Why I Became a Plastic Surgeon: It Started on a Monorail at Age 8

How a monorail ride shaped a plastic surgeon. How can a monorail ride taken at Disney World at the age of eight impact the rest of someone's life? I'm gonna tell you at the end of this video. What you're gonna see is a journey. Let me tell you something.

How a plastic surgeon analyzes every face. I have been analyzing people's faces for as long as I can remember. Analyzing them, asking myself what's attractive, what's less than attractive, what makes their face work, what is the key feature that drives their identity. I've been thinking about this for so long. So long. I think about it. Every time I'm out, I'm looking at people's faces. I'm doing surgeries on their faces, whether they like it or not in my mind. I'm looking at their faces and thinking about how would they benefit from a facelift. Are their brows low? Do they have too much excess skin in the upper and lower eyelids? What are the proportions between the neck and the face? I do the same thing with noses too. I ask, how does that nose balance with the rest of the face? What are the features that need to be changed to complement the rest of the nose and the rest of the face.

Let your lives speak: a Quaker principle. I went to a small high school, happened to be a Quaker high school. Not many people know what Quakers are, but Quakerism was started by someone by the name of George Fox. He had a principle in mind, and it was called “Let your lives speak.” And I've always, always felt that that's an important way that we should understand people. What are they trying to tell us? What does their life tell us? I also believe that everybody's life is essentially a universe of experiences, of interactions, and it's also a universe of impact on other people's lives. We as plastic surgeons have a very, very important role in people's lives. We alter their appearance and we do it in the context of people trying to reimagine the way they project themselves to the world. This is really important work. It's really important work, and I treat it very seriously because of those reasons.

Why do patients choose plastic surgery? I don't know how many of you know who Simon Sinek is, but he's a thought leader, both in the business community realm, but also from a psychological standpoint or a psychological evolutionary biology framework. And he has something called the Golden Circle. And what he says is, things that drive people's decisions aren't necessarily the what or the how, but it's the why. And I really care about the why when I'm interacting with patients. I really care about it. I try to understand the why. Why is it they're sitting in front of a plastic surgeon? Yes, I care about the what, like what features don't they like? And I'm gonna help them work through the how. Obviously, that's my role. But the why, a common understanding of their why is really important for me to understand. When I'm engaging with a patient who's going to undergo a really serious thing, such as a facelift, such as a rhinoplasty, such as a breast augmentation or abdominoplasty, that's really important. Really, really important. Now, the why. The why. The why is often that patients feel a discordance, a lack of coordination between what they see in the mirror and how they feel. Let's say for the face, people see themselves and they feel that their facial features and perhaps what aging has done to their anatomy, they feel that that makes them look more tired, less engaging, less happy than they really feel on the inside. And they recognize that can have an impact on the people around them. They find it difficult to let their lives speak. They find it difficult for whether they can put their finger on it and understand it. They find it difficult for their universe of possibilities to be expressed outward, to have a positive impact both in their lives and other people's lives, to have meaningful experiences. I know that this is really philosophical, and I know perhaps it's a little bit of an overreach, but I really do believe this. And I need to understand people's why. What is it that's motivating them to have surgery? In what aspects of their lives do they feel they lack confidence? In what way do they feel making a change in their appearance would impact their life? It's really important to investigate that.

Why I became a cosmetic surgeon. And it's important for patients, for future patients, to understand my why. My why. Why am I doing this? Well, there's the simple things. I do love working with my hands, and I like to help people make changes in their appearance through surgery, things that they can see almost immediately, these sort of immediate moments of gratification where you can really see something has changed. I love being a part of that. But more profound than that is in terms of my why. Like, why am I doing plastic surgery? Why do I do cosmetic surgery? It's because I want to have people feel easier in their skin. I want them to look in the mirror and truly see themselves. And I want them to know that they can go about their day projecting outwards what they feel on the inside. Those things are really important to me.

Self-conscious about my ears as a kid. Let me tell you a little bit more about my pathway to becoming a plastic surgeon. Okay. I told you about a monorail ride. And I'm going to tell you a little bit more about that at the end of this conversation. Shortly after that, age of eight, shortly after that, I started, as we often do, become aware of our own appearance. And believe it or not, you probably can believe it because you're looking at me, that I used to be very self-conscious about one particular aspect of my appearance, and that was my ears. Arguably, my ears stick out a little bit, right? A little bit, okay? It's not terrible, it's a little bit. Stop focusing on them. A little bit, okay? My ears stick out a little bit. And when I was younger, it bothered me a little bit. Not enough, actually, that I even talked to my parents about an otoplasty, because even then, you kind of research these things, understand these things. But it wasn't that much, but it was enough that I noticed it. And I remember kind of how I felt about it. You know, for me, I was able to kind of work through that, if you will, without surgery. But I kind of recognized how being preoccupied with your appearance can have an impact on the way you feel sometimes. So that was another factor that contributed to sort of my understanding of what plastic surgeons do, what they have the potential to do, what they have the potential to do for other people, and what I would like to do with the rest of my life. Believe it or not, that was like when I was 10 or 11 years old. I can remember at my great aunt's house looking in the mirror thinking this. It's true, I'm not making this up. Okay, now fast forward to the age of 12.

Microtia ear reconstruction that inspired me. All right, age of 12. Now, let me give you a setting. My father's a doctor, he's an OB-GYN. And so, being a doctor was something that was, you know, a potential reality to me. And another thing that was true is I did pretty well in school and I liked the sciences. And I liked working with my hands. I was actually really good in art class. In particular, I was good in the projects where we were working with clay, kind of building things with our hands, really did quite well on that. Really loved it, really enjoyed it. Okay, so father's a doctor, I like working with my hands. And something came on TV one evening, and it was this documentary. It was a documentary about a woman, a young woman, she was in high school at the time of this documentary, who was born with very small ears, essentially without ears. She had what is called microtia, or small ears. It's a condition that I actually ended up taking care of young kids for this later in my career. All right, and this documentary chronicled her ear reconstruction by someone by the name of Joseph E. Murray. Now, Joseph E. Murray, and you can look this up, Joseph E. Murray is a plastic surgeon, get this, who won a Nobel Prize, right? What in the world would a plastic surgeon be winning a Nobel Prize for? It's actually really interesting. He is the first one who did a kidney transplant. That's right. Yeah, plastic surgeons, plastic surgery happens to be a super innovative discipline of medicine. And it allows people to think outside of the box and solve really challenging problems. Anyway, so later in his career, he went back to doing more traditional plastic surgery and he was building an ear for this young woman in this documentary, this young high school student. And that was really cool. And just hearing about the process of taking someone's rib and building it underneath the skin, and, you know, it's just amazing surgery. And that's why I ended up actually doing this kind of stuff later in life. And, but what I was most impressed with, and again, this gets back to the why, this gets back to what motivates me to do plastic surgery and gets back to make me feel like it's like a compulsion to understand why people are undergoing plastic surgery. In this documentary, they interviewed her classmates in school, and what they revealed was so fascinating. They said that this young woman, that she, they didn't really know her before she had surgery. She was very shy. For the most part, she ate lunch alone. She was quiet. She didn't interact with many people. Now, afterwards, during this documentary, after they showed the ear reconstruction, the present time of the documentary, they're saying, like, she's like an active part of the school class. She's got many friends. She's going to parties, you know, she's part of clubs. And that said enough to me. I mean, that said a world to me. If you hear someone else's, you know, someone who's not the patient, being able to say what happened to a patient from the outside, we know that this surgery, like many, many plastic surgery procedures, cosmetic surgery procedures that change the way people look, we know that it lets a patient's life speak, their life speak, right? Remember, I was telling you, they barely interacted with this young woman. And then here she is, at the time of the documentary, is like fully integrated into social circles. So that I was 12 years old. Hook, line and sinker, I knew that I was going to become a plastic surgeon.

From Swarthmore to plastic surgery residency. So I finished high school and then I went on to go to Swarthmore College, which is a really intense liberal arts institution where I was exposed to all sorts of different trains of thought, different disciplines of study. Believe it or not, I did equally well in my like English classes with writing. I love like, I did a class in film history, amazing architecture, archaeology, Greek archaeology, Roman art. I mean, just art history, like really incredible stuff. But of course, I did my core sciences. And fortunately, I did well enough that I went off to medical school. Now, I chose Baylor College of Medicine because, and this is before you could use Medline to research journal articles, I used sort of a computerized index, if you will, where you could do some very simple cross-references. So what I did was for every medical school I was applying to, I ended up cross-referencing plastic surgery and that medical school so I could determine what medical schools I was applying to were producing the greatest amount of plastic surgery literature in a particular year. And I used that as a guide. I figured like if they're making a lot of, if they're producing a lot of papers in plastic surgery, that's a good institution. And that's what led me to Baylor College of Medicine. I'm so glad that it did because it was such a well-rounded education for plastic surgery, right? Okay, and so then what happened is from the very beginning, I became very involved with plastic surgery. I started as a medical student already doing research into fat cell biochemistry, to bioengineering and how to work with fat cells, fat grafting very, very early. Other work involved with plastic surgery, got involved with the department. And because they knew me so well, they ended up taking me as a plastic surgeon. I did that. And some of my early experiences that I so enjoyed were working with Dr. Stal doing cleft lip, cleft palate rhinoplasties, cosmetic rhinoplasties, Dr. Steven Hamilton doing facelifts that at the time were really modeled after Bruce Connell.

Facial and oculoplastic surgery fellowships. When I finished my residency though, I knew I really wanted to be able to deliver patients the highest level of care that I could. And so I went on to do two fellowships each six months. I went on to do a fellowship focused on facelifts and rhinoplasties, but also migraine surgeries, believe it or not, with Bahman Guyuron, a world-renowned leader in all three of those areas in addition to others. And that's where I really started to understand deep plane anatomy for facial rejuvenation, facelifts, deep neck anatomy, submandibular gland, anterior belly digastric muscle reduction before it became so popular and trendy. So I have very early exposure to that, been doing it for many, many years, greater than 19 years now. And then I went on and I did a fellowship that was a mixture between oculoplastic surgery and cosmetic surgery. So oculoplastic surgery focused on the eyes and then also focused on the brows. In addition to that, there was a lot of body work as well. It was a breast and body heavy cosmetic surgery fellowship as well. So very, very, very, very well-rounded education. Clinton McCord, oculoplastic surgeon, Mark Codner, oculoplastic surgeon, plastic surgeon, Foad Nahai, who needs no introduction from anyone, world leader in plastic surgery education, both in reconstructive and cosmetic surgery. So then I came back to Texas, ultimately ended up in Austin.

Reconstructive experience in cosmetic surgery. This has been 19 years overall, but 18 years here in Austin, Texas. And from the very beginning, had a very meaningful cosmetic surgery practice, really kind of a very boutique practice, but also did a lot of reconstructive surgery, some of it being a lot of it actually being trauma surgery on the face. Now, you may be wondering, how does that play into what I'm doing now? Well, if you have seen a face that has unfortunately been dismantled, if you will, from a car accident or a fight, God forbid. You understand what the inside of a face is made of. And it helps you when you're a cosmetic surgeon because there's nothing you're going to be afraid of. You're going to really understand the anatomy and you're really going to understand how bone and tissue interact. So a really important part of my development as a cosmetic surgeon. I also did a lot of breast reconstruction and not just regular breast reconstruction with implants. This is breast reconstruction for women with breast cancer. Not just that, but also breast reconstruction using microsurgery, where we disconnect parts of the tissue, the abdomen, transfer it to the chest. Now, why am I telling you about that when I'm telling you about cosmetic surgery? Well, first of all, because if you can build a breast with an implant after a mastectomy for breast cancer, if you can build a breast out of someone's abdominal, excess abdominal tissue using microsurgery, suturing together little tiny blood vessels, little tiny blood vessels, a millimeter, two millimeters, eighth of an inch at the greatest together. Then you really understand the anatomy of a breast. You understand what it takes to create a beautiful, attractive breast. Not only that, all of that microsurgical work really, really, really fine-tunes your motor skills, your ability to concentrate. Really, really important preparation for what I'm doing now, where I'm in a practice that I'm fully, fully dedicated and focused on cosmetic surgery, both of the face, facelifts, rhinoplasties, all the things that go along with that, but also body surgery, surgery of the breasts, surgery of the abdomen. Did you know that every single breast reconstruction where you transfer tissue to the breast, every single one of those involves an abdominoplasty? I've done hundreds of abdominoplasties because I've done hundreds of microsurgical breast reconstructions. An immense wealth, an immense wealth of experience and expertise in not just facial surgery, but in surgery of the breast and the body as well. Having said that, I think you've got a full picture of my origin story.

The monorail ride: why I study every face. Now, I'll bet you forgot, I almost forgot that monorail ride. Why was that monorail ride so important? That monorail ride was the first time at the age of eight years old where I looked at someone's face and I thought, that's an attractive face. And I asked myself a question: why? And I do that every single time that I look at someone's face. Now in a consultation room, before surgery, even after surgery, I ask what's attractive and what's less than attractive. What are the features a patient wants to change? In that monorail ride, Disney World, age of eight years old, I looked across the center aisle. There was a young girl about my age, probably eight, and I looked at her face and there was something that I found striking about it. And I just sat there, and just for a couple seconds, I asked myself, why? Why do I find that attractive? And that is my origin story.