Photo Credit: beautyinthebag.com
For over twenty years, Dr. Michael Kulick has been serving the greater San Francisco area as an internationally recognized plastic surgery expert specializing in facial procedures.
Dr. Kulick uses cosmetic surgery to help patients overcome concerns about their physical appearance caused by birth defects, injuries, genetic structure, and the effects of aging. In these cases, the result of plastic surgery has increased self-esteem and enhanced quality of life for each patient. Dr. Kulick is a firm believer that having a strong level of self-esteem is one of the many factors that lead to an emotionally satisfying life.
BITB spoke with Dr. Kulick on why he became a plastic surgeon, popular procedures and the future of aesthetics.
Who / what inspired you to become a plastic surgeon?
My pathway was not typical. For sure there is a higher power that impacted my life. I was a dentist in my early 20’s and capitalized on my hand-eye skills needed to provide high quality dental care. I wanted to be the best dentist ever. However, as it turns out, this was not my calling. I was exposed to a plastic surgeon, Dr. Raymond Warpeha. Soft spoken, a brilliant mind and kind heart, he saw something in me I was unaware of – I should be a plastic surgeon. He too was a dentist originally and had a PhD in anatomy but became a plastic surgeon. From my interaction with him, I saw the opportunity to do both reconstructive procedures and aesthetic surgery. I could talk with patients during my work efforts. I fell in love with the ability to actualize my basic science knowledge and do research. I also learned that I could tap into my passion for artistry as part of my clinical practice. Being a more “relatively mature” person at 23 years old, I was blessed to be accepted into Stanford’s combined general surgery / plastic surgery program. What Dr. Warpeha saw in me was a gift that I have benefited from since I made the decision to go to medical school. During our conversations, he calmed my anxiety about such a career change with the following advice: “Do your best no matter what you are doing, actualization of communication requires an understanding of the other person’s perspective and follow through with your word. If you can do this, all things will fall into place no matter what you do.”
What are the most popular procedures you recommend to your clients and why?
The most popular procedures I recommend come from two pathways, non-surgical and surgical. I am actively involved with research efforts to improve non-surgical results as many patients want to minimize their post treatment “down time.” Technology has provided patients many clinical opportunities to improve their appearance. Skin fillers have evolved. Initially, “collagen” fillers developed by a Stanford colleague was the state of the art. Today, hyaluronic acid fillers such as, Juvadrem, Restylane and Belotero are the standard of care. Using one’s own fat has been very effective to improve skin irregularities. Going forward, there may be new ways to “fill” in a line or contour defect. Neurotoxins are very popular and predictable to reduce fine skin wrinkles. I have not found a significant difference in the clinical result when using BoTox or Xeomin. The clinical impact is consistent and the lasting result often depends upon the amount of medication injected and patient, reflex muscle use.
Light and energy based therapies have been a large part of my non-surgical practice. I have championed intense pulsed light energy to simultaneously reduce unwanted brown, redness and even fine skin wrinkles. In my hands, patient satisfaction is extremely high using devices made by Lumenis, Syneron and InMode. For patients that want a reduction is skin wrinkling and not a change in skin color as may occur with ablative skin resurfacing, I have recommended bi-polar radio frequency energy such as InMode’s Fractora device. For patients that do not want a surgical solution for body contour and cellulite, I suggest the use of the SmoothShape device or InMode’s BodyFx therapy. The most dramatic results for patients that want only one treatment for a body contour improvement, I use the Vaser ultrasonic liposuction device. Even in hard to treat areas such as the love handle region, back and dealing with gynecomastia, this technology makes it easier for me to provide a high degree of patient satisfaction.
The gold standard for removing extra skin on the body and face is a surgical procedure. For patients that want a face lift, I still advocate using a laser to dissect / divide tissue vs. using just a scalpel or scissors to divide tissue. The laser energy simultaneously cuts tissue and seals small blood vessels. In my experience, this results in a shorter recovery period, less bruising and post-operative pain. To date, I have never had a hematoma (blood clot under the skin) once I started using a laser to dissect tissue when performing a facelift. I have been very impressed with the LightScapel laser device. It is compact in size vs. other CO2 devices. It has a flexible waveguide to deliver the laser energy, which makes using this device easy to use vs. having a cumbersome, articulated arm to deliver the laser energy.
What are some of the trends and treatments you are most excited about in aesthetics and why?
Companies are listening to patinets wishes to shortening recovery time, provide a more lasting treatment result and focusing on non-invasive methods of improving one’s appearance. Many of these efforts cannot be discussed in detail as they are investigational and information confidential. In terms of body contouring, efforts are being made in terms of limiting fat cell absorption so that unwanted calories are excreted vs. being absorbed. Conversely, research is underway to have one’s own fat cells become larger to fill out a wrinkle. Non-injectable neurotoxins to block muscle activity and reduce wrinkles is an option that all patinets would like. Stem cell research is a fascinating pathway of research efforts for many reasons.
While all of these research efforts are happening, there is something that addresses the common concern of many patients receiving in office treatments – the discomfort and anxiety of an in-office treatment that is available today – nitrous oxide. Known as “laughing gas,” there is a device provided by a company called ProNox that delivers a safe level of this gas that reduces the pain and anxiety of my in-office treatment. Unlike oral medications that take time to work and have a lingering effect, this gas can be provided just before an in-office injection, body contour treatment or whatever. After the treatment, there is no lingering effect of this gas. Having my patients feel less pain / anxiety is something that I want.