Dental ‘rockstar’ Michael Apa, DDS, expands to Dubai

Since the last DentistryIQ Q&A with Dr. Apa two years ago, he has opened a state-of-the-art luxury dental office in Dubai; he has released his Apa Dental Product line now sold in top department stores; he has bought out his partner and mentor, Dr. Larry Rosenthal, and is the new proprietor of the Rosenthal-Apa Group in New York City; he has grown his list of celebrity patients; he has graced the cover or was profiled in several magazines; and he has created his own YouTube series. One thing that continues to be the same, however, is Dr. Apa’s continuous creation of beautiful smiles.

The last time I interviewed Dr. Apa, he was traveling to Dubai four to five times per year. He’s now traveling there 20 times each year. Having opened Apa Aesthetics UAE in 2015, Dr. Apa has grown his Dubai office to full-time, and it now employs two full-time associates and a large staff. At age 39, Dr. Apa has achieved more in a decade than most practitioners achieve in their lifetime.

Social media stars and celebrities flock to Dr. Apa’s Dubai office, including patients who fly in from Europe simply for a checkup and prophy. Treating royalty has become a weekly endeavor for Dr. Apa. Just as we were wrapping up our interview, he was heading back to the Rosenthal Apa Group office to treat a Saudi prince. I recently had the opportunity to sit down with Dr. Apa for an interview.

Dr. Iman Sadri: Thank you for meeting with me. Congratulations on everything since we last spoke. How often do you go to Dubai now?
Dr. Michael Apa: I go every two weeks and work for four days. I opened full time a year ago last March. I had been going there since 2008 as a visiting doctor and I used one chair. Now I have six rooms, a lab, and two dual-trained surgeon/cosmetic dentists who live there full time. I recruited them out of NYU and sent them over there.
(Pictured right, Dr. Michael Apa with patient Vera Wang, fashion icon)

Dr. Sadri: It’s wonderful that it’s busy enough and you have enough patients for two full-time associates.
Dr. Apa: Yes it is. What happened is that I’ve been trying to create a brand of dentistry—less on me personally and more on the name, and it’s happening. People are walking in asking for cosmetic dentistry. They know the Apa name without really knowing who Apa is. They’re going in, doing the consult, doing the case. No one really knows who I am, which is good.

Dr Sadri: You’re being too modest.
Dr. Apa: And it’s working. When I go and work for four days, I’m averaging three to four cases per day. It’s crazy. I take up all six rooms. I’m doing consults, inserts, and preps, all at the same time. But when I leave it’s more controlled chaos. What happens is, if I started a combination case, they do the surgery when I’m gone, which keeps them busy. Or they have patients walk in and want dentistry when I’m not there, and they’ll start a case. Maybe they’ll stretch that case out for the day. Both of the associates are busy when I’m not there, and that happened faster than I thought it would.

Dr. Sadri: Does your lab tech, Jason Kim, still travel with you every time?
Dr. Apa: Yes. But we also have three other full-time lab guys.

Dr. Sadri: Is there any type of dental insurance in Dubai?
Dr. Apa: To be honest, I don’t know. Everyone pays us cash.

Dr. Sadri: What are the most common cases that your associates are doing?
Dr. Apa: I’ve been very strict about not becoming a general dental office. However, if we’ve done someone’s case and they need additional work in the future, for instance, a crown, then they are our patient. But we’re not promoting the practice that way.

Dr. Sadri: That’s why I call you the Bradley Cooper of dentistry. Only A-list. So when patients come in, they’re coming in for a smile makeover?
Dr. Apa: Exactly. I don’t know how to run a general dental office, which is almost not good. There was a six- to eight-month period when the associates would call and ask me what they could do to stay busy. I said, “Have faith. Trust me. I don’t want you seeing 100 patients like every other dental clinic in Dubai, because then we’re like every other dental clinic in Dubai. We’re going to be special. No one else is set up like us.” Now it’s crazy in Dubai. People say they want to come in for a smile makeover. It’s heavily social media influenced. It’s different.

Dr. Sadri: Are patients scheduled according to who wants to see you versus seeing your associates?
Dr. Apa: There are two different fee schedules, one for me and one for them. People who can’t afford me are given a consult with the associates. We figure this out in a phone call before we start. So we normally give patients ballpark figures regarding what I charge. They might say they’d rather see an associate. But the good thing is that it’s not turning into a lower quality thing because we have the lab, and they know they’re under my umbrella. I think patients feel comfortable seeing someone else. The difficulty with treating people in Dubai is they’re not a schedule-oriented culture. I could have 50 consults scheduled over four days, and 30 of them might show up, or 20. And these are people from all over the world; Saudi, Qatar, wherever.

Dr. Sadri: Do you charge a no-show penalty?
Dr. Apa: No, that would only turn people off. Hopefully they will call back and reschedule and I’ll see them at some point. Yes, it’s disrespectful of my time, but it’s a cultural thing. We used to try and combat no-shows by doing prescreens. People would call in for me, and I would send them to the clinic one or two weeks before I would get there. The staff there would prescreen for me. They would take models, photographs, and do waxups. They would go over general treatment, and maybe I would Skype with them. They would be set up to do treatment by the time I got there.

Dr. Sadri: Do you plan to or need to go more frequently to Dubai?
Dr. Apa: Right now I’m making close to 20 trips per year, which is a lot. Think about it; 20 first class flights. I pay for business class for my dental assistant and Jason. So I buy three tickets 20 times a year. So, no. I don’t plan to go more frequently.
(Pictured right, Dr. Apa with lab tech, Jason Kim)

Dr. Sadri: You can’t just keep your assistants there? Is it imperative to have one travel with you?
Dr. Apa: I have four assistants in Dubai. My assistant who travels with me is like my third and fourth hand.

Dr. Sadri: Are the majority of the cases that you’re doing veneers or full coverage crowns?
Dr. Apa: Whatever people need.

Dr. Sadri: Is there a specific brand of veneers that your ceramist, Jason Kim, has come up with that is your go-to veneer?
Dr. Apa: He makes his own blends. He’s done many studies on enamel. That’s why his teeth look so good. He figured out how much light is reflected, refracted, and passes straight through enamel. So when he uses these blends he’s using the same light properties of real enamel. He has a formula for every single patient for what blends he puts together for that person.

Those who talk digital are saying monolithic is going to replace true artistic ceramists. Maybe in the general public it will. But I work with a guy who’s on a totally different stratosphere. A lot of guys are trying to do that now, young ceramists. They make beautiful looking teeth. But they’re missing the boat on what a tooth looks like. A tooth doesn’t have that much translucency at the incisal edge.

The other thing is that I’ve worked with these other artistic guys and the way they stack their porcelain, it fractures, it stains, it has air bubbles, it leaks. It’s just not the same with Jason—the way that he covers margins, the way that he trims a model. It’s on such a different level. The reason why teeth work and last and have marginal integrity is not based just on me, but on he and I understanding each other and having a great partnership together.

Dr. Sadri: Do you do night guards with most cases?
Dr. Apa: Yes, with every patient.

Dr. Sadri: What are your thoughts on the criticism of veneers versus crowns?
Dr. Apa: Think about it this way. What’s the strongest thing in someone’s mouth? Their tooth. Anytime you can put something on with someone’s own tooth, it’s going to last longer. Say you have a root canal in the front tooth with a post in it. When that tooth was root canaled, a small hole was put in the back of the tooth, and 95% of the tooth is still there. Most guys would cut that for a crown. To me that’s insanity. I’ll put a thin piece of porcelain on it. If there is a color issue, I’ll do the proper amount of preparation for a veneer. Tuck it underneath the gum and I promise you that substrate will last much longer than a crown. Once you put a crown on somebody’s tooth, it’s going to leak. It’s going to need to be replaced. Normally people don’t want to go in and replace them.

Let’s say you had a crown on your front tooth. Over time would you be quick to replace it? No, you’d keep it forever. You’d probably let it sit there until the tooth fractured or whatever. You can’t go back and say I want to put my tooth structure back. Once your crown fails you’re at the next step. Now if you had a post and crown that failed your next step is an implant. If I had a veneer that failed my next step would be a crown. I’m always looking at patient age, type of occlusion, and I’m trying to figure out what is the best restoration for this person. It doesn’t always have to be a veneer. I just know that a veneer is a more conservative way to go every single time and I would rather do that before I go to the next step.

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Dr. Sadri: What is the most common type of full coverage crown that you do?
Dr. Apa: All ceramic in the anterior, or PFMs in the posterior, which Jason does really well. I also have a ceramist in Dubai who is a big e.max guy. He does e.max everything. So if I go to Dubai and prep 10 cases in four days, I have four ceramists who I work with there. Each of them has a different specialty. So when I’m in there prepping cases I’m divvying out the cases to whoever is best suited. If I have to break contacts because there’s decay and old fillings, it’s better for an e.max case.

Dr. Sadri: Has the cementation process changed over the years?
Dr. Apa: Silinate. We usually put some bonding agent on the veneer and then etch. Glumma, bond, and put cement on the teeth.

Dr. Sadri: Which cement do you use?
Dr. Apa: Luxaflow. It’s a flowable composite. It’s not a true luting cement.

Dr. Sadri: What’s the reasoning for that?
Dr. Apa: With true thin ceramics, not pressed, when you try it in with water, which is what you’re supposed to cement it with, it sucks up the prep and sucks it down to the margin. There is nothing separating it from the tooth. Most luting cements are so thick they’re not actually fully sealed. There’s this microlayer where it’s not actually on the margin. It doesn’t fit as well. When you use Luxaflow it’s like running water. It’s the thinnest cement.

Dr. Sadri: What are your fees per veneers in NYC and in Dubai?
Dr. Apa: I charge $4,000 per tooth.

Dr. Sadri: In terms of the cementation process for full crowns, what kind of cement do you use for full crowns?
Dr. Apa: I use NX3 Nexus Third Generation Universal Adhesive Resin Dental Cement from Kerr.

Dr. Sadri: Does social media drive the most of your business in Dubai?
Dr. Apa: I have never paid for advertising, but I have paid to produce content to market it, such as the YouTube series. The differences are interesting. Here it’s about having an established name. When I got there I had to tap into the right social influences in Dubai. You have to really get the right ones, and you have to really know the market where you’re going.
(Pictured right, Dr. Apa with founding partner Dr. Larry Rosenthal)

Dr. Sadri: What is your five-year and 10-year goal for Dubai?
Dr. Apa: My five-year goal is to open in London. I’m excited about that. It’s a 10-year contract on Dubai for the partnership and the sponsor. My goal is to not have to go 20 times per year. But right now I’m going to make sure that we’re making money. I love going to Dubai.

Dr. Sadri: Congrats on your new product line. How is it being received?
Dr. Apa: It’s all supposed to be under one umbrella, and it’s all meant to create a brand. It’s doing amazing. We’re doing it very cautiously in the markets where we’re placing it. We’re in a Net-A-Porter worldwide in Europe, Asia, and the U.S. We’re going into Bloomingdale’s all over the Middle East, and then we’re going into Blue Mercury in the U.S. If you don’t have a really big name, it doesn’t pay to have the product in department stores. Once you put it in the store you want it to stay. In Dubai my reputation is a lot stronger. It’s a smaller place, so everyone knows who I am. When they go into Bloomingdale’s and see my products, they’ll buy them.

Dr. Sadri: What’s the best selling product in the Apa line of products?

Dr. Apa: It’s interesting. Out of Violet Gray it’s the toothbrush. Out of a Net-A-Porter it’s the tooth gloss, which people went crazy over. It’s weird and you can’t predict it.

Dr. Sadri: Can you name a few high profile people who come see you in Dubai?
Dr. Apa: Huda Kattan is huge. People cry at the sight of her in Dubai. It’s insane. When she says she’s going to launch a product in Sephora, she’s got lines out the door. I hate to say it but she’s like Kim Kardashian. When I met her she had not released any of her products and only had a strong social media following, with six million followers. Now she has 15 million followers.

Dr. Sadri: What’s your timeline with London like?
Dr. Apa: The Brits do not like Americans and they don’t want us practicing there. It’s really hard to get your license there as an American. So I have to go for a week to take Part 1 of my test, then I have to go back after I pass that to take Part 2. It’s a written exam as if graduating from dental school. It’s crazy.

Dr. Sadri: Are the cases more challenging in Dubai versus your New York office?
Dr. Apa: It’s a mix. First of all, we see everything in both locations. I see people with no teeth here, where I’m putting implants in and making teeth. I see people who have to take most of their teeth out in both locations. But that’s the easiest part of my day. The hardest part of my day is to make sure patients keep coming to the door, because it’s a business based on new patients. Doing dentistry is when I’m most calm. I’m never sitting in someone’s mouth stressed out. It’s the easy part.

In Dubai there’s a lot more revision work than there is in New York. What’s interesting is that Lumineers were promoted strongly to dentists in that area. There was not a lot of good continuing dentistry, and now there is. For a long time, people went to Saudi and dentists used Lumineers. Forget the esthetics of the case, the function, the gums. A lot of my work is cutting those off and replacing them, whether it’s veneers popping off or inflamed gums.

Dr. Sadri: Do you see other opportunities in the other Arab States, such as Qatar or Abu Dhabi?
Dr. Apa: I think what I’m going to try to do is New York, Dubai, and London. I also just got an offer to open something in Toronto and in Guatemala. They want to open Apa-Aesthetic Centers. The question is if my brand is big enough. Right now I don’t think I will go any other place other than New York, Dubai, and London. I plan to help staff and oversee other offices.

Dr. Sadri: What makes a standout associate you’d want to hire?
Dr. Apa: I like them from NYU. I can see what their work is like. I can talk to their professors. They have to be creative and really into good dentistry. And talented.

Dr. Sadri: How often are you teaching now?
Dr. Apa: I’ve really become disheartened with teaching because of all of the negativity that dentists bring. I’ve really stepped back from teaching a lot. I’m at this point in my life where I have to do what’s best for me. The more successful I’ve become I’m seeing people try to cut my techniques, or say, “Oh that guy only markets well.” I’m truly the biggest dental nerd that worked his tail off to figure out how to do this for people. I see guys now that insert one tooth at a time and when they insert 10 teeth it takes eight hours. I wonder if that’s really necessary? Who’s really winning in that situation? Do you think you’re doing your patients a service by keeping a rubber dam in their mouth for eight hours? I don’t know one of my patients who would sit with a rubber dam in his or her mouth for eight hours.

Dr. Sadri: What is the average time you spend per patient?
Dr. Apa: Depending on the size of the case, about three to four hours.

Dr. Sadri: How many new prep cases are you doing per Dubai trip now?
Dr. Apa: Twelve to 16 cases per visit. This is not for everybody. Do you know how many people email and message me to say, “I want to do what you’re doing.” If you only knew the sacrifice that goes into actually doing this. There were times when I thought I would drop dead of a heart attack heading into an airport because I’d been up for days working and staring through microscopes. The more people you treat the more problems you incur. It’s not like you treat a person, and they leave, and you never hear from them again. You can never put your phone down. This is not for a lot of people. I don’t think people want this life.

Dr. Sadri: Where do you get your ambition?
Dr. Apa: It started because I had the goal of buying Dr. Rosenthal’s practice. I became partners with him quickly and I bought it at age 37. That was my lifelong ambition. When you accomplish that in your early 30s you have to then set new goals. Then it becomes, “I’m not going to waste this opportunity.” Part of it comes from the people around you. You have to be with ambitious people. And I love dentistry, which helps.

Dr. Sadri: What do you do in your free time?
Dr. Apa: One of my favorite things is to play with my cars. I have five Ferraris. I go on a racetrack or I drive to Montauk for the day. An hour car ride in any one of my cars is bliss. I watch a lot of Netflix series late at night. It kind of shuts me down. That’s really all I have time for.

Dr. Sadri: You have accomplished more as a dentist than most dentists could in 10 lifetimes. What are some milestones left for you to accomplish?
Dr. Apa: My main goal is to create a franchise-able business of Apa-Aesthetic centers in all major cities, in underserved areas. If I do this Dubai, London, New York product line right, I think it’s a possibility. That’s my goal at age 39. Talk to me in five years and I’m sure it could change.