In our long-running series "How I'm Making It," we talk to people making a living in the fashion and beauty industries about how they broke in and found success.
I'll admit I was a little starstruck upon meeting Dr. Simon Ourian at his now-iconic Beverly Hills medical spa Epione on a recent Thursday, after hours. Until recently, I was actually not one of his 3.6 million Instagram followers, but I'd seen him countless times on "Keeping Up With the Kardashians," where Kim, Kourtney, Khloé and Kris have all been filmed receiving his signature non-surgical aesthetic treatments in those pristinely white rooms. For years, I'd been deeply fascinated by the existence of a place like Epione and the casualness and comfort with which this famous family walked in to get prodded with needles and lasers.
Today, injectables and the spa-like establishments in which they're administered are far more commonplace than they were when Ourian began appearing on reality TV. One might say he was a pioneer in helping to normalize these procedures, which he often films in graphic detail and posts to Instagram, where he easily has the largest following of anyone in the medical field. That's thanks in part to his celebrity clientele, but his account is also almost educational in nature; Ourian says many of his followers are other doctors.
But he didn't get here overnight, though he might have wanted to. Having immigrated with his family from Iran as a teen, he gave up his dream of being an artist to do something more "pragmatic." He regrettably opened a practice right out of medical school and, lacking an understanding of the business and legal side of things, he struggled in early years to keep the lights on. Despite his popularity — he's typically booked around six months in advance — he's also been criticized for lacking board certification, a fact he's happy to defend.
We chatted about all that, as well as how being an immigrant and artist drew him to aesthetic procedures, how he developed his signature techniques, Instagram fame, his secret skin-care line and how Lisa Vanderpump helped him build his celebrity clientele. Read on for the highlights.
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Were you always interested in the medical field?
Everybody just said, 'Oh, you're smart you should be a doctor.' But I didn't think that's what I wanted to do. I was very right-brained, I always wanted to be an artist. I was painting and sculpting in college, I minored in art. But my parents came here as immigrants, and I came here when I was 15, 16. You kind of become more pragmatic as a child of immigrants.
I tried to have a couple art shows and tried to self promote my art and nobody bought anything, so, [I thought,] I guess this is not going to happen. When I was 17 or 18, I was also very introverted, I was very shy; the fact that I came from another country contributed to that too. Also looking different than people who lived here. Thirty years ago, it was very homogenous. I felt like maybe if I looked the same as everybody else I could blend in better.
I think these were my first introductions to the concepts of cosmetic surgery. Also, a little bit further back when I was a kid I saw a movie with Elizabeth Taylor, 'Ash Wednesday,' and it stayed in my mind that if you get old, you can go and get surgery and you can look younger and I could have equated that to being able to live longer.
When I was 17, I convinced myself that I needed a nose job just to be able to blend in. That nose job helped me a lot, but what helped also was that [the doctor] was an artist. He found out that I sculpted, so he talked to me about the sculptures that he makes. And I saw a path that I thought I could use some of my right-brain skills and kind of match it to the part that's more pragmatic. I had no idea if I'd be successful, but I thought that at least I could make a living from this.
What were the next steps?
When I got out [of medical school] I knew that I was very fascinated by lasers. Lasers were new in the market and most doctors didn't know what to do with them. So, I basically dedicated my life to learning what there was to know about the lasers, and that gave me a huge edge very quickly.
The laser companies contacted me because I knew what to do with lasers and I already had a medical degree so it kind of put me in an area that was rare. I didn't have patients [yet], I could just sit down and do research and then offer answers.
So you were a consultant for the laser companies?
Initially [I was] a consultant but I was very naïve, I didn't really know how much money these guys could make from what I was telling them. Then a few years later, there was a laser that I had developed, which was Cool Laser but I didn't have a patent on it.
The simple physics of it is that it, instead of creating a lot of heat on your skin, it creates the heat underneath your skin, a few layers below. The huge advantage of that is that of course you don't get burned but you get the side effect of it, which is what you want, which is fooling your skin to think that you just got a third-degree burn. To me, it made perfect sense but I didn't realize that to physicists who don't deal with human tissue, that's a novel concept. So, they liked it. A year or two later, I realized that there's a company that's coming up with this very similar concept that I thought, 'Wow, great minds think alike.'
So, I went back and I realized that the CEO of the company was in my office two years before. So, they got a lot of their ideas [from me]; they came up with a billion-dollar industry, it was really an amazing company and they did do really well. In the beginning, I was very bitter about it, but I learned a lot from it. I went and got a very good patentor, and I patented a lot of the stuff that I was coming up with.
When was this?
This was 10, 15 years ago when I first sold my first set of lasers. The actual selling of the lasers wasn't huge, but it created a big name for me, because I was now an inventor of a device. So, a lot of people who wanted to get procedures done, they wouldn't want to go to the person who had the machine, they wanted to come to the person who had actually invented the machine.
Now, I've given you the glossy version of it. It was a lot of ups and downs, there were many, many months that I didn't have the money to pay for my rent in my office, or I had to go back and move back to my parents' apartment. I thought maybe I'd made the wrong decision because in the beginning, 20 years ago when I first started, there wasn't anybody else that I could model [my business] after.
My practice was mostly lasers but then at that point Botox and fillers were starting to come into the market. I started working with those, but the problem with the fillers was that they were very expensive for very small amounts.
I started working with fat transfer. The problem with fat transfer is that it is so unpredictable. If you get fat from part of the body that is very good quality fat, that means that every time you gain a new pound, that part of that kind of fat gains even faster than the rest of your body.
[Clients] would gain like five pounds and suddenly would have a moon face. So, that's when you saw a lot of people walking around and you still see people walking around with like chipmunk's faces, because a lot of doctors still believe that fat is a good product for the face.
Luckily, I was talking to a lot of these manufacturers and they came up with a few different products that I was able to mix and match and create the type of looks that I wanted. And again, because the fact that I had a background in sculpting, it was very easy for me to go and say I wanted to create a face that was chiseled, I would [practice with] clay, without having to worry about how a face would turn out and then see which areas I wanted to have more and which areas I wanted to have less. And I would translate that kind of result to the human face.
Then I think people saw [they could get] results without having to do any cutting and people started to come and they brought their friends, and the celebrities, and then celebrities told other celebrities and then, here we are today.
Going back a bit, when did you first open Epione?
Twenty years ago, that was the naïve part of it. As soon as I got out of residency, I thought, 'How difficult can it be? I'm just going to open a practice and people who come, I'm going to treat them.' Unfortunately, medical school, like most other professional schools, they don't teach you how to run a practice. To this day, I think it was foolish to do it.
What were some of the biggest challenges you faced in the beginning? Or mistakes you made that you had to correct?
Initially these challenges were not really understanding the business part of medicine, the legal part of medicine, the customer service part of what I do. I thought every month we're going to be able to pay the bills, and it didn't happen for probably the first year or so, I had to borrow money from my friends, from my brother, from anybody, credit cards, I maxed out every single credit card just to keep the business going for the first year. What continues to stay a challenge is still the balance of having not to work too many hours and still have a life and have a decent quality of life outside [of work].
How big of a team do you have, do you see every patient yourself?
I see every single person who comes to our practice. But, probably 50% of them are then treated by nurses and another 50% by me.
Which treatments do you do yourself?
I do all the injections myself. Anything that's technique-dependent that it has more to do with a little bit of art as opposed to science. Patients expect me to do that, and I think it's very difficult to teach, to transfer my art or my aesthetic sense to someone else.
A lot of patients who come to me, come from overseas because they can't find that one person. A lot of people, celebrities who trust my work, they trust me because of what they've seen I've done on other people's faces and they want that kind of a predictable result. And I can't just risk it, there's not a huge window of mistake that I could have to hand off to someone else.
Who were your first celebrity clients?
Lisa Vanderpump [of "Real Housewives of Beverly Hills"] was my neighbor and then she found out what I do. She said, 'Can I come to your office and bring the cameras?' And I said, 'Sure.' They filmed it and because of the fact that people respected her and they liked the fact that she didn't look artificial, a lot of people came, a lot of her coworkers [on the show] came.
Lisa Vanderpump brought Lady Gaga and a lot of the celebrities she knew, and that became known. They saw people's faces, they realized that they're not looking crazy, so the agents told their clients and it got out.
Then the social media happened, with Instagram sort of coming out, and then I met Jonathan Cheban. He wasn't Foodgod back then, he came in and he said, 'How come you don't have a social media?' I'm like, 'Oh, I don't know.' He said, 'No, it's the biggest thing.' Like six years ago exactly. He said, 'Have you heard of Instagram?' I said, 'No, is it the same as Myspace?' He said, 'No it's the best thing, it's really happening.' He had close to 80,000 followers and he said, 'You know what, let's take a picture together and we'll write something and see what you get.'
So, he posted something and from his 80,000 followers, I got 12,000, so just to show you how amazing Instagram in the beginning was. Then he said, 'I'm going to introduce you to Kim.' And I honestly had no idea who Kim was, I heard about Kim Kardashian but I thought they must be very loud and rude people. I had never watched the show, but I had seen them [on magazines] in the supermarket, I assumed that they must be very loud, I thought, 'Okay, if she wants to come that's fine.'
So she came in and we hit it off really well, she was very nice, very sweet, very down to earth, and she said, 'Is it okay if I bring my camera next week?' I'm like, 'Yeah, bring it.' So, she brought it and then she actually posted a few things [on Instagram] and then that kind of opened up the whole Instagram to people feeling comfortable with posting things.
And then she of course she was the queen of Instagram, of social media, so people who followed her came to see what I do, and they wanted to have her features.
Why do you think you've become the most-followed medical practitioner on Instagram?
I think it's because, number one, I'm not curing cancer, we're not showing bad cases, this is a light side of medicine, and at the same time it's relatable, there's not a person who thinks being attractive is bad. So, if you live in a society, everybody wants to be a millionaire or attractive, it just makes you better in society, better in business, better in finding the right partner in your life.
I have close to 50,000 doctors who follow me, they use it as a latest and greatest medical journal. Not because I do anything necessarily better than anybody else, but I try to find things that are unique and new and exciting and effective and safe. And instead of posting them on a medical journal that would take maybe five years before it's posted, once I know something is effective I post it the next day, so everybody gets the same access to that. It has really created a nice environment for not just my patients, but a lot of doctors to communicate.
How do you choose who to film, what is that conversation like?
So many people want to be on the videos and it's become a difficult task to pick and choose. I don't want to have 20 of the same procedures so I try to pick people who will have nicer results and I feel like there could be a [significant] difference in their appearance and they'll be happy with their result. Sometimes they're sitting in front of me and I just think, this will be very educational, and I ask the patient if they would be okay with that.
Are they given a discount or anything in return?
If it's something that I request them to do, I give them a discount, so I give them a discount for them to allow me to post this.
Overall, how do you feel like social media has changed your field?
Because of the fact that it's so transparent, people realize what choices they have, so it's a lot easier for them to make decisions. You can do a lot of quick reference checks to see what kind of things you like. Maybe you like the way I do cheekbones, maybe you like somebody else's, so you can see people's galleries, it's like looking at their resume.
Let's say you see something a doctor posts and you see the patient posts something, you can actually directly DM the patient and say, 'What are your thoughts?' That's a very huge advantage.
But, like anything else it has negative consequences too. I think a lot people discount that it's still a medical procedure, it needs to be done by a medical doctor in most cases. It does have side effects, and it's very important that you have a communication with your doctor.
Also, I welcome the fact that as recently as probably a month or so ago, Instagram decided to block those images of cosmetic procedures to anyone younger than 18.
Can you tell me a bit about the Epione we're in today? What vibe did you want it to have?
I wanted it to be opulent and nice, and luxurious, but at the same time homey. I wanted to feel like you are in a five-star boutique hotel as opposed to a medical office that's sterile and scary. I used to go to every boutique, I used to go to Chanel or Ralph Lauren and the Wynn Hotel in Vegas and I would take notes, I'd take pictures of everything that I liked that were there.
So what's next for you and Epione? Any plans for expansion?
The problem, again, is quality control. I have to be here. I don't think I'm going to have multiple offices ever, it's always better to have this one office that I can deliver the level of care that I want to.
A lot of what I do is skin care so I would put everything in little jars and give it to my patients and I realized my patients actually liked what I was giving them. And probably a year or so ago, two years ago, I put them in nicer jars.
I just wanted this to be the best in category and every single one of [the skin-care products] I tested. Just for the cleanser alone, I probably tested 20 different cleansers that are best sellers in the market. We've never done marketing for it, it's just basically a cult growth: They see it, they like it, they order more.
There's been some criticism online of the fact that you aren't board certified. Was that a choice? Are people missing something?
There's really one board in California that's for anything to do with cosmetic and that's plastic surgery; every other board has nothing to do with cosmetic. Dermatology is dermatology, ophthalmology is ophthalmology. The only field that is remotely close to anything aesthetic is plastic surgery, and I don't do plastic surgery.
In most of the country what I do is done by nurses, so for me, to go get a creative board of aesthetic medicine that doesn't exist is futile. In this point in my career, I don't need that to validate what I do. I don't want to be above everyone, it's just I have my own people who see what I do, and the proof is in the pudding.
What advice would you give someone hoping to enter your field?
It's a very good idea to find a mentor, or at least somebody that you can model the practice after, that you can learn from and go learn the tricks of the trade from them. Take a couple business courses, and if you want to be in the aesthetics field, you really have to understand aesthetics in all fields. You have to understand what's fashionable now, what is the best designer, the houses, it's a visual thing. If you are not a visual person, this is probably not the right field for you.
This interview has been edited for clarity.
Homepage photo: Paul Archuleta/FilmMagic