Plastic surgeon Robin T.W. Yuan, MD, spends hours with each patient to get the best handle on what they want to change about their appearance, and develop the most appropriate action plan to achieve it. For these reasons, his Beverly Hills, Calif-based practice is not a factory. Far from it. Yuan is all about fostering the doctor-patient relationship. He doesn’t even have nurses or consultants that act as go-betweens. It’s his desire to provide patients with the best possible experience and outcomes that encouraged him to pen Behind the Mask, Beneath the Glitter: The Deeper Truths About Safe, Smart Cosmetic Surgery and another book juxtaposing relationships in cosmetic surgery and marriage, The Skinny on Marriage… A Plastic Surgeon’s Practical Guide.
Yuan received his medical degree from Harvard Medical School in Boston, and completed his internship at the University of California, Los Angeles. He did a residency in general surgery at UCLA and Cedars-Sinai Medical Center and a plastic surgery residency at University of Miami-Jackson Memorial Hospital. In addition, Yuan completed a Research Fellowship at the UCLA Division of Plastic Surgery.
He recently discussed his practice and what sets him apart from others in Beverly Hills with Beauty in The Bag. Here’s what he had to say:
Why inspired you to write Behind the Mask, Beneath the Glitter: The Deeper Truths About Safe, Smart Cosmetic Surgery?
First of all, I was doing a lot of reconstructive surgery early in my career. The choice of procedure was clear since most of the time I was trying to restore function or recreate normal from abnormal. Since I believed every patient was a unique individual, purely cosmetic surgery seemed to have limitless options. As I was referred more and more patients for cosmetic surgery, it was clear that there was often a disconnect between a patient’s goal and what surgeon’s perceive as the goal of cosmetic surgery. I saw too many unhappy or injured patients with unnatural results for such an elective endeavor. The book was the result of my trying to uncover the truths about cosmetic surgery and explain what the field is really about in order to increase the chance of success and safety.
How have the lessons in your book helped improve your consultations?
I am very focused on the patient’s perception of him or herself and resist the urge to operate until we have a mutually clear understanding of the goals and risks. The only way to ensure this understanding is direct one-on-one time with the patient so my consultations are comprehensive and performed on a number of office visits.
Explain how you apply the artistic concept of the Fifth Dimension to your surgeries?
The Fifth Dimension is the key to successful cosmetic surgery. It involves achieving a meeting of the minds regarding three dimensional space of anatomy, and the fourth dimensional changes of this three-dimensional anatomy over time. There is so much that goes into achieving the Fifth Dimension. It is what happens when an “artist” produces or performs a work that satisfies an audience that “gets” it. But it is not achieved by chance or force, but communication and customization.
Tell us about your approach to cosmetic surgery?
I do not look at what I do as anatomically limiting. Every part of the body is merely an anatomical structure built from all the same material of skin, fat, muscle, cartilage, vessels, bone, etc. As long as you know how to manipulate and use these tissues, you can modify any anatomical structure. I also explain to the patient how each anatomical area is connected to and influenced by other adjacent anatomy. For example, the peri-orbital region is connected to the brow and forehead, as well as the cheeks and midface, which in turn are connected to the chin, jaw, neck, and even peri-auricular area. So I look at things (w)holistically in an anatomical sense.In the end, it is the highly customized approach that is my specialty, not the body part. Anatomical specialization is somewhat artificial, either because of training, such as in ophthalmology or otolaryngology, or due to public demand for “super”-specialists. Of course, having said that, facial, breast, and body contouring surgeries are the most common.
What sets you apart from other surgeons in Beverly Hills?
I think I have a very unusual and personalized approach, having no consultants or nurses that interpose between me and my patients. I spend an inordinate amount of time with each patient (many hours versus tens of minutes) trying to achieve the Fifth Dimension. I have had a wide and extensive training with unparalleled mentors and a large experience in reconstruction that brings a varied and important fund of knowledge to cosmetic procedures. Cosmetic surgery is reconstructive in nature and reconstructive surgery should be cosmetically pleasing. It is a continuum.
What role do you think the plastic surgeon should have in treating patients with breast cancer?
My personal view is that there should be a paradigm shift in the team approach with the plastic surgeon at least on par if not at the head of the table. The basis for this is that in some ways breast cancer is a cosmetic disease as well as a oncological state. There should be a more complete evolution from the old days where cosmetic appearance was completely sacrificed for attempts at cure by radical surgery or radiation to a more cosmetic goal of not necessarily preserving, but enhancing (if desired) the breast without sacrificing potential cure. As opposed to the usual situation of the oncological team deciding on treatment and then inviting plastic surgical input if they deem it necessary, the treatment options should be outlined and then the plastic surgeon should decide with the patient as to the most optimal cosmetic plan. Quality of life should be as important as quantity. Plastic surgeons are uniquely trained to project into the future what cosmetic result could be obtained by various treatment options.
Michael Edwards, MD, FACS, is a board certified plastic surgeon who has an unmatched comprehensive understanding of the medical profession. Not only does he hold two board certifications—general surgery, in addition to plastic surgery—he was an RN before obtaining his medical degree,
He recently formed a new group practice in Las Vegas with plastic surgeons Dr. Goesel Anson and Dr. Terry Higgins, which offers a full range of facial and body procedures and treatments. Dr. Edwards specializes in breast revision surgery, a focus he feels very fortunate to address. Anson, Edwards, Higgins Plastic Surgery Associates also includes a board-certified dermatologist and a fully trained skincare team.
Here, Beauty in the Bag talks with Dr. Edwards, who is also President Elect of the American Society for Aesthetic Plastic Surgery (ASAPS), to get his tips for getting the results you seek from a surgeon.
Tell us a bit about your background. How did you come to choose plastic surgery as your specialty?
There aren’t many jobs in the medical field I have not worked at. This includes working as an EMT, ER technician, nursing assistant, and house orderly. I then became a registered nurse not knowing exactly what lay ahead. Thanks to a very understanding and supportive wife, I pursued medical school while working nights as an RN. Once in medical school I knew early on that I was bound to be a surgeon and really enjoyed the wide variety of surgical procedures the plastic surgeons were performing. I was hooked once I rotated in my fourth year of medical school. I decided to follow the more common general surgery route and completed five years of general surgery training and I still maintain my board certification. Plastic surgery was all I had hoped it would be. Our surgical cases are virtually head to foot with microsurgery, hand surgery, and incredible reconstructive techniques. I have never looked back and draw on my medical and surgical training almost daily as I care for my patients.
You recently joined a new group practice in Las Vegas. What is the group’s objective and what types of services/treatments does it provide?
I recently merged with Dr. Goesel Anson and Dr. Terry Higgins (Anson and Higgins). We have an 11,000 sq. foot office with three board-certified plastic surgeons, a board-certified dermatologist, two RN nurse injectors, four medical grade aestheticians, a highly organized and efficient practice manager, and a great staff of medical assistants, surgical technicians, and front desk personnel. We are able to provide our patients a complete range of state-of-the-art surgical and non-surgical procedures allowing each of the surgeons to focus on a specific area of expertise. Our goal is to provide a comprehensive approach where our patient’s experience, safety, and satisfaction come first. We are committed to coordinated, personalized aesthetic care for life, not just a single procedure.
What is your signature procedure?
Over the years I have been fortunate to focus my talents primarily on breast surgery, more specifically breast revision surgery. We, as plastic surgeons, all want our patients to be happy with their surgical results and we strive for that. Sometimes results don’t meet expectations as well our bodies go through changes from weight loss or gain as well as pregnancy. The breasts do change and sometimes benefit from revision. I would say my signature procedure is removing implants from above the muscle, placing new ones partially under the muscle for better coverage and prettier result, followed by a breast lift.
What is the best way to minimize scaring with a breast lift or augmentation?
With any surgical procedure there are incisions and scars. Our job, as plastic surgeons, is to plan and conduct our procedures with gentle tissue handling, tension free closure, and compulsive post-op wound care. I prefer topical silicone therapy for most of my healing incisions but on occasion there may be a need for local steroid injections or laser therapy.
Are there any new developments in surgical or non-surgical body contouring procedures that you find particularly promising?
There are always promises of new, wonderful modalities on the horizon. Unfortunately many of them fail to live up to their expectations. We, as plastic surgeons, try to look deeper at the science, to see if using evidence-based medicine, these are worth bringing into our practice. Surgical innovation is a great aspect of our specialty and we are willing to share our newly developed techniques with other board-certified plastic surgeons. Non-surgical devices are abundant and some appear to give better results in one set of hands than another. External body contouring techniques using freezing, radiofrequency, or ultrasound are promising for the right patient. They are not a means of weight loss but body contouring.
What questions should a prospective patient always ask their plastic surgeon during a consultation?
1. Are they a board-certified/eligible plastic surgeon?
2. Do they have hospital admitting privileges to perform the same procedure they are proposing to perform in an out-patient setting?
3. What are the potential risks/benefits/alternatives to the proposed procedure(s)?
4. How much experience do they have in the procedure you are seeking?
I could go on and on….
Dr. Allen Rosen, MD, is a board certified plastic surgeon who knows that patients receive the best surgical results when they have a good rapport with their surgeon and can clearly and comfortably explain what they want to change. The founding partner and medical director of the Plastic Surgery Group in Montclair, NY, advises that a surgical consultation is not the time to be shy.
As the founding partner and medical director of Plastic Surgery Group in Montclair, New Jersey, Dr. Rosen runs a practice that provides facial and body services. He is a sought after specialist in breast reconstruction and cosmetic surgery, as well as a spokesperson for the American Society of Plastic and Reconstructive Surgeons. Here he discusses surgical trends and issues with Beauty in the Bag.
Tell us a bit about your background. How did you come to choose plastic surgery as your specialty?
Born and raised on Long Island, I had a passion and a dream of becoming a physician and developed an interest in surgery in medical school while in Buffalo. More specifically, surgeons, who were required to do meticulous detailed procedures inspired me.
I explored opportunities in microsurgery, neurosurgery, and pediatric surgery, and then during my second year as a general surgery resident at Columbia Presbyterian Medical Center in NYC, I met plastic surgery Department Chief, Dr.Norman Hugo. He was a bigger than life character, who ran his service like his brother (a five star general) and expected others to perform flawlessly. He encouraged me to join his team.
Our patient population included infants to nonagenarians and each one required a uniquely different and creative approach. All required attention to the finest detail. This was irresistible to me.
What is your signature surgery/procedure/product/service?
After I finished training, I quickly gained a specialty interest in breast reconstruction. This led me, of course, to cosmetic surgery of the breast and to this day, I am typecast in this role as a guru in cosmetic and reconstructive breast surgery.
Facelifts, eyelids, rhinoplasty, and abdominoplasty are additional favorites of mine and I attract patients who are seeking “best of breed” surgeons for these procedures in particular.
I perform all the other “bread and butter” plastic surgical techniques (Botox, fillers, liposuction), but I am sought after as a master surgeon more than for procedures that non-surgeons can easily perform.
I refer all lasers and energy based techniques to my partner and run an active Medispa with two aestheticians to round out and provide a full service.
Plastic surgeons must excel at both technique and aesthetics. What’s the best way for a surgeon to develop his/her aesthetic eye?
Unfortunately, I think you are born with an aesthetic eye in the same way a singer is born with a gift of a melodious voice. That being said, true impresarios need to hone their skills through training, education, and practice.
Plastic surgery is both an art and a science. We are craftsmen and inventors, two very different concepts.
In our field, it is critical for even the most gifted and talented surgeons to constantly refine, redefine, and evolve with new techniques and technologies or risk being obsolete with unfulfilled potential.
Who is a good candidate for liposuction?
Liposuction is like sculpting a clay model. Anyone with any irregular fatty contour or bulge can be anatomically improved. However, selecting a good surgical candidate is not based solely on anatomic criteria.
Lipoplasty is a mechanical process, but it cannot be used to solve non-mechanical problems, like depression, obesity, or to keep a spouse content. Patients who are motivated, make healthy lifestyle choices, and maintain proper diets, regularly exercise, don’t smoke, and are psychologically stable with realistic expectations do extremely well with liposuction.
I have sculpted patients who were incredibly thin and others who were overweight who met these parameters. The best patients are those with real aesthetic anatomic problems and the right “attitude.”
What about a tummy tuck?
Most women after pregnancy and completion of their childbearing years are good candidates. They usually have weak and protuberant abdomens and various degrees of excess skin and fat. Many also have poor quality stretch-marked skin as well. The only way to return that belly to pre pregnancy appearance is through surgery. Only the lucky few escape the ravages of pregnancy.
Post massive weight loss patients, men and women, are also good candidates, for the same reasons
What’s exciting in the anti-aging space right now? Anything noteworthy coming down the pipeline?
It is beyond the scope of this discussion to list all the exciting new antiaging technologies that are emerging. The most important I believe are stem cell technologies (invest in them now), and blood derived growth factors. Genetic and blood evaluation will help specifically tailor physician directed programs for better health and longevity.
Stem cells will help rebuild old or damaged tissues all over the body. Stem cells can now be placed in a 3D matrix in the shape of an organ, like your liver or heart, and actually create liver and heart tissue. (Organovo, Nasdaq, ONVO)
Just beware of junk science and snake oil salesmen who are trying to capitalize on this new field of medicine with unproven claims and products. Wait for real scientists and physicians to bring these new techniques to market.
Do you have any tips for patients to improve communication with their surgeon? What should they ask their doctor and how can they best explain what they want?
This is the simplest question yet. The best way is like Nike advertises, “Just Do It.”
Talk to your surgeon like you would to a friend. Explain what bothers you, why and for how long it has been on your mind. Be direct and don’t’ be afraid to ask anything you want. If you can’t get this type of rapport going with a surgeon, go elsewhere.
Bring pictures to show what you like in others or what you looked like in years gone by. The surgeon cannot recreate that, but it will help him/her understand in images what you may not be able to explain in words.
Bring a friend or significant other to the consult to be a second set of eyes and ears. They may help you feel more comfortable and enjoy sharing the experience.
You are putting your precious body in the hands of a trained professional to help you look and feel better about yourself, this is not the time to be shy!