Be the Boss on your Consult, but don’t be Bossy

I am a firm believer that a patient should be a partner in his/her care, especially in cosmetic Plastic Surgery. While a Plastic Surgeon has a great deal more knowledge about the procedure you want, there are options that are simply a matter of taste.

When I speak to a patient about surgery, I always present the facts as I know them, in as unbiased a manner possible, so that the decision is the patient’s to make. Clearly if asked my opinion, or if I have a preference, I will share it with the patient so that we can come to an acceptable decision. I am not a technician who will do whatever is requested, it has to make good medical and esthetic sense.

If you are looking for something that would not make me proud as a Plastic Surgeon to put my name on, I will decline to operate on you. That doesn’t mean you have to be a supermodel with a perfect feature, it just means that the esthetics have to represent an improvement that is worth the risk.

I encourage patients to be the boss, and really let me know what they are looking for. If I do not know because you are shy or embarrassed, you have less of a chance of being happy. There is no shame, just be honest and everything will work out better.

I do not like it when a patient is bossy, telling me what to do and how to do it. I am here to educate and assist you in determining what has the greatest chance of success. If you do not want to listen, maybe you should learn to do it yourself (not a serious suggestion).

Assert your desires, partner with a Plastic Surgeon who will listen, and enjoy the results of a healthy partnership.

The Dangers of BBL

Just this past week, an alert was issued by the American Society of Plastic Surgeons regarding fat transfer to the buttocks, or BBL. After a survey of members and the literature, it was found that the incidence of death from the procedure were about one in three thousand. This is by far the highest for all cosmetic plastic surgery procedures. Clearly, this is very concerning to me, as I have done close to 3,000 myself.

The problems that occurred seem to have come from fat being injected into and below the muscles, and that fat entering the bloodstream causing pulmonary embolus and death. These findings made me feel somewhat better for a few key reasons.

When I do a BBL, I am always above the muscle in the subcutaneous plane. A death has never been reported from the procedure when the fat is above the muscle. The only limits are that you cannot always get as much volume that way, but I would rather have someone complain they are not quite as big as they hoped as opposed to someone dying.

Secondly, I always stay away from the lower inner area of the buttocks where the major blood vessels are. I clearly point this out to my patients before the surgery, so that they know where I won’t fill and why.

These findings show the importance of technique and doctor selection. Many non plastic surgeons are now doing cosmetic procedures thinking it is easy money. The experience, skill and anatomical precision required cannot be taught in a weekend course, online videos, or by spending a few months watching someone and calling it a fellowship. Be safe.

Celebrate America

As we approach the 4th of July, I think we should all remember what an amazing country we live in. Despite your political leanings, America is still truly the land of opportunity. That is why so many immigrants seek us out as a dream place to live.

My family came to the US over 100 years ago, and each generation has worked hard to raise our level of education and financial achievement. I hope my children do the same. If you have an entrepreneurial spirit and drive, the freedoms and opportunities are there if you want them badly enough.

The leaders of our country cannot see eye to eye with every citizen, as we all have our own unique experiences and thoughts. Part of what I love about our America is that everyone has the right to be wrong. We hope we are right much more often than not.

I suggest that we all put politics aside and celebrate the Fourth of July together as a nation, respecting the noble concepts upon which our country was founded, regardless of who is in the White House. It is our house, and a house divided cannot stand.

I support America whoever is President, and root for their success, as it is my success as well. There is no other country in which I would rather live.

Summer in the City 2018

Summertime is upon us again in NYC. That means hot weather, air conditioning, and many teachers and school employees looking for plastic surgery. Having the summer off is one of the amazing perks of being an educator.

The summer is also a less clothed time, and people become more conscious of their bodies and flaws. Fixing them is where I get busy. Liposuction, breast implants, and BBL’s are all way up at this time of year. I always do abdominoplasties and facial rejuvenation, but these procedures tend to be steady all year long.

Summer is also a time to be careful with your skin. Sun block, hats, and careful monitoring of your sun exposed areas is crucial. My brother died of melanoma, so I know this is a very real danger. Check those moles, my friends.

For those of you travelling, remember to make sure it has been at least 3 weeks from your surgery before getting on a plane to reduce the risks of DVT’s. Be safe and beautiful!

Father’s Day 2018

Yesterday was Father’s Day, 24 hours to express gratitude to the men who have children. It is not as popular as Mother’s Day, and for good reason: women give birth to children after growing them inside their bodies for 40 weeks; men start their work only after birth.

Being a father means different things to people. Some are the primary caretakers, responsible for all aspects of a child’s life, and others are the only parent. These fathers deserve the highest of regard for being entrusted with raising good people. There is no job more important.

Other fathers are not present, either by choice, death, or other circumstances. This absence is hard to replace and burdens the Mother and other people in the child’s life. This can be a major factor in the type of parent the child will become.

Most fathers are somewhere in the middle, co-parenting in either the same house or different accommodations. They share in the child-raising and care. Whether married, separated or divorced, the presence of a father in a child’s life is almost always a good thing.

I am a plastic surgeon, so why am I talking about being a father? Because despite all of my education, training and abilities, being a great father is the most important and challenging role that I have. I can do thousands of cosmetic plastic surgeries, make so many people look and feel better, but I will be judged by the quality of human being my children become. If everybody felt this way, imagine what tomorrow’s world would look like.

A Great Patient Story

I see a lot of patients in comparison to most private practice cosmetic plastic surgeons. The traditional business model is to charge a large fee for the consult, make it 45 minutes long, and to establish a relationship with the patient while selling yourself as the best person for the job. Since the patient has already spent a real amount of money, you tempt them by allowing them to use it as a credit towards a surgery and they feel more obligated to sign up on the spot. I do not do this.
My mission is to serve the Hispanic community by providing affordable plastic surgery at a high level of expertise and to prevent patients from getting taken advantage of. Because of this, I charge a minor fee of $50 for a consult, one tenth of what Park Ave charges, so that even if they do not end up having surgery with me, at least they have received good advice and true information.
I am approaching the 50,000th patient who has made an appointment in my practice, and it is no wonder that I do not remember them all. I am pretty good at faces, but the names sometimes escape me.
I had a woman come in for a consult for abdominoplasty. I had noticed that she had undergone a breast reduction in 1996. After many years, it looked very well done, and I was impressed with the quality of the work. I mentioned to her that whoever did her breast reduction did a great job. She looked at me funny and told me that I was the one who did her surgery when I was at Columbia Presbyterian as Chief Resident in plastic surgery.
I was a little embarrassed that I did not know that I had done the surgery, but at the same time I was incredibly proud.

Income Tax and Plastic Surgery

Today, your taxes are due. Mine as well. Nobody seems to enjoy this day unless a refund is due them. That has unfortunately never happened to me.

Income tax refunds are used by many of my patients for plastic surgery. A check comes in that you are not expecting and you start to think of what fun things you can do with it. After a few years, you plan on it being there. I have always found this fascinating.

As income tax loan advancements became more popular, the surge in plastic surgery came a bit earlier. Now in late January to February, the dates are being filled up. Couple that with the Spring Break holidays and April is insane.

This is my 19th tax season at Yager Esthetics, and it always keeps me busy. Earning the money I need to pay my taxes works out well. In reality, the government is receiving a loan from the people who overpay all year long and then giving it back. After this, the people give it to me, and I send it back to the government. The circle of life!

I love it when tax season brings happiness to others. It is otherwise sad for me.


Today would have been the 47th birthday of an old friend.  He was a remarkably bright presence, and his smile made the world a better place. I miss him.

I met him when he was starting college at Columbia University and I was starting Medical School there. He had a back issue he had been dealing with, and it seemed odd to me.  I sent him to a Neurologist who found a spinal cord tumor.

He underwent surgery and radiation therapy which stabilized the mass.  He went on to finish his degree, get married, and have children. The one thing he could not control was the pain.

Narcotics, Toradol, spinal stimulators, medical marijuana, and all other attempts were not met with success.  Still, he lived with a smile on his face and was there for all.

Finally, after 25 years of suffering, he ended his life.  He had a party to celebrate the 25 years, it turned out it was just to say goodbye. I was not there.

The point of the story is that pain cannot be ignored or disregarded, be it temporary or chronic.  Take it seriously, and save the medications for when you need them.

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.

How Being a Drummer has made me a Better Plastic Surgeon

As some of you may know, I am the drummer in an alt rock band, Used Karmas. If you are interested, you can take a listen on Spotify, and hear our first album. What does this have to do with plastic surgery? Absolutely nothing.

As I have practiced and played the drums more, I have improved. It is no longer just keeping time and fearing a miss hit, it is a sense of rhythm, time, and what is called “the pocket.” Being in the pocket means that you are in rhythm, but you feel the whole song revolve around the time signature you set. This is a musical way of saying you are comfortable with the beat and can dance around it without losing it. It is sort of what happens with a great dancer who is really feeling it.

As I operate, I am in a zone where time, hunger, and the outside world do not exist. I am so focused on the case at hand that I literally do not look at anything but the field I am operating in. I reach my hand out for whatever I need, and it is placed in my palm.

As my drumming has gotten better, I have thought of operating in “the pocket” as a different way to experience surgery. I am still dead focused on what I am doing, but enjoy and feel the rhythm of the operation as if it were a piece of music. Having this time signature in my head has made my favorite thing even more enjoyable.

I guess I dance to the beat of my own drummer. Fortunately for my patients, I have never lost my groove.