Dr Narayan-Denning is the mastermind behind my 8-point harmonizing face lift and my renewed skin, read about that treatment here.
Aarti is the owner of Reverse Time and in this interview she tells me how she got started in the industry and why the consultation matters so much in aesthetic treatment procedure.
Welcome Dr Narayan-Denning, thank you for your time.
Thank you, Gina, for inviting me to your blog.
How long have you worked as an aesthetic doctor?
I initially trained in aesthetic medicine while working toward being a “Portfolio” GP, so that is now about 9 years. I am a full member of the British College of Aesthetic Medicine and hold an international Diploma in Aesthetic Medicine, a Board Certification in Aesthetic Medicine, a Diploma from the Royal College of Obstetrics and Gynaecology. I train other aspiring doctors in the full range of non-surgical treatments via the American Academy of Aesthetic Medicine. I have worked in General Surgery, Urology, Neurology, Medicine, Gynaecology, Child health – the full General Practice training, before working as a sessional GP in Hampshire.
What do you think makes a good aesthetic doctor? Training? Experience? Passion?
All three – and more – Training (background, clinical understanding, breadth and depth of knowledge and application); Experience (learning from mistakes and applying existing evidence to anticipate potential problems, going from the known to the unknown); Passion (believe you me, when done ethically and sincerely, aesthetic medicine is certainly NOT the million dollar ticket everyone seems to think it is)
– and more: Aesthetic medicine is still evolving, it is a concept, so the ability to see what is possible, to extrapolate safely the use of available tools like toxins, fillers, peels, in all the right situations is vital. The true Aesthetic Physician is one who assesses the patient as a complete unit, their lifestyle, their aging patterns, what is unique about them, before putting together a plan to manage their condition. You cannot be an Aesthetic Physician if all you do is botox and fillers!
Aesthetic principles are applied to all aspects of care (and to internal decoration, come to think of it!). In the case of Aesthetic Medicine, I think the term Aesthetic is a red herring, as we do a lot of what we did as GP’s (no sick notes, obviously, but we do recommend some social exclusion periods after medical grade skin peels!). I identify and manage chronic skin conditions (Rosacea, Melasma, Solar urticarial), hormonal imbalance, acne on a daily basis while consulting for aesthetic treatments.
Why do you like working in this sector so much?
Aesthetic Medicine is currently the fastest growing emerging medical speciality. While so many specialities have been created to repair and correct illness and solve problems, aesthetic medicine, when practised correctly, has the potential to identify and manage the root cause of most conditions even before it becomes a problem. It is the medical specialism about managing aging, its causes, its symptoms, and the internal and external signs of aging. It is my dream job.
I have had one of your ‘signature consultations’ and I think they are superb. When did you start offering these and why?
The Reverse Time® concept has always been about clinical history, assessment, diagnosis and then management. It took me over 2 years to learn about all the tools and techniques (toxins, fillers, peels, prescription skin care, mesotherapy, lasers lights and energy devices) needed to offer a complete Medical Aesthetics Specialist consultation. This comprehensive consultation is what I have been offering now for 5 years or so. I have a copyrighted consultation template and protocol that I use for my patients. It takes me longer and is not profitable exercise, but it is what keeps my patients safe and happy.
So right at the start, I started offering my patients a plan, including all their needs and expectations, and what tools used in what manner would give them a benefit, while keeping the risks within reason. I have always treated my patients in this manner.
An aesthetic medical consultation often results in a plan that is like a 3 course meal.
Think of the skin preparation (retinoids, SPF, glycolic or other AHA home products) as the Antipasto. The nibbles and aperitifs that actually prepare the person to enjoy the meal better, or in this case, make the skin and body better able to tolerate the treatment and have a better outcome.
Then come the mains – the Primo for example would be the gentle relaxation of overactive muscles of expression with botulinum toxin, or rehydrating the skin with Profhilo, and a Secondo of multipoint dermal filler placement to restore the volume.
The Contorno could be any stimulatory energy treatment (radiofrequency, plasma, laser), antioxidant supplements (collagen shots, Skinade, vitamin supplements), all that help the body utilise the material that we have injected into it, to integrate into tissue.
Who doesn’t love a good meal? That is what a great signature treatment plan should be.
What is the vital things people should clarify before booking any type of procedure surgical and non-surgical?
When you research, keep and an open but alert mind – check for regulation and insurance.
There is a deeper problem here: people simply don’t seem to understand what constitutes regulation, what is the difference between regulation and insurance as it matters to a patient.
Remember, if you are having medical treatment and that includes toxins like Botox®, injectable dermal fillers, medical grade chemical peels, thread lifts, medical lasers etc. you would want to be considered a patient, not just a client.
In the unfortunate event that something goes amiss, you have someplace to go for help and advice, if you had treatment from a regulated person. They are bound to play it safer as they answer to regulators and will not risk losing their license to practise, especially if Aesthetic Medicine is their entire livelihood.
So why should it matter to you if I am regulated?
I am regulated. I feel that young people seeking appearance alterations should be considered as vulnerable adults. I do not inject under-21’s for cosmetic reasons like lip fillers but I do treat acne at any age. (This choice is not just another of my many charming personal quirks but has a psychological basis – this is a vulnerable adult.)
The bottom line is patient safety. Even if doctors are not always good at aesthetic medicine, they have more at stake; they have to protect their license to practice.
If someone has a botched procedure or simply a failed skin care routine and they have come from another clinic would you welcome them to help ‘fix’ them?
The short answer is Yes. As a trainer I am actually insured to personally supervise other doctors in providing treatments and correcting the results thereof.
There are certain caveats – I cannot guarantee that what I recommend would be different from what was previously done, the consultation becomes even more essential, and I would appreciate it if they first tried to go through the previous doctor’s recommendations for correction before leaving their care.
My intention with all my patients is to have a rewarding long term relationship. This will not happen unless a good understanding and a doctor-patient contract is formed, long before any physical procedure is carried out.
I would always share the aftercare requirements with my patient before the procedure, to ensure that they can actually manage them. For example, if they wanted to have a “thread lift”, one of the key concerns in the aftercare is not to “shear” the treated area, by lying on it or pushing on it. This means they have to sleep on their backs during the first fortnight after treatment. Most patients find this daunting. I advise them to practice this before planning the treatment.
In the last couple of years, I have been receiving more enquiries for corrective procedures than first time treatments, so I have a protocol for these “revision” consultations, assessments and treatments. I often involve the previously treating doctor in the process, have a conversation with them, educate where appropriate. Sometimes it is the patients’ expectations that need to be re-aligned, it is important to be honest and transparent about these things right from the start.
What do you suggest patients ask before any procedure? At consultation stage.
The best way for potential patients to get the most out of a consultation is to be clear about their ideas, concerns and expectations. Be honest, it is a medical procedure. When a doctor specialises in aesthetic medicine, hormonal balancing and regenerative medicine like me, we get to enquire about the things that we in the UK don’t usually talk about.
Ask the doctor about what outcome you want, tell the doctor what bothers you, for example you may be noticing a sagging of your cheek skin. This probably got more noticeable in the past year, and your skin doesn’t look as plump as it used to. At this point, don’t ask the doctor for a thread lift or jawline fillers – tell them what is bothering you and what outcome you want – let them come up with a plan and timeframe for you. Spoiler alert – the good aesthetic physician will at this point ask about your hormones, your periods, because your estrogen levels have a lot to do with skin elasticity.
What is your number 1 top NON-surgical treatment you would recommend and why?
Profhilo is the most popular injectable skincare for me, when you look at individual treatments. I am rather chuffed to say that Reverse Time has been doing this a lot longer, before it became popular with Tatler earlier this year.
What’s next? any new treatments or clinic openings etc?
This winter I hope to help treat all the sun damage this cruel summer caused, using the Plasma Skin regeneration. This is the only FDA approved skin regeneration system.
I have refitted the Winchester clinic, so I am open on more days, Saturdays too. We have a private entrance, and roadside parking, which is like gold dust in Winchester.
So if you want to start taking control of your aging, skin and hormonal concerns, inside and out, simply call 0333 444 0567 and book a consultation or visit www.reverse-time.com