As the last ten years of my practice have quickly passed bye I’ve begun to make a conscious effort to write about the process of becoming, and being, a Plastic Surgeon.  I hope you enjoy what follows.

As physicians we go through many stages during our education and training.  Eventually when those years are behind us, we’re set free and for the first time able to begin shaping the kind of practice we had only dreamed about before.

More so than many of the other surgical specialties Plastic Surgery has two sides.  These are easily split into Cosmetic and Reconstructive surgeries.  However after a closer look, and many years of experience, it becomes clear that these two have more in common than first meets the eye.

Modern reconstructive surgery really took off during and immediately after  World War I,  where trench warfare and mass casualty triage first met in modern military medicine.  Triage separated wounded soldiers into three categories.  Those that would survive their injuries until more help arrived,  those that were beyond saving in the field, and those that needed immediate attention to hopefully be saved.  Focus on this last group of critically injured soldiers led to a large increase in the survivability of wartime injuries.  More soldiers started showing up at military hospitals with previously uncommon facial disfigurements due to more of them surviving their initial injury in the field.  This led to Plastic Surgery giants such as Sir Harold Gillies to open specialized centers near the front lines and to invent many new methods of reconstruction to help with these disfigurements.  In many ways the creativity of Plastic Surgery really blossomed during that time.  Much of the ground work that has gone into today’s cosmetic and reconstructive means was laid during that post war episode (1914 to 1939).

Cosmetic surgery witnessed a large boom during the 1960’s and 1970’s.  Prior to this period elective cosmetic cases were often thought of as only for the well to do.  Many times these types of surgeries were being performed on patients well past their sixties as large overhaul procedures.  Today the increased life expectancy of the World War II  baby boomers combined with an overall increase in the American standard of living and numerous surgery financing companies has made cosmetic enhancement surgery more prevalent than ever before.

For me these two sides of Cosmetic and Reconstructive surgery are easiest to think about as the Yin and Yang symbol, neither one is truly complete without the other.  These two elements are intimately intertwined while appearing to be opposite.  Each side propels the opposite to achieve a higher quality in patient outcome and satisfaction.  For example, reconstructive microsurgery has now advanced to the point where a woman’s tissues can be removed from one area of her body and microscopically reattached on the chest to be sculpted into a reconstructed breast.  However it’s not enough to just get the tissue there and for it to survive.  This new reconstruction has got to look better and more natural than the older techniques it’s replacing; or else what’s the point?  This is how the whole of Plastic Surgery benefits from it’s two halves.

I also see this Yin and Yang element in my own practice.  Starting right out of your Plastic Surgery residency training there usually isn’t a long line of people falling over themselves to get a face lift by you.  What’s more typical is that you perform those cases when they come along and instead set your mind on getting as much reconstructive experience as possible.  If you’re as fortunate as I was you land a dream job as a staff Plastic Surgeon at a large inner city trauma hospital.  This was Jacobi Hospital in the Bronx for me.  At Jacobi I felt a lot like how those wartime surgeons must have felt, never knowing what you were going to see next, or if you had ever seen it before.  The fast pace and high complexity of reconstructive cases at a city hospital is a young Plastic Surgeon’s proving grounds.  It was there, usually in the middle of the night, that cases would come along that would force me to think outside the box, where conventional reconstructive solutions wouldn’t always suffice.  Over the course of a decade much experience was gained and all the “rules” of Plastic Surgery which took so long to learn were now being bent to solve some seemingly unsolvable problems.

This trauma work experience slowly began to weave it’s way into my cosmetic practice.  As time went on and people began seeing my work they began referring their friends and relatives.  Soon I was using all the reconstructive lessons I had gained at Jacobi to solve cosmetic surgery issues which compelled me to try to get the absolute best results possible.  I began to see my cosmetic surgeries more as events than as workdays.  I find it very motivating to think of these surgeries as an athlete or musician would think of their performances.  This level of total focus is difficult to manage with the busy nights associated with Plastic Surgery trauma. Therefore in August of 2008 I gave up my regular position at Jacobi to focus my energy towards my cosmetic surgery practice.  This has been extremely rewarding for me professionally, but at the same time lacking in a certain way.  Remember the Yin isn’t whole without the Yang.

I’ve now entered a new stage of my career where because of the good fortune I’ve had in cosmetic surgery I can now perform reconstructive surgery pro bono.  In December of this year I’ll be traveling down to the Dominican Republic on a medical mission with the Devino Nino charity to perform Reconstructive Surgery on their needy population.  It’s my hope that trips like this will aid me in making the crucial connections necessary for my personal charity, Vanity 4 Humanity, to aid women with breast cancer deformities in underprivileged countries around the world.

There you have it, Cosmetic surgery in Manhattan making Reconstructive surgery possible in third world countries; the Yin and Yang of Cosmetic and Reconstructive Surgery, neither one whole without the other.

Throughout a woman’s life her breasts change.  That can mean a lot of different things to those of you reading this.  Small breasts may become large during pregnancy and stay that way, large breasts can deflate and droop later in life, and breast development can seem to never have taken place at all.  As luck, and Plastic Surgeons, would have it there’s a solution to each of these dilemmas.

Breast surgery should center around the three S’s

Size, Shape, and Scars

A woman’s breast size needs to be compared to her body’s size.  This means that the same sized breast placed on a large woman and a small woman will have completely different proportions to each individual.  Looking attractive vs. abnormal is all about proportions; whether it’s breasts, noses, or waist size.   A medium C cup tends to be the size that mimics a good pair of shoes, these can be most easily dressed up, or down.  This means that a mid-C can be accentuated with push up bras and low necklines to look even larger when desired, or easily concealed beneath a flowing blouse when a more conservative appearance is necessary.

Shape concerns tend to do with droopiness (ptosis-Doctors have a different name for everything).  If we all lived long enough gravity would turn us all into puddles on the ground.  Add to this effect that a woman’s firm breast tissue gets replaced by less firm fat over the course of time and that the skin enveloping the breasts losses much of it snap.  It’s no wonder that many women are seeking out surgical options to correct ptosis after they’re done having kids.  These surgical procedures focus around moving the nipple-areola complex up, and creating upper breast fullness.

In some ways scarring is the most important of the three S’s, because what’s the use of changing the size and/or shape if you can’t fathom having scars on your breasts.  It’s a little like robbing Peter to pay Paul, you have to give a little to get something, you don’t get something for…….I can go on and on.  Basically it’s not magic.  After hearing what your concerns are about your size and shape and then examining you I can present the different options that are possible to give you the look you desire.  This is done with the underlying premise to create the least amount of, and best quality, scarring possible.

There you have it, an introduction to breast surgery.  Look for future entries targeting more specific breast issues and their surgical management.  I hope to give you a glimpse into the way I think about these types of cases and about how gratifying this type of work can be.

It’s that time of year.  Those summer days of squinting in the bright sunlight are now officially over.  Better yet the holiday season is right around the corner, and if you’re like me you have a High School reunion Thanksgiving weekend to boot.  This is by far the most common time of the year for new Botox patients to start making their first appointments.  These interactions always seem to focus around the same four issues;

1- “I don’t want to look frozen.”

Everyone says this the first time, and fortunately it’s not likely to happen.  Good Botox should erase or improve the resting lines on your face, however it should not stop all motion.  People should look rested afterwards, not strange!

2- “What will happen if I never do it again?”

Your facial muscles will return to their pre-Botox strength after about three months.  The lines will slowly appear again and you will in no way be “hooked” for the rest of your life.

3-”What are the side effects?”

It’s possible to experience a mild headache the day after your treatment, all aspirin and non-steroidals should be stopped one week before to lessen the small chance of bruising.  Very rarely the upper eyelid can droop for a week or so, this is treated with eye drops.

4-”I don’t want anyone to know.”

Your secret is my secret, remember good Botox makes you look rested, NOT STRANGE!