When the Hype Exceeds Reality in BBL

I have been a Board Certified Plastic Surgeon for quite some time, being in private practice for more than 20 years. I have been doing fat transfers to the buttocks since before it was called a Brazilian Butt Lift, and continue to perform this procedure more than 150 times a year. I think I get great results, yet I hear some disappointment from patients more than with all other surgeries. Am I just not good at the surgery, or is it something else?

When I compare my results to those seen in the Plastic Surgery journals, I feel they exceed nearly all in effectiveness and fat take. That makes me confident I am doing it well. So why are some people not thrilled? I blame social media.

People watch reality tv, look at photoshopped pictures and posts, and feel that it doesn’t matter what they start with, that a good plastic surgeon can do anything. This is unfortunately not true. The amount of fat you have, the bone and muscular structure, and metabolism are all factors beyond our control. I have miraculous changes walking around who are upset that with white lycra tights, there is a slight difference from side to side, even if they started out horribly asymmetrical.

My choices are to either stop offering the procedure, or to continue to try and educate each patient as to what is possible and what is not. I am not ready to stop. Be realistic and accept a great result. Perfection is sometimes the enemy of happiness.


Safety Trumps Money

As a Board Certified Plastic Surgeon, I have had the privilege of taking care of the Hispanic community for 20 years in my private practice, Yager Esthetics. I have always considered patient safety my number one concern, and have never done an unnecessary procedure to earn money, or sold a service, product, or procedure that I did not feel was of benefit to the patient.

Additionally, I often have patients who want multiple surgeries, and feel doing it all at once is best. That is not always true. You must consider the health of the patient, additional risks of a combined procedure, as well as the positioning and discomfort during the recovery process. For example, a healthy, normal weight, young person can do an abdominoplasty with liposuction of the flanks. If they wanted fat transfer to the buttocks, this would be separate, as to get the proper result from a fat transfer, you need to sleep on your stomach and not sit for a week. This is impossible to do after a tummy tuck. Sitting on a special pillow is not, in my opinion, the best or safest option.

Some patients have risk factors due to age, weight, or medical history. I always suggest separating procedures for safety concerns, often consulting with the patient’s primary care doctor. These are elective surgeries, and every effort to reduce risks should be made.

One of the hesitations I hear is that separating the procedures is more costly, and this is true. You are paying the operating room fee and anesthesia fees twice. In an effort to keep you safe, I have changed my policy so that if you schedule and pay for your multiple procedures and I decide to separate them, you will pay the same as if it were all done together.

That is what I call putting safety ahead of money.


Happy 2017

As we begin a new year, it is a helpful starting point to think about what we can do better in 2017. After 20 years at Yager Esthetics, I am constantly listening to my patients in an attempt to deliver what they need. That has lead me to create an expert team of nurses and estheticians to find solutions specific for Hispanic skin, dark spots, laser hair removal and skin tightening with radiofrequency. We continue to treat cellulite and stretch marks with the latest technology, and have found the best scar prevention and treatment procedures and products.

My surgeries continue to become more refined, even after over 2000 abdominoplasties and 5000 plus liposculptures, and thousands and thousands of breast procedures. I always want to think there is more that I can do, and it drives me to be inspired by each case as if it was my first. My BRA procedure, Breast Reduction with Augmentation, has been a revelation. Lift and reduce the breast, and add an implant for fullness.

Our office is well on the way to a paperless operation, utilizing tablets and computers to streamline your experience, and our website redesign will provide a refreshed and more interactive experience. Look for more video and enhanced social media to come.

We have purchased very exciting new technology that will debut this month. You have been asking for these services for a long time, and finally I am excited that the technology exists to do it for our Latin patients. I will not spoil the surprise yet, but I am sure the majority of you will want it.

My pledge for this year is to stop and appreciate each patient and procedure. I am honored to be able to do what I do, and to have made a difference in the care of my community. I am humbled by your support and love. May you all have a healthy and blessed 2017.


Back to School 2016

As the kids return to school, and teachers begin to work again, the beginning of September is a great time for me to work on learning.  After four years of college, four years of medical school, and 5 years of training in Plastic Surgery, even starting my 20th year of private practice does not mean I know it all.

Every 3 years, I must complete 150 credits of continuing medical education just to maintain my license.  In addition, to remain a Board Certified Plastic Surgeon, I have to do a Maintenance of Certification program in 10 year cycles.  This involves courses, certifications and an exam.

Next year is my exam year, and I will be doing the Cosmetic Plastic Surgery module, as that has been my sole focus for my career.  While I still remain competent in all areas of Plastic and Reconstructive Surgery, I have not performed many of the procedures in decades.

This year, I am on a mission to explore new areas of practice, as well as critically assess what I do best and where I can improve.  I have never seen a perfect result in plastic surgery, be it my own work or others.  I do not think it is impossible, but I like the challenge of getting as close as humanly possible while remaining safe.

I invite you to assess your own work, whatever it may be.  I am sure there are courses or videos that might expand your abilities, as there are for me.  Let us all return to school and learn for a lifetime.  School is definitely in session.


Early Results With Inspira Breast Implants

Another breast augmentation blog!  Whenever something new comes out, I do my due diligence and report back to my patients.  When I was informed of the Natrelle Inspira line, I naturally read all I could and spoke to my implant people. I have been using these implants for 6 months, not exclusively, and find that they are not the only answer, but a very helpful tool in my implant arsenal.

Inspira is a silicone gel based breast implant of the traditional type.  It is not a highly cohesive gel, or gummy bear type.  What distinguishes it from the standard or classic gels is that the same dimension shell is filled to a higher percentage.  This results in a bit more fullness.

Inspira implants come in different profiles, which further adds to the options for custom tailoring each procedure to each patient.  I can select many different implants for the same size breast and create different looks depending on the personality and desires of each patient.

I find that for the patient who wants that little bit more upper pole fullness without looking fake, it is an excellent option.  My patient satisfaction has been extremely high so far, and I have not yet had a capsular contraction.  This most likely will happen at some point.

I would be happy to offer my advice to those of you who are considering breast augmentation.  Inspira may not be right for you, but it is worth considering.  The search for the perfect implant continues.


Victim of my own Success

When I decided to serve the Hispanic community after my training in Plastic Surgery, I opened up Yager Plastic Surgery in 1997.  I had no business plan or experience, no training in HR or administration, and plenty of school debt.  All that I knew was that I was a good plastic surgeon who could serve a need for Spanish speaking patients in Washington Heights, New York.

As I became more popular, I have expanded the office twice, and rebranded as Yager Esthetics to encompass all of the nonsurgical treatments and spa services we offer.  Fast forward to starting year 20, and I have become busy to the point that there is a wait for surgery and appointments, despite the massive staff I have assembled to keep up with demand.

The good news is that due to my experience, I am able to deliver the highest quality surgical results to more people.  The bad news is that I cannot see everyone at every visit for as long as they might like.  I love my patients, and enjoy talking with them, but have to strike a balance to serve the community as a whole.

This does not mean that I miss anything, or give less care.  I see everything on everyone and ensure the best possible care medically as always.  It is the social part that suffers for some.  This is such a hard balance to strike, and I am still working on it.

Please know that I always give my all, and think that surgically, I have never been better.  I want to make it so people do not have to wait long to see me, but there are only so many hours in a day.  If you need more from me, please tell me.  I am still here for you.  It has never been about the money, only the opportunity to help the Hispanic community.


World’s Best Plastic Surgeon

I am not the World’s Best Plastic Surgeon. In fact, if I even made that claim, I would be in jeopardy of losing my status as Board Certified. But what are the qualities that make for great Plastic Surgeons, specifically Cosmetic Plastic Surgeons?

Ability is obviously important. You must be technically gifted to perform the procedures properly, and with appropriate education and training, most Plastic Surgeons are. The surgeries are not that difficult in concept, and can be mastered.

Judgment and an esthetic eye are not as common, and cannot really be taught. You see some surgeons at esthetic conferences feverishly writing notes, and asking for formulas or exact steps in a hope to recreate what they see. These doctors are usually not blessed with the talent for cosmetics.

The ability to connect with the patient and communicate well is also tricky. You can be the smartest and most talented plastic surgeon, but if you can’t convey that to a patient, no one will trust you to perform a procedure. Be honest and educational, and make the patient comfortable. It has to be a match on both sides.

Knowing who NOT to operate on is to me the most difficult. I like to give people the benefit of the doubt, and my first instinct is to help. I do not like to think that people have bad intentions, and have been burned a few times.

While I may not be the World’s Best Plastic Surgeon, I certainly try my hardest to deliver for each patient. Judging by the number of surgeries I do each year, it’s good enough for nearly all.


Santa Claus and Plastic Surgery

Almost all little children look forward to xmas, a time when good behavior is rewarded with family time and the fulfillment of wishes for presents.  It is a happy holiday, but one in which many lose the true meaning of sacrifice for others, and instead focus on themselves.

Sometimes, cosmetic plastic surgery patients act the same way.  They see their plastic surgeon as a type of Santa Claus, who can magically grant every wish for physical improvement with the wave of a scalpel.  The bandages are like the wrapping paper, which when removed reveals the wonderful gift within.

Many times, patients are thrilled with the results, and understand the work that went into creating them.  All the training and sacrifices made by their doctor to acquire his or her techniques and esthetic eye are evident.  Some, however, like spoiled children, can never be satisfied or have enough.

I always meet with my patients several times before performing a surgery upon them, so that I may review the risks and alternatives of each procedure, and try to give them a realistic idea of what to expect.  Unfortunately, not all patients listen well.

Over 99% of my patients are quite satisfied with their care and results of treatment at Yager Esthetics, but that 1% is what makes my life difficult.  If everything is done well and the results are excellent, and the patient is unhappy, there is very little that can be done.

If plastic surgery is under your tree this year, don’t be naughty.  Listen to your doctor, try to have realistic goals, and all will turn out nice.  Happy Holidays!


How to Plan your Surgery

As I continue my seventeenth year at Yager Esthetics, I am fortunate to have built a busy and successful plastic surgery practice. I work very hard to minimize the wait for consults and surgery, but will not do more than I can safely manage with professionalism and personal attention.

While I operate two to three days every week, work, life, and school sometimes limit my patients as to when they can get the necessary time needed to recover properly. Because of this, certain surgical dates are more popular, especially around school holidays and over the Summer.

As we are in September, I have already had to open extra days around Christmas and Thanksgiving to try to accommodate the desires of my patients. This is why you should book early, especially if you are looking for a popular date. I am only one surgeon, and I have to make sure I only operate for the amount of time I can give 100%.
When a patient comes in for a consult and expects surgery the next week, it is still surprising. The planning on my side takes significant time. We need to get you to your doctor for testing and clearance, the anesthesiologist has to review your history and lab results, we need to measure you and order garments and bras and implants you might require, and you need a preop visit to review all of your consent forms. The nurses and I have to educate you on risks, alternatives, and the process. For your safety, we spend this time on you.

I would love the opportunity to be you plastic surgeon, but you need to plan well. Come well in advance, and make sure I am the right fit for you. Remember, it is not like buying shoes. This is you life, and you need to be smart.


Anesthesia 101

More patients have realized the importance of finding a board certified plastic surgeon with the right experience to enhance their chances of good results. While this is a step in the right direction, it is not only checking you need to do.

The physical act of the operation is rarely dangerous in cosmetic plastic surgery, assuming you have found a board certified plastic surgeon. The anesthesia you receive, where the operation takes place, and who is giving the anesthesia are critical.

Make sure you know where your surgery will take place before agreeing to schedule. It should be an Accredited Ambulatory Surgery Center or Hospital. You can check with AAAASF, JCAHO, and AAAHC to insure the site is inspected every year, and is currently certified. The center should be able to show you a certificate good during the date you are having your procedure.

Simply having surgery in an office means there is no oversight or control over the operating room or emergency protocols, and if it is anything more than a mole, it should make you nervous.

Some doctors save money by giving anesthesia themselves, or using a Nurse Anesthetist instead of a board certified anesthesiologist (a doctor with specialty training in anesthesia). I do not feel I can give you anesthesia and concentrate on your surgery at the same time. While some Nurse Anesthetists are fantastic, I feel more comfortable with a doctor giving anesthesia. I am not trained in anesthesia, and shouldn’t be supervising a nurse in that capacity if I am not an expert in that field.

So, do your homework- board certified plastic surgeon, board certified anesthesiologist, accredited surgical center. Good luck!