Building a Practice That Supports Your Life

Dr. Kouros Azar

As surgeons, we're kind of taught that you need to be 24/7 at your job, and most of us did do that for many years, but to be able to step away from it just a little bit to raise a family is huge for me. So I'm very grateful for that.

Erica Crawford

So I am here live at the Aesthetic Meeting with Dr. Azar. Welcome to the podcast.

Dr. Kouros Azar

Thank you so much, Erica. Thanks for having me.

Erica Crawford

Thank you. Okay, I want to talk about something a little bit different. So you run a successful practice in Thousand Oaks, but you're also a dad, and something that you and I have talked about many times socially is, let's talk about life-work balance for you as a plastic surgeon.

Dr. Kouros Azar

Absolutely. It's definitely part of our challenges day in and day out. How do you focus on your job, which is very intense, very focused, very high responsibility, but also raise a great kid? It's definitely a challenge. So like most things, I'm learning as we go, but the biggest thing is obviously setting your priorities straight. Obviously we're never going to compromise our patient care for some formals, but whenever you can, you can set aside some time for your kids. And I know my dad was a surgeon also and he didn't spend that much time with me because he just couldn't. So I find it to be a luxury that I can take a little bit of time.

So it's kind of like when I go into my patient's exam room, I kind of put all my other questions in my mind aside. You know, like Yoda says, like, clear your mind of questions, you know.

Erica Crawford

Yes.

Dr. Kouros Azar

So I kind of use that to help me focus on my patients. And then when, you know, there's nothing going on with my patients, then I focus on my daughter. So it's a sort of a multitasking, but not really, sort of serial multitasking, I think.

Erica Crawford

Yeah, that makes sense. And then, um, do you have like particular OR days versus admin days?

Dr. Kouros Azar

I do. I have typically Mondays and Wednesdays I like to do surgery. I've spent some of my Wednesdays with my daughter instead and swapped it out for Sundays because my staff is willing to work on Sundays. And if I need an extra OR day, um, just to accommodate my patients, I have no problem switching a day here and there.

And what's really great I think as a parent is like, if you tell your patients, "Hey, I need to go pick up my daughter from school," they're really pretty understanding. And same with my staff, if I tell them, "Look, I'd rather operate Sunday instead of Wednesday because I got to spend time with my daughter." It's a very good excuse in the sense that everybody's very understanding. So I'm grateful for that.

Erica Crawford

That's amazing. And then you do wonderful facelifts.

Dr. Kouros Azar

Thank you.

Erica Crawford

And it's my understanding that that's part of your focus in your practice, is you're not trying to be a volume clinic. You're trying to have the higher ticket facelifts. Um, you're at a higher price point, which is a good thing, right?

Dr. Kouros Azar

Yes.

Erica Crawford

And so you're not trying to get just, you know, you're not clocking in for like four surgeries in a day here or five dogs in a day.

Dr. Kouros Azar

Not at all.

Erica Crawford

But you're trying to focus on the higher ticket procedures at the right price point. So it's really about quality, not just a huge quantity.

Dr. Kouros Azar

Absolutely. That's been a big goal of mine from the very beginning when I started 23 years ago. I never signed an insurance contract. I always thought, "You know what? If my patients want me to take extra time with them, I will."

With our facelifts now, we've incorporated so many new technologies that make it safer and better for the patient. I just picked up a new one here at the meeting today

Erica Crawford

Wow.

Dr. Kouros Azar

that I'm excited about. Um, and so there's always things you can add in to make it safer, better, you know, overall better result. And it costs money, unfortunately. And so patients have to understand the standard of care, right? Like if you go to a car dealership and you ask for $2,000 off the car, the car doesn't change. It's still the same car. But in our industry, there's a standard of care. So if you want to provide a lot of extra things, it does cost money, but I only provide things that I think are worth it. You know, we're not doing things that are just fluffy or just to do it. You know what I mean?

Erica Crawford

That makes sense. So you're basically adding value to the procedure.

Dr. Kouros Azar

That's right.

Erica Crawford

And do you mind me asking what are some of those things?

Dr. Kouros Azar

Absolutely. So we started, you know, like a lot of plastic surgeons, coming around to using, for example, TXA, which is a medication that our orthopedic colleagues started using to prevent bleeding. So we started doing things like that, and then, you know, I pre-treat my patients with um medications and, for example, nutritional supplements and things, vitamins and all of that, and we get you skin care, professional skin care. I use the ZO line, which I love, um, to prepare their skin.

And then intraoperatively, you know, there's things that we do, for example, to help make things a little bit safer for the patients. So I'm applying a new product called CO2 Lift, which helps increase the oxygen levels to the tissues and helps prevent them from having any skin necrosis and heal faster. Um, hyperbaric oxygen, we also try to include some of those treatments if we can. Um, so things like that to really make it overall better experience.

Erica Crawford

That's amazing. And I love a CO2 Lift. It's my favorite go-to after traveling.

Dr. Kouros Azar

Oh, great.

Erica Crawford

Traveling, yeah. Like if I'm, I'll put it on on airplane. Uh, just because you get dried out when you travel, right?

Dr. Kouros Azar

Absolutely.

Erica Crawford

Um, so I just need some of that hydration back in my skin.

Dr. Kouros Azar

Perfect.

Erica Crawford

Um, that's fantastic. So I love that. So, cuz I would argue that to some degree, you have a better work-life balance than some plastic surgeons. You spend a lot of time with your family, and I mean that in the most beautiful way.

Dr. Kouros Azar

Thank you so much.

Erica Crawford

Um, and I think that a big part of that and your success has been the fact that you have niched. And I know you do, of course you do other procedures, but you have become really specialized in facelift. And you get to charge right for it, and you get to go in, do a really wonderful facelift, and call it a day.

Dr. Kouros Azar

Absolutely. It's something that I've been focused on since I was a lot younger, when I was even a student, you know, watching some of my colleagues before me who were masters, you know, all little tips and tricks that they learned. I made notes of them. And I do see it as a luxury as a dad to be able to step away sometimes from work. And, you know, surgeons were kind of taught that you need to be 24/7 at your job, and most of us did do that for many years, but to be able to step away from it just a little bit to raise a family is huge for me. So I'm very grateful for that.

Erica Crawford

Yeah, it's amazing. I also think in today's age AI is specializing people, meaning that the practice that does everything is not something that AI rewards. AI rewards specialization. So to that degree, have you had people check you out in ChatGPT or Grok or Gemini?

Dr. Kouros Azar

We have. Yes, surprisingly we've had patients show up and say, "Oh yeah, ChatGPT told me to go to you." I actually had my sister look up randomly who did Nicole Kidman's facelift. And she dug a little deeper, asking, you know, for who's really good, and the AI totally independently recommended me to my own sister who lives like in New York and I'm in LA. So I thought that was pretty cool.

Erica Crawford

That is amazing. That's incredible. Yeah, I guess that for people who have specialized, AI really rewards that. And some people are very frustrated by that. Some people go, "Well, I give great breasts and tummies and I do great facelifts." And that's very true, and nobody's trying to negate that. Nobody's trying to say something's a certain way. It's just a fact that AI specializes right now. It just is.

Dr. Kouros Azar

I don't think it's any different than what we went through with Google 15 years ago, keeping up with all the algorithm changes when Google decided that it wanted to make you be found in a certain way, because you used to be found the 10 years prior just by your name. Now they wanted you to have more credibility. I think it's going to look at different indices like, have you published papers, and what are your reviews, and it'll hopefully be a little bit more sophisticated. It could also be susceptible to herd mentality problem, but we'll have to see where it's headed.

Erica Crawford

Yeah, I think it's a bit of both. I think there will be some of that herd mentality. I just, unfortunately even on social media that's been the case, and I do think some of that will be, I think the one biggest plus about AI is that it very much cares is board certification.

Dr. Kouros Azar

Oh, that's great.

Erica Crawford

Heavily. And being members of places like the Aesthetic Society or ASPS. And it does recognize that. So I do think that it will weed out some non-board certified plastic or cosmetic surgeons even, you know? And I think that that will be very good about AI.

Dr. Kouros Azar

And another thing I think I'm hopeful that it will be helpful for is when somebody rehashes something that we did 20 years ago with marketing mumbo jumbo and they try to, you know, dust it off and rehash it. It will kind of cut through that and say, "Hey, this is a procedure that people have tried over the years and these were the pros and cons that, you know, came out." Just like everything in life has a cycle.

We see things come and go, and hopefully the AI will help kind of smooth some of that out and say, "Hey, this is not exactly new. Doctors have been doing this for about 20 years, but it comes and goes."

Erica Crawford

It's so funny. You said everything has a cycle. And somebody was, asked me the other day how I felt about RealSelf. And I was laughing my head, cuz like if you asked me about RealSelf a year or two ago, I was very neutral on it. It's not like I thought poorly of it, but I didn't think great of it. I just didn't see it as like a super viable marketing channel.

But now you ask me about today, I think RealSelf is great because AI pulls from RealSelf. Because of AI. I think there was a time when RealSelf was really great cuz Google pulled from it a lot. Then there was a big Google algorithm change and then they stopped pulling from RealSelf as much, right? And then now here we are with AI and now they're pulling from RealSelf again.

Dr. Kouros Azar

Well, so now you're teaching me something because I hadn't had the time to come around and revisit that issue. I am on RealSelf, but I haven't revisited how AI is pulling from it.

Erica Crawford

It is. And now is in a way. So it's the cycle, right? It was relevant, then frankly it was irrelevant, and now in my opinion, it's possibly the most relevant it's been in quite some time. So now I'm like, "Oh yeah, absolutely. You should be on there putting some things on there because AI is going to pull from it."

Dr. Kouros Azar

You know, one of the things I use RealSelf for is when I want to introduce a new treatment or a new device to my practice. I do like to go on there and see how many patients have given it a thumbs up.

Erica Crawford

Yeah.

Dr. Kouros Azar

You know, if it has like a 90% plus thumbs up rating, you know, I'm more happy about bringing that device into my office.

Erica Crawford

Yeah, that's how I feel about Motiva right now, right? Like, you know, Motiva does such great marketing themselves, right? Um, and every client that I've had of added Motiva has gotten more breast docs, right? And I'm not even saying it's the best breast implant, although it's fantastic. I'm not even arguing that. I'm just saying I'm only talking from the lens of marketing. It is well marketed and it brings in more patients, so it's worth having.

Dr. Kouros Azar

Absolutely. Yes. And I'm not one to bring something in just because it's new, but if it happens to be new and it's got chops behind it, it's definitely going to increase your value. And then, you know what I've been through with some of the acne treatments that I've pioneered as well, you know, that helped me get out of COVID. I brought on a new acne treatment that no one else was doing called Sebacia, and we've treated so many patients with it, more than anyone else in the country, and I feel like that helped us recover from 2-3 months of being shut down. So anything new you can bring in, if it's helpful,

Erica Crawford

you should. You should always, it's always worth putting the bet on being first to market, new to market. As long as it's something that you believe in, right? That makes sense medically. But it's worth the risk to bring something in that's new because the reward might be worth it, like with you and Sebacia.

Dr. Kouros Azar

Definitely. I'm a big proponent of new technologies.

Erica Crawford

Yeah.

Dr. Kouros Azar

I'm evaluating a new cellulite device right now called Cellulaze. I don't know if you've heard of it yet.

Erica Crawford

Not actually.

Dr. Kouros Azar

It's sort of, it's reminiscent a little bit of Aveli, but it's not

Erica Crawford

I was going to say, I definitely know what Aveli is, yeah.

Dr. Kouros Azar

not quite the same. It looks kind of similar, but Aveli is for distinct sort of dimples in the buttock. The Cellulaze is a little bit more for like a diffuse cottage cheese type of cellulite.

Erica Crawford

Well, that interests me.

Dr. Kouros Azar

Yes, yes, so it's applicable to a larger area. And new company out of the Netherlands, but they're FDA approved here in America and I did some of the first cases on the West Coast already. And so we're evaluating it really well for larger areas like lateral thigh and buttock, but very different than Aveli in the sense that it's more for larger areas.

Erica Crawford

I think that's fantastic. I think Aveli has had some great results for the dimples, but I think the problem they run into is people want to fix the cottage cheese cellulite.

Dr. Kouros Azar

Yes.

Erica Crawford

Expectations are off because they think it's going to be the dimples and the cottage cheese is going to go away, and it does not fix the cottage cheese.

Dr. Kouros Azar

It doesn't. We're hopeful that this would be an adjunct because they can actually be done together on the same day. So for patients that have both, you know, we can offer both.

Erica Crawford

What? Like 95% of women or something?

Dr. Kouros Azar

That's true.

Erica Crawford

It's a big percentage.

Dr. Kouros Azar

Definitely. It's a common problem and people have been asking us for treatments for decades, you know.

Erica Crawford

Yes. Yeah. Well, that's really cool and that is innovative. So I love that you're doing that.

Dr. Kouros Azar

Thank you so much.

Erica Crawford

All right. Well, that's all we have. Thank you so much for being on the podcast.

Dr. Kouros Azar

We appreciate it. Great to see you.