Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome to Meet the Doctor. My guest this afternoon is Ami Shah Vira. She's a board certified ophthalmologist and oculoplastic surgeon right here in Austin, Texas where I also live. Thank you for joining me today.

Dr. Ami Shah Vira (00:43):
Thanks for having me.

Eva Sheie (00:44):
So let's start with how did you end up in Austin?

Dr. Ami Shah Vira (00:49):
So it was the first time that my husband, who's also a physician, we got to choose where we got to live. If you know anything about residency and fellowship, it's always a match that tells you where you go, ends up lucking out being in a city or a place where you kind of want to be, but it's almost like you were told to live there. So when we finished our fellowships, we were looking at a map. I'm originally from Arizona. His family's in Chicago, and so we said, okay. He didn't want to go back to Arizona. He thought it was too hot. I didn't want to go back to Chicago because it was too cold. So we kind of looked at places in the middle for both our families to not be too far away from, made a trip out to Austin, fell in love with it. I think everyone who comes here does, and then we're just lucky enough to both end up and build our careers out here.

Eva Sheie (01:38):
And you chose the kind of north part of town, you're near the Domain for anybody who's listening locally.

Dr. Ami Shah Vira (01:45):
Yeah. When we first moved here, we lived closer to downtown. I worked in Westlake, which is just a little west of downtown. And then when we moved here, we were just a couple years, newlyweds. Didn't have any kids or any really ties to Austin. As we continued to grow our friendship circle, we've had two kids in the interim since been here. We started moving north just to be able to be around some friends and become family and then the schools and the neighborhoods.

Eva Sheie (02:20):
And so what's your practice like? Are you by yourself? Are you in a group?

Dr. Ami Shah Vira (02:25):
So I started my own practice about four years ago, and it's just me. I do neuro-ophthalmology as well as oculoplastics. And so when I started my practice and I kind of left the big ophthalmology groups, I decided to step away from the insurance game. And so I started kind of a direct care, almost concierge type practice, which always is done for the aesthetics or the cosmetic side of oculoplastics. That's always kind of been that feel, but I just kind of expanded that to also the medical side with ophthalmology and oculoplastics, just cutting out that middleman. I feel like insurance has taken over medicine and ruined it per se, in some ways with limiting who people can see or how much is actually covered. And this way we just got back to it's just the patient and the physician. It's just me and the patient, we keep our staff pretty minimal, so I know every single person that comes through the office. I know the patients, they know me, they can always get ahold of me and it just kind of brings back almost that way medicine used to and should still be practiced.

Eva Sheie (03:39):
Is it like a monthly subscription or is it just a cash practice where we can come to you for anything in your scope?

Dr. Ami Shah Vira (03:48):
Yes, we have both options. A lot of times people come to me just they were told that, oh, something looks wrong. Is it really? Or is this an underlying issue? And those we have is the pay per visit. But then some of my longer, more chronic patients, where there are underlying medical issues that do need that more constant or the more frequent follow up, we do have a monthly option for them.

Eva Sheie (04:16):
That is really interesting. I can say things like this because I'm all coming up on 50. I don't know how that happened, but when you start having issues with your eyes, they can kind of go on for a long time and they are really hard to resolve sometimes. So I can see how there would be a lot of people really interested in having you sort of on call all the time without going through the messy parts of getting to the right specialist or getting to the right testing even. So is that kind of how it works? You have people who are trying to resolve a more serious eye issue and they just become your best friend for a while?

Dr. Ami Shah Vira (04:56):
A lot of what I see with neuro-ophthalmology is patients, they also have chronic underlying medical conditions. So they have other medical issues that are leading to vision issues. And so those can flare up at any time. Those can come about almost unpredictably or typically it's always on a Friday night or a Saturday morning when something will flare up or be of concern. So I definitely have a lot of those patients as well, who know they can just shoot me a text, send me a call, and we can go from there.

Eva Sheie (05:32):
That's got to be such a relief. So can you expand a little bit on neuro-ophthalmology and how it's different from what younger people might think ophthalmology actually is?

Dr. Ami Shah Vira (05:43):
Yeah, so neuro-ophthalmology is really just the connection of the brain and the eye. So especially any sort of intra cerebral or brain issue can cause some vision changes due to that connection from double vision, vision loss, visual changes. And so with that I kind of delve deeper into the vision changes there.

Eva Sheie (06:06):
What is it that you like about this particular specialty?

Dr. Ami Shah Vira (06:10):
I went into fellowship actually, I went to ophthalmology knowing I wanted oculoplastics. I knew I had this passion, I wanted people to look and feel better about themselves, not just cosmetically or just not that they wanted to look like they were 20 or anything, but starting when I was in ophthalmology residency, noticing that a simple blepharoplasty like an upper eyelid lift, just removing that skin just made patients feel so much more confident and better about themselves. And so as I delved more into oculoplastics, there's a whole realm of it. There's the aesthetic side, which I love, and then there's the functional side from different things that can also change the eyelid and the eye socket appearances or probably the most common one that we see is thyroid eye disease. And so as I kind of went down that path, I realized some of those patients were coming from the neuro-ophthalmology side because they were presenting with double vision or vision loss or vision changes.

(07:09):
And so while I loved the surgical part, I also enjoyed the puzzle and the perplexity and the complexity of seeing these patients in clinic and figuring out exactly what was going on and then following through, being able to do their surgery and help 'em feel better, help 'em look better, help 'em look more like themselves and being with them throughout that whole journey. And so that kind of led me to do both fellowships there. And then after finishing those fellowships with doing a lot of the functional reconstruction and the functional oculoplastics patients started asking about other aesthetic things, I think they just developed that trust and that sense of comfort in knowing what I was doing, which was super appreciative and kind of the most flattering thing a patient could tell you when they want to give you more of their money because they believe in you and they trust you to help 'em with other things that they feel it will help them.

Eva Sheie (08:01):
That is the telltale sign when we say take my money that you know they trust you.

Dr. Ami Shah Vira (08:09):
I mean, you came to me, you had double vision and we helped fix that, and now you have that trust and comfort and you're asking me, what should I do about these fine lines and eyelid bags? And so then through that, in the past year, actually not even the year, I would say six months, I kind of developed the aesthetic side of the practice called Aesthetics md. And we just differed in the sense that we're not really a med spa is what I tell patients because while we offer some of the same treatments, the great stuff for fine lines and wrinkles and all that, but everything that you're getting done is done by me, a physician and a surgeon, or I brought my husband on board to do some of the other body contouring things. And so I was like, everything you're getting done is by a physician. And I think they appreciate that because developed that rapport with us, they've developed that trust with us and we hope that we can deliver on that.

Eva Sheie (09:01):
So go back to this one for a second, your husband works for you?

Dr. Ami Shah Vira (09:06):
He does not like to say that. No. The secret goal of mine, he's an ER physician. And so my ultimate goal, which most people know ER docs have the craziest schedules. They are night shifts, weekends, the most randomest things. And so my secret push to get him to come join me and do some things and to expand his skillset was I was like, maybe this will keep you from ever having to work a night and weekend, and so I'll never have to solo parent again. But he said, that's not how it works.

Eva Sheie (09:41):
I'm starting to see your motivation here. It was really, I just want you home on the weekend and at night.

Dr. Ami Shah Vira (09:46):
Exactly. I was like, sure. I was like, I won't tell anyone you work for me as long as you never work a weekend shift.

Eva Sheie (09:53):
I have seen a lot of husband/wife practices where they have different names and they don't tell anybody that they're married. They keep it a secret.

Dr. Ami Shah Vira (10:03):
Yeah. I dunno why. I think people, it was funny when we did our headshots for the aesthetic side, we told our photographer, who I loved, but she was like, I like the fact that you guys are husband and wife. And so if you look at her websites and think the way she kind of positioned me, she's like, you guys are close, but it's not a prom photo. So people kind of know that. She's like, I think it's, it's that comfort level and they know you're comfortable with each other. So because again, we're a small practice, but we're all about personalization and being one with our patients. And so she really brought that out on there. But it was funny because she even asked before we started, she's like, do you want people to know you're married or not? She's like, I can change this in any way.

Eva Sheie (10:48):
That's a good photographer. It's a beautiful photo. I love it. I'm looking at it right now. Okay. So kind of take us through the menu. What are all the aesthetic services that you've brought into the practice?

Dr. Ami Shah Vira (11:00):
Yes. So we have kind of the surgical and the nonsurgical. The nonsurgical are probably the newer ones that we brought on in the last six months, mostly because I started off, I'm a surgeon, and so I said, cool, I'm just going to do all the surgeries from upper eyelid to lower eyelids, blepharoplasty, droopy eyelids, heavy eyelids, lower eyelid bags from a lower lid blepharoplasty or a mini midface lift or just that little bit of sagging skin. I feel like as Covid came about and patients didn't really want surgery, they're like, well, I am looking at my eyes all day on a zoom, but I really just don't want surgery for them. And I was like, that's fair enough. So did all our research and looked at what I felt were really good modalities to kind of treat eyelids. And so brought in the radio frequency microneedling with the Morpheus8, which really is a game changer in skin tone and skin tightening as well as scarring and then brought on AccuTite, which is super cool.

(12:02):
I was a non-believer until I kind of saw the results of it, but it's basically a minimally invasive way to get rid of the lower eyelid bags. So it's procedure we do in the office. It uses that radio frequency of technology, so it kind of melts the fat pads as well as tightens the skin on the top. And it's such a great alternative for, there are certain occasions where you still have to do a surgical lower lid bleph, you take consideration eyelid position and the amount of fat and other things like that. But for patients who are good candidates, it's a great alternative to almost an invasive surgery procedure. With the AccuTite technology, very similarly, they have BodyTite which helps focus on those stubborn little fatty areas that never go away despite diet and exercise. And that's what I brought my husband on for.

(12:52):
I stick to my lane. I'm an eye person, I know the face, I know the anatomy very well. I'm up to date on facial anatomy and that technology. And I was like, it's been a while since I've looked at a belly, but my husband, who's, he's an ultrasound fellowship trained ER doc, and so he's like, oh yeah, the belly's easy. He's like, we could ultrasound guide this and keep it safe for patients and make sure we're in the right plane. And so it was kind of a no brainer to bring him on to focus on that side.

Eva Sheie (13:22):
Definitely. So will you even go to the neck? Is the neck included in what you will treat?

Dr. Ami Shah Vira (13:28):
Yeah, so I go from the forehead to the submentum. So underneath your chin and some of the skin there.

Eva Sheie (13:36):
What about injectables? I assume you also do Botox, fillers, things like that.

Dr. Ami Shah Vira (13:41):
Yeah, I do like Botox and then the skincare products definitely help patients develop a good skincare routine. I actually do not do fillers, and we may add it later. I just feel like, especially in my patient population that I see, the way we've structured it, I think just with who we are is a lot of our patients are kind of like us. They're the 40-year-old mom who just realized that time has gone, one day when they look in the mirror and just they want to look refreshed. And in that population or the population that we see, fillers have such a minimal effect. They can have more risk than benefit. And so that's not really a primary focus of what we want. I mean, we've had patients that want 'em and we do 'em, but that's kind of not the main focus of it.

Eva Sheie (14:31):
Yeah, there's been a lot of chatter really in the last year, maybe a little longer, about HA fillers staying in the face much longer than people thought they would. And it sometimes is a controversial question that people don't want to be asked. But have you seen that yourself when you're doing surgery that there's filler hanging out in there?

Dr. Ami Shah Vira (14:54):
Yeah, I will say when it comes to fillers, I have taken out more fillers than I've put in. Not from me, but they've been put in and they've migrated, they've stayed around longer than they should have or they're causing other issues. I've had a filler that was done at the tear trough once that caused this patients that became so heavy, it's almost called a mechanical trope, it caused the lower eyelid to get pulled down and out, and she was getting vision loss because of corneal scarring, because of this. And eventually I had to kind go in and take the filler out just because it had migrated to a place that it shouldn't have.

Eva Sheie (15:32):
Is this something you see pretty often? Are people coming to you for help actually getting filler reversed?

Dr. Ami Shah Vira (15:38):
More often than I prefer.

Eva Sheie (15:40):
Yeah, that's maybe a topic for another day. Where do you see your practice going kind of in the next two to five years?

Dr. Ami Shah Vira (15:53):
I see the aesthetic side growing just with the way the patient population is in Austin, and I'm really excited about that. It's super fun because that's almost a instant making people feel better and feel more confident. So I definitely see that side growing. Hopefully they, I like our location. We're in north Austin behind St. David's Medical Center. I see us outgrowing that area maybe in the next five years or our office space, but I love the area, so hopefully we stick around there. But just hoping to grow that side and help more people from that side.

Eva Sheie (16:29):
There's a lot of solo practices in the world. I think there's about 50% of people in aesthetics are in solo practice and the other 50% are in some kind of group. But your model is really different. And I don't know everyone, but I have talked to a lot of doctors and I've never heard of a concierge practice like yours. And so I want to come back around to this and ask you what made you so entrepreneurial in the first place? Where did you get the confidence in this sort of boldness to say, I'm just going to make up my own thing?

Dr. Ami Shah Vira (17:08):
In complete honesty, it was luck. I was in a bigger ophthalmology group and I left when I was 30 weeks pregnant with my daughter, my second child, mostly just because I realized I didn't like the way ophthalmology practices were having to be set up. It was based on how many patients you saw per hour. That's how you got paid. So you were like most medical practices, so you were just trained to see more and more patients, less and less time. And I just didn't like that. And then I knew I was coming up on my maternity leave with my daughter, so I was like, okay, I think this is a good exit strategy. So that was August, 2019, and then we went on vacation the week after. And I had always given my patients my cell phone number. That's just kind of how I was, all my surgical patients, everyone always had my cell number.

(18:02):
And while we're on vacation, my phone just kept ringing. And it was patients going, wait, where are you? What are you doing now? Where can we see you? And my husband was like, I think this is a sign that you need to start your own practice. And so I was 30 weeks pregnant. It takes a while to get on any insurance plans. So I was like, all right, let's just start this little once a week cash-based practice, kind rented a room till I go on maternity leave and then we'll figure it out. So we did that for about a month or September, October, had my daughter in November, was going to take December to figure out what I wanted to do, came back and things were working well. So my husband's like, let's just keep this going. And so while I was on maternity leave, kind of read about and learned about the direct care model and how that works, and I was like, this is actually a great model.

(18:49):
I can spend as much time as I like with patients and see them how they need to be seen as quickly as they need to be seen without referrals and all those things like this is great. So we kept it going when I came back mid-January, February, and then Covid hit and March, 2020. And so having that flexibility, we were like, hold on, this is actually great, because I could still talk to my patients like I was virtually or on the phone and seeing 'em as I needed to. And so then it was during that time we said, okay, let's just make this kind of more official and let it grow from there.

Eva Sheie (19:26):
It's a great story. I'm really proud of you. Okay. If someone's listening today and they want to come see you or learn more about you, where should they go look for more information?

Dr. Ami Shah Vira (19:40):
Our new website is hopefully launching this week. We kind did a whole revamp on it once we started this aesthetic side. I'm really excited. It's just taken a while, but really wanted to delve our personal part into it. But so our website, it's basically my full name.com, so it's amishahviramd.com, A-M-I-S-H-A-H-V-I-R-A-M-D.com. You can follow me on Instagram. Same thing, Ami shah vira, md. You can always send me a message, send a message to the website, give us a call. We're totally happy to see you.

Eva Sheie (20:18):
Thank you. It was truly a pleasure getting to know you today, and I'm so glad you came on the show.

Dr. Ami Shah Vira (20:24):
Oh, thanks for having me.

Eva Sheie (20:27):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at MeettheDoctorpodcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, theaxis.io.