Ask Dr. Shridharani

What Is Your Favorite Minimally Invasive Procedure to Perform In Your Practice Today? How Has This Procedure Changed Your Practice?

My favorite minimally invasive procedure to perform today in the practice is Kybella. This procedure has changed the nature of my practice by being able to help contour the face and body permanently by destroying focal areas of fat. Ten years ago, if you told me that I would have a safe, FDA approved fat destroying injectable, I would have felt that was science fiction. Well… we have it, so I’m using it.

Looking At The Current Injectables (Neurotoxins and/or Fillers) Market, What Pipeline Agents Are You Most Excited About? Where Do You See Ongoing Need? Please Explain.

There are a few newer treatments on the horizon that are exciting. Certainly, new neuromodulators with possible greater longevity are exciting. New fillers from tried and true companies that have approvals in Europe and Asia are on the horizon in the US. Finally, topical fat reducing agents are moving along in the FDA process. This is really exciting and will change the way we practice plastic surgery.

Similarly, For The Energy-Based Devices Market: Which Of The “Newer” Indications/Applications Are You Most Excited About? What Is The Most Significant Unmet Need In This Arena?

Newer indications for energy-based devices are exciting for purposes of building muscle. Burning fat and building muscle are a winning combination, clearly. There is an unmet need for destroying DEEPER fat pockets. Right now, there is improvement in superficial fat, but we are limited by the depth of penetration and zone of injury to fat, while balancing not injuring the skin.

Are There Any Surgical Techniques That You Feel Have Become Underutilized/Overlooked In The Current Treatment Landscape? Please Explain When And Why You Think This Surgery Deserves Further Consideration.

I think brow lifting has become underutilized/overlooked. No question that neuromodulator use in the forehead, glabella, and lateral peri-orbital region are exceedingly helpful in rejuvenation of the upper third of the face. In addition, energy-based treatments to the dermis can firm the skin and improve skin quality which conceptually may increase brow position. Finally, dermal fillers in the temples and peri-orbital region can help “lift” the brow a few millimeters, but true brow ptosis is best addressed with a well-executed surgical brow lift. The scar burden, downtime and longevity associated with brow lifting techniques has made many patients and surgeons take pause prior to having or performing this sound surgical technique.

Is there anything you would recommend that a younger doctor should do early in their career to assure long-term success?

Early in one’s career, I would recommend that unless absolutely necessary to the success of your practice, stay away from large capital purchases like devices. When starting a practice, there is a need for capital injections into the practice and wrapping up large single purchases or expenses ongoing leases can jam up a practice. On the other hand, I found investing in good staff and EMR to be worthwhile and paying dividends today.

It’s been said that you should think about your exit plan the moment you start planning your practice. What is your personal approach to exit planning? What tips would you share with other doctors?

I feel thinking about contingency plans and practice diversification to be important, though I do not feel an exit plan was something part of my thought process at the beginning. I wanted to focus on being “all in” and how to build my practice as opposed to how I will retire. Prior to purchasing my office space and building my operating room, I started to think about asset management making sure I do not acquire “white elephants” with no ability to sell in the distant future.

What is one thing (or more) you plan to implement in your practice in 2019 with an eye toward long-term practice growth? Why?

I plan on implementing new technology/devices in my practice that physician extenders can utilize to help care for patients and continue to add value to the practice.

What do you predict is the big surgical procedure for 2019?

Based on what I am seeing, there is continued interest in breast implant exchange/downsizing. Patients are seeking a more refined and athletic look. I see patients coming in for smaller implants.


Over the next 10 years, what advancements do you want to see in plastic surgery?

The advancement I hope to see are ancillary procedures to help with skin tightening and elastin/elasticity restoration. This is still the holy grail to complement a well performed surgical procedure. Also, non-surgical management of cellulite is brought routinely in the office by patients. 


Do you think patients are seeking more conservative procedures? If so, please explain. 

Yes, I do feel that patients are seeking more conservative treatments. As the desire increases for individuals to look and feel there best, there is tremendous interest to undergo procedures or “treatments” that have an impact but do not require surgery, pain or downtime. This isn’t always possible, but patients are requesting a more “natural” look and conservative management often. There is renewed interest in my practice for non-implant-based breast augmentation. Also, patients are seeking body contouring to INCREASE volume: Sculptra in the buttocks and muscle building with fat reduction.


With more men seeking plastic surgery and becoming more comfortable with seeking aesthetic procedures, what do you predict will be their go-to procedure in 2019?

Men seeking to undergo plastic surgery procedures continue to grow in large percentages in my practice. They often and I predict will continue to seek liposuction for contouring purpose. Many of them are requesting skin care, fillers, and Kybella.


How do you see the influx of plastic surgery on social media affecting societies interpretation of beauty in 2019?

I feel the influx is helping patients figure out their comfort zone and clinician to deliver that outcome. Patients gravitate towards procedures that pique their interest and seek out the doctors who perform these treatments. Altogether, the awareness grows, but not always for the better and not always from clinicians qualified to treat these patients.


The total number of surgical and nonsurgical procedures for women under 30 increases each year, what do you predict will be the trends this younger group will seek in 2019?

I feel this group will only continue to grow and the trend will be stable with these patients requesting dermal fillers (primarily lips), botox type treatments and skin care (microneedling with PRP, etc…).


What are the major motivators patients reference when seeking a procedure?

The major motivators in my practice in Manhattan are looking their best at work or for work advantage and then “preventative” reasons. 


Procedures you want to see phased out? Advise against?

Non-FDA approved dermal fillers, buttock implants, lip lift. Less about procedures and more about the number of untrained and unqualified clinicians performing these procedures.


What is your take on “preventative injections?” Is there a general age for patients to start Botox or other neurotoxin injections? 

I feel there is value to the concept of preventative injections, especially on the neuromodulator side. Decreasing extraneous muscle motion leading to slight atrophy and staving off lines/creases in your 20’s has to pay dividends later on. There is no split face study or great data, but inherently these seems to make sense. General age is a tough question, since treatments in my practice are predicated on patient’s maturity, goals and expectations. Botox and fillers in one’s mid to late 20’s seems reasonable depending on the patients’ expectations.

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If you are looking for an experienced Board-Certified Plastic Surgeon, call LUXURGERY at (212) 508-0000 to schedule a consultation with Dr. Shridharani in New York City.

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