CELL Phones at Concerts and Plastic Surgery

Recently, artists have begun asking concert goers to refrain from taking pictures and videos during the show. Some, such as Jack White, have gone on to require that all phones be sealed in a bag prior to entering the venue so that this does not occur. I was at a show, and he had someone come out and let the audience know that he had hired professional photographers and videographers to shoot the show, and gave access to them for free for anyone who wanted a memory or to post on social media.

Bob Dylan, during a show in Vienna, stopped singing due to this distraction and said “We can either pose or play, it’s up to you.” The frustration built up to the point that it not only ruined other audience members’ experiences, with upheld phones and selfies taking away from the moment for them, but for the artist as well. I have to side with the artists.
I can’t tell you how many times a cell phone interrupts a consult or patient visit, making it hard for the patient and me to maintain concentration. I always find it telling that when a patient is naked in a gown, they still hold their phone in their hand. Who are you going to call?

Don’t even get me started on employees who are sneaking a peak at their phones during work. It is a theft of my time, and a disservice to the patients.

If I take a call during a patient encounter, it can only be from another doctor or something I am doing for that patient. If you see me doing otherwise, please scold me. I would deserve it.

A Taxing 2019

Today is the day that taxes are due here in the United States. For some, it is a happy time when withheld funds are returned and can be used for frivolous things such as Plastic Surgery. For others, it is a frightening day, making sure there is enough in the account to pay what is owed. For accountants, it is when a lot of the money is made and extra hours worked.

When you think of the purpose of taxes, it should be money you pay for the services that the government provides of which you are the beneficiary. Plowing roads, paving streets, infrastructure, and keeping the government running is but a few examples. I believe all should contribute, but might question the efficiency and cost of delivery of these services.

What does this have to do with Plastic Surgery? I think that the fee you pay has a lot of similarities to taxes. You think of what is charged for a breast implant surgery. For me, it takes less than an hour, and if I could keep the whole fee, my hourly wage would be amazing. Unfortunately, I have to pay anesthesia, the implant, surgical supplies, like PPE, insurance, employees, electricity, water, certification, and licensing fees, keep all emergency equipment and medications up to date, bras, recovery room staff, oxygen, medications, facility fee, rent, the cost of my training and Board Certification, provide 24-hour on-call coverage for emergencies, housekeeping, post-op care, and visits, just to name a few.

Although my fees at Yager Esthetics are more than reasonable, you can certainly find a cheaper place, fly overseas, or to another state. I suggest you really make sure you are getting all of the services that you are the beneficiary of. Board Certified by the American Board of Plastic Surgery, accredited facility, with the experience and results you like. The penalty for not paying this tax may be your life.

April Fools 2019

To become a doctor, and a surgeon in particular, you must endure decades of study and dedicate virtually all of your awake time to patient care and craft. To truly understand the weight of having someone’s life in your hands on a repeated basis is only the first step in realizing the responsibility and pressure that one must embrace.

I like to believe that I have a very quick wit, and can see the humor in most situations. Perhaps it is a coping mechanism that I have developed to deal with the rigors of my work. Being able to make others laugh without playing the fool is an art that brings me tremendous pleasure.

The unfortunate side effect of this is that I can never let loose of the rational side of me that is so essential to being a great Plastic Surgeon yet does not allow me to completely relax and not think of every possible outcome of my behavior. I sometimes give of the aura of a stiff and somewhat unapproachable person in social situations, especially with strangers. They are often shocked at how opposite to that image I really am.

I have never regretted the sacrifices I have made to be where I am today, and consider it an honor to continue to serve the Hispanic community as the Plastic Surgeon of choice. I take what I do seriously, and would never compromise on patient care.

If you see me outside and want to say hello, please do. I truly enjoy the life I have, and even if I don’t act “the fool,” it doesn’t mean I can’t make you laugh.

St Patricks Day 2019?

What in the world could St. Patrick’s Day have in common with Plastic Surgery? I am referring to the legend of St. Patrick driving out the snakes from Ireland. Plastic Surgery certainly has some snakes that deserve to be driven out.

First, it would be nice if doctors who perform cosmetic plastic surgery procedures were required to have actual training in Plastic Surgery. While it is perfectly legal for anyone with an MD degree and license to do whatever surgery or treatment they can convince a patient to do, many unsuspecting people assume they are Board Certified Plastic Surgeons. These providers at the least do not volunteer that they are not Plastic Surgeons, and some even outright lie.

The point is not that they necessarily do a bad job, it is that the public is not fully informed before consenting to a procedure. Just because I call my practice ABC Plastic Surgery does not mean I am a Plastic Surgeon by training. There are even doctors who got together and created a Cosmetic Surgery Organization to certify each other and try to claim equivalency with the American Board of Plastic Surgery, but the AACS (American Academy of Cosmetic Surgery) was recently denied that right in court. The members still claim Board Certified.

The solution, barring new legislation, is to be a smart consumer. Go to and enter your doctor’s name. If He/she is not there, they are not certified by ABPS. You can also simpl ask the doctor directly if they are certified by the American Board of Plastic Surgery. The only answer that assures that is yes. If they mention another board, it is not the same.

Dialectics in Plastic Surgery

Dialectics, for those of you who were unaware, are two seeming opposites that can both be true. Still confused? I am happy to expand on this topic. It was complicated for me as well.

The statements “I am doing my best” and “ I can do better” create a dialectic. On first glance, if you are doing your best, how can you be able to do better? I struggled with this. I then realized that doing my best at this moment means that with my state of mind, physical abilities, distractions and time constraints, the results are my maximum effort for these conditions. I can do better indicates that with further training, a better night’s sleep, more experience, I can still learn to improve.

What does this have to do with Plastic Surgery? I have had, over my more than 20 year private practice career, instances where I did the surgery perfectly, yet I could see ways to improve the result afterward. I did my best, but I also believe that a better result can be obtained. These are the key to being a great Plastic Surgeon, understanding you always do your best but that you can do better as well. Without this, you either doubt yourself or never improve.

If a patient comes to me after having surgery and points out an area that is not perfect, I remain humble and open minded. I explain that I did everything perfectly, but acknowledge that improvements might be possible. That is what a touch up or revision procedure is all about.

It is important in my profession, as well as in life, to understand other peoples’ perspectives, as well as to share with them your own. Both of you can be correct. That is how I choose to interact with my patients. Mutual respect and understanding can solve virtually any situation.

Other People’s Plastic Surgery

As a Board Certified Plastic Surgeon in his 22nd year of private practice, I have seen many people who have had prior cosmetic procedures done by other doctors. I am often asked my opinion of the work. I try to avoid this answer at all costs.

One rule I have is to never ask who performed the surgery, as I do not want anything to bias my opinion in either direction. My personal feelings toward a particular doctor, or my prior experience with patients of his/hers, should be left out of the equation.

I also state that it is impossible to judge a result without first seeing the before photos from the surgeon (no offense, but some patients use a before photo that was altered or from many years in the past that do not reflect the true appearance on the day of the surgery). A slightly wider or larger breast on one side may be a horrible error, or a miracle of surgical wizardry to even approach two even sides.

With regard to scar quality, unless it is horribly malpositioned, often the scar depends mainly on the genetics and skin of the patient and the care given after the procedure. An ugly scar does not mean your surgeon did a bad job. When I revise scars, I even tell patients that there is no guarantee it won’t look worse.

I advise patients to look forward, not back. You cannot change the surgery you had, but can try to achieve a better result in the future. I am always happy to have an honest discussion of the options for improving prior surgery, but you need to let go of anger and be positive for a healthy start on getting better.

Presidents Day 2019

Today is Presidents Day, a made up arbitrary Monday in between George Washington and Abraham Lincoln’s birth dates so that we can have a 3 day weekend instead of 2 random days off. While I have tremendous respect and gratitude for both great men, I doubt that even 1% of the people who take the day off will spend even a moment to honor either man.

I guess I have a problem with the concept of moving the date of a holiday observance to a Monday so that people can have three days in a row off. Is the holiday a paid vacation, or the intended honor of a person or event? Is it about travel or respect?

I especially love it when a holiday falls on a Saturday or Sunday and they still declare Monday a holiday, lest someone think they are being cheated out of a day off. Heaven forbid we celebrate when we are not working.

My suggestion is to honor the intent of the holiday, be it on the actual date or a Monday. Let it not be a day of X Box and sleeping in, but one of discussing the meaning of the day. Visit a museum, donate your time to a charitable cause, or even read about the history of the holiday. Even if this is just for an hour or two of the day, it is honest and genuine.

Valentine’s Day 2019

It is a few days before Valentine’s Day, so I hope you who participate have made all of your arrangements for dinner reservations, flowers, and chocolates. Jewelry, for those who prefer, can still be purchased.

For me, I would like to send a Valentine to Plastic Surgery, whom I have loved for over 30 years. But how do you send chocolates to a field of medicine? Can flowers be appreciated by techniques? Do books appreciate jewelry?

I show my love for plastic surgery through my faithfulness to her principles. I never wander from her scope of practice, am loyal to her core principles, and do not entertain thoughts of other specialties. Despite being committed as a Board Certified Plastic Surgeon, I participate in a lifelong program of study to maintain my certification, and try not to forget all I have been trained to do.

I have sacrificed a lot to stay with Plastic Surgery. I spent so many years in Medical School, Residency and Fellowship to prove myself worthy. Many sleepless nights spent in hospitals, missing many events due to the demands and needs of the practice.

I want to say that with each year I love Plastic Surgery more. As I age, I understand its importance more. Even if I put away my tools one day, I will always be a Plastic Surgeon in my heart.

The Super Bowl of Surgery

Every year, a billion people or so gather to witness the NFL championship game being played by tuning in to the broadcast. It goes beyond mere sport, it has become more of a shared cultural experience that transcends gender, race and religion. Even the interruptions in the action, the commercials, are met with eager anticipation.

What if there were a Super Bowl of Plastic Surgery? The best surgeons going through a season of patients, followed by the highest ranking few having a playoff until the final top 2 remained. It would be the reality show to end all others.

The commercials would be equally interesting, with many industries wanting to cash in on the beauty interested public. Make up, hair care, fashion, nutrition, exercise, as well as luxury goods would kill for the opportunity. Celebrity endorsers would be simple to find.

Imagine the technology that would be employed. Cameras from every angle, graphics on ideal angles and proportion, slo mo replay- it would be amazing. The venue would unfortunately not be large enough for a big audience.

And finally, we could have a panel of judges, enhanced by a phone in vote from the public. There can be world famous plastic surgeons as well as patients who have had a lot of plastic surgery serving to compile the scores. Imagine, the winner would actually be the patient!

Scars are Forever

I had a patient come to me for a second opinion consult after having had a breast and body surgery done elsewhere. This is not surprising in itself, as I see so many people dissatisfied with results of other plastic surgeons. What was unique was that she liked everything about her procedure except the scars. And the scars were perfect.

Each body heals differently after injury, and as a Board Certified plastic surgeon, I am well trained in techniques to try and hide or minimize the appearance of scars. The overwhelming majority of my patients heal well, but not 100% Having a thick, dark, red or even keloidal scar is not always the result of a poorly performed closure. In fact, I would place the majority of the scar on the patient’s skin type.

I always discuss scarring with patients before performing procedures, and it is spelled out clearly on all of my consent forms. I even work with the patients at every visit, advising them as to the best care of the incisions. We offer treatments including creams, lasers, microneedling, and injections.

I had to explain to this patient that her scars were of good quality and no further treatment was needed or advised. That the most important word of the two word phrase “plastic surgery” was “surgery”. The patient left unsatisfied, thinking all plastic surgeons stick together. She said she had the surgery part, and would find someone to fix the plastic part. I wish her good luck.