World’s Best Plastic Surgeon

I am not the World’s Best Plastic Surgeon. In fact, if I even made that claim, I would be in jeopardy of losing my status as Board Certified. But what are the qualities that make for great Plastic Surgeons, specifically Cosmetic Plastic Surgeons?

Ability is obviously important. You must be technically gifted to perform the procedures properly, and with appropriate education and training, most Plastic Surgeons are. The surgeries are not that difficult in concept, and can be mastered.

Judgment and an esthetic eye are not as common, and cannot really be taught. You see some surgeons at esthetic conferences feverishly writing notes, and asking for formulas or exact steps in a hope to recreate what they see. These doctors are usually not blessed with the talent for cosmetics.

The ability to connect with the patient and communicate well is also tricky. You can be the smartest and most talented plastic surgeon, but if you can’t convey that to a patient, no one will trust you to perform a procedure. Be honest and educational, and make the patient comfortable. It has to be a match on both sides.

Knowing who NOT to operate on is to me the most difficult. I like to give people the benefit of the doubt, and my first instinct is to help. I do not like to think that people have bad intentions, and have been burned a few times.

While I may not be the World’s Best Plastic Surgeon, I certainly try my hardest to deliver for each patient. Judging by the number of surgeries I do each year, it’s good enough for nearly all.

Size Does Matter

As I finish my 18th year in private practice at Yager Esthetics, one of the procedures I do most is breast augmentation (implants). I have placed many thousands of them, and I feel it is a procedure I do very well. Patient satisfaction is extremely high, but it is not 100%. Unfortunately, it is not due to what I do in the operating room. That would be easy to address.

While I make every effort to educate patients as to the full range of options, the risks and benefits of the surgery, and demonstrate my style of a natural looking breast in proportion to the body, some patients do not listen as well as I think they do.

I spend a long time at the initial consult informing the patient of all the approaches and implant types, as well as pointing out asymmetries and differences between the existing breasts. I let the patient make all the decisions, and then we decide if I am comfortable with those choices. At the preoperative visit, we go over all of this again, and really get into the size.

I have found the best way to gauge size is to show a series of before and afters of patients with similar bodies, and not reveal the bra size. I simply ask if they like the size, prefer bigger or smaller. Once we find this information, I tell them the approximate size they have chosen. I stress the fact that the bra size is not important, it is how they feel when they look in the mirror. With this approach, 98% of my patients are happy.

The 2% who want something else are usually not truly unhappy with the size, but unhappy in life. When the implants do not fix life’s problems, it is easier to blame the surgery than face the issues of bad relationships and personal issues. Even still, I try to help them.

Breast implant surgery in the right patient can transform your physical being, and even lift your self esteem. Size does matter, but being happy with yourself is more important.

At What Cost Happiness?

Ever since I was a child, I thrived on being liked. I always behaved, did my homework, was respectful to persons of authority, and tried to elicit praise. Who doesn’t like to be liked?

When I set up Yager Esthetics, my goal was to create a practice that offered the Hispanic Community a safe place where they would be treated with respect and care, and the highest level of service possible. I invested a lot financially and emotionally in the building of the practice, and try to make each patient happy.

Unfortunately, you cannot make every patient happy. Sometimes, it is that their expectations are not realistic, although I try to explain the limits clearly before surgery. Other times, they do not get the response from a loved one or coworker they were hoping for, and in their mind it can only mean that the result was not good. It is almost never the case that the technical aspects of the surgery were not perfect.

I recently had a patient who came for correction of a poorly performed surgery done elsewhere. I reviewed the goals and risks, showed what I could do, and executed the procedure perfectly. Afterward, she was unhappy, and brought me photos of women who looked horrible, fake, and were a totally different body type. None of this was done at any of our 3 visits before surgery.

The patient agreed I did a beautiful job, and the results were natural. She just wanted to look like these photos she brought, and also wanted me to redo the surgery at no cost for her. On the one hand, I do not like an unhappy patient. On the other, I am a physician, and I cannot in good conscience create something esthetically unappealing, not to mention risk complications.

Even if she were to pay me double, I would not do it. Sometimes, happiness is not something plastic surgery can achieve.

Breast Reduction with Implants?

When I first opened my private practice in 1997, the thought of putting breast implants into a woman who was having a breast reduction was ridiculous, bordering malpractice. If you have more than enough volume, just leave the right amount behind and avoid the potential complications of breast implants altogether.

As regular readers of my blog know, I am constantly reevaluating my results, in the attempt to further enhance what is possible while remaining safe. The only disappointment in breast reduction results has been a lack of fullness in the upper part of the breast, the same as in breast lift surgeries. What could I do?

I have, over the years, found that adding an implant to breast lifts increased patient satisfaction, as the breast appeared more youthful with the extra volume up top, kind of like many young actresses you’d see. I had corrected old overreduced breast with implants before as well. Why not add an implant to the reductions, just reducing a little more to achieve the same volume in a different distribution?

There are technical considerations, as you have to be careful with the blood supply to the nipple, and the surgery needs experience and careful planning. It costs more, and you have to consider the additional risks of having breast implants, such as leakage and hardening.

Just like in life, the things that sound crazy to you when you are young sometimes make a lot of sense as you get older.