Shawn O'Hara: Welcome, everybody. My guest today is Shandalin O'Mahony, who has been a nurse practitioner for eight years, having founded SHAN Esthetics, a medical spa and skincare clinic in Chilliwack, BC, which is about an hour, an hour and a half outside of Greater Vancouver.

Shandalin has a background in emergency department care and family practice, and now focuses on evidence-based cosmetic and skin health treatments that help clients look and feel their best. At SHAN Esthetics, Shandalin and her team of nurses offer a wide range of evidence-based treatments, all delivered with a warm, boutique-style approach in the Fraser Valley and also in Williams Lake, which is more in the center of British Columbia.

Outside the clinic, Shandalin gives back through volunteering with local and international nonprofits. Welcome, Shandalin, and thanks for being here.

Shandalin O'Mahony: Thanks, Shawn.

Shawn O'Hara: So tell me, what does SHAN Esthetics do?

Shandalin O'Mahony: It's always a great question. Our clinic, SHAN Esthetics, is, as you mentioned in your introduction, a nurse practitioner-led aesthetics and wellness clinic that offers curated treatments to meet people's concerns through various stages of life, in order to enhance confidence and wellbeing. We provide excellent evidence-based interventions in, like you said, a warm boutique setting, and the pillars of our clinic are, of course, our aesthetics clinic, which is the pillar of what we do.

That's your injectables, Botox, fillers, bio-stimulators, skincare. But we also offer a wellness component to our clinic, and part of that is our weight management. There are people who are not necessarily obese and meeting requirements from the public sector to be treated for obesity, but they're midlife, maybe they're 15, 20 pounds overweight.

They're seen at our clinic because they're falling in between the worlds, and we're able to bring them in, offer them consultation, lifestyle interventions, education, and then oftentimes that's paired with a medication. And then the other component to our wellness clinic is IV therapy, vitamin IV therapy.

We use various different vitamins in IV form or intramuscular form that allow people to optimize how their body uses vitamins. Because what we're seeing is that people try to eat well, and I think especially those who are concerned about their physical looks and abilities are going to be eating salads and protein.

But a lot of this is coming through, at least for me, using bagged salads, prepackaged meat, because there's no way that I can go out to the field or even get my lettuce off the farm all the time, wash it, all the things that happen because we're all living busy, full lives. So what we're seeing is that people are not getting the nutrition that they need.

So by offering injectable form, we can get a hundred percent of that nutrition to your bloodstream, and your body can utilize it rapidly. We also, as another component to our business, do hormone optimization. Women were told for many, many years that menopause, perimenopause was just something they had to suffer through and get to the other side, they'll be fine.

But we now know that a lack of the body's exposure to estrogen, if their bodies are not being exposed to estrogen for an elongated period of time, is bad for their bone health, bad for their mental health, bad for their brain health, heart health, and bone health. And so we know if we can give them some progesterone, estrogen, maybe even a bit of testosterone, that these women...

...function better for longer. Their chances of getting dementia are decreased. Their chances of stress fractures in their hips and vertebrae are decreased, and also they're just going to look and feel better. So that's for the women. And then the men, we know that midlife, with stress and all the things men go through, their testosterone can often play a role in that, and a decreased level of testosterone for many men often contributes to fatigue and also osteoporosis, muscle mass loss, and depression.

So we can see that men who optimize their testosterone, they can also function better through the decades: 50s, 60s, 70s, 80s, and beyond. So that gives you a little bit of an overview of what we do at SHAN Esthetics. It's sort of two main components, aesthetics and then wellness, and we try to combine those so that people can look and feel their very best.

Shawn O'Hara: It's amazing. You're describing some of the symptoms from men at that point. So it's certainly much deeper than just the aesthetics and the facial part. So, quick question about the vitamins: do you monitor them to get what's optimal for each person?

Shandalin O'Mahony: Some of the vitamins are actually not really able to... we're not able to measure them in the blood easily. And again, you could do it, but it's going to be extremely costly. But because people are coming a couple times a month usually, we don't necessarily need to test their vitamin levels. The one level that we see and we do test is vitamin D.

Most, if you come to my clinic and you don't want to do the testing, or you haven't done the testing, it's not necessary, because chances are if you live in the Fraser Valley or north of the Fraser Valley, you're going to be low in vitamin D. We just don't get enough sunlight here, and people just aren't outside enough, even if it is a sunny day.

So your vitamin D levels... and that's going to contribute to seasonal affective disorder. Again, bone health is going to be affected by this. So I tell people, unless you're taking oral vitamin D, you're going to be low, and 100% of our patients are. You can optimize your vitamin D level just by taking oral supplementation, or you can come into our clinic.

We can top you up with our IM injections, that's intramuscular, IM. And then you can also take oral, especially those winter months, so it's November to February kind of timeframe when people are just... everything's rainy and dreary, and the daylight is short. We really see people do much, much better when they're using vitamin D optimally.

Shawn O'Hara: Good, because we don't live in a sunny area. We have sun, but we evolved closer to the equator where there was more sun than now. And so much more is being learned about vitamin D and the importance of it.

Shandalin O'Mahony: Yeah. We know that it contributes to autoimmune disorders, low deficiency, some cancers are associated with deficiency in vitamin D. Of course, like I mentioned, mental health, bone health, there's just so many things. The body's so synergistic, the way that everything interplays with everything else. So it's nice, as we want to live better, longer, that we optimize all these things, and we have knowledge, and we have the access to it. These things, a vitamin D injection, for, you know, $40, you can have. It's not unreachable for many working people.

Shawn O'Hara: Neat. And we're finding out so much more, more products, more research, more clinical trials, so it's a fascinating industry. What inspired you to get into this?

Shandalin O'Mahony: In 2022, nurse practitioners were authorized to order and provide aesthetic services. This became my open door, and my entrepreneurial mind got moving, and I thought, 'You know what? This is an opportunity, let's just start.' I started with a couple needles, a bottle of Botox. One of my friends wanted to start getting into the industry.

She was a registered nurse, and I'm like, 'Let's just do this, let's try it.' And one thing leads to another. All of a sudden, you have a skincare line, you have a device, you have radio frequency, you have a laser, and you need to hire more nurses, and now you have an office manager and a laser tech, and then all of these things sort of snowball, and you realize that you can't just do one without doing the others, and then you have to build.

Each has to build on each other. You can't just do Botox, you need to talk about skincare. And while you're talking about skincare, all of a sudden estrogen becomes a huge part of it, so now you're talking to women about menopause. And while you're at it, they want their partners checked for testosterone replacement.

So things just sort of snowball. You listen to the patients in your chair, and they'll basically tell you where your clinic needs to go.

Shawn O'Hara: So what personally motivates you?

Shandalin O'Mahony: I really love being part of people's stories. And when I get to have them in my chair and they tell me about the sadness of their lives, maybe their partner's cheated on them, they've had a loss, a death, they're going back into the workforce, they've recovered from cancer, they want to feel more like themselves again.

They're not looking to feel something different. They want to go back to what they remember feeling: confident, happy, attractive, desirable. And if I get to, first of all, hear their stories and listen, and just get to be part of hearing what they have to say, and then get to be part of the healing.

Because, yes, I'm not healing their bodies with antibiotics and chemotherapy, but I get to help them in the process of getting back to what they were. So whether that's skincare or Botox or doing their lips, or however that looks, even if it's in the hormone realm. And then they come back, and they tell me, 'You know what, Shandalin, I just feel good. I feel happy. I feel good. I love my lips. I love my Botox.'

Whatever it is that they were concerned about, I think it's very much an instant gratification, and it kind of puts you in that loop, so you feel really happy, so you do more. It's like, for me, that's pure joy, of caring for somebody and having that gratification instantly.

Shawn O'Hara: Great, so a lot of satisfaction from that. So who regulates your industry?

Shandalin O'Mahony: The British Columbia College of Nurses and Midwives, that's what BCCNM is called. Our industry is widely unregulated as a general industry. So the health authorities are going to look at each physical layout of these different aesthetics clinics. As a nurse practitioner, I answer to my college. A physician or surgeon in this industry, they're going to answer to their own college.

Those are the regulatory bodies. But as an industry, there is no one central regulatory body.

Shawn O'Hara: Does that mean that a regulator, do you get audited, or is it just if there's an issue that comes up?

Shandalin O'Mahony: I have to answer to the college yearly and do a review, and they'll ask me a bunch of questions: where I'm working, who I'm working for, what kind of continuing education I've been doing, who works for me, all of that sort of stuff. And if there's a problem, they'll be coming, talking to me.

Shawn O'Hara: The regulator for you could be an actual different person than for a physician, then, because it's a different college.

Shandalin O'Mahony: Yeah, absolutely. Yeah, it's very different.

Shawn O'Hara: One would have to take precedence over the other, otherwise that risks getting some degree of confusion.

Shandalin O'Mahony: Yes. So I do not have to answer to a physician in my clinic. Nurse practitioners are their own, essentially, medical director. So I have this clinic, it's myself, the nurse practitioner. If I'm away on holidays, I would have another nurse practitioner, physician, or naturopath able to step in and help with oversight.

There can be some people within the industry who would like to own medical aesthetics, and they would like to have control over that. But I don't think, at this point, because there are two different colleges, or actually three, because the naturopaths have their own regulatory body with the ability to provide oversight, then I don't think... it's very much decentralized.

Shawn O'Hara: It's interesting. Are there people who provide similar services to you that don't fall under any of those colleges potentially?

Shandalin O'Mahony: No, you can't provide the service unless you're... I forgot to mention the dentist. Dentist, physician, naturopath, nurse practitioner in British Columbia.

Shawn O'Hara: Which is four different colleges.

Shandalin O'Mahony: Yes. And to be able to inject, so it's one thing, I can provide the medical oversight, but the nurses, you have to be a nurse in order to inject. I think it does close the door in some ways, right? But it's not going to allow one body to completely control the injectable portion.

Shawn O'Hara: But having a separate college with their own bylaws is what helps protect consumers, because that's ultimately why those colleges exist.

Shandalin O'Mahony: Yes, ultimately it is for public protection.

Shawn O'Hara: Have you seen the regulations change since you opened SHAN Esthetics, and has that affected your business?

Shandalin O'Mahony: I don't know that they've changed, but they might have tightened up a bit, especially in regards to some of the marketing and what you're allowed to market, how you're allowed to market yourself. We have to be very careful that we are not telling people what kind of dosage or what kind of products they need to be putting in their faces without having done an assessment, so we have to be very, very careful of our wording, even to the point of promoting a certain brand, like say Botox or Nuceiva or whatever.

The college, I think, frowns quite heavily on anybody promoting a certain brand or telling a patient, 'Hey, you need lip filler,' or, 'You need Botox,' or those sort of things. So I don't know that necessarily their regulation has changed. I think we're becoming more aware, and there are more case studies of people who have been brought up for concern, so then we become more aware: 'Hey, you know you can't do this,' or whatnot.

Shawn O'Hara: Can you give us examples of what you can and cannot do or say?

Shandalin O'Mahony: It would be, say I say, 'Hey, you're 15 pounds overweight, you need Ozempic.' I can't say that. Or, 'You got thin lips? Lip filler's definitely your answer.' I can't say that. Or, 'Botox is the best brand out there.' No, you can't be saying these things.

So don't cut that and put it out there as a sound clip, right?

Shawn O'Hara: Oh, no, wouldn't use that as a clip.

Shandalin O'Mahony: No, I know. I'm just joking, yeah.

Shawn O'Hara: That must make some of the marketing very interesting for that. Have you faced any challenges with marketers in this area?

Shandalin O'Mahony: I have a great team. I use Longhouse Media, and they've been fantastic. Jake's my main guy, and he's just been so great. They help me all the time. With a lot of our marketing, we just show people what's there, or I educate people around it. So instead of saying, 'Hey, we have Ozempic,' or, 'We have Mounjaro at our clinic, come and get it,' we say, 'If you happen to be on one of these medications, whether it's from my clinic or somebody else's clinic, these are the things you need to be aware of. You need to be eating your protein, you need to be doing weight training,' all of these things, so then it becomes more about educating while letting people know that we have this available, as opposed to overtly saying, 'Come and get this.'

Shawn O'Hara: You do have a good, extensive blog on your website as well.

Shandalin O'Mahony: Yeah. That's Longhouse, they do all that.

Shawn O'Hara: Good, and that helps with the searches, and with the AI searches as well. What would you like the general public to know about your industry?

Shandalin O'Mahony: Our industry is quite often misunderstood. I hear this a lot, whether it's the spouses or the family members of people who are receiving aesthetic services, there's a lot of judgment, which is interesting in this day and age, where people say very little about other people's lifestyle choices, that this actually does come under attack more often than I'd like to see.

People hear medical aesthetics and they picture vanity, quick fixes, a frozen forehead, pursuit of perfection, fussy women, highfalutin brats, right? However, the work we're doing is so much deeper. At its core, the industry is about being human, because each of us carries something, a feature that we've learned to hide, something that we airbrush, an insecurity that shapes how we carry ourselves, how we enter a room, or catch a reflection in a mirror.

It might seem like this is really a trivial concern to others, but to the one carrying that concern, it's real, and it's really personal.

And so if somebody's vulnerable enough to share that in our chair, we're going to listen, because my role isn't about changing somebody's face. It's about really attuning to that person's concern and hearing what they're trying to tell me on a deeper level than just it's this or it's that.

So as a provider, I can address these concerns with care, precision, using evidence-based procedures. And then they leave not looking different, but they feel restored and free to move forward with confidence. I would like for people to truly understand that, and I feel that if more people did, I think we'd have an easier time getting women to come and do these treatments when their husbands are aware of it, as opposed to feeling that they have to hide things, like, 'Don't bruise me, I'm going to be in so much trouble,' or, 'I'm not allowed to get Botox,' or, 'I'd never get Botox.'

People kind of throw these terms out there without fully understanding, first of all, what it is, second of all, what it does, and maybe the deeper need that it is actually addressing. Because it might not be the wrinkle in your forehead, but it's something about that stress that you've carried for 14 years, because it appeared when your son was going through a mental health problem, and all of a sudden that line appeared, and it never disappeared.

So every time you look at it, that's what it reminds you of. So if we can go in, make it better, soften it, we can also maybe soften that memory a bit. So I wish people understood this.

Shawn O'Hara: Yeah, that's fascinating. That's very deep, and that's a huge impact.

Shandalin O'Mahony: Yeah, I think we misunderstand this, and I misunderstood it when I came into the industry. I didn't know what I was getting myself into. I just thought, 'Oh, I'll get a little bit of Botox, I'll do this, do that.' And then all of a sudden, I started hearing the stories, and I started seeing the faces and watching women cry, and feeling like, women walking in my room and saying, 'Shandalin, I just got my breast removed. I feel awful. Can you make me feel like a woman again?'

Because about 90% of our patients are women, and femininity to many women is core to who they are. And when they lose that, or feel like they're losing that, through whatever life event, sickness, pain, menopause, whatever, if we can help them restore that to some degree, what does that do for somebody, right?

Shawn O'Hara: It's huge and life-changing.

Shandalin O'Mahony: Yeah.

Shawn O'Hara: Yeah, that's fascinating and a huge impact, and I know there's a lot of work and research and clinical trials and so on going on, plus regulations, because we are in an era when regulations are continuing to increase. What do you see happening over the next five, ten years in the industry, and maybe in business as well?

Shandalin O'Mahony: What I hear a lot of at conferences, and from different people I follow, and talking to my patients, particularly my male patients and my entrepreneurial patients, because they're always sort of thinking about the next thing, the next thing, that's just how I think our minds work, is that there are some things already out there and really exciting, and they're not necessarily regulated by the medical profession.

And one of them that comes to mind, of course, is peptides. I hear about it every single day. Somebody will ask me, 'Shandalin, what about peptides? What about this BPC-157 glow complex?' These stacks, and Retatrutide, Retrutide, sorry, GP3, GLP-3 is what they kind of call it. Retta is the other term.

And what's happened right now with that is that the government has decided that we're not allowed to have it in Canada, so Health Canada hasn't approved it. In my perspective, and you might have somebody else who'd say something different, what this does is drive everything underground, because people want this product.

And what we're seeing, my husband had a young man in his chair, he's a psychologist, so he had somebody talking about two young science students making this in their basement and selling it to the public. You can get it, in the fitness industry, there's a lot of this going on, the selling and buying of it, people selling it online.

So it becomes decentralized. There's not standardized protocols, there's not standardized dosing. It's kind of the Wild West, literally, and the government has no control. There's no say that medical experts have input into how we're going to disseminate this information, how we set up protocols, what's safe, what's not safe. Everybody's just doing their own thing.

In fact, one of my friends came in for a treatment, and then she handed me... she said, 'Oh, here's a peptide for you.' She handed me this. As you can see, it's a white powder, unlabeled, unmarked, and she told me what it was, so I said, 'Thanks so much.' I took it, so I'm going to send it off for testing and see what it is. But obviously, I'm not going to be using it.

But it's just really, really interesting, this is the day and age we're living in. But rather than Health Canada, I think what they should do, and maybe I'm going on a bit of a tangent, is allow this to become regulated. Let the professionals and the people who work in this industry have some ability to utilize the knowledge that's been gained from south of us right now. It's all being used. And let's... then we can have some control over it. It can be taxed, it can be... now we have an economy.

So I think it's coming. I think Retta, the GLP-3, is coming, hopefully next year, I've heard. Because we had Ozempic, which was the first generation GLP-1, and then now we have Tirzepatide, which is Mounjaro or Zepbound. That's the second generation. Excellent medication. These are life-changing for many, many people.

And now we have the Retta. It's going to be the third generation, even better, has glucagon in it. It's just a fantastic product, from everything I've read. And I think that's going to come next year, and I think some of the peptides can be life-changing, if we want to talk about longevity. So that segues into the longevity talk, which is also a branch of aesthetics.

People want to live well. Most of us would say, 'I don't want to be stuck in a care home for 10 years, brought out in a wheelchair, and sat in front of a TV while I drool. That's just not the life I want.' And I don't think there's one person who would say that's the life they want. And I'm not saying it's not a meaningful life, and I'm not saying that there's not value in that life.

Of course there is, but it's not the life I'm dreaming of. So when I'm in my 90s, I want to see my grandkids. I don't want to have chronic inflamed injuries and have no memories, and just, I want longevity. So longevity is about those years that you're living, you're living them well and in full health.

So I think there's already been a huge shift in this way of thinking as a society, but I think some of these newer modalities coming in are going to allow people to live well, live longer. And of course, that segues back right into the aesthetics, because if I'm going to live with this face for 90 years, at 50 I certainly don't want it full of wrinkles and decrepit with no fat in my face.

We're going to restore that volume. We're going to keep those wrinkles at bay, and we're going to do that thoughtfully, carefully. Sometimes it's bio-stimulators. Natural products are more in favor right now, skincare, sunscreen, all of those things that are going to preserve our skin, our face, the fat in our faces, all that.

So, hopefully that answers your question.

Shawn O'Hara: Yeah, that's excellent. Yes, huge opportunity. I was listening to a podcast out of the US with somebody who is a specialist in peptides, who encountered a stewardess, didn't know her background, but just, I guess, looked at her and was trying to sell her stock, basically would put her in touch with her dealer, and she was horrified by that.

And what she was talking about was completely unregulated, even by the FDA, and people just don't know what they're getting into.

Shandalin O'Mahony: Yeah, they don't. And I think the reality is, when people feel that something's unjust or there's no rationale, then people take justice into their own hands, and they're like, 'Well, you can't stop me,' because we as humans want to be free to make our own choices. We get to choose how we age.

And I think Canadians are saying, 'Why won't you let this stuff be open in the market? And if you're not going to, I'm going to find it another way.' Especially when we look around and we see all these other things that are allowed and permissible, and then you think, 'I just want to be a little bit healthier, so let's...' And the evidence looks excellent for all of these things, so let's do this.

Shawn O'Hara: Yeah, it'll be a fascinating future to see what happens. So tell me about some of your outside-of-business, personal interests. You're involved in some local and international nonprofits. What can you tell us about those?

Shandalin O'Mahony: These are absolute passion projects for me. I got involved with an organization called Seeds of Hope a number of years ago. My husband and I did a trip to Zambia, and there's a children's home there. It was originally started as a palliative care program for kids who were infected or affected with HIV.

The couple who started this children's home were from Mission, a local couple. They now live in Chilliwack. And they would go over and help these children, who often had been abandoned, left on the side of the road, left in garbage cans because they're dying, to bring them into the home and let them have a short life with love, to be loved, and with dignity.

As, of course, the antiretrovirals came, that allowed the children to live. And so now many of them are living still with HIV, but living to go on to university, doctors, and lawyers, and nurses, and teachers, and thriving. And now the home has grown. There are, I think, 150 kids there. Of course, many of them have had very traumatic childhoods.

And so my husband's work as a psychologist was trying to bring some Zambian supports and some culturally appropriate therapy to help these kids. And then my job, I sit on the medical board, and we help with protocols and bringing these kids healthcare, basically, especially because many of them are living with chronic illnesses.

And when you have HIV, there are things that have to be considered. So they also have a home in Thailand, which is for children and women who have been sex trafficked, who have been victims of sex trafficking. The home is on a beautiful piece of property. I haven't had a chance to visit it yet, but we help support that.

And the kids are, of course, coming from horrific backgrounds. As you may have heard, children and humans can be sold many times throughout their life. And it's one thing, which is noble work, to rescue those children from that life. But unless we bring them into a home, teach them, give them skills, education, a loving environment, and a different set of values, the chances of them returning to that life, because it's the only life they know, is very, very high.

So what the home in Thailand does is they educate the children. They have them in private schools. They have therapists on staff. They have a house mother and father. They have routines, a swimming pool. They teach them music and swimming and all of these things, in order to bring them into adulthood and launch them successfully to have a meaningful life.

The women that they care for have often had such a hard go that many of them just come into the home, and that will be their home forever, because of the tragic life that they've had up till that point. Many of them being sold by their mothers, their brothers, over and over and over again, enduring torture, enduring many, many horrible things. So that is the things that I'm involved with at an international level.

At a local level, I sit on a committee for Young Life, which is a not-for-profit youth organization, and what we do is bring... we have a staff member that meets with youth once a week, and then throughout the week coming alongside them in order to influence, mentor, and walk through their whole high school years with them.

So that staffer, the leader, comes alongside the kid. He goes to their basketball games, invites them to what we call club, which is like a youth group, but with a party basically, and then they go to camp in the summer. So this is a Christian organization, and it's not denominationally affiliated, but it is really bringing kids that...

There's some of the kids, their parents have died, or one of the parents is not really involved in their lives, and this is a really huge way for them to connect with an older mentor, somebody who can speak into their lives and hopefully help them and bring them through all the things that we go through as young people.

And then hopefully they come back and do the same for the next generation. So that's a really fun part of our lives, and for a while, when I started my clinic, we were still hosting the groups at our house, the clubs. We had the clinic running sometimes, and the kids would be crawling up the side of our house like Spider-Man.

And then eventually we got another space so the kids could go somewhere else, but it was a bit wild for a few months there. Anyway, so that's a huge joy for me, to be able to be a part of that, and a big privilege for both those organizations.

Shawn O'Hara: And they both have websites?

Shandalin O'Mahony: Yeah, they do.

Shawn O'Hara: Good, we can add those into the show notes. This has been fascinating, Shandalin. How can people reach you?

Shandalin O'Mahony: Yeah, I'd love to hear from anybody. We have our Instagram, which is shan.aesthetics, hello@shanesthetics.com email. Or shanesthetics.com is our website. So I'd love to hear from people if they have any feedback, or would like to know more about any of these things we chatted about. It's really been a fun time with you, Shawn, so thank you so much for having me and taking the time to hear my story. It's very fun.

Shawn O'Hara: Great. Thank you so much. So my guest today has been Shandalin O'Mahony, who is a nurse practitioner with SHAN Esthetics in Chilliwack, BC. Thank you so much for being here, Shandalin.

Shandalin O'Mahony: Thank you so much, Shawn. I appreciate your time.

Shawn O'Hara: That's a wrap.

Show Notes

• Website: shanesthetics.com
• Email: hello@shanesthetics.com
• Instagram: @shan.esthetics
• Seeds of Hope
• Young Life