Entropy

From physics, we know that the Second Law of Thermodynamics says that the universe is always becoming more random. We see that in a number of ways such as ice melting and the flow of thermal energy from regions of higher temperature to regions of lower temperature in the form of heat. We also see it throughout our daily lives where perfectly trimmed trees lose leaves and clutter our yard, the paint on walls chips and all of the things we do to create order and neatness eventually come undone.

Entropy also occurs in human beings. Aging is a very slow process where the order and function of youth deteriorates over time in the body. Many aspects of aesthetic plastic surgery are essentially a fight against entropy, an attempt to stop it from happening (even though it's inevitable). However, the one thing that nature shows us though is that any of our victories against entropy are only temporary. Entropy continues. We are fighting a futile battle because the history of the world shows that all human endeavors eventually come undone.

But we fight on and it helps us define who we are. In plastic surgery, the battle against entropy is fun. We get to manipulate things and, even if only temporarily, see the world the way we like it to be and strive to achieve that.

Aesthetics

I just recently finished reading Steve Jobs' autobiography. It goes without saying what an incredible inspiration this man was but what struck me was the emphasis he put on the look of things. Aesthetics were extremely important to Jobs, not only with the products Apple manufactured, but with everything that encompassed the Apple brand. From advertising to packaging to marketing collaterals, everything has always been uniform, clean and concise. It was important to Jobs that the consumer experience enjoyment at every single point of interaction with the Apple brand. Anyone who has bough an iPhone or iPod knows that from the minute of opening the box, everything is "beautiful" and properly put in its place. Another aspect of the Apple brand that makes it so "beautiful" is the simplicity to all its products. Everything is so intuitive and doesn't need the never-ending, tongue-twisting list of instructions and directions.

While plastic surgery is also focused on aesthetics, it isn't quite as simple. This industry is much more complex than the manufacturing of products in the sense that we are dealing with human beings in a moving environment where infections, anesthesia and other variables that need to be taken into account. That being said, I still find it important to emphasize beauty in all aspects of our practice, not just in surgical results. I regularly try to evaluate the practice to ensure that patients always have an aesthetically pleasing experience, beginning to end. Everything matters - from the pens we use to the quality of paper for patient forms, even the garbage cans in the exam rooms (which we recently updated!). I truly believe that the success of our practice, similar to the success of Apple, in large part is due to the emphasis we place on the aesthetic aspect and making it "beautiful" for our patients.

Nipple Work

 I am always struck by the variation of cosmetic issues that are out there when it comes to nipples and areolas. In terms of "natural" issues (i.e. the patient was born with this), there's size and shape of the areola, inverted or elongated nipples and uncentered nipple-areolar complex. If I were to concentrate on procedures solely to correct these concerns, I could be busy for weeks, no problem! These procedures require a fine eye and delicate technique to transform the area into something the patient will be happy with.

In addition, I often see nipple/areola issues that were caused by previous surgery. Some of these include improper placement of the nipple-areolar complex - placed too high or too low, asymmetry and shape, poor scarring , pigmentation and problems with placement of the nipple within the areola. Fortunately, all these issues can be corrected with careful technique. 

Believe it or not, I think it could definitely be possible to make a career solely on nipple and areola issues, however I personally would never limit myself to this. It's interesting that these are actually common issues, but the general public doesn't realize that they can be easily fixed. Some people don't even realize that there are people that deal with them. The appearance of the nipples/areola can cause some insecurities and self-consciousness, and many of my patients are extremely happy to know that there's a simple solution to them.

Private Practice

 "Business, more than any other occupation, is a continual dealing with the future; it is a continual calculation, an instinctive exercise in foresight." 

- Henry R. Luce

 One aspect of being in private practice as a physician that often goes unappreciated by the public, and sometimes the physician as well, is that in addition to being a great doctor, one must also be a great businessperson. I've heard countless stories of physicians who are great doctors, but horrible businessmen, who have struggled and/or have even been forced to close their practice. Unfortunately, "business savvy" is not something that is emphasized during medical training and in recent years, due to tough economic times, poor business strategy can mean the end of a practice. Doctors and their practices can go bankrupt just like any other business.

It is a very complicated process running a medical practice. Twenty years ago, I had to start from scratch. 1 employee. 1 computer. No marketing budget. Not much of anything. Fast forward to today, and Miami Plastic Surgery  has 4 surgeons, 23 employees and a major computer infrastructure. We've expanded to multiple aspects of aesthetics surgery, including our own skincare department. We have our own operating rooms, nurses, aestheticians and management team. It's a huge undertaking.

Thankfully, our practice has been able to successfully continue to grow over time. It wasn't something that happened overnight. Our growth is attributed to years of careful consideration and planning. I am extremely fortunate that my partners and I have made good business decisions and that the practice functions so well.

In recent weeks, we are embarking on a new phase for the practice that includes welcoming a new physician as well as opening a second location. We will hopefully continue to grow as demand allows. It is an exciting time, but one that has to be carefully thought out and watched with close scrutiny. Growth is great but it is important not to overstep our resources. Needless to say, I am looking forward to this next phase!

Training for the Future

This year, we took our first fellow doctor to the practice, Dr. Johnny Franco. A native of New Mexico, Dr. Franco completed his residency last year at Saint Louis University School of Medicine. He came to Miami Plastic Surgery to augment his cosmetic surgery training which he feel he didn't have enough of during his residency.

It's been a little over eight months since he's been with us, and it's been such a pleasure having him.. My two partners and I have taught him all the nuances of plastic surgery- which techniques work, which ones don't, etc. Even learning how to deal with cosmetic surgery patients is an art in and of itself! Dr. Franco has gained insight of the many years of experience we've had.

It's really been a "the more you give, the more you receive" situation. Dr. Franco has diligently been there to help during consultations, surgeries and follow-ups in hopes to learn from us. However it goes both ways. Through his questions and insight from previous training, we've learned a great deal as well. It's a two-way street that's benefited us all. 

Although his fellowship is soon coming to an end, a surprise outcome has arisen. We've enjoyed Dr. Franco's time with us so much and are so impressed with his skills, we have decided to offer him a position at Miami Plastic Surgery and he will be joining us as a colleague. His addition allows us to grow as a practice and continue to offer our patients the very best!

Welcome aboard Dr. Franco!

The "Grateful" Patient

A few weeks back, I wrote about the "selfish patient". As a patient you can't help but only care about yourself during the stressful process that is plastic surgery. Am I going to be okay? How's the recovery going to? Is it going to hurt? Am I going to be happy with the results? It's the natural, expected response.

On the flip side, I also encounter the "grateful patient and I've been lucky enough in my career to experience this on a daily basis. The mother of a patient of mine left me a message yesterday asking that I please call her back. The patient had a breast reduction a little over three months ago, and I couldn't for the life of me think of why she was calling. My immediate thought was that there was some sort of problem...

I was wrong. When I got her on the phone, she told me that she just wanted to let me know how happy both she and her daughter were with the results. Apparently, they recently went bra shopping and her daughter was smiling "ear to ear" the entire time because she now had more options with her smaller breasts. She genuinely just wanted to let me know that I had made an extremely positive impact on her daughter's life and that they were both grateful and happy.

These comments are honestly the most fulfilling part of my job. I obviously work to provide for my family as well as to keep my staff employed, but the most important reason I do it? To make people happy.

The Art of Plastic Surgery

Today we checked out a new, non-invasive skin tightening machine and I was actually quite impressed with the results. It's incredible to see the increasing role technology continues to play in creating advances for the cosmetic side of medicine with no downtime and significant improvement in one's appearance. This particular machine, Ulthera, uses focused ultrasound below the skin to tighten the skin and it really effects the underlying structure and cause remarkable improvement in the patient's skin tone.

Nonetheless, the proper utilization of these technologies for physicians is to recognize who's a candidate and who's not. While many of these new machines do work well, not everyone will be benefit from them. I've learned with other non-invasive treatments that we use here at Miami Plastic Surgery, there's never a substitute for a facelift. If I believe a patient needs a facelift, I would never recommend a non-invasive procedure as an alternative. Chances are if I were to tell a facelift candidate to get a non-invasive treatment done, they would not be happy with the results. The only treatment for someone that needs a facelift... is a facelift!

However, for patients that are too young to be facelift candidates and who's problems aren't severe enough for surgery, I would definitely recommend a treatment such as Ulthera to help turn back the clock a bit without going under the knife.

As with most aspects of plastic surgery, it is not only about technique but about the surgeon's judgement as to what approach to take with each individual patient. Plastic surgery truly is an "art" in the sense that it's not just about treating patients like factory parts. The "one size fits all approach" does not work with plastic surgery. We need to take the time to speak with every patient honestly and select the approach that's right for them in which they will truly benefit from it and be happy with the results.