Following a successful beginning as a consultant dermatologist in the NHS, aesthetics wasn’t a career choice that Dr Sandeep Cliff had considered until patients began requesting treatments for their photo-damaged skin. “This fuelled an interest in pursuing more aesthetic treatments, but from an evidence-based perspective,” he explains.
Dr Cliff’s family emigrated from Uganda to London in 1971 when he was four. After attending a North London state school, Dr Cliff studied medicine at University College London followed by a paediatric fellowship at Harvard Medical School.
Dr Cliff completed his dermatology training at St George’s Medical School in London and, in 1999, was appointed as a consultant dermatologist and Mohs surgeon at East Surrey University Hospital and St Helier Hospital where he still practises today. “I enjoy my work for its variety and case-mix; I still feel the need to continue in dermatologic research and development,” Dr Cliff explained. Currently, he also serves as the clinical sub dean for Brighton and Sussex Medical School. Enthused by the advancements of HIV medicine in the 1990s and fascinated by the cutaneous manifestations of HIV, Dr Cliff decided to pursue a career in dermatology, and has never looked back since. “I was debating whether to leave medicine to go into pharma and become a company medical advisor,” he explains. “But being able to help very sick people motivated me to pursue my passion for clinical medicine in dermatology.”
Following his training in Mohs micrographic surgery, treating skin cancer has become Dr Cliff’s passion. “Many skin cancer patients come back to me after treatment and say their skin has lost its quality, lacks lustre and looks scaly and dry,” he says. “Helping these patients improve their skin texture and condition is very satisfying. I aim to provide advice based on good clinical data not on hearsay; something my patients continue to appreciate.”When first contemplating aesthetic medicine, Dr Cliff confesses, “Initially, I felt very sceptical. Then I realised dermatology bridges aesthetics. I have patients who are bothered by their rosacea, their erythema and their acne but they also want to protect their skin from early signs of ageing and attain optimal skin quality. So I find that clinical management of skin often dovetails with the cosmetic aspects of skin management, such as photoageing. Today there are aspects of cosmetic dermatology which are now on the curriculum of dermatology registrars in the UK.”
Dr Cliff advises newcomers to medical aesthetics to focus on improving treatment techniques, have a keen eye for patient safety and be realistic in terms of what can be achieved. He recommends budding medical aestheticians to keep their eyes open for the latest trends and to keep abreast of the latest techniques. “If practitioners don’t, we’ll never move forward,” he says, adding, “When practising aesthetic medicine you have to balance the need to be careful and cautious with the natural inclinations of an inquisitive mind to push the boundaries.”
Staying up-to-date is essential for future development, affirms Dr Cliff, however he is passionate that practitioners shouldn’t be ‘cajoled’ into using products or devices unsupported by robust clinical data. A regular speaker at conferences and events on behalf of pharmaceutical and skincare companies, he says “I cannot possibly feign interest in a product that hasn’t got strong clinical evidence to prove it works and is safe. I advocate the ‘family test’ where I ask myself, ‘Would I be happy to use this on a close family member?’”
Dr Cliff urges that beginners to aesthetic medicine should attend meetings and observe peers in practice. He says, “Whilst it’s important to learn how things should be done, it’s crucial to be aware of potential complications. In medicine, unfortunately things do go wrong and the skill lies in recognising and treating complications.” He adds, “It’s important to be transparent when communicating with your patients. Securing a reputation as a thorough and honest practitioner is the key to success. If you follow best practice and do it properly, carefully and skilfully and you will find your practice will grow and everything else will follow naturally.”
What treatment do you enjoy giving the most?
Giving dermal fillers is the most enjoyable, because you can see the results immediately. What technological tool best compliments your work?
The cannula, as it has a multitude of uses and allows treatments to be delivered with minimal downtime for the client – a definite plus.
What’s the best piece of career advice you’ve been given?
Approximately 20 years ago Professor Brian Gazzard, who was a professor of HIV medicine at Chelsea and Westminster Hospital, took me aside and said, “You need to pursue a career in medicine which is expanding. With an ageing population there will be more skin diseases, in particular skin cancer and skin surgery will expand; you will never be bored.” I thank him for his advice and guidance; his sage words inspired me to pursue a career in dermatology.
Do you have an industry ‘pet hate’?
I don’t like the promises everyone seems to be able to offer. I think you’ve got to be absolutely transparent. Patients are often drawn-in by incredible pictures. Expectations are raised when, in reality, the results can’t always be achieved and disappointment follows, which is not good for the reputation of the aesthetic medicine industry.
What aspects of aesthetics do you enjoy the most?
I enjoy the meetings, the social aspects and the constant learning. I also love to teach and lecture on dermatology, in particular discussing cosmetic ingredients that have real evidence behind them. I am looking forward to some talks coming up soon where I will be discussing different approaches to skin health with my colleague and friend, consultant plastic surgeon, Mr Paul Banwell.”
