clerical staff and those who were applying to assist the doctors also met with the medical staff. If the staff found the applicant not to be personable, professional and if they didn’t seem to have a trustworthy personality, the applicant wouldn’t make the next part in the process. If it was a clerical position they had to prove their skills with a test and those applying for a medical position were positioned in the room with me while I was seeing patients. They got to see if they wanted to work with me and my workstyle and pace, and we got to see their behavior under stress. No matter how much I liked an applicant, if the staff voted them down, I would not hire them. We always did a background search as well and obtained the necessary documents and permission from the applicants.
Question: What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?
The list of devices we have is quite long, approximately sixty and they encompass many types of lasers and devices. We have only one IPL. We have gentle laser toning with Cutera XEO Laser Genesis and PicoSure focus lens array and Clear & Brilliant and Permea. Lasers for resurfacing include Fraxel Restore/Dual, and Fraxel Repair.
How do you decide in choosing the IPL or laser technologies in your practice?
Choosing new technology requires much thought about the ROI, customer service of the company, reliability of the workmanship, whether the new device provides any advantage(s) over current technology such as less pain during treatment, quicker treatment or less numbers of treatment, lower risk of complications, ease of use, efficacy, name branding, etc. Often we speak with doctors we trust who use the device and ask of their experiences with the treatment. The company will usually, not always, leave the device for us to get acquainted with its use before deciding on purchasing it.
The following pages list most of the devices we have and how we position their use:
- ActiveFX & DeepFX™ (Acne Scarring)
- Cellfina (Body Contouring)
- Clear + Brilliant® (Age Spots & Brown Spots, Acne Scarring, & Melasma)
- Clear + Brilliant® Permea (Age Spots & Brown Spots, Acne Scarring, & Melasma)
- CO2RE® (Acne Scarring)
- CoolSculpting (Body Contouring)
- CoolTouch CTEV™ (Leg Vein Treatment)
- Cutera XEO™ (Age Spots & Brown Spots)
- Cynergy™ (Broken or Enlarged Vessels)
- Erbium: YAG (Acne Scarring)
- Excel V™ KTP (Broken or Enlarged Vessels and Leg Vein Treatment)
- Fraxel Re:pair® (Acne Scarring)
- Fraxel Re:store Dual® (Age Spots & Brown Spots, Acne Scarring, & Melasma)
- Fraxel Repair ( CO2) (Sagging Skin)
- GentleLase® (Hair Removal)
- GentleMAX and GentleMax PRO™ (Hair Removal)
- GentleYAG® (Hair Removal)
- Infini™ (Sagging Skin)
- miraDry® (Hair Removal)
- nd:YAG (Age Spots & Brown Spots, Acne Scarring, Leg Vein Treatment, & Melasma)
- PicoSure™ (Age Spots & Brown Spots, Acne Scarring, & Melasma)
- Pulsed Dye Laser (PDL) (Broken or Enlarged Vessels)
- Ruby (Age Spots & Brown Spots)
- SculpSure (Body Contouring)
- Thermage (Body Contouring)
- Thermage® CPT (Sagging Skin)
- ThermiSmooth (Sagging Skin)
- ThermiSmooth 250 (Body Contouring & Sagging Skin)
- ThermiTight (Body Contouring & Sagging Skin)
- Ultherapy (Body Contouring)
- Ultherapy® (Sagging Skin)
- UltraShape (Body Contouring)
- V-Beam Perfecta™ Pulsed Dye Laser (Age Spots & Brown Spots, Broken or Enlarged Vessels, & Leg Vein Treatment)
- Vectus™ (Hair Removal)
What are your marketing strategies?
We do not pay for any media marketing, whether print, radio, TV or private TV infomercials. We do get occasional media interviews and use brochures for internal marketing and send newsletters via snail mail and email to our patient list. We do keep up our website.
Which of the offered treatments are most popular in your practice?
There is no doubt that in any cosmetic practice, the ROI is the highest with Botox and fillers considering the cost of material and the time needed to perform a treatment. Next is Laser treatment of facial redness, tattoo removal and brown spot removal, wrinkle laser resurfacing (excluding the Fraxel Repair CO2 laser which takes more time during and post op). Ultherapy follows this hierarchy and then CoolSculpting. ThermiTight comes next. The least cost effective is large surface area of the body treated by ThermiSmooth or Pelleve radiofrequency as I, not a provider extender, performs this lengthy treatment.
What can you share to us about your years in practice?
All physicians providing cosmetic treatment have seen the extreme end of the spectrum in terms of patient emotions. It ranges from those patients for whom you may do such a minimal correction and they break down in tears of joy seeing a better appearance they have desired for so long, to the patient for whom you have invested so much energy and precise treatment whom you can’t make happy. It is the latter type of patient you always regret you didn’t perceive their personality trait that makes it extremely difficult to please them. There are those patients one has delivered from captivity in their own home who now feel confident to be in public and see their relationships with their loved ones improve on account of this, as well as their job performance. But balancing the cosmetic energy in our universe, one has also created results, despite them looking good or normal to the physician, that are so displeasing to the patient, they don’t want to leave their home.
What advice can you impart fellow physicians?
Treat patients the way you would want to be treated. Recommend treatments you believe will benefit the patient and if you’re not sure, while starting to work with a new device, then don’t charge the first several patients you treat.
Apologize to the patient if you were late to see them for their appointment.
Don’t allow your patients to treat your staff rudely.
Have cosmetic patients who have large procedures booked, pay for their treatment in advance. A colleague of mine told me a story of a well-dressed woman who was carrying a couple of shopping bags from fine department stores filled with overflowing with the colored wrapping tissue paper, went to the front desk to pay and realized she left her purse in the car. She set down the packages and asked the front desk if it would be ok for her to leave them for just a minute while she went out to get her purse. When she didn’t return the staff picked up her shopping bags, only then realizing they were completely empty except for tissue paper.
If you agree to treat a patient and you think there is a small chance of improvement but the patient insists on undergoing the treatment, reiterate twice, that you think there is a high chance they won’t get the result they wish and you can’t refund the fee.
Trust your gut. If you have a feeling that the patient you’re seeing in consultation, will be a problem patient, don’t agree to do their treatment. You will regret you didn’t trust your instinct.
About Dr. Shelton
Dr. Shelton has been in practice for more than 27 years. Upon completion of his Dermatology Residency, he was assigned to be the Chief of Dermatology at the Langley Air Force Base Hospital in Hampton, Virginia. Dr. Shelton then did further training to specialize in cosmetic and reconstructive dermatologic surgery and Mohs Micrographic Surgery. He was then recruited by the Mount Sinai Medical Center in New York City to create the first Division of Dermatologic Surgery at that hospital. After five years as a full time faculty member, Dr. Shelton entered private practice in Manhattan. He is one of only a small number of Mohs surgeons in New York City.