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.


Labor Day 2016

It is Labor Day! Enjoy your day of rest and relaxation. This means that tomorrow, all the kids go back to school, and my teachers have to return to work after a summer of vacation.  The rush of plastic surgeries for the teachers is over, and now they start coming to book for Thanksgiving and Winter Break.

The first weeks of September are usually quieter for most people in my field, and an excellent time for vacation for me. I usually work hardest when most people are on vacation.  Although I am a professional and highly educated, I am a servant to the needs of the public, and therefore must make myself available at their convenience.

The side benefit of this strategy is that when I take vacation, most people are working.  This means the vacation spots are less crowded, and sometimes even less expensive.  You have to look on the bright side of things, as every seeming negative usually has a positive hiding somewhere.

The year has been quite rewarding for the first 2/3. I have a solid and stable staff, we just refreshed the entire Surgery Center OR and Recovery areas, and are getting ready to launch our new website design.  Our transition to electronic medical records continues, and we hope to be paperless by the end of the year.

Please keep reading weekly, as some exciting news will be revealed over the next months.  I will share details as they become finalized.  Enjoy the last day of Summer (unofficial), and get ready for an end of year to remember.


Is it Okay to Visit Cuba?

I was speaking to a patient the other day who was about to travel to Cuba. She is of Cuban descent, and she was born here in the US. She had mixed feelings about the trip, and would never have done it while her Cuban father was alive. He absolutely refused to return until the country was free.

I have other Cuban friends and patients, and the dividing line seems to be similar. The older generation wants nothing to do with the Castro government and is resentful of what they endured. The children are a bit unsure, but most want to see the island firsthand.

My patient told me that her children wanted to see where they were from, the places in the stories that there grandfather told them. The house where he was born, the building that he owned that is now home to 20 families. Even though he still has the deeds, there is virtually no hope of reclaiming it.

I understand both sides, and do not want to help a regime that has oppressed its people for so long unless my visit can somehow improve the quality of life of the people of the island. But how can I do that?

For now, I will wait and see what the future brings. There is no right answer, only what each person feels.


Aug August

It is August already, and as Summer marches on, I am reminded of the Summer of 1998.  It was my second year in practice, and I was not as well known as I am now.  For some strange reason, I got an influx of patients for breast implant surgery.

I was so excited that my practice was growing, and that I was making it happen for myself.  With no real money and a lot of school loans, I had managed to survive a whole year as a solo plastic surgeon in Manhattan.  I could feed myself and afford rent on a one bedroom apartment outside the city.  Sadly, this was similar to when I was a resident in terms of my disposable income.

I had always been very good at selecting breast implant sizes, even as a student.  Spatially, I could see a woman and a photo of what she wanted in terms of breast size, and instantly know the implant size required.  I never use sizers during surgery, nor do I order multiple sizes for a single patient.  I had been fortunate to have a patient or two who didn’t mind sharing the fact that they had surgery with me.

It came to pass that in that month, I had a string of days where nearly all the cases were breast augmentations.  At that time, it was far and away a record for most implants in a single month.  We called it “Aug August.”

Now, I sometimes do that many implant cases in a week.  Don’t worry, the breast is yet to come.


Sunglasses and Wrinkles

I have always been blessed with perfect vision.  I never liked to even wear sunglasses or hats to shield my eyes.  It was a feeling of freedom to have nothing on my face.  I thought that glasses were foolish if you did not need them to see, and used for status symbols or fashion and attention if they were not prescription.

I have come to realize that sunglasses are important in anti aging. They can prevent wrinkles and discoloration, and potentially even eye cancer.  I have since started wearing them, and so should you.

When the sun is bright, it can cause you to squint, thus making crow’s feet lines that over time might need Botox to treat.  The lines can become permanent over the years, aging you.  Sunglasses with proper uv protection can filter these harmful rays.

Melanoma can occur in the eye, and sun exposure is always a factor, so shielding the eye from the sun seems to make a lot of sense.  Always check with your doctor if a new dark area appears on the eye.

The sun also ages skin, causing a breakdown of collagen and elastin fibers that can lead to sagging and thin skin, wrinkles and discolorations.  Proper lenses can filter out these uv rays and keep the periorbital area looking youthful.

So go ahead and splurge on some cool shades, as long as they have proper lenses and size to protect the area well.  You can look great as well as maintaining your youth.  Total win-win.


Bra Strap Fat

As I enter my 20th year in private practice plastic surgery, I think back on everything I have learned since finishing my training.  Ninety percent of what I do was not learned in my training.  One area which is not mentioned in any anatomy books or plastic surgery articles is bra strap fat.

Bra strap fat is the roll or bulge that can be seen above and/or below the bra in the back of a woman.  Sometimes it is excess fat, sometimes loose skin, and other times it is simply the creation of wearing a bra that is too small or tight.

Usually, I do not get asked to treat this alone.  With good liposuction of the back, the area will disappear.  It is important to point out to patients before lipo if there may be an excess skin issue with the “BSF” appearance being created.

I have written hear before about women wearing the wrong bra size.  A bra that leaves marks on the skin after being removed does not fit.  Do not be worried about what the numbers say, get the bra that fits.  Stores like Soma, or lingerie departments in Lord and Taylors or Neiman Marcus will be happy to help you understand your size at no cost to you.

Help eliminate BSF, and restore lycra confidence in all women!


I Finished Listening to 1001 Albums I Must Hear Before I Die

As I am in the operating room for 20 hours a week, I have ample opportunity to listen to music.  I had read a book a few years ago, “1001 Albums Yu must hear before You Die.”  It took me a year, but I managed to track them all down.  A year ago, I started listening to them in alphabetical order and just finished last week.

Listening to them could have been done chronologically, to see how music progressed, randomly, or alphabetically.  I chose the abs’s, as that is how I had them arranged anyway.  This order lent itself to a random mix of genres and time periods that left you guessing what was coming next.

I am very open minded about what I listen to, and the process of listening and doing plastic surgery makes me reach new creative heights.  I think of plastic surgery as Jazz, or Social Music as Miles Davis calls it.  There are basic rules that must be followed, but you should explore and innovate where need be to truly create art.

I did not love every cd, but I have a much deeper understanding of music and how it interconnects across genres.  It will definitely help my band, Used Karmas, in the writing of our second album.  I just hope that I don’t have to die since I have heard it all!


June is Busting out all over

It is the end of the first half of the year this month, and I have noticed that June seems to have an increased number of breast procedures. Mainly, it is breast augmentation and breast lifts and a combination of the two.  Breast reductions tend to happen in the fall and winter for some reason.

I theorize that it is due to the warmer weather, when thoughts turn to the beach and more revealing clothing.  Also, teachers, college students, and many other professions have time off over the summer to recover.

As I get ready to start year 20 in private practice cosmetic plastic surgery, I have noticed a trend toward fuller upper breasts.  The number of simple breast lifts that I do has gone down, compensated for by the increase in breast lifts with breast implants at the same time.  The lift fixes the nipple position and shape, while the implant can add the volume to the upper pole of the breast.

What was long considered the normal and natural breast appearance is no longer what most patients want.  While I refuse to make fake looking round balls on a woman’s chest, I do think that the right sized implant can artfully improve the results of most breast lifts.  I use them more for fullness than size.

If you have some time off and have always been curious about your breasts, please come to Yager Esthetics.  There are a host of new implant types and shapes, and the lift techniques have options as well.  Find out why June is busting out all over!


The Ramones and Plastic Surgery

I recently went to the Queens Museum, and was amazed by the special exhibit on the punk rock group, The Ramones. Just four guys from Forest Hills High School who captured a spirit that sparked a great revolution in music.  With a distinctive sound, short lyrics, and a look that changed fashion, The Ramones remain one of the most recognizable groups in rock history.

In some ways, I identify with the group.  When I was finishing my training at Columbia, the path of wisdom for me would have been to join a practice, join an academic institution, or go to a hot bed of plastic surgery like Park Avenue or Beverly Hills.  I had an independent thought.

Opening a beautiful high rent office in Washington Heights, 100 blocks from anywhere, and marketing to the Hispanic community was not just outside the box, it blew up the box.  The more I was told I couldn’t, the more I wanted to make it happen.  No one was going to tell me my instincts were wrong, and if I failed, it would be on my terms.

Now, 19 years later, I am continuing to rock out at Yager Esthetics, creating some of the most compelling work around today.  I err on the side of helping people, no matter the consequences, and 99% of my patients are pleased.

To those on Park Avenue, I wish you the best.  Keep imitating and following the formula.  I will blaze my own trail.  To my Latina friends,  “Gabba gabba, we accept you, we accept you, one of us! “


Make Your Plastic Surgery Fun

As I get ready to start my twentieth year at Yager Esthetics, I think back on all the different patients I have had the pleasure of helping.  Each personality is different, and a good doctor must adjust accordingly.  My interactions with each are professional, but vary in style.

There are the nervous patients who are embarrassed to even mention what they want done.  They are reluctant to be examined, and are more shy about having my female escort see them than myself.  I have to stay calm and soothing, and let them go at their own pace.  I can usually put them at ease enough to give them the information they need.

There are the totally dominated by the husband/boyfriend/family member types.  These patients do not open their mouths, but have others spoken for them while they look down or away.  The key is to make sure that the desire for surgery is their own, not that of the other, and to empower the patient to take control.  Sometimes I have to remove the other person from the room to get this done.

There are the crazy patients who come in two varieties- quirky and dangerous. The quirky ones just have their own view on life, and you need to make sure you are on the same page with the esthetic they are looking for.  They are enjoyable.  The dangerous types have no moral compass, or a skewed idea of what to expect.  I was taught that you can’t argue with crazy, so I try my best to avoid operating on these patients.

The confident patients are the easiest.  They know what they want, take personal responsibility, and are doing the procedure for themselves.  Never an issue.

Lastly, there are the soul vampires- people who feel they own you because they paid for a procedure.  They want 24/7 access to you forever, not just for emergencies.  They take all of life’s problems out on you, and refuse to be happy.

I say, enjoy the process of plastic surgery.  It is happy surgery that you choose to look better.  Let your personality show, be honest and open, and don’t be afraid to laugh at the process.  Remember, we are sticking bags of gel and water in our chests, sucking out fat we refuse to diet away, and trying to fool the world into thinking we are younger by tightening skin or injecting goo and toxins in our faces.  It is ridiculous, but it makes people happy.