In The Life Of: Dr Sophie Shotter

The clinic owner and complications advisor gives us an insight into her daily life

Exercise kick-starts my day... I usually get up at around 6am and have a black coffee to help wake me up. Then, I’ll do some form of exercise – either by myself or with a personal trainer. I absolutely love working out and I’m a bit of a fitness freak, so I tend to only have one rest day per week. Since the end of the first lockdown I’ve had a really great routine, and I think part of that is having an exercise bike at home. Not having to get up at 5am and go to the gym has really helped my mornings and given me some extra sleep! Sometimes I’ll meditate in the morning if I have time, but most commonly I’ll do it at night because mornings can often be quite a rush. I usually leave for work by 8am at the very latest, but it really depends which clinic I’m in. Every Tuesday I work in London at the Cosmetic Skin Clinic where I have a 9am start, and it takes me roughly two hours to get there from my home in Kent.

My day is full of patients… When I get to my own clinic, Illuminate Skin Clinic in Kent, I’m seeing patients back-toback until the moment I leave – I rarely have time for a lunch break. This differs slightly when I’m in London as I use most of my morning to speak to and see the press, so this helps break up my week a bit! I do a lot of work with key journalists to raise consumer awareness about safe aesthetic treatments. That often means meeting with the media and sometimes treating them, giving them an opportunity to ask questions or interview me, and sometimes treating them. Typically, I see about 20 patients a day, and the most common treatment I’ll perform is facial fillers or botulinum toxin. I always tend to do a full-face approach when treating, and I very rarely will have someone in to do just their lips or just their cheeks. The ones who I treat more holistically are much more satisfying! The reason I enjoy doing them so much is because of the immediacy of the results, and I think it’s how we can make the most impact non-surgically. Before the patient leaves the clinic, they can see the difference you’ve made to their face and their smiles are what gets me through the day! I’ll finish work any time between 8:3010pm. Once I get in, I make myself a quick and healthy dinner, check over all my emails, and go to bed. If I have the energy, I’ll read a book but I really try to prioritise my sleep during the week, so I would rather have less unwinding time and make sure I’m asleep by 10:30pm at the latest.

Helping with complications… Once or twice a week will involve aesthetic complications. I am part of the Allergan Aesthetics complications help group, meaning that anyone who buys filler from Allergan and feels they need help, advice or medical input on something can get referred to me by their product specialist. The cases are given to me remotely by Allergan so that I can have a phone call with the practitioner and tell them exactly what I would do in their position, which they can then replicate. Every now and then I’ll have to see someone face-to-face if it’s a tricky case.

Having support like this is something that I think is integral in our industry, because when we work in the NHS we’re so used to working in multidisciplinary teams and we lose this sort of support in aesthetics because we’re often working alone. Being a complications advisor means I can give practitioners another port of call for second opinions and stop them from feeling alone.

My most memorable day… I first trained in aesthetics in 2012 while I was working in anaesthetics and intensive care, and during the next two years I fell in love with the specialty completely. So, my most memorable day has to be when I started doing aesthetics as my full-time career! I remember it specifically as being the first Wednesday in August 2014, because this would usually be the day in the NHS that I would be assigned my new jobs. Instead, I got to wake up and think ‘this is the start of my new adventure!’ At that point I had set up my first clinic as part of the Illuminate brand, and now every first Wednesday of August I think about that day and remember that feeling. I really do love my job, and even though it seems like I have a really busy schedule I’m so lucky that for almost seven years I’ve been able to do what I’m passionate about every single day.

On the weekends… My weekends are full of self-care, and I have a strict rule of no alarm clocks. On a Saturday I have a personal trainer in the morning and then make time for pampering – getting my hair and nails done is a must, as well as a lovely hot bath.

What I would change… Not much now, but I used to find it very hard to get a good work/ life balance. It’s important for practitioners to try and make some more time for themselves!

What’s exciting me at the moment… The Profound radiofrequency microneedling device by Candela! Even though it’s not super new to the UK it hasn’t been talked about that much, and I’m just so happy with the results I’ve been getting from it.

The Last Word

Dr Steven Land argues why the responsibility of complication management resides with the treating practitioner

All aesthetic practitioners will experience some kind of complication during their career and, in spite of a lack of empirical data, anecdotally the number of complications is increasing.1,2 This would be in keeping with the growth of the sector as a whole – even if the complication rate remained steady, we would expect a greater number if more procedures were being done. As we see more and more inexperienced, unregulated, non-medical injectors enter the market it would seem only logical that this rate is actually on the increase,3 and that certainly appears to be the case to those of us who regularly pick up the pieces. So, who is responsible for these problems? Who should be accountable and who is it that actually ends up shouldering the responsibility? Here I discuss these questions and propose what we can do about it.

The medical practitioner’s responsibility It’s commonly argued that complications should ultimately come down to the person that does the treatment – if you caused the problem, you should fix it. But we know it’s not actually that simple as fixing the adverse event may require resources outside of what you have available personally. Alongside this, many training providers do not go into much depth when it comes to complication recognition and management in a short foundation course. No one expects every practitioner to be able to fix every single potential complication and side effect from aesthetic treatments. However, I would expect every medical practitioner to make an appropriate differential diagnosis of the problem based on their history and examination and refer the patient on appropriately. Ultimately, the responsibility still resides with the original treating practitioner to ensure they have access to the resources needed and seek additional training to correctly diagnose, and manage, the complications that their treatment may cause. The individual practitioner’s role in complication management has many facets. Primary amongst these is education – knowing how to avoid complications and how to manage them requires constant updating of knowledge and skills as new research and new modalities become available – such as ultrasound.3 This leads onto self-awareness: good practitioners know what they know, but also know what they don’t know and the gaps in their knowledge and skills. Known as the Dunning-Kruger effect (a hypothetical cognitive bias stating that people with low ability at a task overestimate their ability)4 practitioners need to be able to recognise gaps in their own knowledge or skills and what can help them plug these gaps. Support networks can be vital in avoiding and dealing with complications. They can be a way of learning from others ‘mistakes’ (thus avoiding or lessening certain stages of the Dunning-Kruger effect) and they can be a source of help in the event of a complication. All practitioners should strive to develop a support network of some sort – this may be local practitioners they can call on for help and advice, a regional online support group, industry associations such as the BACN or BCAM, or one of the well-established complications groups such as ACE Group World or the CMAC. I feel all practitioners should strive to make contacts within secondary care organisations too, for example, those in plastic surgery, maxilla-facial surgery and/or ophthalmology. These colleagues can provide vital input in the event of serious complications – dermal filler-related necrosis or blindness, significant abscess or infection. Armed with all of these weapons – education, complications management skills, self-awareness and a support network – most practitioners should be able to deal with almost anything the field of aesthetic medicine can throw at them.

Regulatory considerations and the NHS As we know, there is no regulation of who can carry out aesthetic procedures, no benchmark for the standards they should be achieving, or even a legal framework for the level of education they should have attained before putting needle to skin. How do you know your training and complications course actually equip you to avoid or deal with a problem when it occurs? Furthermore, aesthetic complications are medical conditions requiring medical intervention, which makes it difficult for non-medical injectors to take proper ownership of their complications. What we should all be certain about is that these problems should not default to the NHS. Time and again across internet forums we see the default option ‘send them to see their GP/A&E’ and I see this from both medics as well as non-medics. There is a very minimal role for the NHS in dealing with the majority of aesthetic medicine complications as they do not usually have the skills, knowledge and training in specific aesthetic complications – read more on p.20. Certainly, there is the odd, incredibly rare complication that will require NHS input – blindness, abscesses requiring formal surgical drainage – but this pathway should be the absolute exception, not the norm.

Complications are a priority We move this forward by getting our own house in order. Every practitioner should come to terms with the fact that they are responsible for the outcome of their treatment. They should have up-to-date knowledge of aesthetic complications – how to avoid and deal with them – from a reputable training provider. Every practitioner should endeavour to cultivate a support network to help out should the worst happen; and every practitioner needs to be pushing for regulation to remove the cowboys (both training and practicing) and create a safer specialty.

Dr Steven Land qualified in 2001 and has trained in medicine, surgery, plastic surgery, and emergency medicine on his journey to be an A&E doctor at the regional MTC and an aesthetics doctor. He has a special interest in dermal filler complications. He is the clinical director of award-winning clinic Novellus Aesthetics in Newcastle and is due to launch his own training academy later this year. Qual: MBBS, MRCEM

REFERENCES

1. Save Face, Complaints Report. 2019. <https://www.saveface. co.uk/complaints-report/> 2. Kilgariff, S, News Special: Aesthetic Complications, Aesthetics journal, 2019. <https://aestheticsjournal.com/feature/aestheticcomplications> 3. Kilgariff, S, Utilising Ultrasound in Aesthetics, Aesthetics journal, 2020, <https://aestheticsjournal.com/feature/utilising-ultrasoundin-aesthetics> 4. Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated selfassessments. J Pers Soc Psychol. 1999 Dec;77(6):1121-34.