Today’s cases ended about an hour ago. Somewhat frustrating because a case that would have taken me 1 hour in the States took 3 hours because of the lack of the proper skin grafting machine. My wife has tackled this and one should be showing up in the next few days. Time management is very important here as there are so many cases to get done in these 5 ORs. The other 2 Plastic Surgeons just left for the airport, over the last 24 hours they’ve handed over their cases to me. Tomorrow should be very busy. Thanks to everyone for your support, your donations have bought 16 suitcases of supplies, 25 wheelchairs, 2 large generators, and the skin grafting equipment mentioned above.

If you could see this place with your own 2 eyes you would never look at your life the same way again. Thank you everyone.

Goodnight from Haiti.

Drove with 25 people in 5 vehicle caravan from the Dominican town of Barahona at first light. Crossing the border into Haiti, was crowded but seemed extremely safe. We traveled 11 Km to an orphanage that’s been converted into a medical facility. Patients are receiving incredible care considering the circumstances. I branched off from my last team and I’m now at Good Samaritan Hospital being briefed by 2 Plastic Surgeons from Florida who are heading home tomorrow. Here major surgeries are being performed in 5 ORs daily. I just watched a 6 week old little girl come in in respiratory arrest. 10 pediatricians worked on her and she’s now stabilized. Tomorrow AM I’ll start operating here. Everywhere I turn I seem to bump into the most amazing people here. It really renews my faith in the human spirit.

Goodnight from Haiti.

I arrived in the DR around 2:30 yesterday morning, stopped at a friend’s parents house for some light food and 2 hours of sleep. We happened upon a small hospital with several Plastic Surgery and Orthopedic patients waiting for someone to help them.   I let my team continue on and I stayed behind with Dr. Michael Vitale, an orthopedist that I met, to do the necessary work. We did 13 cases and are now figuring out how to get to a new Haitian facility where their casualties are being taken. These are some of the most horrific injuries that I’ve ever seen in all my years of trauma.

Goodnight from Haiti.

As I write this my office is organizing my departure for Haiti tomorrow.  Like everyone I’ve been watching the horrific images on the nightly news for a week now.  Last night I decided that I could not sit around and watch any more.  Since our first medical mission last month to the Dominican Republic I’ve come to realize that charity work is one of those deeds which encourages you to do more.  If you can help us in any way please contact my office at 212.744.9400 and speak with Fatima.

Thank you

Today is December 17th and I returned from The Divino Nino Foundation’s medical mission 5 days ago.  Going to the Dominican Republic to operate on the needy is an eye opening experience.  My colleagues and I evaluated and operated on 155 patients.  Their problems ranged from poor dental hygiene to advanced inoperable breast cancer.  Ironically both of these conditions, though extreme, could have been prevented from reaching the stages that we saw in the clinic there.  Small children were seen with horrific deformities from burns and trauma which are less common in the U.S. due to the safety requirements in our building and manufacturing industries.

Our days on the mission were long but there was an incredible energy among our group.  We were Pediatricians, Internists, Surgeons, Dentists and Physician Assistants.  However some of the people who worked by our sides had no medical training.  These members helped prepare the patients for their treatments, organized post operative prescriptions, translated and confirmed local follow up for the patients.  There was something for every member of our team to do, and when we finished our final case there was a unanimous agreement that we would all be back to do it again in the near future.

The Divino Nino Foundation President is Juan Romero, also known as Rubio, of Cafe Rubio in Queens.  His dedication to improving the health of the children in the small village that he grew up in inspired me. He and his assistant Fabiola became very close with my wife and me during the mission.  After we finished at the hospital they took us to visit with some of the children and their families that they had organized complicated surgeries for in the U.S. the previous year.  Each of the children had spent 6 months in Queens while undergoing multiple procedures due to Rubio’s foundation.  Seeing their reunion in D.R. made me realize what it means to help those in need and how no matter what your professional background is, we can all help others less fortunate than ourselves.  I think that in today’s world we have a tendency to put ourselves first and become fixated with “why me” and “why this economy” etc., but if we all took a few moments every morning to think about some of the incredible suffering that others endure I think we could all find ways to contribute our strengths.

With the holidays here I’ll be throwing an annual party, as I’m sure many of you will as well, but this year I will be showing my slides from this mission and introducing Rubio to those in the room.  Next year I plan to turn the party into a fundraiser for my charity, Vanity 4 Humanity, and The Divino Nino Foundation so together we can continue this work for years to come.

Have a happy, healthy and safe holiday season and when it’s over don’t forget that many others didn’t.

I just got back from an intensive five day conference in San Francisco entitled The Art of Rhinoplasty.  This course has been in existence for 47 years, all under the watch of Dr. Leslie Bernstein.  Dr. Bernstein is in his eighties and his enthusiasm for teaching his accumulated knowledge involving the nose to his pupils is electric.  I feel as though I was lucky to meet someone whose found his life’s passion.  Dr. Bernstein had our conference begin everyday between 6 and 6:30 am, and jammed the day full of lectures by his proteges.  We quickly advanced to discussing the most complicated cosmetic rhinoplasties possible.

As the name of the course implies much emphasis was placed on the artistic nature of cosmetic surgery.  I’ve long thought about this subject and felt that after the years it takes to accumulate the knowledge and techniques necessary to perform cosmetic surgery there’s another dimension to embark on.  I feel that this is where artistry comes in.  A Plastic Surgeon that I trained under used to say,”Plastic Surgery isn’t Art, it’s a craft.  One needs to have predictable outcomes which fall into the range of the ideal human figure, such as a master craftsman builds furniture or weaves a fine fabric to certain standards.”  That statement never felt right to me.  I believe that Surgeon was correct in describing the middle stage of a cosmetic surgeon’s career, after the technical skills are achieved, but I think that in some ways that’s just the beginning.  Most people would agree that fine art such as the Mona Lisa wasn’t done by a craftsman, Leonardo breathed life into those paint strokes.  By seeking perfection Leonardo became known for his work because it stood out from the other painters.  This is exactly the same pursuit for the cosmetic surgeon.  However it’s a little more difficult because the science of healing, aging, and patient selection all comes into play.

One of the week’s highlights for me was to perform nose dissections on human cadavers at the UCSF Medical School.  For a Surgeon the cadaver lab is a sacred place.  It’s where another human being has died and given you permission to take a look inside to educate yourself to help the living.  It’s a powerful experience that always has mixed feelings of humility and excitement for me.  In the lab I was reminded of Irving Stone’s description of the young Michelangelo dissecting corpses in the catacombs to a single candle’s light in The Agony and the Ecstasy. That’s where the famous Artist learned his anatomy in the middle of the night.  During Medical School we had 24 hour access to our lab and I would often go late in the evening to try to emulate the artist.  Needless to say I found the experience at UCSF immensely helpful in furthering my understanding of the human body.

Dr Bernstein repeatedly urged those in the audience to follow his example and take adult education courses in drawing and sculpture.  He told us that in his earlier career he did this and it made a huge impact on his cosmetic results.  One of our many talented lecturers was a former student of Dr Bernstein’s who took his teacher’s advice and found that he was gifted in sculpture.  His name is Dr. Steven Neal from Oregon.  Dr Neal is the most accomplished Surgeon/Artist that I’ve met.  Dr Neal’s talks revolved around bridging that gap between Art and Science, he backed up his talks with examples of his patients as well as photos of monumental bronze sculptures that he was commissioned to create by his home city.  Dr Neal brought 50 clay human faces to the conference.  He asked us to sculpt noses where he had left a void.  I found it interesting that so many rhinoplasty surgeons in the room couldn’t do it.  It’s not as though they didn’t try but the proportions were off or the anatomic structures that we had been discussing at the conference were all ignored.  I found this exercise really gratifying, I quickly made a well proportioned nose with some subtle details that I was happy with.  More importantly while I was sculpting I quickly entered a zone where I wasn’t thinking about the 10 hours we had already spent listening that day.  The Japanese have a word for the mind and body becoming one during an activity, Satori.  This is where time stands still and you become engrossed in an activity such a tea ceremony, flower arranging, calligraphy or in this case sculpture.  I find the act of surgery to be exactly the same way.  A surgeon needs to have his/her judgement and skills perfectly in tune so that the differences in patients anatomy can be seen and thereby a surgery can work with the patient, not against them.  I’m more aware of these relationships now than I was 10 years ago and I try to incorporate them into my OR cases.

As I was sculpting that night I keep thinking that this could encourage areas of my brain to grow in ways that could benefit my patient’s results.   I’ve decided to take Dr. Bernstein’s advice, so I’ve enrolled in a continuing education sculpting class starting in January.

I’ll let you know how it goes.

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!

I think most people would agree that there are few areas on the human body that have a deeper connection to who an individual is then the eyes.  I suppose this is because of the eye’s ability to convey emotion and to hint at what an individual may be feeling as in, “a window into the soul”.  When someone is considering cosmetic eye surgery usually their biggest fear is that they don’t want to drastically change their appearance.  Generally what they are saying is that they don’t want to change their identity that they feel they convey with their eyes.  What most of these patients do want is to just discard their  tired look that brought them into the Doctor’s office in the first place.  Fortunately for the Plastic Surgeon only the later of these is possible.

The eye area is one of the first problem areas that cause patients to seek the help of a Plastic Surgeon.  This is because eyelids comprise the thinnest skin on the human body.  Thousands of times a day we move this skin while blinking and conversing.  All this movement paired with a greater amount of sun exposure than other body parts causes the skin to wrinkle at an earlier age than the rest of our face in most people.  The protective fat around our eyeballs begins to herniate out causing those unattractive bags.

Like all new prospective patients, the first consultation starts off with a detailed interview about the overall health status of the patient.  Then the conversation turns to focus more on the specific complaints relating to the appearance of the eyes and any associated problems or issues pertaining to this area.  The eyes are then examined with the patient in front of a mirror so she/he and I are looking at the same thing as I discuss what can be done and how.

Cosmetic eye surgery centers around removing or relocating the fat bags, as well as tightening the skin.  Patients generally state that the surgery is less painful than they anticipated and all sutures are removed by the sixth post operative day.  Results start to show by one week and continue to improve over the first few months.  For those not ready, or willing, to undergo a surgical procedure great gains can be made with Botox.  This agent can reduce crow’s feet and change the shape of the brow to minimize the extra upper eyelid skin.

Wherever you draw your line in the sand options to improve those windows into your soul exist.

Dr Roland