Announcer (00:06):
You are listening to the Aesthetically Speaking Podcast presented by Nextech.

Tyler Terry (00:13):
Hey guys. Welcome back to the Aesthetically Speaking podcast. My name is Tyler Terry, and I'm your host. Today I have two incredibly special guests, Dr. Joel Schlesinger and Dr. Daniel Schlesinger. So happy to have both of you here and honored to have you on the podcast.

Dr. Joel Schlessinger (00:31):
Hey, it's great to be here. We're at the American Academy of Dermatology here in San Diego.

Tyler Terry (00:37):
Beautiful San Diego.

Dr. Daniel Schlessinger (00:38):
Thank you for having us.

Tyler Terry (00:40):
Of course, of course. Our pleasure. And you guys have been clients of ours for over a decade and really one of my favorite practices.

Dr. Joel Schlessinger (00:48):
Well over a decade actually.

Tyler Terry (00:50):
Okay, well how long has it been, do you know?

Dr. Joel Schlessinger (00:52):
I think it's been since 2006.

Tyler Terry (00:56):
Wow.

Dr. Joel Schlessinger (00:57):
Almost two decades.

Tyler Terry (00:57):
Yeah. Yeah. That's incredible.

Dr. Joel Schlessinger (01:00):
Two decades worth of work with Nextech. It's been amazing.

Tyler Terry (01:04):
Wow. And I know with TouchMD it's been over a decade, so you've had two technologies even prior to the acquisition. Nextech acquired TouchMD back in the fall of 2022,

Dr. Joel Schlessinger (01:16):
And actually we go before Nextech with Chiron, which I think was kind of melded into Nextech, which is why we ended up with Nextech.

Tyler Terry (01:25):
There's some history there.

Dr. Joel Schlessinger (01:27):
Before that, we were using an abacus and just papyrus for our notes and stuff like that, and that was really uncomfortable because those scrolls, you can never really use them all that well.

Tyler Terry (01:42):
Tell us a little bit about yourself. So I'll start with you, Dr. Daniel, if you could tell our listeners a little bit about your background.

Dr. Daniel Schlessinger (01:48):
Yeah, so I am currently a Mohs Surgery and Cosmetic surgery fellow at Northwestern University in Chicago. And in the fall I'm going to be joining my dad in practice. But before then I grew up around dermatology. I've worked with my dad my whole life on various projects. We've researched together, we've created products together. We have produced, invented and patented a medicated lip balm with 1% hydrocortisone called Fix My Skin Healing Balms. Wow. And after that I went to Northwestern for undergrad and medical school. I was at Mass General Hospital in Boston for my first year of residency, followed by Wash U in St. Louis for dermatology residency and then back at Northwestern for my fellowship.

Dr. Joel Schlessinger (02:36):
And before we did that, we even did research together, but we have continued, we've done some clinical trials over the couple of years that we've been separated. Well, Daniel is in residency in medical school that we were kind of involved with each other in clinical trials and continue to do clinical research.

Tyler Terry (02:55):
Dr. Joel, I'd love for you to share with our listeners a little bit about you and your past.

Dr. Joel Schlessinger (02:59):
So I'm board certified dermatologist, board certified Mohs surgeon, and previously board certified pediatrician. And I've been in practice now for about 32 years on my own and have done quite a bit of work, not only with the medical dermatology, but cosmetic dermatology and clinical research. And so we have that in the practice. The practice itself is rather large practice. We do about 20,000 patient visits a year and we have a med spa associated with it as well as a store associated with it. So Nextech kind of takes all those aspects, all those disparate aspects and ties them all together.

Tyler Terry (03:42):
And the store that you're referring to is one of my favorites, Lovely Skin. And you were one of the first to actually have your own online skincare store. Can you tell us a little bit about that and how you're able to dream that up and see it before others even really caught that vision?

Dr. Joel Schlessinger (03:58):
Well, when I started practice in 1992, I actually joined a group for about a year, and then I started my own practice in 1993, somewhere in 93 and immediately started taking on skincare products. I knew that cosmoceuticals had a valid opportunity for helping people with skin problems that were out there and things that I couldn't touch them with. In other words, I would see people come in that had this panoply of products that were just garbage from this store, that store. And they'd been sold a bill of goods on so many of them. And really I wanted them to have products that I knew would help them with their conditions. And as we know, there are cosmoceuticals that are able to help you with whether it's keratosis, PIIs or dry lips, as in the case with our fixed my skin or dry skin, that we have 1% hydro hydrocortisone or other options that are out there that might be better than picking something up at a drug store or a department store.

(04:58):
So that was the whole goal of it. But when we had been doing this for about four or five years, I realized that a lot of my patients were moving out of Omaha and they needed it and they were calling us up and saying, Hey, could you send it to us because we can't find it. Our dermatologist hasn't carried it or it's not available. I moved to somewhere remote and I can't find that in my remote area. So we started to sell them those products via phone, and I thought, well, maybe we'll just set up a website for it because they had a website, this is back in 97 for the medical practice, and it was so boring. It was just like a few little hours and what we did. And I thought, well just add a shopping cart at the end of that. And so we did that first purchase was in January of 99.

(05:44):
Our first sale was in January of 99, and it was very slow for the first five years. From 97 until 2002. We lost about $50,000 a year during Lovely Skin. Oh my gosh. It was just a of love. And I just kept on thinking, well, there may be something more to this than that and maybe one day we can make it successful. And around 2002 when Google took off, Bing took off. We really became inundated with people and we invested all of our money into search, and we were buying pay per clicks at penny and click, which as you know right now, it can be a hundred dollars, $200 a click. It was a penny a click, and we just put every single dollar into that. And that's how we built this list of 2 million names that we have of people that shop at Lovely Skin, 1.3 million that are opted in for email, 70,000 for SMS texts. So it's become a fairly large business.

Dr. Daniel Schlessinger (06:36):
Wow. The funny thing about the pay-per-click back in those early days is I was actually in elementary school and my older sister and I would bid on these search terms after school.

Tyler Terry (06:47):
No way

Dr. Daniel Schlessinger (06:47):
And that was just what we did, and it was basically set up a game for us, get us the best deal for the best search terms, for the best deal, and we would just come home and we'd play that for a few hours and buy him customers.

Tyler Terry (07:03):
Thank you guys for sharing that story. That's incredible. And the.com era, and you did it and you started it out for the care of your patients because they were moving away and you're trying to help 'em out, and you did it before, it was cool to even start, or people even talked about e-commerce.

Dr. Joel Schlessinger (07:18):
We always used to say it's for the housewife in Montana, but it's so much more than that. It's just for that person who is out there and can't get access to these products, they may see something in Allure or Vogue or something else that they couldn't see, or a doctor's product like what we had, where our patients move. They couldn't find it in their local areas. So it's become quite an interesting thing to have so many people that I think of as my pen pals, but in so many ways we're taking care of them. By the way, every single piece that you see that comes to you, I've looked over personally. I look over every single marketing piece that goes out of lovely skin to make sure that it has a dermatological bent and that it's ethically and that it's made to my specifications.

Tyler Terry (08:02):
I would like to shift gears a little bit and ask you guys what trends that you're seeing in the dermatology industry, both medical and aesthetic, and Dr. Daniel, I'll start with you.

Dr. Daniel Schlessinger (08:14):
Yeah, well, it's a great question and I actually had an opportunity just a few hours ago to lecture on AI in dermatology, which I have a special interest in. I think it's definitely something that's a big trend in dermatology, and I think it has a lot of potential for both Good and for also some drawbacks as well.

Dr. Joel Schlessinger (08:35):
Yeah.

Tyler Terry (08:36):
What are some things that excite you the most?

Dr. Daniel Schlessinger (08:38):
Yeah, so this afternoon I was speaking on large language models, things like chat, GPT and Google's, Bard or what is now called Gemini. So these are superpowered chatbots that even as few years ago were simply not possible. You can have a conversation with them and it's almost like you're speaking with a human. They might make a mistake, they might completely mess up something and make up information, or they might have an incredibly creative response to something that you had never considered. They have a lot of potential. You can also, in addition to having text in and text out, you can give it an image and have it give you a diagnosis. You can give it text and have it give you an image to supplement it.

Tyler Terry (09:24):
What are some ways over the next five to 10 years that you see this impacting the industry and even impacting potentially your research? Is it something that you're using actively as you're researching?

Dr. Daniel Schlessinger (09:34):
It's absolutely something that's going to impact the industry. I mean, it already is in so many ways in the practice management sphere, thinking about things like Nextech, it absolutely will be able to help with patient scheduling and feedback, patient education tools, wound care and management of post-procedural complications. It will also help with research, most likely in the clinical research sphere. This is something we've been talking about a lot. There's a huge need for standardization of the outcome measures that we use. So if you do a clinical trial of something, you have to measure how well it works. But those measurements are imprecise. There's a lot of subjectivity involved, and the way I might measure something is different than the way you might do it and was different from the way my father might do it. AI could potentially have a role in standardizing those outcome measurements.

Tyler Terry (10:32):
I couldn't agree more with you in terms of software, how it can fit in and how it can play a role to enhance the patient experience and to help standardize care and to help with research. And what excites me most is the speed, the speed that we can get to places that may have taken us potentially 20, 30, 40 years. And hopefully that's getting us in that 2, 3, 4, 5 year mark. So I'll turn the time over to you, Dr. Joel, to share what trends you're seeing and what excites you as you look towards the future.

Dr. Joel Schlessinger (11:01):
I think that the biggest things that I'm seeing right now are additions to the neurotoxins. I presented today on a new form of neurotoxin, rol botulinum toxin, which is a Galderma product that will be a toxin that is a liquid toxin. It won't be one that you have to reconstitute. It will be coming in the bile in liquid form, which I think is nice. It takes some of the guesswork out of it. It makes it more reproducible. I think that's going to be good. The data, of course, for this is very, very good. A lot of our toxins are becoming a little bit more long lasting, whether it's because we're concentrating them a little bit more, we're getting a little bit more per unit of the actual botulinum toxin protein, but whatever the case, we're starting to see that last more than three months if we handle them correctly.

(11:57):
We're also seeing additions to the areas that we're treating with toxins. Like five, 10 years ago, it was very rare for us to do off-label areas like DAOs or for the neck. We're starting to see a lot more of that, and that's going to be codified. We're doing clinical trial right now on master Botox for master hypertrophy, so there are a lot more indications, Tyler, I think that are going to be coming out, and I think that's going to be great. We also see a lot of new lasers that are quite exciting that we're going to be including in patient care regimens, and we've been on the forefront of laser treatments for literally 30 years. I think I bought my first laser about 30 years ago, which was a CO2 laser, and we did full face CO2s, and it was quite grueling. Now it's like night and day.

(12:49):
The reasons that we do it are so much better, I think, than what we started off with. People are addressing their concerns much earlier. The whole idea of rejuvenation versus rejuvenation, I'm so excited to see people that are taking care of their skin and really proactively looking at what they can do to keep themselves in the best health that they can. When I started practice in 1992, it was absolutely impossible to find good treatments for certain conditions. And until really recently, there weren't adequate treatments for so many conditions that we came in touch with each day, whether it be vitiligo, alopecia, areata, even psoriasis, hs. And we have knocked out so many conditions, whether it be psoriasis, psoriatic arthritis, alopecia, areata, so many that we're going to have good if not great treatments for, and that makes me so very happy. Even something as simple as wart treatments. We're doing clinical trial right now on a Canada Antigen product, and it might be interesting to see how that goes over time. If we have a good treatment for warts, there are other treatments for warts that are coming out from other companies for molluscum. So there are a lot of things that we just are bit by bit taking out problems that we couldn't cure or we had very limited options for, and it's exciting. Be a dermatologist circa 2024,

Tyler Terry (14:25):
What would you say has been one of the most rewarding things about being a board certified dermatologist?

Dr. Joel Schlessinger (14:32):
It's always got to be the relationships that we have with the patients. And I think that probably the most rewarding thing is that I have Daniel over here who has followed my work since he was born and is now joining me, and I have the ability to pass on this love of dermatology, this love of what I do to the next generation. And I think it's going to be a great opportunity for us to continue the care of those patients because as you take care of those patients, you want to make sure that they're in great hands after you're gone. So I think it's not that I'm planning on it, but I want to make sure that there is continuity. So I'm very excited about that.

Tyler Terry (15:14):
Dr. Daniel, I would love for you to tell us

Dr. Joel Schlessinger (15:17):
How

Tyler Terry (15:18):
You were driven to become a dermatologist and what led you to walk in your father's footsteps.

Dr. Daniel Schlessinger (15:25):
Well, I mean, speaking about that love, I literally grew up around this and our dinner table discussions. Were talking about some rash from clinic that day and growing up around that and seeing my dad's love for this profession, it's hard not to fall in love with something when someone that you admire does too. And for almost as long as I can remember, I've been interested in science medicine and dermatology. It was a natural choice. I explored many different fields of medicine, and I was the kind of person in medical school who truly loved almost every rotation I was on. But in the end, nothing came close to dermatology. And I just feel so lucky to have ended up in this field, to have the opportunity to work with my dad, to learn from him, to work together and just have this special moment together.

Tyler Terry (16:22):
Yeah, it doesn't get any more special than having that type of relationship with your parent. You have an incredible family, and I can tell Dr. Joel that you are passing the baton on to someone who will take it to the next level and who will make you proud

Dr. Joel Schlessinger (16:38):
Already has, already has. And you've met my wife, Nancy, who's amazing. Incredible. And she's made such an impact in the practice and in our lives and the medical site as we function and the website. And Nancy has an integral role. And even my parents, June and Bernie have made a huge impact in our business. And Daniel's married now, his wife, Steffy is helping out as well in so many ways with some of the things that we do.

Tyler Terry (17:09):
Oh, wow. Congratulations. Yeah,

Dr. Daniel Schlessinger (17:10):
Thank you so much.

Tyler Terry (17:12):
I would love to have you both on again and maybe to go over other topics. What you shared with us today is so incredibly valuable and super exciting and is making me want to ask even more questions. But I just want to thank you both for your time and would love to invite you back on in the future.

Dr. Joel Schlessinger (17:32):
Absolutely. Let me say one thing before we do go, and that is just talk about Nextech. I know that that's kind of one of the reasons that we're here, and I want to say how impactful Nextech has been on our practice. So we started Nextech back in 2006 just for the billing part and practice management. Now, we added in the EMR part back in, I think it was about 2012. And it was done kind of kicking and screaming because we didn't know what we were in for, how it would change things, whether we could adapt to it. And best thing that we ever did was going to the EMR. We took about a hundred thousand charts and gone. They were out of there. That allowed us to reclaim incredibly valuable space in our practice so that we had the ability to expand our nurses stations so they could have a place to go that was enlarged because there were so many new things that the nurses were doing.

(18:32):
They had gone from just having paper, of course, to work with, to having to have a computer station to work with to document things. And so that transition allowed them the opportunity to go from paper to computer. And we have evolved with EMR so remarkably over time that, especially during the pandemic, I have to say that the Nextech people were absolutely incomparable. When we were down and out, and we didn't have the ability to see patients other than through telemedicine. Nextech came out within one week with the telemedicine option that we were able to see people. Literally, we would've not had any income into the practice. And it was a scary, scary thing, but Nextech took care of us within one week. It was absolutely nothing short of miraculous that they were able to set that up, and that allowed us to keep every nurse employed, every employee employed during that time period.

(19:31):
So I'll never forget that. And then the other thing that they did was allowing it to be on an iPhone. So the opportunity for me, like last night, I got a call four in the morning from a patient that had a procedure done by one of my associates, and there was a question about it, and I was able to look it up on my phone and say, oh no, that was something, here's what you do for that. And here I am in San Diego, 2000 miles away from our home, and I was able to help that patient out within about one minute by just looking her up on the Nextech system, find out exactly what had been done for her, what her allergies were, and how to handle it. So kudos to you guys. You make our lives as dermatologists so much better.

Tyler Terry (20:15):
Wow. Thank you for saying that. I know it means the world to our entire company, everybody that is listening to this and just know that we really value our clients. And our goal is to really treat you like family and going back to that family centerpiece and being the heart and soul. And thanks for sharing that incredible story of our company, being able to innovate, shift, and develop something within a matter of a week when everything shut down, which obviously made a huge impact on your family, on the family of your practice. So thank you for that, Dr. Joel.

Dr. Joel Schlessinger (20:48):
Thank you. And thanks. Nextech.

Tyler Terry (20:49):
Yes, thank you. Nextech.

Dr. Daniel Schlessinger (20:50):
Thank you Nextech.

Tyler Terry (20:52):
Thank you both. Appreciate your time.

Announcer (20:56):
Thanks for listening to Aesthetically Speaking, the podcast where beauty meets business, presented by Nextech. Follow and subscribe on Apple, Spotify, YouTube, or wherever you like to listen to podcasts, links to the resources mentioned on this podcast or available in your show notes. For more information about Nextech, visit Nextech.com, or to learn more about TouchMD, go to touch md.com. Aesthetically Speaking is a production of The Axis.