Rachel Carter speaks to Sohail Karim about how he set up a successful aesthetics clinic alongside his role as superintendent pharmacist.
Service type: Aesthetics.
Name of pharmacy: Hempstead Pharmacy, Gillingham.
Name of pharmacist: Sohail Karim.
Why did you start offering the service?
I’ve been offering this service for three and a half years. I had a few casual enquiries from a handful of people as to whether I offered Botox, anti-wrinkle treatment and dermal fillers. At the time I wasn’t, but those enquiries planted a seed and I decided to look into it.
How much did it cost to set up the service?
It was initially in the thousands (four figures), but you can’t just set up a service and hope it’s going to remain as it is. You always have to modify it and do upgrades, so the costs have gone up to a five-figure sum now. The main costs involved are training, insurance and the treatment room.
What, if any, training did you or other team members have to undergo?
I went back to university to qualify as an independent prescriber, in 2017, with the Robert Gordon University. As it stands, a pharmacist does not have to be an independent prescriber to actually carry out treatments. However, undertaking this qualification will help you dramatically because it means you can issue prescriptions for anti-wrinkle treatments. It does also seem to open up more doors, in terms of having certain recognition in the aesthetics industry and being accepted onto training. Training providers always seem to ask if you are an independent prescriber, so that seems to carry value.
I also undertook an initial training with Derma Medical. At the time, they were offering training for pharmacists as well as other medical professionals. It was a two-day course. The first day was a foundation course, which taught us the basics of Botox and dermal fillers, what they are, how they work, and where and how we can inject them. Day two was an advanced session, which covered what we did at foundation level in more depth. We were also shown more areas that could be treated using anti-wrinkle injections.
What I would say on reflection is that this initial training, although it was great, is absolutely not going to be enough to prepare you for what lies ahead. Since then, I have invested a lot of time and expense in doing further training. This has included aesthetics masterclasses, which are very important and help you to become an expert in, for example, lips. CPD in aesthetics is absolutely vital, as is embarking on anatomy and complications courses. It’s a never-ending process and important to constantly refresh your knowledge.
Finally, I have taken the step to do my level 7 accreditation in aesthetics with Acquisition Aesthetics. This will take me to a particular standard and is regulated by the Office of Qualifications and Examinations Regulation (Ofqual). Achieving this standard means that, as a pharmacist, I am taking on board the nature of what I’m doing and the seriousness of the complications that may arise from what I’m doing. It’s absolutely imperative that I can learn as much as I possibly can, because client safety is of paramount importance.
I have also provided some training for other members of staff, essentially on how to receive a client and help them to fill out the initial questionnaire.
In a nutshell, what does the service involve?
Initially, I will carry out a very informal consultation with the client to make sure that I feel it is going to be safe for them to have the treatments involved. For example, if it is a female client and she is pregnant, then we would not be able to go ahead with an appointment for a full consultation.
If we’re going ahead with a full consultation, then this is usually done on an appointment basis so I can dedicate time to the client. Nothing is ever rushed. At this first consultation, I will sit with the client, find out more about them, what it is they are looking for, and what is bothering them from a facial perspective or otherwise. It’s not just a couple of questions, we literally go through everything, we address the issues and take a full medical history.
I have a patient consultation form and a set pattern of questions, and every single question is asked. When addressing the main points the client is concerned about, we have to educate them as to why these changes might be happening. For example, a client may be worried about lines between their nose and their mouth, but it’s not just about targeting those lines for treatment. We have to look at other areas, and we might have to deal with the cheek area and lift the face slightly to soften those nose to mouth lines. That’s a basic example, but it is important to educate the client about the age, lifestyle and genetic factors that could be causing those changes.
We can then tell them about the ways we can address these changes safely. In some cases, the client is just not a suitable candidate for the treatments involved. As an aesthetics practitioner, you have to be able to recognise that and know that the treatment the client is asking for is not right for them. Sometimes clients find that hard to accept, but as a good practitioner you’ve got to tell them and may have to signpost them elsewhere. There is no point in treating someone who is potentially a surgical case with a non-surgical aesthetic treatment and then getting a bad outcome for that client.
If we’re proceeding with treatment, then the client will have to go through our consent process. We have to obtain consent in a written format, but also go through the consent verbally too. This is to ensure that the client fully understands what the treatment involves, any potential risk factors, side effects, and the negative elements of any treatment such as potential bruising, pain and allergic reactions. There has to be absolute transparency.
The clinic is accredited by the Save Face organisation, and they have provided us with a whole host of materials and support. I use their consent forms, which are very comprehensive and have all the information to hand.
After consent has been obtained, and both the client and I are happy that the treatment is safe for them, then we can put together a treatment plan.
Usually the treatment itself will be done at another date. The patient needs a cooling off period to give them a chance to think about what it is they have just signed for, and this is normally a couple of weeks. Even on the day of treatment, if they get second thoughts and decide not to go through with it, they are free to walk away with no questions asked and no charge. Patients are also always asked if they would like to bring a chaperone with them.
Before giving treatment, I will always check whether anything has changed during the cooling off period. This is to make sure there are no changes to their medical history and there are no new health problems. If everything is good and we’ve gone over the paperwork, I will do the treatment.
Afterwards, I provide aftercare advice and give the client an aftercare card. This is written documentation of the do’s and don’ts, for example avoiding vigorous exercise and excessive heat in the first few days. I also give them a contact number that they can reach me on 24/7 if they have any problems.
I always do treatment in a logical, safe manner and give lower doses first. There will be a face-to-face follow up after two weeks, so I can see how things have gone. I can then talk about the results with the client, reassess, and if further treatment is needed then I can carry that out.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it?
I would never sell an OTC product to the client just for the sake of it. If the client asked me, I would make a recommendation. Or, if I genuinely feel that the client would benefit from a particular add-on product after their aesthetics treatment, then I will make a suggestion to them. It’s also important to remember that some clients coming for this treatment will be on a budget, and if I’m aware of that then I probably wouldn’t suggest anything.
How have patients responded to the service?
Feedback has been very good. I think you’ve got to be a people person to do aesthetics. You’ve got to have good consultations skills, be able to understand and listen to what it is that is worrying the client, especially from an aesthetics perspective, and understand your limitations as a practitioner.
Many clients have also said to me that they like coming here because it is a pharmacy. The pharmacy has been here for a number of years; we feel we have a good reputation within our community, and people trust us.
Roughly how often each month do you carry out the service?
As the superintendent pharmacist, my time to do treatments is quite limited because I dedicate most of my time to NHS services. Pre-Covid-19, my treatments were taking place after 6pm and at weekends, on an appointment basis. On average, I was seeing between 20 and 50 clients per month.
How much do you charge for the service?
The consultation element of the service is free. Treatments range from the low hundreds into the thousands, although that could be due to a client having multiple treatments over a period of time. Treatment prices take into consideration the cost of the product. Botox, for example, is not cheap and you cannot interchange stock because it is a prescription-only medicine.
Roughly how much a month do you make from offering the service?
The takings turnover varies from month to month. It depends on the total number of clients I see per month, and how many treatments a client has.
Would you recommend offering this service to other contractors?
For other contractors who may consider offering this service, I think they need to have a dedicated aesthetic pharmacist to do this, either for or with them, in their pharmacy. Or, if like me as a pharmacy owner you feel that you want to do the treatments yourself, then you have to be prepared to invest a lot of time, effort, hard work, dedication, finance and commitment to make this service work safely. The risks involved in aesthetics are very high.
You have to really take aesthetics seriously. If I’m doing treatments during the day, then I would need to have a locum pharmacist here to deal with prescriptions and queries. You therefore need to consider that additional cost and have enough clients per month to make the whole system work.
It is also imperative to keep on top of your CPD, go to conferences, network with other practitioners, get yourself affiliated with Save Face, and do your research about training providers and which companies offer good products.