In this episode, hosts Brad and Michael are joined by Dr. Chris Surek, an expert in facial anatomy and the founder of the Academy for Injection Anatomy (AIA). Dr. Surek discusses the disparity between license criteria and formal training requirements for injectors. Learn how understanding facial structures and pursuing continuing education can help you prevent complications and elevate your practice.
Listen to the full episode using the player below, or by visiting one of the links below. Contact ByrdAdatto if you have any questions or would like to learn more.
Transcript
*The below transcript has been edited for readability.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto, legal issues simplified through real client stories and real world experiences, creating simplicity in 3, 2, 1.
Brad: Welcome back to another episode of Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, my co-host, Michael Byrd.
Michael: As a business and health care law firm, we meet a lot of interesting people and learn their amazing stories. Brad, this season’s theme is Compliance Fundamentals. We’re going to take real client stories, of course, scrub their names for confidentiality, and we’re going to build these stories around navigating compliance obstacles in the business of health care.
Brad: Yeah. And Michael, since we’re talking about compliance so much this season, what does that even mean?
Michael: Well, compliance is a broad word that’s basically meant to capture the state and federal laws that govern the practice of medicine or, or other health care practices. As we’ve talked about in other episodes, health care is one of [00:01:00] the most heavily regulated industries in the United States. And so if you’re being compliant, Brad, it means that you’re running your practice consistent with these various laws.
Brad: Very good. Michael. So, like you said before, now, before we bring on today’s guest I have a really important question to ask you. Do you find zombie movies a little bit too realistic?
Michael: Well, no. I thought we agreed. No sci-fi. I don’t want sci-fi Brad showing up with a guest and Brad, no, I do not find zombie movies realistic, so I don’t know what to say about that.
Brad: I mean, look at those cadavers. I mean, they’re at these med schools, they’re at these trade shows. I mean, it’s easy for you to say, but I mean, these students, they have to cut them open. I mean, how do they know that the cadavers aren’t secretly waiting for that right moment? A little low and boom, zombie city.
Michael: Yeah. You’re watching way too many movies again, Brad. If cadavers could come to life, though, I will say they’re probably going to go after the [00:02:00] medical students and doctors first because they’ve been cutting on them.
Brad: That is unusual. Normally the lawyers go first.
Michael: Yeah. Well, that’s what the doctors will do when you mislead them.
Brad: All right. Doesn’t it creep you out a little bit to be around cadavers? I mean, you’re kind of close to like the newly departed or reasonably departed.
Michael: Well, that’s a different question. That’s not a zombie question, and so I’m not worried about them coming to life, but dead bodies do creep me out. And as you know, I decided early on, no medical school for me. because I could barely get through ninth grade biology, frog dissection. And the frog did not fare very well either in that whole scenario.
Brad: Yeah. I think my frog did a little bit better than yours, but my partner was that guy who went to med school, so maybe that helped a little bit. But my dad did tell me his first day in med school that when they started going to the cadaver course and started cutting open bodies, one guy looked over and just walked right out of the room, he never saw him again. Another guy ran to the trash can and just start puking his brains up.
Michael: [00:03:00] Well, I know over the years listening to my dad, the stories they told from medical school probably can’t be repeated on the different pranks and things that – shenanigans that went on over the years during the, I guess to relieve some of the pressure in their training.
Brad: All right. Well, fine. I’m the only one here probably that has the zombie fear then. But if one night I hear eerie groans walking out of cadaver course at a medical conference, I’m grabbing a baseball bat first and asking questions later.
Michael: Okay. Well, I’ll be curious why you have a baseball bat at a conference, but that’s a different conversation. Let’s bring our guest on, Brad. What do you think about that? You good with that?
Brad: Great idea.
Michael: We have a friend and second time guest joining us, Dr. Chris Surek. Little background on Chris. He is from Kansas City, went to Kansas City University undergrad at University of Kansas Medical Center. He did his aesthetic surgery fellowship [00:04:00] at the Cleveland Clinic. He is a board certified plastic surgeon. His private practice is Surek Plastic Surgery. He also founded the Academy for Injection Anatomy or AIA, and I mentioned a minute ago, he is a second time guest with us. He was on during season six a while ago, with our partner Alex Thiersch.
Brad: Chris, welcome.
Michael: Yeah.
Chris: You guys are like the modern day Suits. I mean, what season are you on? Nine now, or what?
Brad: This is season 19.
Chris: Season 19. That’s amazing. Yeah, I don’t like zombies either. When I was in med school, I did a one year fellowship in anatomy where we had to process all the donor bodies so they could be set up for the medical students to learn. Do you guys have a shop vac at your house?
Brad: Yeah.
Chris: So, not to gross you out, but just some real world story. We had to shop vac all the formaldehyde that [00:05:00] did not actually go into the body. So, the first job as a fellow is to shop vac the excess fluid, and then transfer the body to their new location in the lab. So I can just see the two of you trying to do that.
Michael: It would not work out well.
Brad: And off camera, you should have seen Kennedy’s face as you were talking. It looks like Kennedy did not want to go to med school either. So I guess the important question, I think, to start with, Chris so you’ve never been afraid that as you were cutting a cadaver, it would start complaining to you?
Chris: No. No. Nope, I have not.
Michael: Okay. That would be an unrealistic fear, Brad. Well, let’s jump in. So a lot of people are familiar with the Academy for Injection Anatomy. We talked a little bit about it last time you were on as well, but for those that don’t know, I’d love to just share for our audience, talk about what the Academy for Injection Anatomy is and [00:06:00] why you started it.
Chris: Good question. So we started in 2019, and as you guys talked about compliance, the health care industry is heavily regulated, however, injections are not. I mean, it’s kind of the wild, wild west. Yes, there are certain criteria to be licensed, but there’s no requirement of formal training. There’s no requirement for a board certification injectables. Plastic surgery, you go through four years of med school, six years of residency, maybe another year of fellowship, and then two years of practice. Then you sit for your board examination, then you’re board certified. Technically speaking, if you’re in a certain state, you could become a nurse, pass your NCLEX or whatever it might be, and the next day hang a shingle and say you’re an injector with no training. And so, what I realized is that that probably won’t change much. However, we can provide an education platform for those who want to learn, who want to improve their game, who want to get optimal outcomes.
When it comes to injectables, in my opinion, [00:07:00] if someone’s trusting you to put a needle in their face, whether it’s a neurotoxin or a filler, you need to be an expert in the anatomy that you’re treating and the product that you’re using. And that requires training. So in 2019, I started this course just here in Kansas City. Our first class was 12 people, and I recognized that there was a thirst for anatomical knowledge, which is a skillset that I spent a lot of time on. I’ve been studying and publishing in anatomy now for over a decade. And it’s an area that I love to teach, and it’s an area that is critical for an injector to understand. And the best way to teach them is with hands-on training.
I’m a visual and tactile learner, so the way I teach is with visuals and hands-on training. So we started that course in 2019. We had 12 attendees for the first one, and now we just eclipse 64 courses. We’ve got almost 3,200 alumni, and we’ve done over 575 dissections. A lot of that made possible by the national tour that we’ve been on now for four years with AM Spa. [00:08:00] so I’m really proud of what we’ve created, but the whole idea and concept is safety in injectables, optimizing outcomes for patients, and minimizing complications. And so, that’s the mission. And the tagline that I always use is the fear of injections is the fear of anatomy. And what I mean by that is, I want every injector, just like a surgeon, to have a healthy fear of what can go wrong, so they stay sharp, they stay up together, and they stay…in their safe approach to injecting patients.
Brad: Fascinating. And so with your course, or maybe your course is different, but what are the typical kind of topics that are covered, and I guess that a i a would be one to use like as you’re going through it; tell the audience, give like a little more details.
Chris: The first thing we do is we go on – it’s kind of like a magic school bus ride through the face – if you remember that show. We take them on a 3D journey. We travel through all the critical areas. We start from the temple through the midface [00:09:00] around the nose, piriform, chin, and jawline. And so I lecture for probably close to five and a half hours, I think it is, in the morning. And then we finish that with a specialty talk on jawline usually, or whatever hot topic it is, whether it’s ultrasound, jawline, temple, yada, yada. And then that afternoon, we take a deep dive into radiology. And so radiology is a term for gel science. In the aesthetics industry is very impulsive. There’s a lot of sexy things about it. But also when your rep’s trying to sell you a filler, they use all these terms that make it sound attractive, but they’re not necessarily scientific.
And so with rheology, we try and walk the injector through what actually is comprised in these gels, how they’re made, proprietary manufacturing, pros and cons, yada yada, so they understand what gel to use and where. And then we finish off the first day with a complications panel, because if you inject enough, you are going to have a complication. The question becomes, when you have that complication, [00:10:00] how do you respond? You got to run towards it, not away from it, and you have to have a plan. So that’s day one. and then typically we do dinner and a book signing and a reception that night, and then Sunday morning, so it’s usually a weekend course, Saturday-Sunday. Sunday morning, we do a five hour hands-on cadaver lab. And again, we’ve done that 63 times. So we have it down to a pretty polished sequence.
But the idea is that cadaver dissection is destructive, right? Because you’re trying to explore structures where you have to recognize them before you remove them to get to the next structure. And so we walk these attendees through a very structured full face, three dimensional cadaver dissection. The real pearl to AIA for those who out there are looking for a course, there’s a lot of options out there now for cadaver courses, which is good for the industry. However, what’s unique about us is we teach what’s called cross-sectional anatomy. So a lot of meetings you go to with your baseball bat, and you’re [00:11:00] going to see that there’s these layered dissections where they peel the face apart in layers. And that makes for pretty camera time for those who are interested.
In real world, we’re not peeling apart our patient’s faces when it comes to injectables. You’re not doing surgery. And so we teach cross-sectional cuts, which means we teach what’s happening in every single layer from skin all the way down to bone. And when you cut it down, like you’re cutting a cake, each layer is exposed. And so you can see what’s in each room, in each floor, if you will, as you travel from your injection point to your target. And that’s really I would say the special thing about the way that we teach anatomy.
Michael: That’s amazing. Well, I, I should have said this. You said we were the modern day Suits. I think you’re the medical training version of Suits with the 64 times now and the number of people y’all have trained. That’s amazing. Talk a little bit about kind of what level of subject matter [00:12:00] expertise do your trainees have? Are we talking about beginners or people that already have experience as injectors?
Chris: Well, both. I kind of consider us, you guys use the term bootcamp for your, your conferences. This is truly a one-stop shop for an injector. If you’re a beginner, it equips you with all the baseline knowledge you need. It might be like drinking from a fire hose. Yeah. But you need that knowledge, right? So you could take in as much as you can at the actual conference, but then what you process, because sometimes it takes the brain time to process over the coming weeks and months post course. It’s prepares you with all, again, it is truly a bootcamp for the injector. So even though it’s called advanced anatomy, I still encourage someone, you need to take an anatomy course before you inject people. And then, in my opinion, you need to actually inject on a cadaver and practice before you do it. It seems intuitive to me, however, not to everyone, but that’s [00:13:00] how I would approach it. I mean, it’s see one, do one, teach one type thing. You need to see, feel, and touch that anatomy prior to hanging a shingle and injecting people.
Second, if you’re an advanced injector, again, I’ve had a lot of alumni come back, and so I love that someone comes, maybe they’re early in their career. You know, we’ve been open now going on six years. Someone comes back two or three years later, and the course is a completely different experience for them. They now know the baseline knowledge, but they miss those pearls of advanced technique because they were still trying to focus on the beginner stuff. And so, the course really transcends all skill levels. And that’s by design. I just want to put the bar up here and have everyone reach there. They may not reach the day of the course; they may come back to get to that bar, but at least now they’re equipped with the knowledge that they can process and utilize that gives them a foundation to get good outcomes.
Michael: Amazing. I was thinking about too, the second day in the hands-on training, when you’re doing the cross-sectional dissect. [00:14:00] Talk a little bit more about what the trainees are doing that day. Are they creating the dissection and then are they actually practicing injecting and seeing what happens? Talk us through that.
Chris: Yeah, so they’re doing both. They’re going to practice all the techniques that I taught them the day before. So we’ll take them through advanced injections in the temple and jawline. I would consider standard injections in the cheek, piriform, et cetera. So they’ll do the injection, and then they will cut down to visualize their – so we dye the filler with color, so we use two colors, and that way when they dissect down, they can see the filler that has dyed a certain color and how it relates to the vessels and the structures around it. You know, one of the things that we do do is we do invest in injecting all the cadaver vessels with latex. So you can actually see where the arteries and veins are. That’s an added expense, but it’s absolutely necessary because [00:15:00] the biggest fear that most injectors have when it comes to filler injections is a vascular occlusion where you clog the vessel with filler, and then you have skin compromise and sometimes even worse outcomes.
And so they’re going to, yeah, it’s all hands on. So I do nothing. I simply, me and the faculty are there to guide and support them, but they’re going to go through that dissection themselves. And typically the way that I do it is I do two sides. So you have four to the table, you pair up – the first side of the dissection, I kind of walk them through each step and really give them very dedicated guidance. But then the second side, I tell them to do it as a team. In other words, I’m not going to guide them. The first group’s going to guide the second group, and that way they’re forced to walk through with each other. I mean, obviously, we’re there, we’re available, and we walk around and help. But it’s really the kind of the final step is like, all right, I walked you through it, now walk yourselves through [00:16:00] it. And I do think that that increases… it decreases the learning curve and increases their retention.
Brad: You said something earlier about how at the end of the first day you start talking about adverse events or situations where they had something go wrong with an injection. And I guess going back to the beginning of this podcast, not that the cadaver came to life and you had to use a baseball bat on it. But let’s talk about in your course. So everyone’s sitting in a room and they’re kind of sharing some stories about what happened. So now that you have this knowledge, how do you guys apply that education about how to handle these complications? And what are some of the things they learned from, obviously not only the course, but I guess as you’re trying to come up with best practices there?
Chris: Sure. Well, two things. 20 years ago, if you went to an injection conference, don’t even talk about anatomy, right? I mean, it wasn’t even discussed. I mean, I have people on my course who’ve been injecting for a few [00:17:00] decades, for example. And when they first started, it was, Hey, point and shoot the goo. There was no training. There was no guidance, and that scares me. I mean, again, as a surgeon, especially a plastic surgeon, we’re held to such incredible high standards, both ethically as well as education-wise before we can even touch a patient, right? And that does not exist in the injection world whatsoever. And so, (a) anatomy is super critical, and (b), complication management has not been talked about until recently. Everyone wanted to pretend like they didn’t, didn’t have complications.
So when it comes to research and medicine, you need case examples. You need data. Well, if no one’s going to share their complication data, how do you learn? How do you improve, right? And so, what I’ve seen is a paradigm shift in the industry over the past, let’s call it five, 10 years, where now we all talk about, about complications because we want to learn on how to handle them. So there’s been a ton of literature that’s come out that discusses complication protocols. And they’re mainly based [00:18:00] on thought groups, right? A group of experts get together, they do an ad board, they sit around a table and say, “Oh, I had this complication, I had this happen.” And slowly the case numbers, the experience level, and the protocols have slowly shown themselves. And so, the complication panel is my favorite part of the course, and it’s probably the most fluid, meaning that it changes on the regular, because we learn more and more and more about how to treat complications as more people talk about it, and transparency has become a big thing in injectable, which I think is fantastic.
So in the complication panel, we address three major problems. When it comes to injectables, your three biggest issues are (A) vascular occlusion, (B) delayed onset nodules, or contamination of the filler, creating problems for the patient, and three lymphatic issues, blockage causing swelling and prolonged edema and edema is just swelling. So what we do is we use case examples from our own practices, or from people that we’ve worked with. [00:19:00] As a matter of fact, we’ve had three that I can think of, three attendees who were dealing with an occlusion in their practice while taking our course actively, like that weekend. So we actually share those case reports with the people that are there. And I had a bad occlusion myself right before course. And I share that and how I corrected it with ultrasound.
And so I think sharing that transparency and being open, not only does it humanize everybody and disarm them, but it allows us to have very good open conversations about what happens when things go wrong. Kind of like le legally; whenever I use a lawyer, they always say, listen, the contract’s not designed to talk about when things are good, the contract is designed to talk about what happens when things don’t go well. And so, we want to equip them with the ability to process, act appropriately and execute complication management.
Michael: Fascinating. That’s really [00:20:00] cool. I know a lot, I know even with our phone ringing, we get questions all the time with this kind of wave of practices or business owners wanting to set up some form of training schools, and as you said, generally this is a good thing that there’s a wave of education. But I also think it could be a little confusing too, because you’ve spent time today helping the audience understand kind of the benefits of this anatomy focus. And then there’s other courses where there’s live models involved, and so people are injecting humans as a part of the course. I’d love to kind of hear your perspective on that. Like, what are the advantages and disadvantages of each – what place do, if any, do these kind of types of training have and love [00:21:00] your expertise on that.
Chris: Yeah. I mean, I think being in the industry now, you know, I’ve worked on the industry side with the companies doing education training. Obviously, what we developed is a private training, that way we could train on what’s called on and off label. So industry trainings, you can only talk about what the FDA is approved for on-label injection. But typically those techniques lag behind, because it takes time to get things approved by the FDA. And so off-label training, meaning techniques that we do every day in our office and our, in our patients, but cannot be taught by a company who sells the filler, become very popular. I think that this industry is very impulsive as well, and so social media and just inertia of the industry can drive people to certain courses.
I can’t comment on all the other courses that are [00:22:00] out there necessarily, but what I can comment on is the authenticity of ours. And I think initially it bothered me a little bit when I thought people were trying to replicate what we had designed with the cadaver course. Then I soon realized that it’s not really able to be replicated because again, the strength, the course and the faculty and the content and again, the intimacy of the course and the way we teach and deliver it. So all I would say is for those seeking education in the aesthetic industry, I would really vet where you’re headed and what you’re doing. I always tell people, just because someone’s famous doesn’t mean they’re right. And social media has created a platform for people just to act as if they’re experts and present stuff, some stuff which is fine, and some which is just blatantly, in my opinion, not ideal, or bad advice, simply because they want to make a buck or make a name for themselves. And so, I think my only advice to anyone out there is again, vet your resources, stay educated. And social [00:23:00] media is a double-edged sword, for sure. And again, evidence-based medicine, research data, that’s where the meat of it is. Just talking heads on social media, that can be a very dangerous rabbit hole for someone to travel down, especially if they’re trying to search for education.
Brad: For Yeah. And I can tell, I mean, if the audience can tell too, you’re very passionate about education and making sure that you’re kind of lifting up all the non-invasive services that are happening here because that’s what we’ve been concentrating on. And so when someone does complete your course, what are the other post course assessments or trainings that they should be keeping up with?
Chris: That’s a good point. Good question. I can’t spill the beans yet, but we have some really cool initiatives coming forward with AIA this year, as a matter of fact. Those who are listening who are alumni, or those who have been looking at the course for a while, stay tuned because we have made some upgrades, some changes, and some adjustments, especially on post-course credentialing, and [00:24:00] just really making sure that your, your patients know that you’ve trained with us, and that you’ve gone the extra mile to get the appropriate training to optimize outcomes for them. We want you to be recognized for that. So as of right now, you get a certificate, you get a copy of my book. I just wrote my second book, which was published in September, so this year we have a new book.
You’ll get a new book this year at the course, which we’ll sign for you. And that book is essentially all the work that I’ve done between my first book in 2017 to now. So it’s a compilation of eight years of anatomy training distilled down to, again, hopefully a level that multiple skill levels can process. And that’s combined with my co-author Steve Weiner on ultrasound. And so it’s an atlas of facial anatomy combined with ultrasound, which is a new modality that by all means, should be incorporated to any advanced injector’s office. We’re super excited about that, and that’s doing exceptionally well. It’s selling really well, which is great. But anyhow, getting back to your original question. Simply hanging that diploma in your [00:25:00] office and being able to say that you’re an AIA graduate, I think already carries a lot of weight in the industry.
I think that if you explain to your patients what you did and why you did it, and how it benefits them, that’s also a plus. But we are going to add another layer, hopefully to that. I mean, the industry is ready for more designation for those that have appropriate training versus those that don’t. In a commodity business like Botox and fillers, you need to be able to designate and separate yourself appropriately, at least your patients know, okay, this person has done the legwork, they care enough to go take these courses to make sure that my outcomes are the best. And what I tell everyone when we have the course is, everything we do – even in surgery, is treat anatomy. Every crease, crevice, shadow, contour in the face, it’s all anatomy. So literally, anesthetic medicine, whether you do lasers, peels, Botox, rhinoplasty are faceless, all you’re doing day in and day out is treating anatomy. So if you [00:26:00] don’t know your anatomy, how can you treat it properly? It just doesn’t make sense.
Michael: That’s amazing. Well, we’ve run our course, so to speak, today. Our time together flew by. It was extremely helpful, and we’re grateful that you joined us today on the Legal 123s with ByrdAdatto. Thank you for joining us. After we let you go, Brad and I will after commercial wrap up with a little legal summary.
Chris: You guys are the Kelsey Brothers. You should get a Amazon deal for your audience.
Brad: All right, Amazon, I hope you’re listening.
Michael: Yes. Yeah, same numbers.
Chris: Yeah.
Brad: Good to see you, Chris.
Michael: Thanks.
Chris: All right, guys. Take care. Thanks for having me.
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Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd. Now Michael, this season, our theme is Compliance Fundamentals. And today we had amazing conversation with Dr. Chris Surek, who we, even as lay people, I think, learned a lot about how complicated the anatomy is and how important it’s truly to understand it in these training courses. But you and I have had a lot of conversations with individuals out there that are interested in education, but Chris made some interesting points there.
Michael: Yeah. I mean, first off, we have to acknowledge that training courses are popping up like crazy. And we get phone calls all the time to help them be set [00:28:00] up compliantly. I think for whether you’re thinking about doing a course or you’re thinking about participating in a course his point about the subject matter expertise of the trainers being the focal point is so important. If you’re going to offer this, you want to make sure that the people teaching it are appropriate people to be teaching the course for the sake of the industry and for the sake of your own rib.
Brad: So I shouldn’t teach the course?
Michael: Yes, you should not teach the course. Yeah, Brad. And then I’ll just take it from – if you’re a business wanting to offer training, it’s super common because there’s a lack of injectors and providers out there, and so that’s the big push behind having these courses is that there also is some compliance considerations in setting them up appropriately. [00:29:00] And from our view of the world, there are big differences on the compliance steps that go into an anatomy-focused class where you’re working with cadavers versus having live models in because the main message on the live models is, that’s regulated in the same way as your practice would be. You’re treating a patient. And so, there’s a little bit of having to adapt the practice of medicine into the context of a course that goes into documenting it and setting the arrangement up in an appropriate way. The overall message for those out there is, whether you’re thinking about getting training, doing your due diligence on who the trainers and making sure that the course is set up correctly. And then if you’re setting up a course, really making sure that you follow these steps to really have a robust course. [00:30:00].
Brad: Yeah, absolutely. All great points. And unfortunately, audience members, that’s all the time we have today. Next Wednesday, we’ll be back with a special on Compliance Fundamentals when we really dive deep into medical weight loss industry with doctors, Johnny Franco, Alan Durkin, and Jonathan Kaplan. Thanks again for joining us today. And remember, if you like this episode, please subscribe, make sure to give us a five star rating and share with your friends.
Michael: You can also sign up for the ByrdAdatto newsletter by going to our website at byrdadatto.com.
Outro: ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on [00:31:00] your legal issues.
