Philosophy

There is no question that we are our own worst critic. Many of us are unhappy with a particular part of our appearance that is not even noticed by other people. In fact, many patients describe their frustration over the fact that when they tell their friends or family that they are thinking about having cosmetic surgery, many respond by telling them that they are being silly. What seems obvious to us is often not obvious to others. It is for this reason that I begin all of my consultations by asking very specifically what it is that bothers you most. My job then becomes figuring out what options are available to best help you look the way that will make you happy, not having you look the way that will make me happy. Because of this we spend a lot of time with this initial consult which commonly takes up to an hour, and often will spend time fine tuning the surgery at a second consult.

We use computer imaging, a technology that involves taking your picture from a variety of angles and using computer software to change your photograph in a way that you can see what you will look like following the surgery. Many offices do not use computer imaging, saying that it can give a false impression of the surgical results. We look at computer imaging not as a sales tool, but as a communication tool. By giving you an idea of what you will look like following the surgery, we are making sure that we are both talking about accomplishing the same thing. We then look at a number of before and after photographs so that you can see real results in real patients. Finally we have you talk with patients who have had a similar surgery to make sure that you truly understand what the process will be like. We find that by doing it this way our patients are generally very happy with both their results and the process.

As far as the surgery is concerned, I have found that there are four factors that must be present in order for us to achieve great results. Science tells us how to perform the procedure, but art tells us when to perform the procedure. Both of these components are critical to great results and happy patients. The science is clearly incredibly important. Every year I spend a great deal of time traveling across the country, to watch, learn and share ideas with other facial plastic surgeons. When it comes to the science of surgery, the day you stop learning, is the day your results become average. I was at a multispecialty meeting recently, with a long list of very well respected Plastic Surgeons, Facial Plastic Surgeons, Dermatologists, and Oculoplastic Surgeons. With each lecture on a new technique I evaluated their before and after pictures, knowing that my results were already as good or better than the ones they were showing. Near the end of the meeting, however, a surgeon from San Francisco got up and showed photographs of recent results he had obtained using a new technique in facelift surgery. The results were without question better than the results that I was typically able to achieve. Following his lecture I pulled him aside, talked to him at length about the changes that he had developed, and upon getting back from the meeting spent many hours reading, thinking, and practicing these changes so that the next facelift I performed was done using the new technique. During this time my kids kept asking me, why I was spending so much time learning something new when the “old” way worked well on it’s own. The answer came easily, if not very eloquently. “If you know you can do something better, and you don’t put in the energy to do it, it is time to find something else to do”. The results of this “new” facelift were better than I had been able achieve previously and well worth the extra effort.

The art of surgery is much more subtle. It is not about knowing what to do, but rather knowing when to do it. For example, over the years I have learned over 500 different techniques that can be used during a rhinoplasty. In any particular rhinoplasty, however, I may use only 15 of these techniques. The key is knowing which 15 are needed in order to get the best result for that particular patient. In most of the patients that I see for a second opinion because of a result that they are unhappy with, the problem is usually that the wrong combinations of techniques were utilized. It turns out that one of the nice features about getting older is my ability to know specifically what needs to be done in a particular patient in order to achieve the result they desire.

The third component in achieving a consistently great result comes from studying what makes attractive faces attractive, and what makes young faces look young. These images are in the forefront of my mind during every surgery. It’s not about pulling, stretching, or moving the skin around. It’s about recreating a youthful appearance that looks natural, healthy, and appropriate. Typically patients tell me that people comment on how great they look, but would never guess that they had cosmetic surgery. This is ultimately what we are after; the patient likes what they see when they look in the mirror, and their friends and family are none the wiser.

The final factor involves how we treat you. I’m a very good facial plastic surgeon, not because I’m better than anyone else, but because it’s what I wanted to do, it’s what I enjoy doing, and because I have worked very hard at being good at it, just like you are good at what you do for the same reasons. There are no egos here. We will treat you with respect because we respect you. We’ll treat you like friends because we’re friendly. We’ll treat you like we like you, because we like people; we like meeting new people, talking to new people, and being a small part of people’s lives. Patients tell us all the time that they chose us from a large group of good plastic surgeons because they felt comfortable with us. Some people have already consulted with 4 or 5 other plastic surgeons (and sometimes even have surgery scheduled somewhere else) but say that they knew right away that we were the right place for them. Others have seen us first only to cancel consultations already scheduled with other plastic surgeons once they got to know us. We are very gratified to hear frequently that they feel comfortable with us.