How Dr Tvacha began: Thane, 28 November 2005

Key takeaways

• I have been practising in Thane since 2005, as founder and Director of Dr Tvacha (Reg. No. 2001/02/1124).
• I grew up in a family of doctors and with a love of technology, which is how lasers became my field.
• I chose aesthetics over psychiatry because people always want to feel good or look a better version of themselves.
• We grew to nine centres and then went back to four, on purpose, so the doctors stay close to every patient.
• The habits I started with in 2005 still shape every programme: diagnosis first, fees in writing, fixed review dates and a plan for the end.

Who started Dr Tvacha?

I did. My parents were doctors, and I come from a Thane family of doctors. The other thing I grew up with was a ZX Spectrum, one of the home computers of the early 1980s.

That machine matters to this story. I have loved technology ever since, and I like to understand how a device works and what it can actually do before I trust it. Years later, when I chose my field, that same curiosity pulled me towards lasers and devices. I am an Aesthetic Physician, trained with an MBBS and a Diploma in Dermatology from the UK. I am not a dermatologist, and I am careful that we describe me correctly. Patients deserve to know exactly who is treating them.

Why aesthetics and not psychiatry?

At one point I was weighing psychiatry. Both fields deal with how people feel about themselves. I chose skin and aesthetics for a simple reason, and I still say it the same way: people would always like to feel good or look a better version of themselves.

That sentence explains a lot about how I talk to people. I do not treat a wish to look better as vanity. It is a normal human wish, and it deserves an honest medical answer. Sometimes that answer is "this will not help you". I would rather say that than sell something.

What did the early years look like?

I opened the clinic on 28 November 2005 in Thane. The main centre is still in Thane, on the 1st Floor of Suraj Arcade on Gokhale Road, and I still see patients there in the mornings.

Here is how the practice took shape, using only dates I can confirm:

Two things stand out when I look at that list. First, hair has been part of my work for most of the clinic's life, so the hair approach was built slowly, one patient conversation at a time. Second, I have changed my mind more than once. We grew, then shrank. I was really late to GLP-1 medicines, and I say so openly. Basically, I would rather think for a long time before adding something new than add it and regret it.

Where does chess come into it?

I started playing chess at three and a half and played at the national level as a child. My coaches taught me in an unusual order: the endgame first, then the middle game, then the opening. You learn what a winning position looks like before you learn how to start.

I plan treatment the same way. Before any procedure or prescription, my first question is: what does a good result look like for this person, and how will they keep it once treatment ends? Only then do I work backwards to the first step. In chess you win if you checkmate the person, so it's about results. That is why the weight programme is called The Endgame Weight Programme, and why every plan includes a maintenance stage from the start. I have written more on this in why I plan treatment like a chess endgame.

Why did a growing clinic choose to get smaller?

By around 2014-15, we had nine centres. On paper that looks like success. In practice, more centres meant the doctors were spread thinner, and patients saw me less.

So I took us back to four. The phrase we use inside the clinic is "depth over scale". Four centres is a number at which the doctors can still be hands-on, know their patients, and keep the same standards in every room. I explain the full reasoning in why we went from nine centres back to four.

What has stayed the same since 2005?

Technology has changed a great deal since I opened. The habits underneath have not:

• Diagnosis first. Nobody is sold a package before someone has looked at the actual problem.
• Fees in writing before you pay. You know the cost of the option you choose before you commit to it.
• Review dates fixed on day one. Follow-up is planned, not left to chance.
• A plan for the end. Every programme includes what happens after treatment, so you are not left wondering how to keep a result.
• Options, not pressure. I explain what is possible and you choose. I do not push.

These ideas line up with what Indian medical ethics has asked of doctors for a long time. The Code of Medical Ethics Regulations, 2002 says a physician should announce fees before rendering service, not after treatment is under way. I simply made that, and the other habits above, part of our daily routine.

The work has also widened. Dr Anagha Karkhanis, a Gynaecologist and Fertility Specialist, runs Cocoon × Dr Tvacha on the 2nd Floor of Suraj Arcade, one floor above our Thane centre, for women from 40 onwards. She tells her own story in from fertility care to midlife health.

How we approach this at Dr Tvacha

If you are thinking of visiting, the simplest start is a diagnosis consult, either in person at one of our four centres or online for weight care. I will tell you what I think is going on, what your options are, what each costs in writing, and when your reviews will be. What you do with that is your call.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.