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Posted by 08.17.14

Dr. Julian De Silva, an eminent UK facial plastic surgeon, talks to BITB about microsurgery and what it means to be one of London’s go-to face experts.

Educated at the London Teaching Hospital, De Silva studied plastic surgery at the University of California, Los Angeles in 1999 during an international elective. His transatlantic training and subsequent network have served him well, giving him real appeal with his clients and a pipeline into the evolving cosmetic trends and techniques from overseas.

De Silva performed his first facial surgery over 12 years ago, and went on to complete fellowships in facial cosmetic surgery in Los Angeles and facial cosmetic and reconstructive surgery in New York, an oculofacial plastic surgery fellowship in London, as well as the inaugural Darzi Clinic Leadership Fellowship in London. When the Olympics were held in London in 2012, the international organizers selected De Silva to provide clinical care to the competing athletes and coaching staff.

Today, he is known for perfecting procedures that require tiny incisions between 2-3 millimetres. He has also consulted for the UK National Health Service (NHS). It’s no wonder patients seek him out for his “small incision and fast recovery technique” to give natural-looking results.

Here, he tells BITB more about his achievements and his brand of super-surgery.

Tell us a bit about yourself

I am a London-based facial cosmetic surgeon who specializes in the eyes, nose, face, and neck areas only. I am a perfectionist and that’s what patients need—someone who has fastidious attention to detail with the surgical skill to back this up. 15-20% of my work is complex revision surgery on patients who have received treatment elsewhere and are not satisfied with their results so you could say that I am a fixer as well as first port of call for people that want to address a facial complaint. I’ve completed over 1,000 procedures to date but no two cases have been alike. There is no formula for the perfect nose for example and unlike what surgeons believed in the 1980s, one size definitely does not fit all. To get the best possible result for your patient, you really do need to love what you do and approach each and every case with the same enthusiasm and uncompromising care and attention in order to continue to create happy patients.

Why did you choose to specialize in facial plastic surgery?

I pride myself on my attention to detail and I am sure this stems from my training in microsurgery plus I love of arts and am a keen sculptor in my spare time so I think this was the natural direction to take. I like the fact that facial plastic surgery is hugely challenging, not simply from a surgical point of view, but also because of the extraordinary level of trust you must establish with your patient before making it to theatre. It’s a real honor when you are entrusted with somebody’s face. You need an exceptionally well-trained eye in this area—it’s not enough to be good at surgery, you need to have the vision to achieve the desired outcome. My obsession with this specialty has helped me achieve triple memberships in British, European, and American surgical organizations.

What advice would you give to someone considering facial plastic surgery?

If you think that 15-20% of all my patients see me for revision surgery (and that’s just at my clinic) imagine the numbers of people all over the UK that are not happy with their result. It’s so hard to pick the correct surgeon and to communicate what you want when it is effectively an image or idea in the patient’s head—how do you describe what you want to a surgeon? The answer is, find a way! Take photos of you with from all different angles, tear sheets of images that you like from magazines, touch your face to illustrate what you are talking about, and don’t be afraid to cross-question the surgeon to see if they really understand your vision. In fact, don’t be afraid to fire questions at the surgeons you meet because they owe you a response to each and every question you have no matter how silly you think it may be. I would recommend asking what percentage of a surgeon’s cases result in revision surgery, i.e. how often does this surgeon get it right and how often does he or she need to get a patient back on the table for further treatment.

Are there any tips that you would give to a budding facial plastic surgeon wanting to make it big?

Find out what you are good at and what you actually like to do; if you can tick both boxes you can become an expert. I would suggest having a portfolio of case studies for people to look over and keep that up to date so everyone has access to your most recent cases. You are only as good as your last result. It is hugely motivating to have satisfied patients so for that reason it’s best to work out how you are able to make the most people happy that you can.

Tell us why you have the edge on other facial plastic surgeons?

I specialize in a technique that reduces scarring and minimizes downtime and people come to me for that and the fact that I can offer a very natural look. I have treated people in the public eye, show business etc. and they, like everyone else, don’t want to look like they have had work done. It’s the rapport you build with patients that gives you the edge. If you can understand what a prospective patient wants, you are realistic about what you can achieve, and you communicate this clearly then this provides the basis for a happy customer. Manage expectation all along—the best kind of plastic surgery is undetectable and a natural looking improvement. Perfect is a very subjective term and there really is no such thing and therefore no magic formula for perfection. My patients know that they are going to emerge from treatment looking their very best.

Are there any new or unique techniques that you offer?

I have pioneered innovations such as the use of fibrin tissue adhesives and laser research. The techniques I use foster natural looking results, and I am continually bringing in new equipment and innovations to give patients faster recovery times and longer lasting results. The use of endoscopic and key-hole techniques minimizes scarring and the use of other innovations such as tissue glue can result in no need for conventional sutures in some facial procedures. I am always looking to improve patients’ recovery and reduce down time and invest in the latest in high-tech innovations in order to provide patients with these advancements.

How would you describe your style?

My style is a natural looking result and this will depend on the individual—their genetics, age, and ethnicity are all key factors. I don’t have the same approach for any two cases so I’d say that having a style would mean that you tend to follow a formula or prefer a certain kind of look, which just isn’t the case. I am a big believer in creating the best natural looking result possible. I look after all my patients on a personal level, and treat them as though they were my friends or family; this has resulted in patients coming back for more procedures and bringing their friends and family to see me.

How do you think your transatlantic training and connections help your work?

My experience from working in the US had helped me give the very best treatments and procedures to my patients. Having worked in both Los Angeles and New York, I use the most advanced techniques to give patients the results they are looking for. Ninety percent of the skills and surgical techniques that I use on a daily basis are from the US, as they minimize incisions, give faster recovery, and deliver more natural looking results.

What do you love most about your job?

I enjoy the challenge of facial cosmetic surgery; every person requires a different set of my skills, whether blepharoplasty, rhinoplasty, or face and neck lift. The relationship and trust that is built between patient and surgeon is quite amazing and it’s a privilege to be chosen.

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Posted by 07.20.14

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.

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Posted by 06.29.14

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.

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