Dialectics in Plastic Surgery

Dialectics, for those of you who were unaware, are two seeming opposites that can both be true. Still confused? I am happy to expand on this topic. It was complicated for me as well.

The statements “I am doing my best” and “ I can do better” create a dialectic. On first glance, if you are doing your best, how can you be able to do better? I struggled with this. I then realized that doing my best at this moment means that with my state of mind, physical abilities, distractions and time constraints, the results are my maximum effort for these conditions. I can do better indicates that with further training, a better night’s sleep, more experience, I can still learn to improve.

What does this have to do with Plastic Surgery? I have had, over my more than 20 year private practice career, instances where I did the surgery perfectly, yet I could see ways to improve the result afterward. I did my best, but I also believe that a better result can be obtained. These are the key to being a great Plastic Surgeon, understanding you always do your best but that you can do better as well. Without this, you either doubt yourself or never improve.

If a patient comes to me after having surgery and points out an area that is not perfect, I remain humble and open minded. I explain that I did everything perfectly, but acknowledge that improvements might be possible. That is what a touch up or revision procedure is all about.

It is important in my profession, as well as in life, to understand other peoples’ perspectives, as well as to share with them your own. Both of you can be correct. That is how I choose to interact with my patients. Mutual respect and understanding can solve virtually any situation.


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.


Zapatos Baratos Salen Muy Caros

It is said in Spanish that cheap shoes can be costly. This is a phrase that is applied to buying something inexpensively that ends up costing you much more in the long run. Unfortunately, it applies to cosmetic plastic surgery as well.

Being in Washington Heights since 1988, and in my private practice, Yager Esthetics, since 1997, I have seen my share of poorly performed plastic surgery, as well as procedures done by unlicensed people resulting in often irreparable damage.

The procedure that irks me the most is silicone injections. Sometimes, as in the lips or cheeks, it simply results in a disfigured shape. Surgery can sometimes debulk and assist in correction.

Injections in the buttocks are more common. Some patients develop abscesses or infections, others get hard balls, others create a rock hard contour that can be painful and change color. There are cases that I prescribe steroids for comfort, others I inject, and others where I can simply use a liposuction technique to reduce the silicone load. Some, I can offer no help, as the cure is virtually an amputation of the skin and tissue which I do not feel comfortable doing.

I recently had a woman who had silicone injected into her breasts. She had red damaged skin, hard masses, and a disfigured appearance. She was devastated, and it ruined her self esteem and relationships. I was able to perform a partial mastectomy with implant reconstruction and a lift which miraculously even preserved nipple sensation. She was lucky, but it cost her 10 times what the injection did.

Be smart with your health and body. There are places to save money, but plastic surgery is not where I would suggest.


Being a Good Patient Escort

So, you have carefully vetted your Plastic Surgeon, insuring he/she is Board Certified by the American Board of Plastic Surgery, and that he does plenty of the procedure you want with great photos of results you like. He/she is a good fit emotionally and trust wise, and has the experience to make you feel confident. You have gotten great patient recommendations, and are ready to go.

The office looks great, the Operating Facility is accredited, and the staff seems warm and professional. All goes according to schedule on their end, so no problems, right? Um, what about your situation at home or wherever you will be recovering? Who will be helping you?

Oftentimes, people think about things like walking up stairs, or where they can be comfortable sleeping. They make arrangements for child care and coverage at work, and make sure they have the house stocked with the food they will need. What they do not always choose wisely is the escort.

The patient escort has to get you to the office on time, and have the means and abilities to take you home safely and care for you. They will be given all the instructions, as you are just out of anesthesia, and may not remember or be able to do it all on your own.

You need to choose someone smart and capable who can deal with medical situations without panicking, and that can make you feel safe and calm so that your recovery is uneventful. People who annoy you or get under your skin should be avoided. Jealous people who will try to knock you or your decision to have surgery can be toxic as well.

Your patient escort should be positive, supportive, and caring, and want you to look and feel your best. My office and I do everything in our power to take the best care of you, but it is up to you to select the best patient escort.


Beware the Brides of March

While most brides choose June or another warm month to get married, the preparations start much earlier. In some cases, years in advance. What is dangerous is when it is March, and the wedding is less than 3 months away, and the diet and exercise plans are failing.

Sometimes, the brides turn to a plastic surgeon to help the magic moment of their nuptials come off like the fairytale they have imagined since they were 5. Other times, it is the mother of the bride either pushing their daughter into it, or trying to do something for themselves.

The problem is that when a woman comes in a few months before their biggest day ever to date, by the time all the testing and scheduling is completed, there is zero margin for error. Flights have to be safe, dresses have to fit, swelling has to be gone. Heaven forbid a complication occurs and there is no time to revise a result.

I choose my Brides of March carefully, as my reputation depends on my results. Ruining a wedding is something I hope never to do. I must, therefore, insure that expectations are realistic, that the timeline is safely doable, and that the motivations and health of the woman are both sound.

If you are planning a wedding, and part of your happiness depends upon cosmetic plastic surgery, start waaaay in advance, at least 6 months. The stress of getting married is high enough. Let me help you achieve your goal in a relaxed and peaceful way.


Laser Tattoo Removal is here

After years of requests from my patients, I finally have the technology needed for safe tattoo removal in darker skin types. It is so important that I offer only treatments that work for my patients, and do not simply market whatever is new and in the news. The trust that I have built in the Hispanic community over the last 20 years is vitally important, and no amount of money can make up for it.

The technology started 3 years ago, and has improved to the point that I feel it is the gold standard for tattoo removal of all colors on all skin types. It is faster than the old lasers, and requires fewer treatments to clear. It is also less painful.

Not everyone is a good candidate, and older tattoos are easier to remove. If you make a mistake in judgment, you have to wait 3 months to laser it off. Our system has 3 different wavelengths, so even the trickier colors can be treated.

All who perform this treatment have passed a comprehensive laser safety and science program, and received training hands on with a certified company trainer. They have all practiced on actual patients and staff, and only those with the top skills are allowed to perform this service.

I love adding a new tool to our shed, especially one as amazing as this. Call or email us for questions, and to make an appointment. Introductory special pricing will not be available forever, so get rid of that exes name or that poorly drawn picture. No regrets!


Loyalty and Plastic Surgery

I always look for the good in people, and believe that deep down, all people want to do the right thing.  Until proven wrong, I place my faith in other people every day.  My employees are so critical in maintaining a safe and pleasant experience for each patient, and we train each one for a tremendous amount of time.  I want each person who works at Yager Esthetics to be a great ambassador for the practice, and to comport themselves as an honest advocate not only for the practice but for the patient as well.

Being in private practice here for 20 years now, I have had many employees.  While I am dedicated to the practice, many of my employees go on to get married, have children, move out of state, or get degrees or return to school.  As their lives change, sometimes they have to move on.  I am happy when I see them grow as people and go on to do great things and achieve happiness.

I tell each employee from the beginning that if they reach a point where they are not enjoying their work at Yager Esthetics, to let us know immediately.  We try to see if there is a modification that can be made, and if not, are happy to help them transition to another field or adventure in life.  We only ask for the professionalism and courtesy of being honest and upfront with us, and giving the time needed to seek a replacement.

Over the years, we have been very successful by treating patients and staff in this respectful manner. Of course, my trust has been betrayed on a few occasions by less than honorable staff.  I would rather live my life believing in the good in people than being mistrustful of everyone.  I will not change for the few bad apples.  They have to look in the mirror and live with who they are.


Rocktober at Yager Esthetics

As we are now rolling along in October, I get to enjoy some of my favorite music in the OR.  Classic rock is the music of my youth, and everything from Heavy Metal, to Hair Metal, to Alternative and Grunge will make the playlist.

Operating to music makes everything better.  It activates my creative brain, puts the patient more at ease upon entering the room, and keeps the energy level of all of my employees up throughout the session.

As a recording artist with an album under my belt, (Used Karmas- check it out on itunes, Spotify, or at usedkarmas.com) it keeps me humble to know how much better everything we listen to is than my own music.  If it weren’t for all the cosmetic plastic surgery, I might have the time I need to get better.

The mood extends into patient days as well, although we do not pump metal into our waiting room.  Sometimes Spanish Rock sneaks in, with Jarabe de Palo and Mana.  It is all rock and roll to me.  It is my tribute to the music that fed my soul growing up.

Please join me and appreciate the Rock inside of all of you.  Be it at work if possible, in the car, at home, or during exercise.  Rock on, my brothers!


The Most Valuable Gift from a Patient

I am a Board Certified Plastic Surgeon, and I do not complain about my income.  I could certainly charge more here in my 20th year of private practice, but I try to keep plastic surgery accessible to working people in my Hispanic community.  I do not expect anything more than what I charge for each surgery, and feel it is a bargain for what is provided.

Some of my colleagues on Park Avenue charge considerably more, and are often given expensive gifts as a routine by their patients.  I have heard of expensive watches, jewelry, use of vacation homes, and even a car or two, far exceeding the value of the surgical fee.

I recently received a wonderful present that I feel is worth more.  A young woman, very quiet and respectful, came back one year after her surgery to tell me how much her surgery meant to her.  She felt that it helped her self esteem, her job, and her relationship, and wanted to thank me so much. I was touched and grateful for the appreciation, and then she handed me an envelope.  Inside was a Starbucks Gift Card.  She wrote “Thank You For Everything.”

It may not have the street value of a Rolex, but the thought was far more precious to me.


The BRA- Thinking Big While Going Smaller

One of my favorite operations in plastic surgery has always been Breast Reduction.  It is the only operation I still do that is not purely cosmetic.  It has been done for over 100 years, though techniques have changed.

I had always been very happy with my results, and still think my traditional breast reduction results compare to any I have seen.  The one thing I did not like, and is a limitation in breast lifts as well, is the lack of fullness in the upper part of the breast to make it seem more full and youthful.

Patients come to me because they have very large and heavy breasts, and want to remove the extra weight, and lift them so they appear more attractive.  What they want to look like is someone who had breast implants.  That’s when I got inspired.

Why not do a breast reduction and put in an implant at the same time? Breast Reduction Augmentation- BRA.  Of course, you need to be very careful technically to insure you preserve sensation and blood supply to the areaola and nipple.

I have performed the BRA about 30 times now, and have been more than thrilled with the results.  Implant selection and care with the size is crucial. I hope to publish my series soon.

So, going smaller does not mean it is necessarily a reduction alone.  Sometimes you need to go back a little farther to move ahead..