An Interview with Apprentice Winner: Dr Leah Totton
 
The Apprentice winner Leah Totton opened her first cosmetic skin clinic in 2014, funded by a £250,000 investment from Lord Sugar.  Situated in the lively London city centre, the Dr Leah clinic offers clients a wide range of aesthetic treatments, all of which are aimed at helping you to achieve a more radiant, youthful appearance.
 
The 25-year-old doctor from Northern Ireland is passionate about bringing excellence and a medical influence to the cosmetic industry and has been vocal in her calls for regulatory change.
 
What inspired your transition from medicine to cosmetics?
 
There was one particular incident that first sparked my interest – one of my mum’s friends had poor results from a dermal filler injection back home in Northern Ireland, and that’s when I started to read a bit more about the sector.  I soon realised what state the industry was in; there was a lack of regulation in terms of the amount of ‘cowboy practitioners’ that were on the market and the real risk to patients was what motivated me to make a change.  Through The Apprentice I was able to help vocalise regulation in the industry and hopefully work some way to increase patient awareness regarding the issues involved.
 
When did you come up with the idea for the clinics; was it before or during The Apprentice?
 
It was probably halfway through medical school when my interest in aesthetics started to grow.  When I qualified as a doctor, I spent a lot of time shadowing various aesthetic doctors privately and really trying to build up my experience through mentorship.  I think it is really helpful having a good mentor – or several if you can – who you can shadow and who can oversee your development.  Cosmetic doctors should never stop learning, but I think the role of a really good mentor is important because of the lack of an official training scheme.
 
From there, the opportunity for The Apprentice came up and it seemed like a good platform to shine a light on the real feelings within the industry and an opportunity to try to educate patients and, hopefully, provide them with an example or a standard within the industry.
 
Is there anything in particular you would like to see implemented or changed?
 
For me the priority is the dermal filler issue.  The fact is we have a substance which is not a prescription only medication and that has now, under government regulation, become a medical device.  That isn’t strong enough.  There should be a strong push from the industry and from patients to truly put pressure on the government to make dermal filler a prescription only medication. 
 
To what extent does the Keogh Review push forward towards change?
 
I was recently at the ACE Conference (Aesthetics Conference & Exhibition) and the general consensus among the expert panel was that the Keogh Report was great because it shone a light on the issues within the industry, but what is lacking is the government response to the Keogh Report which first of all took quite a long time to come to light.
 
Though there are many things that I think are lacking in the report, (I’m not going to go through everything as it’s not really my place to comment) essentially what we have at the minute is an industry where it’s largely self-regulated and we as clinic owners and as clinicians need to educate our patients to make informed choices about the treatments they are having.
 
Do you think we need to introduce a formal training or qualification scheme?
 
Of course, that would be absolutely phenomenal and I think that is something that Health Education England (HEE) are looking at which is obviously brilliant.  At the minute we are still in an industry which is largely self-regulated and in the meantime it is important to get the message out to the public that these procedures are medical interventions.  It’s not the equivalent of having your hair done or a manicure – you need to be aware of the risks involved and the importance of the complication process.
 
Moving on to the Dr Leah Clinics, can you talk us through some of the procedures you offer?

We offer a range of non-surgical treatments.  Our maintenance division offers non-enhancements such as electrical facials, microdermabrasion, gamma roller and chemical peels; mainly glycolic.  Then we have an enhancement division which covers your injectables such as Botox and fillers for cheek enhancement and lip enhancement.  We will also be launching a laser division in June.  That’s an exclusive – we haven’t talked publicly about our laser division yet!
 
What will the laser treatments involve?
 
The first treatment is laser hair removal as there’s obviously a big market for this.  We will offer treatment of vascular lesions, pigmentation treatments and acne treatment with laser.  There will be an advanced version of dermal roller with laser face lifts and laser resurfacing which is very popular at the minute.  Overall I think it will be a really exciting and amazing addition to the clinic.
 
You have previously mentioned your reluctance to provide treatments for teenagers.  Will you readdress this stance with the introduction of laser treatment for acne?
 
That’s a good point.  Anti-ageing treatment is not relevant to that age group whereas acne treatment is certainly more relevant.  Obviously teenagers do have acne and we do want to help those individuals but you have also got to think of it from an insurance point of view as well, as there have been various issues with informed consent for under-18s.  I need to sit down and have a talk with my legal team before making a decision at the clinic. 
 
Despite not being aimed towards teenagers there still seems to be a rise in those looking to receive Botox and anti-ageing treatments.  What are the main dangers or long term effects of having these procedures at such an early age?
 
From our point of view there are psychological implications.  Again there’s also the issue of informed consent for under-18s where you’d be looking for guardian approval from a legal stance.  But to me it’s an issue with ethics.  How can clinicians justify administering the prescription of medication to someone who I don’t believe currently justifies the treatment? It is very rare for teenagers to demonstrate lines and wrinkles that warrant treatment with botulinum toxin.  In fact, I have refused treatment to a few people in their late twenties and early thirties for the same reason.  It’s not age specific; it’s about whether you can justify after consultation and examination that treatment is justified. 
 
How would you determine whether you can justify treatment?
 
Every case is individually assessed after consultation and examination.  We determine the criteria case-by-case at the discretion of the treating doctor.  I can’t see every single patient that we treat but I have doctors that work for me who have had the same training as me and understand what benefit you are going to get from Botox when it is indicated and will treat accordingly. 
 
Why do you think we have had a significant rise in Botox and plastic surgery?
 
We tend to follow the US trends.  We’re a bit behind and I think we tend to replicate their pattern.  They’ve obviously seen an increase in cosmetic procedures and I think society as a whole has become more image aware, especially in the UK.  There is a huge celebrity culture with various tabloids promoting this idea of ‘celebrity’ and celebrity ‘selfies’.  I do think there is a certain societal pressure to adhere to that sort of beauty and aesthetic ideal and the reason for that is the media.
 
Have you witnessed any shifts or trends in demographic from what you expected?
 
Very much so.  We are based in Moorgate, London, so in terms of location we are very much aimed towards the corporate professional and female professional; ladies who are in their late thirties or early forties and are maybe getting to the point where they would think about the ageing process.  But we’ve been surprised at the amount of men that we’ve seen.  We are in the heart of the city so there is the typical male demographic in the surrounding area so that may be why, but I’ve been astonished at the amount of male enquiries we’ve had for all of the procedures – and not just Botox.  I've looked at multiple other clinics and they don’t seem to have the same gender ratio as we have so it may be due to where we’re situated geographically in a predominantly male area. 
 
Do you have any procedures aimed specifically at corporate professionals?
 
We have an express facial which is a 25 minute facial procedure during your lunchtime.  It’s a product-based facial administered by one of our aesthetic therapists and its ideal for men and women who work in the city and want to nip out on their lunch break and have a rejuvenating facial.  We have some great products and it is something that happened to be quite popular with both men and women in the city. 
 
What made you choose to focus on non-surgical cosmetic procedures for your clinic?
 
I’m not a surgeon so I wanted to stick to what I knew.  I think when you do delve into the surgical end of the market you’re dealing with much higher risk in terms of the procedures, such as general anaesthetic risks, post-op complications and also the psychological effects of having a permanent change in your appearance.  The consultation, which advises anyone before they have any kind of cosmetic surgery, should be seen by a qualified psychologist that can discuss not only the cosmetic implications of the treatment, but also the emotional and the psychological implications of undergoing surgery.  For me it wasn’t something that I wanted to get in to.  Besides, I think the non-surgical market is so good right now.  It’s ever-evolving and is advancing so much.  It’s a really exciting place to be.
 
How difficult is the task juggling the role of a businesswoman as well as someone who is still actively working in the field?
 
I still work in A&E as well as it’s something I didn’t want to give up.  It’s difficult but once you’re a doctor, you’re always a doctor.  I find it difficult to switch in to business mode but even from a business capacity I will run my business as a doctor as opposed to a businesswoman and that is why I need Lord Sugar.  He’s very much the business person.  It’s quite a nice balance because I have my priorities, which is to focus on our patients, and I think it’s nice to have someone who is always looking at the accounts, numbers and from a strategy side of things.  For me it’s the perfect combination that allows me to continue to focus on my patients.
 
Have you had a chat with Lord Sugar on what treatments would be suitable for him?
 
Of course.  I’ve had a look and there have been some recommendations made but he hasn’t taken me up on any as of yet.
 
No, and if he did, obviously that would be client confidential information anyway.
 
Exactly.  If he’s looking better in the next series of The Apprentice I will take the credit, but unfortunately he hasn’t agreed yet to have anything done.
 
Dr Leah skin clinics are committed to safe, effective and ethical cosmetic treatment.  If you have any questions, you can get in touch with Dr Leah and the team by calling +44(0)20 7877 5999 or sending an email to info@drleah.co.uk