For more than 30 years, board certified plastic surgeon, Jack Fisher, MD, has been helping residents of Nashville, TN, achieve the results they want. He is a firm believer in choosing a surgeon who is board certified and to further the excellence of the profession, he served as the president of The American Society for Aesthetic Plastic Surgery (ASAPS) from 2013 to 2014. ASAPS is the leading professional organization of plastic surgeons certified by the American Board of Plastic Surgery who specialize in cosmetic plastic surgery. Dr. Fisher specializes in face and body procedures and is known for his dedication to safety above all else. He performs surgery almost exclusively at a state-of-the-art, fully staffed plastic surgery center adjacent to a major medical center.
Here, Dr. Fisher tells Beauty in the Bag about his experience as president of ASAPS, and why it is important to understand the medical board certification system.
What was the best part of being president of ASAPS?
Working with my colleagues and the incredible staff of ASAPS. We have a unique organization in which the doctors and full time staff work together for the benefit of our members. I also had the opportunity to travel and not only meet our members in the US but many abroad.
What would you say was the theme of your year as president?
Providing the best education possible, as well as promoting patient safety. ASAPS is the number one source of quality teaching in the aesthetic field.
ASAPS 2013 survey showed that plastic surgery is on the up. What is driving these numbers?
Probably two major factors, first an aging population with financial resources, allowing them to have aesthetic procedures. Second, is an improving economy and increased confidence in the future. Another factor is probably a reduction in any stigma associated with aesthetic surgery.
Any surprises in the statistics?
Not really, many of the numbers are fairly stable; however, non-invasive techniques have had a dramatic rise. Although, the statistics show a significant jump in both buttock surgery and labia plasty, overall these procedures represent a small number of total plastic procedures performed.
Do you think the concept of board certification is starting to resonate with patients? Why or why not?
Yes and no. There are parts of the country where I think patients tend to understand the critical importance of board certification. The problem is there is a great deal of confusion around this term. There are physicians who call themselves cosmetic surgeons and say they are board certified but the board certification can have nothing to do with cosmetic surgery. There are states attempting to have the physician clearly state what the board certification is so that the patient is not misled.
How can patients make sure the doctor they choose is board-certified and why does this matter so much? How do you explain the different boards to make sure they “get” it?
Obviously, the patient needs to ask the physician if they are board certified and specifically what the certification is in. Beyond this request, this still remains a very confusing situation for patients attempting to identify qualified physicians. The key factor here is identifying specifically which board.
When it comes to turning back the hands of time, Alan Gold, MD, FACS, a board certified plastic surgeon with offices in Great Neck, NY, and Boca Raton, FL, knows that satisfactory results require more than surgical technique and artistry. The surgeon must also study and appreciate varied cultural standards of beauty. Understanding subtle ethnic anatomical differences incredibly enhances the surgeon’s artistic eye, he says.
After finishing his undergraduate studies at Colgate University, Gold received his medical degree from New York’s Downstate Medical Center Colleg, and completed his plastic surgery residency at New York’s Kings County Hospital-Downstate Medical Center. He has served as president of more professional organization’s than we can count, including the American Society for Aesthetic Plastic Surgery.
Here, Gold tells Beauty in the Bag how he creates customized, natural, and individual “looks” for his patients.
Tell us a bit about your background. How did you come to choose plastic surgery as your specialty?
Long before I entered medical school, I was fascinated by surgery and the ability of skilled surgeons to treat disease, injuries, and deformity. Once exposed to the various surgical disciplines during medical school, I found orthopedic and plastic surgery to be the most exciting surgical specialties for me. Of all orthopedic specialties, it was the necessary meticulous attention to fine detail in hand surgery that I found most stimulating. However, once exposed to the even more artistic and creative challenges of plastic surgery and the opportunity to employ my sense of aesthetics, my career path was clear. I was then, and remain to this day, excited by the opportunity to practice such an artistic specialty in which the demands for both form and function are equally critical.
What is your signature surgery/procedure/product/service?
My signature surgery or service would probably be “facial rejuvenation.” Patients who present for that surgery usually just want to “turn back the clock.” They most often want to look “like they used to look,” just a younger version of themselves, and don’t want to look “different.” While most people would usually consider that to require just the surgical reversal of the aging-related changes of the eyes and face, to be most effective I believe it frequently needs to include more. I perform a great number of rhinoplasties, more commonly on younger patients, who often wish a more significant change in their appearance. Often, however, even subtle changes in the appearance of the aging nose can also greatly enhance the overall result and “balance” of a facial rejuvenation procedure, so I will often address that as well. Another factor that many people don’t appreciate is that surgery alone has its limitations. Surgery can reposition or restore the “volume shifts or losses” and tighten the “excess” skin that has stretched and sagged with age. It reduces the “quantity” of that skin. However, it doesn’t address the “quality” of the skin, and both should most often be addressed for optimal “rejuvenation.” Chemical peels and/or a variety of “energy-based” treatments such as laser, intense pulsed light, radiofrequency, infrared, and ultrasound can significantly improve that skin “quality” and are often included as part of the treatment regimen.
Plastic surgeons must excel at both technique and aesthetics. What’s the best way for a surgeon to develop his/her aesthetic eye?
The study of art, especially sculpture and painting, an appreciation of the importance of balance and of the interplay between light and shadow, and very importantly the ability to see and reproduce what you see in both two and three dimensions are critical skills for an aesthetic plastic surgeon. However, to develop a true and clinically important “aesthetic eye,” aesthetic plastic surgeons require more than just a study of art, form, and structure. To be able to successfully address the concerns and needs of our patients, we also need to study and appreciate the varied cultural standards of beauty. While there are some patients who wish to change or obscure the physical characteristics of their ethnic identity, most wish to enhance and refine them. A knowledge of those diverse cultural standards as well as of the associated often subtle ethnic anatomical differences allows us to develop an “aesthetic eye” that can best see the potential in our varied patients and how to best achieve their desired “look.”
Do you think that injections and less invasive treatments like lasers or radio frequency devices will ever replace surgery?
Nearly all of the minimally-invasive or non-invasive treatment modalities available today can effectively address certain aspects of the inevitable aging process. “Fillers” can obliterate or soften lines and wrinkles as well as restore lost volume or camouflage shifted facial volume. As mentioned above, energy-based treatments can change the “quality” of the skin, reducing superficial rhytids, dyschromia and other signs of actinic and environmental damage, reducing pore size and acne scarring, and even stimulating the production of collagen, and possibly even restoring some degree of skin elasticity. All of these treatments may be helpful in delaying the “need” for surgery, especially in younger patients, and will often be able to add significantly to the overall result of surgery by producing a “healthier” and “younger” appearing skin…….but, no, I do not think they will ever replace surgery.
What’s exciting in the anti-aging space right now? Anything noteworthy coming down the pipeline?
One of the most exciting areas of research involves the many potential applications of stem cells. Unfortunately, many physicians are promoting treatments using the “buzz word” of “stem cells” without proof of the efficacy or safety of their proposed treatments. Patients need to be “educated consumers,” and carefully research and question both the physician and proposed treatments until the claimed results are validated by peer-reviewed research, but the potential to restore or replace damaged tissue with stem cell-stimulated “younger” and “healthier” tissue is certainly exciting. Other exciting but often overlooked progress is being made in developing improved transdermal delivery systems to permit “cosmeceuticals” and other topical applications to penetrate into the deeper layers of the skin were they can act most effectively.
Do you have any tips for patients to improve communication with their surgeons? What should they ask their doctor and how can they best explain what they want?
Patients need to be both educated and discerning “consumers” when seeking cosmetic surgery. There are many well-trained and talented surgeons for them to choose from, but they need to carefully research both the credentials and reputation of the surgeon as well as the procedures he or she recommends. They should be wary of advertising “hype,” claims that appear “too good to be true,” high pressure “sales” by the surgeon or staff, and should never pick a surgeon or procedure based on price. They should be comfortable with their ability to relate to and communicate freely with the surgeon and staff, and be sure that the surgeon realistically and clearly reviews the risks and benefits of the alternative treatments available to them. There can be complications with any surgery that may cause a less than optimal result, and they need to feel assured that the surgeon will “be there for them” if things do not go exactly as planned. If they’re not completely comfortable, they should not hesitate to seek another consultation. Cosmetic surgery, if done with skill and artistry, can produce dramatic and positive improvements in both appearance and quality of life, but patients must take care to choose a surgeon wisely.
Dr. Robert Leonard, founder and chief surgeon at Leonard Hair Transplant, is widely sought after for his soft touch, artistic eye and extensive knowledge about advanced hair loss. He is licensed in six states, including Rhode Island, Massachusetts, and Connecticut, and currently sees patients in seven offices – in Cranston, Rhode Island; Newton, Massachusetts; Braintree, Massachusetts; Hyannis on Cape Cod; Boston, Massachusetts; Worcester, Massachusetts; and Salem, New Hampshire. In addition to performing hair restoration surgery, he acts as a hair loss expert for ROGAINE®, educating others of the potential hair loss treatments hold.
Dr. Leonard is a past President of the International Society of Hair Restoration Surgery and was recently appointed to the American Society of Hair Restoration Surgery Advisory Council. He was also one of the early adopters of the innovative ARTAS ROBOTIC SYSTEM®, the first and only FDA cleared robotic hair transplant device.
He recently answered some questions about the evolution of hair transplantation for Beauty in The Bag.
How long have you specialized in hair restoration?
I began my training in hair restoration surgery in 1986 after I met my mentor, the late Dr. C. P. Chambers. This was during the days of the no-archaic “plug” transplant era. Transplants in those days required several sessions in order to provide a natural look.
What has been the biggest change that you have seen in your practice?
The biggest change in my practice was the revolutionary miniaturization of transplanted hair grafts. This occurred in a very few years beginning in the early 1990’s. Today’s transplants contain only one to four hairs, which provides hair loss patients a very natural result even after only one surgical session. There are two different harvesting techniques that I utilize today: strip harvesting and Follicular Unit Extraction Technique (FUE). Each method offers wonderful aesthetic results. It is very important, however, that patients know that it will take several months to achieve these great results.
What do today’s hair transplant really look like?
Unlike in the past where grafts were very large (about the size of a pencil eraser), today’s grafts contain only one to four hairs. In the past, these big grafts needed to be spaced significantly apart so they could grow properly; they also were planted in sort of a “corn row” configuration, providing a not-so-natural effect with only one surgical session. The whole world of hair transplantation has thankfully changed today—and, for the better—much better! We now transplant tiny grafts, very closely together, in order to provide patients with very natural results.
Do you treat many women, and can they benefit from transplants too?
I have welcomed women as patients from the earliest days of my career. I am asked by my colleagues throughout the world to speak about my approach to treating the female hair loss patient. Not all women are candidates, mostly due either to unrealistic expectations of results or because they do not have enough donor hair to provide a proper result. It is critically important that women do as much as possible to stabilize their progressive hair loss with minoxidil and/or low level laser therapy—I personally use the Capillus Laser Cap. If they have enough donor hair, women are excellent candidates for hair restoration surgery. I must say that these patients are the most appreciative of my care as it is not “normal” for women to lose hair or get bald.
What role does technology play in hair restoration today?
We are in a wonderful time in the history of hair loss treatment. The tools we have really work very well to both slow down the progression of male and female pattern hair loss as well as to regrow hair. However, the patients need to be willing to use them. For men, I treat hair loss with finasteride (Propecia), minoxidil (Rogaine, Keranique, etc.), and Low Level Laser Therapy (Capillus Laser Cap, etc.). For most women, I do not use finasteride; however, for some, it is a good option for them especially post-menopausal women. The more of these treatments the patient does at the same time, the better effectiveness. Two are better than one; three are better than two.
There are no other medically proven, scientifically sound therapies available yet to treat genetic hair loss. Some doctors are using purported “treatments” such as PRP (Platelet Rich Plasma), Stem Cell injections, and various lotions and potions. None of these have had proper scientific studies to prove that they are at all effective to treat hair loss.
To provide the latest in hair restoration treatments and offer our patients superior results, we have also added the advanced ARTAS® Robotic System to our line of surgical technology. This minimally invasive, outpatient procedure allows us to transplant the patient’s own hair without stitches or visible scarring. Recovery time is fast, we can achieve fuller, natural looking hair that will last a lifetime.
Tell us about your fellowship at the International Society of Hair Restoration Surgery?
The Board of Governors of the International Society of Hair Restoration Surgery (ISHRS) recently offered the “Fellow” designation in order to recognize members who meet its exceptional educational criteria. It is a great honor for a member to achieve the Fellow designation (FISHRS). This recognizes the surgeon who strives for excellence in this specialized field. To maintain this status, the surgeon must continue to meet established educational criteria over time. I am proud to be one of 61 Fellows of the ISHRS.