In this month’s “Meet the Aesthetic Expert” column, Will Kirby, DO, FAOCD, talks with José Raúl Montes, MD, FACS, FACCS, a board-certified Oculoplastic surgeon and established injector, researcher, speaker, and trainer. They speak about his aesthetics journey, the changing aesthetic patient, and the future of the field.
Welcome to “Meet the Aesthetic Expert,” where, each month, dermatologist Will Kirby, DO, FAOCD, of LaserAway, will connect with select industry leaders to get their expert opinion on the aesthetic specialty. With an emphasis on straightforward, candid questions, Kirby will focus on the best in aesthetics and get the experts’ frank thoughts on where the field is headed.
José Raúl Montes, MD, FACS, FACCS, is board-certified oculoplastic surgeon in both the United States and Puerto Rico. He is a Fellow of the American Academy of Cosmetic Surgery (AACS), American Academy of Ophthalmology (AAO), American College of Surgeons (ACS), and American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS). Also, Montes is a member of American College of Surgeons Association (ACSA), Colegio de Médicos Cirujanos de Puerto Rico, PanAmerican Association of Ophthalmology, and Puerto Rico Society of Ophthalmology, as well as an honorary affiliate of the American Society for Dermatologic Surgery (ASDS).
With more than 25 years of experience in the field and a member of various pharmaceutical advisory boards, Montes has overseen the process of introducing new products for FDA approval. He is an established top injector, author, researcher, speaker, and trainer with numerous publications in medical journals and contributions in medical books.
In addition to having a successful practice—which doubles as a research and training center—in San Juan, Puerto Rico, in his role as a professor at the University of Puerto Rico School of Medicine, Montes serves as a mentor to medical residents at the Río Piedras Medical Center.
Kirby: Dr Montes! Thanks for agreeing to this interview. Tell me, what led you down an aesthetic career path?
Montes: As an ophthalmology resident, I had the opportunity to treat patients that had eye movement disorders with Botox as early as 1990. After my ophthalmology graduation, I went to the University of Cincinnati to pursue a fellowship in oculoplastic surgery. At my fellowship program, we were using Botox to treat not only blepharospasms patients, but also cosmetic patients in an off-label manner. When I returned to Puerto Rico around 1994 to start practicing, I was already an experienced Botox injector.
In the beginning, my idea was to have a functional practice in oculoplastics, eyelid surgical procedures, orbital tumors, lacrimal pathology, trauma, and reconstructive surgery for cancer patients. However, after having a small clinic of Botox injections for blepharospasms patients, I began to treat patients for cosmetic reasons. Then, I quickly experienced an unexpected growth in my practice of patients seeking Botox cosmetic injections and referring other patients. If there is one thing to which I have to give credit for changing my life and shifting my practice focus was the advent and approval of Botox.
K: If you could do it all over again, what would you do differently?
M: I believe that the best advice I have received is to always try to find procedures that you like performing. After all, people should have fun as much as possible at work. Instead of trying to establish a buffet practice which might have a little bit of everything, why not take the approach of having a boutique practice wherein you may offer fewer things and be the best in those?
K: With so much confusion in the industry, where do you go for trusted aesthetic information?
M: This is a tough question because, regrettably, in this industry for many people the focus is mostly about sales. In my case, I go directly to my peers, especially those who I trust and consider friends.
K: What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?
M: I think that nowadays, due to the boom on social media, especially Instagram, TikTok, etc., young providers in the cosmetic industry are looking more into the millennial and the younger patient population. I, on the other hand, have been in practice for over 25-years, so definitely my patient population is more baby boomers, whom I think are the core of my practice.
Nevertheless, I foresee this shifting as we are now seeing a younger cohort of patients and more men coming into our practices.
K: What aesthetic patient population is the most challenging and why?
M: I think that the most challenging population is defined by the provider’s age group. For instance, providers like myself being a baby boomer, tend to believe that baby boomers are easier patients than young patients like millennials. I think that the younger patients nowadays are more challenging, not just because they are more demanding, but they have more information shaped by social media, which may not necessarily be accurate or true. Therefore, we have to demystify a preconceived idea of treatment aspirations for their cosmetic journey. For me, that is challenging.
K: Is telehealth here to stay? What role will it have in aesthetics moving forward?
M: I personally do not do telehealth. I do not think that it has a place in my practice, so moving forward I think that nothing will replace the in-person assessment, diagnosis, and interaction with patents.
K: Very interesting. What will the aesthetic industry look like 10 years from now?
M: Well, if I knew the answer to this, I would apply to a CEO position in the industry! I would love to think that 10 years from now, the fillers and neurotoxins market will grow. Also, I believe the typical patient will no longer be a middle-aged Caucasian female, instead it will expand into a more diverse population. I contemplate injectables—especially neurotoxins and fillers—will be a commodity and there will be competition for prices. With the rise in people offering these procedures, cost will definitely be an important consideration for providers as they try to attract patients as well.
K: What can the industry do to increase diversity and inclusion?
M: To increase diversity and inclusion, first, it is necessary to ensure that the systems responsible for the education of practitioners (ie, universities offering dermatology, ophthalmology, plastic surgery and facial plastic surgery programs), have a more diverse student population in their programs. Second, if an increase in the industry for a more diverse population is to be made, marketing efforts should be directed to that group of patients, in terms of ethinicity and gender. In addition, the industry should be more inclusive in clinical trials, bringing in principal investigators who represent other ethnicities. Likewise, clinical trials should be comprised of patients of all skin types, ethnicities, and genders.
K: That’s a great call out. What changes would you like to see take place in the aesthetic industry?
M: I would definitely like to see a big advancement or innovation. I think that, after Botox, there has not been anything that compares to it, in terms of the way it has transformed our lives, practices, and industry. We need another big invention in this industry. Also, I would like to see a change in the way the meetings are conducted. Educational meetings for providers should be more practical in terms of content. Usually, speakers are selected for what they are able to say on behalf of industries, but not necessarily freely and openly on their bona fide experience with patients. We need more honesty in the meetings and in the podium from our peers and colleagues. I would like to see an expansion in the aesthetic industry.
K: What advice do you have for aesthetic providers to avoid ‘burnout’?
M: There are many things you can do to avoid burnout. First, have your priorities very clear. For example, in life, for me my ranking is family first, friends and personal relationships are second. Work is important, but it does not have to be the single most important thing in your life.
There has to a balance in your life. Therefore, advice that I would give upcoming aesthetic providers is to avoid getting involved in the social media frenzy, which might put unnecessarily pressure on them. They should focus on their practice and not that of others. Otherwise, you will never be happy if you are paying attention to what is being showcased in social media and what others are claiming they are doing.
K: Ready for the toughest question that one wants to answer? What can a top expert with your credentials reasonably expect to earn?
M: I think that someone with my credentials should expect to earn enough to have freedom to travel the world, do creative things, and share those experiences with loved ones.
K: What is your biggest operational hurdle and what could be done to fix it?
M: At the moment, I think that my biggest operational hurdle is that I have yet to transition to a good perfectly fitted electronic record for my practice. I still have not found the most adequate one. In addition, social media demand is time-consuming, yet necessary for our practices in this new era of technology. However, I am considering hiring someone to handle my social media platforms, because I do not want to do it; it is not my preference or as they say, ‘not my cup of tea’.
K: If you weren’t an aesthetic expert, what would you do for a living?
M: I would have been a doctor in probably any other field in which I am interested. I love science, medicine, dealing with patients, and, above all, I love being my own boss. Thus, this is the profession for me.
K: What is your personal favorite aesthetic treatment to implement?
M: I love injecting Sculptra, because is like sculpting a face. Also, I like to do combination treatments of injectables. I think the power of injectables (fillers and neurotoxins) well-chosen in the right patient are great. I also like to do periocular surgeries. I do not think there is anything that has the power of transforming someone more than upper eyelid, lower eyelid, blepharoplasty, or eyelid surgical procedures.
K: What is your favorite quote (mantra, etc.) that is applicable to the aesthetic industry?
M: Definitely, my favorite quote is, “You are what you do every day.” That applies not only to providers, but also to patients. There are so many people looking to better themselves, their physique, and more, but they do not understand that this is a philosophy, a way of living. If you want to look good, you have to invest in yourself on a daily basis, not just with a visit to a provider. For peers and practices, it is the same way. if you want to become an expert, a trusted successful KOL, it is necessary to be consistent, focus on what you do daily, and always bring the best version of yourself, with an artistic eye and demeanor.
K: What advice do you have for someone not in the industry who wants to enter the field of aesthetics?
M: I can say that as a professor and mentor, I tell my students that this is a great industry, a great field, but to be successful, it is necessary to have a thorough well-rounded education and knowledge. Talent is also necessary to excel in a field such as this one. You need an artistic sense for beauty. Without that, you could be a successful provider, but probably not a top provider.
K: As an expert in the aesthetic industry, people look to you to lead. If you could inspire a movement in our industry, what would it be?
M: Honestly, the movement I would love to inspire and move forward would be to avoid making people look weird and avoid making people all look the same. I would actually put a break on this proliferation of inciting people to get so many injectables and discourage the very young patient population to embark into a journey of injectables. I think that some of our peers, and probably the industry itself, are pushing or trying to expand the market at the expense of bringing very young patients that do not need injectables at such a young age. I would be a deterrent to this proliferation of craziness of looking weird so young.
K: How can readers get more aesthetic expert information from you?
M: I would love to have reactions, comments, questions of the few things that I shared with you through this interview. I want to thank my friend and colleague, Dr Will Kirby, for this opportunity. I invite all of you to reach out to me, preferably via my Instagram account: @jrmontesmd or email: firstname.lastname@example.org. I am very good at responding to questions or emails I receive!