Other People’s Plastic Surgery

As a Board Certified Plastic Surgeon in his 22nd year of private practice, I have seen many people who have had prior cosmetic procedures done by other doctors. I am often asked my opinion of the work. I try to avoid this answer at all costs.

One rule I have is to never ask who performed the surgery, as I do not want anything to bias my opinion in either direction. My personal feelings toward a particular doctor, or my prior experience with patients of his/hers, should be left out of the equation.

I also state that it is impossible to judge a result without first seeing the before photos from the surgeon (no offense, but some patients use a before photo that was altered or from many years in the past that do not reflect the true appearance on the day of the surgery). A slightly wider or larger breast on one side may be a horrible error, or a miracle of surgical wizardry to even approach two even sides.

With regard to scar quality, unless it is horribly malpositioned, often the scar depends mainly on the genetics and skin of the patient and the care given after the procedure. An ugly scar does not mean your surgeon did a bad job. When I revise scars, I even tell patients that there is no guarantee it won’t look worse.

I advise patients to look forward, not back. You cannot change the surgery you had, but can try to achieve a better result in the future. I am always happy to have an honest discussion of the options for improving prior surgery, but you need to let go of anger and be positive for a healthy start on getting better.

Presidents Day 2019

Today is Presidents Day, a made up arbitrary Monday in between George Washington and Abraham Lincoln’s birth dates so that we can have a 3 day weekend instead of 2 random days off. While I have tremendous respect and gratitude for both great men, I doubt that even 1% of the people who take the day off will spend even a moment to honor either man.

I guess I have a problem with the concept of moving the date of a holiday observance to a Monday so that people can have three days in a row off. Is the holiday a paid vacation, or the intended honor of a person or event? Is it about travel or respect?

I especially love it when a holiday falls on a Saturday or Sunday and they still declare Monday a holiday, lest someone think they are being cheated out of a day off. Heaven forbid we celebrate when we are not working.

My suggestion is to honor the intent of the holiday, be it on the actual date or a Monday. Let it not be a day of X Box and sleeping in, but one of discussing the meaning of the day. Visit a museum, donate your time to a charitable cause, or even read about the history of the holiday. Even if this is just for an hour or two of the day, it is honest and genuine.

Valentine’s Day 2019

It is a few days before Valentine’s Day, so I hope you who participate have made all of your arrangements for dinner reservations, flowers, and chocolates. Jewelry, for those who prefer, can still be purchased.

For me, I would like to send a Valentine to Plastic Surgery, whom I have loved for over 30 years. But how do you send chocolates to a field of medicine? Can flowers be appreciated by techniques? Do books appreciate jewelry?

I show my love for plastic surgery through my faithfulness to her principles. I never wander from her scope of practice, am loyal to her core principles, and do not entertain thoughts of other specialties. Despite being committed as a Board Certified Plastic Surgeon, I participate in a lifelong program of study to maintain my certification, and try not to forget all I have been trained to do.

I have sacrificed a lot to stay with Plastic Surgery. I spent so many years in Medical School, Residency and Fellowship to prove myself worthy. Many sleepless nights spent in hospitals, missing many events due to the demands and needs of the practice.

I want to say that with each year I love Plastic Surgery more. As I age, I understand its importance more. Even if I put away my tools one day, I will always be a Plastic Surgeon in my heart.

The Super Bowl of Surgery

Every year, a billion people or so gather to witness the NFL championship game being played by tuning in to the broadcast. It goes beyond mere sport, it has become more of a shared cultural experience that transcends gender, race and religion. Even the interruptions in the action, the commercials, are met with eager anticipation.

What if there were a Super Bowl of Plastic Surgery? The best surgeons going through a season of patients, followed by the highest ranking few having a playoff until the final top 2 remained. It would be the reality show to end all others.

The commercials would be equally interesting, with many industries wanting to cash in on the beauty interested public. Make up, hair care, fashion, nutrition, exercise, as well as luxury goods would kill for the opportunity. Celebrity endorsers would be simple to find.

Imagine the technology that would be employed. Cameras from every angle, graphics on ideal angles and proportion, slo mo replay- it would be amazing. The venue would unfortunately not be large enough for a big audience.

And finally, we could have a panel of judges, enhanced by a phone in vote from the public. There can be world famous plastic surgeons as well as patients who have had a lot of plastic surgery serving to compile the scores. Imagine, the winner would actually be the patient!

Scars are Forever

I had a patient come to me for a second opinion consult after having had a breast and body surgery done elsewhere. This is not surprising in itself, as I see so many people dissatisfied with results of other plastic surgeons. What was unique was that she liked everything about her procedure except the scars. And the scars were perfect.

Each body heals differently after injury, and as a Board Certified plastic surgeon, I am well trained in techniques to try and hide or minimize the appearance of scars. The overwhelming majority of my patients heal well, but not 100% Having a thick, dark, red or even keloidal scar is not always the result of a poorly performed closure. In fact, I would place the majority of the scar on the patient’s skin type.

I always discuss scarring with patients before performing procedures, and it is spelled out clearly on all of my consent forms. I even work with the patients at every visit, advising them as to the best care of the incisions. We offer treatments including creams, lasers, microneedling, and injections.

I had to explain to this patient that her scars were of good quality and no further treatment was needed or advised. That the most important word of the two word phrase “plastic surgery” was “surgery”. The patient left unsatisfied, thinking all plastic surgeons stick together. She said she had the surgery part, and would find someone to fix the plastic part. I wish her good luck.

Income Tax Refunds 2019 and Plastic Surgery

After 22 tax seasons in Washington Heights, I have come to know that many patients utilize their income tax refund checks to finance plastic surgery. It is kind of like found money, and it is a forced savings plan for some.

This year, we are in a government shutdown, and the thought is that these checks may be delayed. The IRS is a government agency, and they will be far behind in the processing of these refund checks. This may lead to a delay in surgery.

February is when the fever usually starts, and it flows into August, as the schools let out and more people have time off. It will be interesting to see how the flow goes this year.

So with all of the craziness and partisan politics, none of the law makers have to forego their salaries as the other government employees do. The people living paycheck to paycheck who can least afford it are the ones getting pinched.

My message to those in charge is to start acting like grownups and learn to play together. Remember, you are in office to serve the people, not your party’s interests. Put the American people first. Do not delay cosmetic surgery. Make America Beautiful Again!

My Friend is Having Surgery Tomorrow

Plastic Surgeons are people, and they have friends and family like everyone else. We get sick, go to see doctors, and even need surgery at times. One of my favorite people is having surgery tomorrow. He is also a doctor, although not in my field.

Just like anyone else, he is a bit anxious about it. He knows that the overwhelming likelihood is that the surgery will go well, and no complications are anticipated, but a tiny bit of fear and respect always creeps in.

Doctors can be more nervous than the public at large, as they think of all of the cases that they have seen and heard of where something goes wrong. Will I wake up from the anesthesia, will they discover something they didn’t anticipate, what if I have a previously undiscovered allergy or medication reaction? Sometimes too much knowledge can be a negative.

As a physician and a friend, I am concerned for his well being, and have spoken to him about the procedure. I try to assure him that all will go well without invalidating his concerns. When it comes down to it, I will not be in the operating room, and he will not be able to participate in his own operation, so we are merely spectators as are most people in this situation.

I will think good thoughts, send positive vibes and be supportive, but as a doctor my degree is useless in this circumstance. Plastic Surgeons are people just like you.

2019 at Yager Esthetics

As we march through our 22nd year here in Washington Heights, the beginning of the year is a good time to lay out our vision for the calendar of the next 12 months. We try to stay fresh and relevant, and always work to improve the patient experience and what we can offer.

We have greatly expanded the nonsurgical offerings, utilizing the latest techniques of microneedling, PRP, and next generation lasers for tattoo removal, facials, scar corrections and skin rejuvenation. Upgraded RF technology allows for better skin tightening and minor fat reduction. Our skin treatments have really taken off with the latest skin care only offered through MD offices, and we have tailored them to our Hispanic patients as we do for all treatments.
We have created a custom electronic charting system which we will roll out to make less waste of paper and allow us instant access to each chart. We continue to add to it with patient portals so that you can access information from your home.

We will be upgrading our social media outreach with professional and educational posts to keep you up to date on hot topics and even on our pop up events and seminars and special offerings. More videos and quick advice on your questions are coming.

While we like to keep current, the one thing that will never change is our commitment to the Hispanic community and providing unsurpassed quality and information to keep them educated as to the safest and best options available. After 22 years here, I still feel I improve every day, and my passion for helping patients achieve their dreams burns strongly within me.

We look forward to seeing you in 2019 and beyond!

Christmas Eve 2018

Twas the night before Christmas and all through the Heights,

Not a fat cell was bulging, not even through tights.

The fajas were off, on the floor in a pile

Looking in mirrors, all patients did smile

For their surgeon had reshaped them with skill and with care,

In the hopes that bikinis and spandex they’d wear.

They needed no bras or scarves on their necks,

No filters were needed when photos they’d text.

With confidence and self esteem they were filled,

And all of their partners were certainly thrilled.

As he left the OR with the last patient done,

Dr. Yager’s battle against aging was won.

As he left in his car and drove out of sight,

He said “Happy Christmas to all, and to all skin stay tight!”

Simplicity in Plastic Surgery

Since I started Yager Esthetics in 1997, I have seen tremendous changes in the way in which plastic surgery is marketed and consumed.  Like with most change, there has been good and bad.

In the past, in order to establish yourself in practice, you either joined a well known plastic surgeon or group as a junior partner, learned from them, and eventually grew your own patient base.  Many would seek out emergency room call to fill in the time.  The brave few would strike out on their own and try to attract patients via friends and colleagues, or host seminars to educate the public.

The next wave was reality television, as you let a production team film your life in and out of the office, making you a more household personality.  Public recognition helped leapfrog the years it took to build your name the old way.

Now, everyone wants to start at the top, and attracting attention is usually done via social media.  People in my field have gone so far as to don costumes and do singing acts in the operating room while performing surgery.  The reach is farther and more frequent than reality tv, enabling an instant impact.  The more extreme, the bigger the audience.  Many are not even plastic surgeons, but dermatologists, ENT’s, and OB-Gyn’s.

I started on my own, and built my practice by giving excellent service to each patient, and treating them all with respect.  Over time, patient to patient referrals have gotten to the point that I am one of the most well known and respected board certified plastic surgeons in my community.

My advice is to be true to your ethics, put the patients’ needs in front of your own, and be fair to them.  Simple and effective, but not instant. Just like in cooking, taking time and love inpreparation tastes better than instant.