BIG Medicine Magazine™-The Plastic Surgery Icons Issue

ICONS of Plastic Surgery!

Thinking of Going Into Private Practice?

MEDICINE MAGAZINE™ The Magazine for Big Thinkers

LOOK INSIDE! MEDICAL HISTORY, EDUCATION AND INTERNATIONAL LEADERSHIP

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Letter From The Editor

Never Judge A book

By Its Cover!

Angela O’Mara Editor-In-Chief Founder

Our mission here at BIG Medicine Magazine™ is to bring our readers fresh content. As you can see from the line-up, this issue is somewhat iconic in its editorial, featuring world business leader Sir Richard Branson, plastic surgeons Dr. Pierre Fournier of Paris, France, Dr. Bruce Connell of Laguna Beach, CA and Dr. Alfredo Ponce of Guadalajara, Mexico, as well as many other great contributors.

Recently an advertising agency asked how much it would cost to feature one of their client’s doctor luminaries on our cover. It was an interesting concept but we declined. You see, BIG Medicine Magazine™ focuses on bringing forth ideas, innovation and inspiration to help our readers build a better medical practice and a better life for themselves. It is not necessarily about promoting a pretty or popular face on its cover.

So far, our covers have sold many, many magazines and have received a great response from our subscribers. And as you can probably tell from the doctors we have selected to feature in this issue, it would be hard to decide which one of them should grace our cover. ALL of them deserve it!

This issue is so far my personal favorite as I was able to travel to London, Paris, Mexico and Laguna Beach, CA to bring you stories that I hope you will find as interesting as I do. I want to give a special THANK YOU to Dr. Pierre Fournier, Dr. Bruce Connell and Dr. Alfredo Ponce for taking the time to invite me into their homes and for sharing their stories with me. Also, a special thank you to Julie Mathias the amazing curator at The Old Operating Theater museum for welcoming BIG Medicine Magazine™ to London!

MEDICINE MAGAZINE™ The Magazine for Big Thinkers

T able of Contents

MEDICINE MAGAZINE™ The Magazine for Big Thinkers

Editor-In-Chief Angela O’Mara Copy Editor Brandon Murphy Barnes Beauty & Grooming Editor Enna Ruiz

6-7 8-9 10

Practice Leadership Social Media Marketing Time Management

Contributing Editor Michael O’Mara Graphic Design Joe Felipe Publisher Giles Raine Tel: 949 768-1051

11

Business Success

12

We Asked The Doctors

14 - 15

Top Telephone Skills

16 - 19

Step Back Into Medical History

20 - 25

Plastic Surgery Icons

26

Education Is Key

27

Why You Need A Coach

28 - 29

7 Deadly Media Sins

30

Beauty & Grooming

Fax: 949 768-1060 www.bigmedicinemagazine.com info@bigmedicinemagazine.com

Advertising Sales 949 768-1051 All content in this magazine is protected and may not be copied, reprinted or republished without written permission of Publisher.

All rights reserved. BIG Medicine Magazine™ is a Registered Trademark.

Step back in time to 18th century London.

The theme of this issue is History, Education and International Leadership. Join us at Europe’s oldest operating theatre, and meet three international iconic plastic surgery leaders...

... begins on page 16

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Thinking of Going Into Private Practice?

5 Reasons Why a Small Practice Should Incorporate Making the leap from medical school student to medical practice owner can be a challenge. Setting your medical business up as a business entity at the start of your career can save you countless headaches in the future. Formatting your practice as a Corporation or a Limited Liability Company (LLC) can offer a range of advantages.

Most notable is that a Corporation or LLC protects your personal assets should a case of debt or a legal judgment be claimed against the business.

1. Personal asset protection 2. Additional credibility and name protection 3. Perpetual existence 4. Tax flexibility 5. Deductible

Should You INCORPORATE Your Practice Or Form An LLC? Consider This!

The chart below can help you in your decision-making: Sole Proprietor Benefit Owners have limitied liability for business debts and obligations Created by a state-level registration (usually protects the company name) Business duration can be perpetual May have an unlimited number of owners Owners need not be U.S. citizens or residents May be owned by another business, rather than individuals May issue shares of stock to attract invvestors Owners can report business profit and loss on their personal tax returns Owners can split profit and loss with the business for a lower overall tax rate

LLC

C Corp

• Corporations and LLCs are separate legal entities (business structures) that enjoy certain protections under the law. Most people form a legal business structure to safeguard their personal assets. Even if you don’t have any personal assets yet, hopefully you will in the near future.

• Incorporating or forming an LLC allows you to conduct your business without worrying that you might lose your home, car, or personal savings because of a business liability.

Deciding Which Business Structure is Right for You Choosing the right type of company structure for your new practice/business helps maximize your chances of financial and operational success. To get the most out of your medical practice, ask your attorney or accountant to help you select the right structure.

Presentation Skills

LEARNING A TRUE VALUE! We all agree that we learn in different ways.

Some of us learn visually, others verbally, auditory and so on. But understanding how others might learn is beneficial, whether you will be educating patients on the services you offer, or are in academia and are teaching other medical students how to be a real doctor. This graph will help you understand more on learning retention something that can bring value to your future career as a medical doctor.

This Little Piggy Went To MARKETing With all the coming changes with OBAMACARE, insurance premiums and payouts (or lack of) at some point in the not too distant future you are going to have to determine which side of the medical fence you are going to sit. And when we say “This Little Piggy Went To Marketing,� we are not kidding. Using the method of Learning Retention (above), how can you apply this knowledge to your marketing? Think about it. Where are you going to spend your dollars so that you can keep the piggy bank full and fat? For more information, write to us at increaseprofits@bigmedicinemagazine.com.

Q. How many times do you have to make a first impression?

STOP Wasting Your Time on Facebook!

Let The EXPERTS Help You!

Facebook is NOW a critical component of your overall practice marketing. It is yet another gateway to you, and can be the bridge that helps a prospective patient decide whether or not you and your practice are the right choice for them.

Remember that even before a patient ever picks up the telephone to call your practice, they most likely have looked at your website and developed an ‘emotional’ opinion about you and your practice that may significantly influence them in taking the next step to call for a consultation.

• What message does your Facebook Page give about you and your practice?

• Does it engage and maintain interest?

• Do people want to “FRIEND” or “LIKE” you?

• Are friends referring YOUR page to their friends?

Some of you might find yourself saying “WHO CARES?” Well, we do. Why do we care? Because at BIG Medicine Magazine™ we know how important making a first impression is, no matter where that impression is made. In today’s online community making a good first impression is more important than ever.

How SOCIAL Are You? What is seen on social media networks and in e-newsletters and announcements is now influencing the decisions of everyday people.

People are sharing their experiences with their friends and colleagues, experiences that can influence their future buying decisions too.

Remember this; Medicine is a commodity.

DID YOU KNOW? There are now over 1 billion daily users on Facebook and over 30 million exchanges of content are made each month online. People are ingesting content and information on a moment to moment basis.

How you build your social media network and share content is up to you. However, one thing we can be sure of is that Facebook and other Social Media networks ARE NOT A FAD! They are here to stay.

Social Media can be likened to a cocktail party. When you meet someone at a cocktail party the general rule of thumb is to introduce yourself, get to know them, enjoy the conversation and, if appropriate, share business information. Think of Social Media as a cocktail party. Generally speaking, it is a forum where people go to connect and interact with others like them. People do not go onto Social Media sites to be sold to. However, once you develop a network, interact with them in a favorable way, and create a safe environment, the chances of you selling your product or service to that network increases tremendously. So remember, go to the party to have fun. Great things await you!

The Social Media Revolution Here Are 6 Clever Thoughts!

1. To gain people’s trust, make sure the tone in your Social Media posts sound friendly, honest and call for interaction 2. Be more personal. Adding photos on your Facebook, Pinterest or Instagram accounts, will make you more approachable but do remember that you are a doctor first and that a picture can speak a thousand words 3. Don’t go overboard. We know you want to add friends, and you may be using an add-friends software program, but you should add no more than 50 friends a day, otherwise it might come across as spam 4. Remember, people love to look at pictures and videos. Use them in your messaging campaign 5. Interact with others on Facebook and Twitter. Create conversations and engage with other people’s conversations 6. IMPORTANT! During all of your social media marketing efforts, make sure that you remain professional at all times. It is fun to be engaging and personal, but remember when and where to draw the line

7 Tips for Measuring the Return On Your Social Media Investment Joining the Social Media revolution is exciting but most of us still need to know what the bottom line is, i.e. is your investment producing new prospective patients and branding your practice effectively? Here are 7 tips to help you measure your Social Media Success!

1. Focus on the metrics that drive the bottom line:

Measure key performance indicators such as subscriber growth, share of conversation, inbound prospect traffic, patient conversions and interaction

2. Measure what matters and analyze changes:

Measuring share of voice demonstrates where you rate next to competitors, but understanding why your share of voice has increased or decreased can help with future messaging techniques

3. Measure and plan social activities within the media mix: Campaign success can be measured and reported by analyzing monthly results of all media, including traditional media, blog impressions, tweets, website, etc.

4. Set Social Media goals:

If your goal is to increase the number of subscribers or inquiries to your medical practice set the number

anticipated and track it

5. Tracking: There are many CRM (customer relationship management) software applications available. Using one to help with tracking can be very helpful for all your Social Media and Traditional Media Marketing campaigns

6. Create your own social ROI executive dashboard:

Today’s social scorecard details has fans and followers, social mentions,

prospect traffic and valid leads

7. Don’t forget the human side of analytics: The tools available through CRM and other tracking services are only as effective as the person using the tools and the clarity with which you are guiding them

Ten Ways To Effectively Manage Your Day

1

Start Early and Plan Ahead

Starting your day 15 minutes earlier each day, can add an extra 30 more minutes of productivity to your day. Also, if you spend the last 10 minutes of today planning for tomorrow, you will be off to an immediate fresh and focused start each day!

2

Make Lists and Take Notes

10

Don’t Wait On Waiting Time

Time spent waiting doesn’t have to mean lost time!

Many of us find ourselves arriving too early for an appointment, or waiting on someone who is late. Use this waiting time effectively by doing small tasks such as sorting through mail, writing tomorrow’s “to do” list, writing down new ideas, returning calls, checking email, etc. Just because you have to wait doesn’t mean you can’t be productive.

No one has a perfect memory, so the best way to remember what needs to be done is to make “to do” lists. One of the biggest time wasters is trying to remember what you have to do. Writing your task down takes only seconds as opposed to the countless minutes it will take to recall what needs to be done.

3

9

There is an effective shortcut for almost every task you do. Finding these shortcuts and putting them to work can save you time on a daily basis!

Is there a shorter route to work with less traffic? Use it! There are many ways you can maximize your time by using effective shortcuts. Just make sure they do not negatively impact the end result.

Handle The Small Tasks First

If you think a task is going to take less than two minutes to get through, do it as soon as possible! It will make you feel that you are getting through your “to do” list faster and the day will seem less overwhelming.

4

8

5

Get Rid of Distractions

The modern world is full of constant distractions, cell phones, email, staff, patients and even other doctors can distract you from your day. Scheduling all of these distractions at a set time is one of the best and most effective ways of getting the job done in a shorter amount of time.

Stock Up On The Basics

How often have you run out of necessary surgical supplies or even simple things like copy paper just as you have needed to print a report?

Doing a weekly inventory of your office and surgical supplies will ensure that you never run out of the basic necessities. Having to make a mad dash to stock up on daily items adds unnecessary stress to the day and wastes time.

Group Similar Tasks Together

If you have a list of calls to do today, group them all together. The same goes for medical file reporting, new business proposals, patient reports, bill paying, etc.

Switching between different tasks can be distracting as it takes a moment or two (or more) to get focused on the task at hand. By grouping similar activities together, you will save valuable time, be more organized, efficient and very productive.

Use Shortcuts Effectively

6

Set A Pattern For Your Day

Most of us have certain responsibilities and activities that take place daily or weekly. By setting a distinct pattern for when you tend to these activities and responsibilities will help you organize and manage your time better. Ask yourself: should I book all surgeries in the morning? When should I attend to staff and sales calls?

Where do new patient consults and post-op appointments fit in? When should I handle administrative duties and paperwork?

7

Organize Organize Organize!

How much time is wasted on looking for misplaced items? Make sure to keep your business and living areas organized at all times.

It will save you a significant amount of time. And remember, saving time equals making money!

Five Top Tips To Starting A Successful Business At BIG Medicine Magazine™ we are BIG fans of Sir Richard Branson.

We admire him for many reasons including his entrepreneurial skills and his philanthropic contributions. Another thing that we like is how easy he makes everything look. Perhaps creating a multi-billion dollar business and living a lifestyle that most people only dream of is easy. What do you think? Here are Sir Richard Branson’s Five Top Tips For Starting A Successful Business as was written on his LinkedIn page.

“As LinkedIn is a business that started in a living room, much like Virgin began in a basement, I thought my first blog on the site should be about how to simply start a successful business. Here are five top tips I’ve picked up over the years.” Sir Richard Branson.

1. Listen more than you talk We have two ears and one mouth, using them in proportion is not a bad idea! To be a good leader you have to be a great listener. Brilliant ideas can spring from the most unlikely places, so you should always keep your ears open for some shrewd advice. This can mean following online comments as closely as board meeting notes, or asking the frontline staff for their opinions as often as the CEOs. Get out there, listen to people, draw people out and learn from them.

2. Keep it simple You have to do something radically different to stand out in business. But nobody ever said different has to be complex. There are thousands of simple business solutions to problems out there, just waiting to be solved by the next big thing in business. Maintain a focus upon innovation, but don’t try to reinvent the wheel. A simple change for the better is far more effective than five complicated changes for the worse.

3. Take pride in your work Last week I enjoyed my favorite night of the year, the Virgin Stars of the Year Awards, where we celebrated some of those people who have gone the extra mile for us around the Virgin world. With so many different companies, nationalities and personalities represented under one roof, it was interesting to see what qualities they all have in common. One was pride in their work, and in the company they represent. Remember your staff is your biggest brand advocate, and focusing on helping them take pride will shine through in how they treat your customers.

4. Have fun, success will follow If you aren’t having fun, you are doing it wrong. If you feel like getting up in the morning to work on your business is a chore, then it’s time to try something else. If you are having a good time, there is a far greater chance a positive, innovative atmosphere will be nurtured and your business will flourish. A smile and a joke can go a long way, so be quick to see the lighter side of life.

5. Rip it up and start again If you are an entrepreneur and your first venture isn’t a success, welcome to the club! Every successful businessperson has experienced a few failures along the way – the important thing is how you learn from them. Don’t get disheartened by a setback or two, instead dust yourself off and work out what went wrong. Then you can find the positives, analyze where you can improve, rip it up and start again.

We Asked The Doctors!

They TOLD US! Dr. Diktaban

Dr. Rnucci

Dr. Collins

Dr. Evans

Dr. Marotta

Dr. Mendelsohn

Dr. Repta

Dr. Miller

Dr. Tepper

Dr. Simon

Dr. Nevin

What Positive Changes Have You Implemented Into Your Practice Recently?

“Our new direction in the practice has been to offer patients’ options that will serve as a vehicle for self-improvement with the quickest recovery and with an emphasis on preventative maintenance, healthy living, dietary modification, etc. rather than implementing a surgical body contouring process as the first option. This creates a long term relationship that goes the distance with our patients.”

Brian Evans, M.D., Beverly Hills, CA “After completing my residency, I wanted to start my own practice, however, due to the economic times I was unable to get a loan. So I had to get creative with educational seminars, creating patient rewards for referrals, and most importantly utilizing social media. Social media is key to my practice now.”

Beth Collins, M.D., Guilford, CT “I learned to keep an open mind. During the last five years the most difficult aspect has been managing employee needs and personalities. It’s important to listen and try to meet your employee needs at least half way in order to keep a happy productive workforce and minimize turnover.”

James C. Marotta, M.D., Smithtown, NY “My challenge during the recession was to further develop and strengthen the non-surgical disciplines in my office in order to accommodate those patients desiring less invasive techniques of restoration. It worked.”

John Renucci, M.D., Grand Rapids, MI “The most difficult obstacle to overcome during the past recession was the realization that the time was not 2005 or 2007. I learned to be flexible and recognize that financial considerations weigh more heavily on patients in this economy. You can be flexible with pricing without cheapening your brand.”

Jon E. Mendelsohn, M.D., Cincinnati, OH In response to the current medical and business climate, I paid renewed attention to the Pareto Principle (80/20 Rule), characterizing and limiting the patients and procedures responsible for the bulk of my stress and unproductive activities.

Scott Miller, M.D., F.A.C.S., La Jolla, CA

“Early in the recession we realized that long term investment in the practice would need to start taking place accordingly to allow us to position ourselves favorably when the economy improved. The most difficult part of this process has been two-fold: 1) trust in the ability to grow the practice through providing great service and results, and 2) managing the growing pains associated with such growth in uncertain times. We managed both successfully.”

Remus Repta, M.D., Phoenix, AZ “We diversified the practice, maintained flexibility with regards to the delivery of care and assortment of treatment, services and products to fit the needs of changing populations, and was more sensitive to the needs of patients, and to the concerns that they had over their own financial situations during a recession or economic downturn.”

Rich Tepper, M.D., Westfield, NJ “For us, the amazing result of this cosmetic surgery slowdown was the discovery (or return) of quick, lunch time procedures with injectables such as Juvederm, Restylane, Radiesse, and Botox. This new demand to “look good now for less” generated very innovative ways for plastic surgeons to make people look younger and better. I have developed techniques to perform fat grafting in the office with the patient awake, and the results can be long lasting and superior to standard injectables or face lift surgery.”

Timothy Neavin, M.D., Beverly Hills, CA We offer a variety of procedures at different price points so we are able to give patients options that fit into their new budgets. Then, as the economy improved and their budgets improved, those same patients opted to have additional procedures with us.

Theodore Diktaban, M.D., New York, NY The general economy will always have ebbs and flows, and although this may require practices to spend more time, effort, and money on marketing, they should not diminish the value of their services. If you have a little extra free time (during a slow period) - use it wisely! Family time, improving fitness, hobbies you love that are relaxing and enjoyable.

Sean Simon, M.D., Miami, FL

If you would like to participate in our “We Asked The Doctors They Told Us” section, write to us at www.bigmedicinemagazine.com.

Hello

Who’s Calling Please?

THE TELEPHONE – A Patient’s First

Verbal Interaction With YOUR Practice

by Angela O’Mara The majority of prospective patients that call your office are generally well educated. They most likely have already researched you on the Internet, shopped around for information and pricing from other doctors (your competitors), have a good understanding of their procedure of choice and are looking for answers and solutions to their problem NOW. Not next week or next year. But right now while they are on the telephone with your receptionist. Do you realize you may never meet this patient if this call is not answered correctly? Do you realize this call could cost you thousands of dollars in lost revenue?

Prospective patients that call your office will become cash-paying customers who will not only be loyal to you, but will also refer their friends and family, if they are greeted by a caring, knowledgeable person who is able to bring them in for a consultation with YOU. While you should not expect the receptionist to up-sell your services, it is ultimately their responsibility to bring that patient in for a consultation with you. If your receptionist ends the call without booking a consultation, or even worse, no contact information or source of the caller, then they are seriously hurting your business and losing you money. You are not alone in this scenario. Countless other doctors experience the same losses, every day.

Do you have the right person answering the telephone?

It has been my experience that many times the receptionist is the least paid and the least knowledgeable person in a medical office.

Many times they act as “gate keeper” and don’t understand that they play a pivotal role in the success of YOUR practice. The receptionist is not just answering the phone.

They are your first and immediate connection with the world outside. This person holds the power to either turn that caller into a paying patient, or lose them allowing them to go

elsewhere for a procedure that you could have performed. Also, consider the fact that we are not talking about just one procedure.

That same patient may have returned to you for further procedures and referred you to their friends and family.

Patient Tracking Tips: 1. Name, address, phone number, email address 2. Telephone and email contact information 3. Areas of interest (type of surgery or procedure discussed) 4. Timeline for treatment (how soon do they want to do this?)

5. Referral source (newspaper, magazine, TV, Internet, friend, etc.)

6. Consultation date 7. Notes on interesting points made during conversation 8. Any concerns to be noted

A prospective patient will never have the chance to consult with you if they have a bad experience with your receptionist I have been in practices where the receptionist complains that the telephone is a nuisance. They complain that it is a distraction, an interruption and never stops “ringing off the hook.” The telephone is your gateway to success and a good receptionist should understand what their role as “gate keeper” truly means. It is the entry to your practice and the doorway to new patients and future practice growth. It is also the welcome mat for past patients to return when they are seeking more procedures from you.

Your receptionist should always answer the phone with a smile on their face. How they greet a caller will set the tone for the rest of the conversation. Their role of “gate keeper” does not mean that they keep the gateway closed as many seem to think. It means that they stand at the gate as the greeter who welcomes visitors to your practice.

Example: With a smile on their face, “Good Morning (afternoon), Dr. Miller’s office.

Jessica speaking. How may I help you?”

Next is the actual conversation. However, before we go there let’s discuss a simple method that will help you track all new calls, so long as the receptionist complies. Compliance with a tracking system, however, should not be a choice. Every practice needs to track new patient calls, and it needs to obtain new caller information in order to grow.

Your receptionist should be ready with pen poised to take down the details such as name, address, phone number, email address, referral source, etc. They should then be ready to engage in a dialogue with the intent of bringing that person in for a consultation. In any other organization these types of calls would be called sales leads. They need to be treated with importance. While your receptionist should be able to answer basic practice and treatment information, they should not try to play doctor on the phone. Booking the consult is the best thing they can do.

What is the cost of Surgery?

Medicine is becoming more of a commodity than ever and in the aesthetic industry it is a buyer’s market where people will ask price over the telephone. However, we all know that they are not comparing apples to apples.

Therefore, your receptionist should have at least three talking points about you that bring value. These talking points could be:

During The Conversation It is always good that your receptionist frequently refers to your area of expertise and credentials wherever possible during the conversation. They can even go as far as elaborating on your state-of-the-art medical office, cutting edge procedures, highly qualified staff, etc., as long as the conversation allows it and so long as everything they are saying IS TRUE. Many receptionists get off track with personal and idle chatter and they forget their true role. That role is to be your ambassador to the caller and make sure that they bring that patient in to meet you for a consultation.

When A Call Becomes A Consultation The whole goal of the receptionist is to turn a call into a consult. It is a learned skill so long as the receptionist wants to learn it. An experienced receptionist should know this, but even a “newbie” can learn this skill fast. The more excited and educated they are about you, the easier it will be for them to make this happen.

Sometimes, the receptionist may have to ask several times if the caller wants to book a consult, therefore, they should remain light hearted in their conversation while still being firm and on task. Asking how “soon” they want to have surgery is a great way for the receptionist to understand what time frame they are working with. If the caller says “Oh, within the year,” then the receptionist will have to work a bit harder to get the caller in to see you. If they say, “in time for a wedding in two months”, the window has narrowed and they should be encouraged to come in sooner.

I Don’t Want To Book Surgery Now If the patient decides “to wait and call back to book a consultation,” rather than book one now, that is OK as long as the receptionist has obtained all the necessary call back information. At this point the receptionist is still left with choices. They can: 1. Ask the caller if they would like a call back in a week or so to check in with them

1. Length of time in practice

2. Invite them to an event or open house that you have scheduled

2. Areas of specialization

3. Add them to your e-newsletter list so they can be updated on the latest developments in the practice

3. Medical School or Ivy League education 4. Number of procedures performed 5. A training site for other doctors to learn firsthand from you

4. Add them to other future event invitation lists It is the job of your receptionist to develop relationships with the people that call in and ultimately book them for a consultation for surgery. A few simple steps can help them be successful in their job, and build you a more successful practice.

6. Advanced training in cutting edge procedures 7. A caring doctor with a world-class practice 8. Patient testimonials As much as economic advisors would like to tell us that price is what matters most to consumers, when it comes to medical care and surgery, it is not. Patients definitely want to get the most from their insurance premiums, but from their doctor they want value, total care, comfort and results.

When asked “what is the cost” over the telephone, this is a key indicator of the importance of price. Health is not just an item to be sold. It is often a dream to be had and selling that dream over the phone can be challenging. Therefore, I suggest that the receptionist understand the value of what they are selling. And ultimately they are selling a consultation with YOU.

How much does a lost call cost in revenue?

The Operating Theatre and Herb Garrett of St. Thomas London, England

The oldest Operating Theatre existing in Europe is in the attic of St. Thomas Church in London and remains as a memory of the original site of St. Thomas’ Hospital. Prior to 1822, surgical operations on female patients at St. Thomas’ Hospital took place on the Dorcas Ward. Hospital Governors, displeased by this limitation, demanded that part of the nearby Herb Garrett be converted into a new purpose-built operating theatre primarily for female patients. By fitting a skylight into the old wooden Church roof, surgeons were provided with a well-lit teaching space.

By the 18thth century, the United Guy’s and St. Thomas’ Hospitals had become important and prestigious teaching hospitals. An Operating Theatre provided the opportunity for apprentice surgeons to watch and learn from their tutors. Among them was famous surgeon and anatomist Sir Astley Paston Cooper.

Photo: Gareth Miles, museum officer, lecturing at The Operating Theatre and Herb Garrett of St. Thomas.

A Step Back In Time In 1862, when St. Thomas Hospital moved from its ancient site to its current location in Lambeth, London, The Operating Theatre was closed and the entrances from the Hospital into the Garret were blocked up. Although it was not completely forgotten, and there were references in academic publications in 1936 and again in 1954, and the skylight could still be seen from the eastern end of St. Thomas Street, it was certainly a case of “out of sight - out of mind” and for many years The Operating Theatre was left to deteriorate in silence. It lay undiscovered for almost 100 years until researcher Raymond Russell uncovered a reference to its church attic location in the hospital archives.

Russell discovered the Operating Theater in 1956.

It was clear that the old theatre could not be left to perish in its state of dereliction and neglect.

Full restoration rather than mere preservation was needed. Apart from the intrinsic interest within Guy’s and St Thomas’s hospitals, it was obvious that the restoration would be of considerable general appeal; both to the medical profession and the public at large. No other early 19th century operating theatre exists in Europe. As the restoration would be within the property of the Cathedral authorities, their permission and co-operation were needed. The Provost and Chapter gave this willingly and graciously and a small Restoration Committee was formed and careful restoration and reconstruction began in the 1960’s. Today the Old Operating Theater is open to the public and has a permanent lease for another 120 years.

Along with the discovery of the medical amphitheater, The Garret contained surgical and obstetric instruments, human specimens, miscellaneous items from the hospitals, such as mugs, a nurses chatelaine, carboys and bell mortars, and other items from the apothecary.

Many of these items are on display, along with numerous other antique surgical instruments, photography and medical equipment. The Old Operating Theater is situated in an old part of London that dates back to the Victorian era.

Life during that time was tough for inhabitants of the neighborhood. Surrounded by hundreds of manufacturers, slums, high poverty, terrible child labor abuses, all levels of pollution and filth.

Doctors at the theater saw a serious increase in the need for medical care and emergency surgeries due to injury and infection. The patients were mainly poor people who were expected to contribute to their care if they could afford it. The patients at the Old Operating Theatre were mostly women and many of the operations performed were for amputation. Until 1847, surgeons had no recourse to anesthetics and depended on swift amputation technique (surgeons could perform an amputation in a minute or less), the mental preparation of the patient, and alcohol or opiates to dull the patient’s senses.

It is said that several of the surgeons became “show men” and gathered audiences of not just medical students, but local people who wanted to see a little blood.

This description of the students packing the Theatre to witness an operation was left in archives by a St. Thomas surgeon, John Flint South: “The first two rows ... were occupied by the other dressers, and behind

Patients put up with the audience to their distress because they received medical treatment from some of the best surgeons in the land, which otherwise they could not afford. Wealthy patients of the surgeons would have been operated on, by choice, at home, probably on the kitchen table.

The risk of death at the hands of a surgeon was greatly increased by the lack of understanding of the causes of infection. Although cleanliness was a moral virtue, descriptions suggest that a surgeon was as likely to wash his hands after an operation as before. Or in other words, they might not have washed their hands before or after surgery. The frock coats worn by surgeons during operations were, according to historical notations, ‘stiff and stinking with pus and blood’.

Beneath the table was a sawdust box for collecting blood. The death rate was further heightened by the shock of the operation and, because operations took place as a last resort, patients tended to have few reserves of strength and subsequently perished.

a second partition stood the pupils, packed like herrings in a barrel, but not so quiet, as those behind them were continually pressing on those before and were continually struggling to relieve themselves of it, and had not infrequently to be got out exhausted. There was also a continual calling out of “Heads, Heads” to those about the table whose heads interfered with the sightseers.”

Thankfully, medicine has come a long way since the Victorian era and while we still have many doctors who are show men, we are pleased to report that, for the most part, they are operating in clean, hygienic and sterilized areas with state-of-the-art surgical equipment and anesthesia. If you’re planning a trip to London this year, you can learn more about this fascinating piece of medical history at www. thegarret.org.uk.

Sir Astley Paston Cooper was born on August 23, 1768 in Brooke, Norfolk. At the age of sixteen he was sent to London and placed under Dr. Henry Cline (1750–1827), surgeon to St. Thomas Hospital.

He devoted himself to the study of anatomy. In 1789 he was appointed demonstrator of anatomy at St. Thomas’ Hospital, where in 1791 he became joint lecturer with Cline in anatomy and surgery, and in 1800 he was appointed surgeon to Guy’s Hospital on the death of his uncle, William Cooper.

In 1802 he received the Copley Medal for two papers read before the Royal Society of London on the destruction of the tympanic membrane; and in 1805 he was elected a Fellow of that society.

In the same year he took an active part in the formation of the Medical and Chirurgical Society of London, and in 1804 he brought out the first (and in 1807 the second), part of his great work on hernias, which added so largely to his reputation that in 1813 his annual professional income rose to 21,000 pounds sterling. In the same year he was appointed professor of comparative anatomy to the Royal College of Surgeons and was very popular as a lecturer.

In 1817 he performed his famous operation of tying the abdominal aorta for aneurism; and in 1820 he removed an infected sebaceous cyst from the head of King George IV. About six months afterwards he received a baronetcy which, as he had no son, was to descend to his nephew and adopted son, Astley Cooper. He was subsequently appointed sergeant surgeon to King George IV, King William IV and Queen Victoria. He died on February 12, 1841 in London, and was interred, by his own desire, beneath the chapel of Guy’s Hospital.

Photos to the left are of actual exhibits and antiques on display at the museum.

Dr. Pierre Fournier

The Secret To Beauty

EXCLUSIVE Paris, France

By Angela O’Mara

“To understand beauty, first you must know how to properly drink a glass of champagne,” said plastic surgeon Pierre Fournier, M.D., as his lovely wife Michelle placed an exquisite silver ice bucket carrying a bottle of vintage Moët on the table in front of us. My first memory of meeting Dr. Pierre Fournier was in the 1980’s when he was a guest faculty member at the Foundation For Facial Plastic Surgery meeting, an annual event hosted by H. George Brennan, M.D., in Newport Beach, CA.

The FFPS as it was known then, started the first multi-specialty aesthetic meeting that joined the various medical disciplines together into one event. It was held every summer and that particular year was momentous as Dr. Fournier was among many famous international surgeons to discuss the development of liposuction, a relatively new technique to US surgeons at that time. Today liposuction is among the most popular aesthetic procedures in the USA and has become a multi-million dollar device manufacturing industry. Liposuction has literally changed the shape of America.

On that beautiful morning I had the good fortune to be invited to meet with Dr. Fournier at his superb home in the 17th arrondissement in Paris. We discussed his many years as a plastic surgeon, his time in the French Army, the early days of plastic surgery, the fabulous life he created, and his continued advocacy and teaching of plastic surgery worldwide.

We, of course, also discussed my recent trip to the Musée du Louvre, home of the Mona Lisa, as Dr. Fournier believes that to become a top rated plastic surgeon, one must first look to the paintings of the ancient masters to fully understand the human body and its beauty.

at the age of eighty-eight and a half he continues his teachings, traveling extensively throughout Europe, Asia and the USA. The day after my lesson in champagne etiquette, Dr. Fournier was leaving for Singapore to deliver his lecture “What Is Human Beauty” to a large group of aesthetic medical surgeons.

According to Dr. Fournier, an aesthetic surgeon by definition must create or conserve beauty. Surgical techniques abound in the textbooks but, in his opinion, artistic teaching on beauty or human beauty is not enough.

Beauty lies within the eyes of the beholder and the sooner plastic surgeons understand the psychology of beauty, the better they will become at aesthetic surgery.

“Beauty is an ensemble of shapes and proportions, which bring pleasure and which we admire, but the concept varies according to different cultures,” said Dr. Fournier. “Beauty stimulates an aesthetic feeling within us, pleasing to the eye, a sense of admiration.

Some say beauty is a visual pheromone. I say it is a work of art. Go to the Louvre, you will see what I mean.”

But, back to the champagne. “Champagne is a great celebratory drink. It sends bubbles up your nose and makes you giggle. It is a drink that makes people happy. Just like plastic surgery is the surgery of happiness,” explained Dr. Fournier.

In international circles Dr. Fournier is attributed to be the founder of modern aesthetics and

Original liposuction equipment from the 1980’s. Owned by Dr. Pierre Fournier.

Much has been written on the psychology of plastic surgery when it comes to patients.

Very little has been written on “surgical psychiatrists” a term Dr. Fournier feels is more appropriate for a plastic surgeon given that when a plastic surgeon changes the outside of the human body, they also change the inside because they almost always make the patient a happier person.

Dr. Fournier continued to explain that in his mind, human beings do not merely want to live, they want to live in the best physical and mental condition. He is obviously taking a dose of his own medicine, and so is his wife. The two are fit, able, active and very sharp minded. The constant lecturing and traveling is keeping them young at heart, in body and mind.

Traveling the world is obviously nothing new to Dr. Fournier whose clients have ranged from queens and dignitaries the world over, to local farmers and factory workers.

He has acquired both fame and fortune over the years. Although he had humble beginnings, he has been able to reach the heights of success both personally and professionally. After World War II and graduating from medical school he had no more money than a pickpocket he says. However, a friend of his suggested he try aesthetic surgery as it was a growing trend in Paris. He did and he found it came quite naturally to him and eventually he opened a small clinic in the suburbs. By offering lower prices than the “city” docs, his practice soon grew and patients began to line up at his door. His big break came when he visited his friend and

How To Pour Champagne The French Way Champagne is a celebration in itself and here are tips from French Plastic Surgeon Dr. Pierre Fournier.

• Chill the Champagne. The ideal temperature is approximately 45 F (7C). At this temperature the aroma and taste of the drink can be fully appreciated • Hold the bottle steady at a 45 degree angle away from people.

Remove only enough foil to loosen the twisted wire top. It is a good idea to hold a cloth (or a finger or thumb) over the cork when removing the foil so that it does not pop spontaneously. Hold the cork and gently turn the bottle to quietly pop the cork • Use a long stemmed flute or tulip shaped glass as they enhance the flow of bubbles to the crown and concentrates the aroma of the champagne. Place them close by so you can pour directly once the champagne bottle has been opened

fellow physician Giorgio Fischer in Rome, Italy. Dr. Fischer was a gynecologist who had invented a machine to “suck the fat of Italian ladies” and wanted to build a factory to produce his invention.

Another friend, Dr. Yves Gerard Illouz approached them with the idea of using a suction machine (that had been developed to perform abortions which were legal) that he thought would work better. Thus began the popularity of the traveling trio that led to an invitation to lecture at the American Congress of Plastic Surgery, and then….. the world.

His principal tool for liposuction was always the syringe which he believed was as

powerful as any suction machine, although I am sure there are many laser and light companies that would beg to differ. Today, liposuction has become an option for weight loss over diet and exercise, especially in the US where instant gratification is the norm.

Whatever way you want to put it, or suck it, pun intended, liposuction is here to stay and has made a lot of people very wealthy.

Dr. Fournier stopped practicing surgery two years ago. His days are now spent studying art and beauty, lecturing and teaching other physicians on his plastic surgery principles and showing admirers like me how to properly enjoy a glass of sparkling champagne!

• Wipe the neck of the bottle with a cloth to make sure it’s clean • To pour, hold the bottle at the base with a thumb in the dimple, and fingers on the bottle itself, pour about one inch of champagne into each glass. Let the froth settle and then continue pouring, topping the glasses up to two thirds full • Champagne flutes have long stems which you should use so as not to warm the contents of the glass • Although champagne is an elegant drink and should be sipped slowly, it should be sipped in a way that the champagne hits the back of your throat first. This way you feel and taste the full vitality of the drink. If it hits your tongue first it will instantly become warm and lose its sparkle

“Remember, gentlemen, it’s not just France we are fighting for, it’s champagne!”

Sir. Winston Churchill WWII

Dr. Pierre Fournier teaching Angela O’Mara how to strike a pose.

Dr. Mario Gonzalez Ulloa

A Visionary In Plastic Surgery

A Report From South Of The Border

By Dr. Alfredo Ponce, Plastic Surgeon, Guadalajara, Mexico Don Mario, as we referred to him, was from another galaxy.

Born into a wealthy family, he studied medicine and, like many people who wanted success in those days, took his dreams in a suitcase and began traveling around the world to meet the best surgeons. He traveled so he could learn surgical techniques from them, techniques that he ultimately brought back to Mexico to the benefit of patients and future surgeons alike. Don Mario, whose full name was Mario Gonzalez Ulloa, became one of the most prominent plastic surgeons in Mexico, not just because of his surgical skills and expertise but also due to his entrepreneurial spirit.

Dr. Mario Gonzalez Ulloa

I, personally never received a single lesson in medical school about how to manage and administer the money earned at my medical practice, or that being a doctor in private practice is just the same as building a company.

I even remember receiving the message from my professors that “doctors should be somewhat like a social worker for the well-being of humanity.”

Over the years, I have met many physicians who, after a life of professional success practicing medicine were passing the last days of their lives in bad condition. Not from ill health, but with economic problems. As you say in the USA, they were bankrupt. I was afraid in the early years of my career that this might also be my fate. That was until my final years of residency in Plastic Surgery in Mexico City where I met a professor who was like a celebrity to me and to many of the other plastic surgery residents. It was at that time that Don Mario began to influence my life. Don Mario contributed more to my future success than anyone.

Don Mario was a pioneer and was always creating something; a surgical technique, an instrument, a new textbook, a novel, an opera or a new building. He was always creating, developing and inventing. One day he performed surgery on one of the most important actresses in Mexico and she paid him with a bag of coins. He took the bag of money to the bank, and the banker told him, “don’t put this money in the bank, buy land for the future,” and he did. He later used that land to build

his first hospital which remains one of the most important hospitals in Mexico City, The Dalinde Medical Center located in the heart of the city.

To this day, it is one of the busiest health centers in one of the most populated cities of the world.

Born in Chihuahua, MX, Don Mario carried a special place in his heart for Mexico City. In the 1950s the governor of Mexico City decided to develop new and modern sections that the city needed, and for that purpose he would have to destroy some of the older areas of Mexico City.

Don Mario was very concerned because a lot of the buildings had such beautiful architectural treatments that carried a lot of tradition in them.

Upon awakening from a troubled night of sleep, Don Mario came up with the idea of buying the building fronts and transporting them to an area where he would build new houses with the facades. After the paperwork was signed, he created new development in the area of Tetelpan, and with this idea he was recognized by many world leaders for his foresight into historical preservation.

In 1973 he bought an old farm that was once owned by Hernan Cortez, the conqueror of Mexico and he converted it into one of the best hotels in the city of Cuernavaca, which is known as the city of the eternal spring. He named it the “Ex Hacienda de Cortez”, innovating with this a new type of hospitality that we know now as “the boutique hotel”. Every Sunday he would have lunch with a group of intellectuals that

he sponsored in his “Foundation For The Study of Mankind”. Being asked to participate in this lunch was an honor and was an exciting and unique experience where writers, sculptors, painters and all kind of intellectuals would enter into philosophical discussions that always kept a flavor of being in contact with wisdom.

He was a friend of all the important people of those times. Presidents, entrepreneurs, artists, philosophers, but he never left the needy. He was one of the first passionate surgeons to correct congenital defects in the poorest of families dealing with cleft lip, and he organized and funded his own campaigns. He used to keep in his desk an acuarela painted in an eggshell as one of the most important rewards that a child gave to him after a reconstruction surgery of a cleft lip.

Don Mario was also a forward thinking plastic surgeon. He was the original creator of gluteus implants that he referred to as the “almond” implants because of the shape of them. He considered that beauty was not complete in a female if she does not have a good projection of the gluteal region. He held a conference that he titled “The Syndrome of the Sad Buttocks” and it was a complete success. Of course, this was decades before we ever heard of the Brazilian Butt. One of Don Mario’s many great plastic surgery accomplishments was founding the Mexican Society of Plastic Surgeons that he hosted for decades.

I knew him in the last years of his life. He died of respiratory complications surely because of his heavy addiction to smoking. I still remember walking by his side and he would take my arms and support his other arm with his eternal companion, his walking cane (he suffered sequelae of poliomyelitis) and he always had a cigarette in his mouth.

Even though I did not have all of the time to share with him that I would have wished for, I learned from him the most important aspects of plastic surgery - the basics of investing from what we earn as a plastic surgeon, and I learned from him how to be an entrepreneur, as well as a successful plastic surgeon. But, the most important thing I learned from him was a philosophy of life, a way to become a person that seeks the best way to enjoy life, to be happy and find pride in what you do every day.

Don Mario was the first and best entrepreneur that I ever met. He started his career as a Plastic Surgeon, but he had also the capacity to be a continual student of beauty, a great philosopher, an incredible speaker, an outstanding professor, and much more. In my esteem, he was also one of the best humans that life placed in front of me as a teacher and mentor.

Today, I see that many doctors in the world are impacted by the recent worldwide financial crisis that we have all experienced, and they still lack the foresight to think beyond their surgical career. As doctors, we need more education in administration and finances because life has changed from when medicine was an apostolic life and we are now living in a very competitive world. We need the teaching experiences from people like Don Mario.

“Don Mario was a pioneer and was always creating something.�

Bell tower of the San Francisco Church in San Miguel de Allende Dr. Alfredo Ponce

Dr. Bruce Connell

The Prince of Plastic Surgery - An American Icon

By Angela O’Mara As rare a breed as the prince whose palace he was guarding, Xolo, the large Xoloitzcuintli dog (Mexican Hairless) sat and carefully observed me from his vantage point on the balcony which overlooked the vibrant blue Pacific Ocean with a panoramic view of Laguna Beach, CA. It is a Saturday afternoon and as I sip tea with world renowned plastic surgeon Dr. Bruce Connell, I can’t help but feel incredibly lucky. The name Dr. Bruce Connell is spoken by doctors who in their own right are considered successful and established leaders, they often refer to him with the reverence of a student for a great master.

Chatting with him on a bright sunny California afternoon ranks as yet another “most delightful days of my career” moments.

A humble man from humble roots in Alabama, this gentle giant of plastic surgery still knows how best to use his Southern charm to make a point and to tell a story.

“I just wanted to be a good physician,” said Dr. Connell with still of a hint of a Southern drawl, as we talked about his early days in medicine. “I learned quickly that a bad facelift was often the result of a rushed surgery so I decided to slow down so I could get it right.”

While he may have slowed down his approach to surgery, his reputation took off faster than a California wildfire. Connell grew up poor as the only child of a divorced mother. His parents, a schoolteacher and a baker-turned-cattle rancher, separated when he was five years old during the Great Depression. Connell graduated top of his class and worked his way through a year at the University of Alabama before winning a scholarship to pharmacy school in Birmingham, AL. After a brief military tour in Italy at the end of World War II, he obtained a medical degree from the University of Buffalo where he was drawn to the challenge of cleft lips and maimed hands. He then took an internship at Los Angeles County General Hospital - now County - USC Medical Center - and a residency at the University of Buffalo in general surgery, finishing his final residency in plastic surgery at the Mayo Clinic. When he graduated, he returned to Southern California to start his practice because the climate he says, reminded him of his time in Italy.

Setting up practice in California was a godsend and it became home to this man whose ideas of beauty extended far beyond the face and body, but also to his garden and his personal

surroundings. It is not a secret that Dr. Connell boasts one of the most beautiful gardens in all of ritzy Laguna Beach, and that his brilliant hands are as agile at cutting and splicing hybrid trees and vegetation, as they are at cutting and draping human tissue. Maybe not considered entirely humble as rumors abound about the size of his home in Laguna Beach, or the lavish life he lived racing around Las Vegas with the “in crowd” on whom he supposedly performed plastic surgery. As Dr. Connell recounted to me, his life and his love of plastic surgery with glee, what struck me most was how genuine and caring he is as a doctor and as a man, and how this man’s quick mind and wit is still more vibrant than most people I encounter.

What is his secret?

“At first, I used to look at patients and wonder what I should fix,” said Dr. Connell. “Then all of a sudden I stopped dwelling on what wasn’t beautiful. The real mystery is in what is beautiful.’”

Ask any plastic surgeon what it’s like to know Dr. Bruce Connell and they will tell you - he is to plastic surgeons what the “Oracle” was to Keanu Reeves in the movie The Matrix. Ever knowing and ever seeing.

Before meeting with Dr. Connell, I sat down with Long Beach, CA plastic surgeon and former Connell fellow, Marcel Daniels, M.D., to discuss this living legend. Dr. Daniels was one of the best resources to discuss this world class icon given the fact that he knew Dr. Connell before Dr. Connell taught him how to become a worldclass surgeon.

“I first met Bruce when he was starting out and he would come to our house to practice French

with my mother,” reminisced Dr. Daniels. “Little did I know then that many years later I would be learning facial rejuvenation surgery from him.”

According to Dr. Daniels, and to many other plastics surgeons we spoke to, Dr. Connell made him not want to be “a general surgeon who just uses tiny sutures!”

Dr. Bruce Connell’s fellowship training program was very selective and he is known for constantly challenging the preconceived notions of his fellows. He has trained several generations of plastic surgeons and has had a huge impact on the field of facial rejuvenation. His critical eye and attention to detail were a great inspiration to Dr. Daniels who says that to this day the techniques he drummed into his fellows in face and brow lifting are the gold standard for natural, elegant results! Techniques that still apply today.

“Even many years after my training, I would attend meetings where Bruce would be presenting and all of the attendees would be awe-struck by the quality of his results,” said Dr. Daniels. “His techniques for face and browlifting remain gold standard to this day and he has had a major influence on many surgeons, including myself!”

Over the years, Dr. Connell quietly became one of the world’s premier face lift experts. As well as training decades of future surgeons, he was sought after at medical conferences and his training seminars were always sold-out.

Details of Dr. Connell’s works and techniques have appeared in many medical textbooks and white papers worldwide. However, if you search for him on the Internet you will find little about

him, but rather hundreds of google pages listing websites of all the other doctors that either trained with him, or reference articles he has written or quotes he had made. Dr. Connell’s reputation has outgrown the USA, over the years he has treated patients from Egypt, Italy, Germany, Australia, New Zealand, England, Singapore and countless other countries. The same can be said for his travels and lectures.

It is said that his former apprentices, known as Connell Fellows, gather regularly from around the globe as the collective Connell Society to learn from one another and their mentor.

So what has Connell been teaching all these years?

“Natural results, of course,” laughed Dr. Connell.

“The majority of people want to look like a better version of their younger self. They don’t want to look like anybody else.”

Connell’s facelift techniques emphasizes careful attention to detail and can take over 6 hours to complete. But in talking to other surgeons they say that Dr. Connell not only taught them what to do right, but also what NOT to do.

Reasons A Facelift Can Fail According to Dr Bruce Connell • A surgeon can quickly tighten the sides of the face with a slice along the front of the ear and into the hairline, or yank the loose skin with too tight stitches that pull back the hairline so that it sits too far back on the patient’s head.

• That same quickie technique on a man might result in earlobes with whiskers growing out of them.

• Even some of the best-known surgeons will neglect to preserve the look of the tragus, or will pull the earlobes forward and down and tack them onto the cheek like a “pixie ear,” a rush-job staple that will later have to be camouflaged with longer hair or, for women, wearing huge earrings that aren’t necessarily in style.

• Or they will make incisions along the front of the ear that stand out like chalk lines on people with ruddy complexions.

• They make scalp incisions that create telltale bald spots.

• Or they will lift just the delicate top layer of skin, rather than the more resilient muscle tissue beneath it, flattening the cheeks like a G-force simulator on a trainee at NASA. • They might also lift both layers and carelessly reattach them.

• Sometimes, they just make a cut in front of the ears, undermine the skin, grab the deep sheet, pull to the ear, and voila - you’ve got that wind tunnel look!

Archaeological evidence shows that the Xoloitzcuintli dog has existed as a native to Mexico for more than 3,000 years. Their value in ancient cultures is evidenced by their frequent appearance in art and artifacts produced by the Colima, Aztec and Toltec civilizations in Mexico. They were considered sacred dogs by the Aztecs (and also Toltecs, Maya and some other groups) because they believed the dogs were needed by their masters’ souls and were useful companions. Some people in Mexico continue to believe this breed of dog has healing qualities.

Two words that sum up Dr. Bruce Connell are precision and artistry. Or, as quoted in a Los Angeles Times article in 2006 “What Michelangelo was to the Sistine ceiling,” said Dr. Richard D’Amico, then president-elect of the American Society of Plastic Surgeons “Bruce Connell is to facial aesthetic surgery.”

And judging from what his friends, colleagues and internet websites say, this opinion is still shared by many.

Xolo guarding his Prince’s Palace

Education is KEY:

For Both Doctors and Patients

Education is to a physician, what water is to a plant. Without it, neither grows. The better educated the surgeon, the better the result. Patient education is equally important; the better educated the patient; the more satisfied they are with the result. BIG Medicine Magazine™ asked Sarasota, FL based, J. David Holcomb, M.D. to offer insight on how he has embraced technology into his practice and used it to further the education of other physicians and his patients.

As a facial plastic surgeon I have found that obtaining visually pleasing results and a high degree of patient satisfaction does not always require surgery. In other cases, a combination of surgical and non-surgical approaches to facial rejuvenation is the best move. As I set about refining my non-surgical, non- and minimally invasive facial rejuvenation options for patients in my practice I researched the types of modalities available on the market to help me obtain the best results. As we all know, there are many companies and manufacturers of brilliant technology.

For me however, being a family man, I wanted a suite (family) of products that provided solutions as diverse as my patient base.

Self Education: As always, whenever starting a new endeavor, it took research and education to discover which “family” I wanted to be a part of. During my research I found Lutronic® and their broad family of products; one of my favorite purchases was the Lutronic Accusculpt™, from which I became codeveloper with Lutronic of the AccuLift™ procedure. The AccuLift procedure is now also known as Laser Assisted Facial Contouring and works by sculpting and tightening the skin of the face and neck, with the goal of changing the “pear” shape typical of aging adults to the “apple” shape typical of youth. It gently and precisely removes excess fatty tissue that has accumulated and shifted downward in the face and neck, leaving behind tighter, sculpted features in just 30 minutes. With the AccuSculpt one quality that I specifically like is the thermal confinement which means that the heat created by absorption of the laser light stays fairly well-localized, and this allows me to selectively and precisely contour facial features with a nice safety margin. This procedure has passed the rigorous scrutiny of international multi-center clinical implementation and a retrospective study has carefully delineated the amazing benefits and safety as well as potential side effects and complications of the procedure. The AccuLift can deliver the type of re-definition and contouring of patients’ features that until now would have required a more invasive surgical approach and it is an excellent choice to bridge the gap between

facial fillers and surgical facelifts. I now routinely perform the AccuLift procedure for the lower face and neck as part of my facelift procedure and the AccuSculpt laser has become so integral to my practice that I hope to pass along this innovation in facial rejuvenation to my colleagues as I also continue to water our ever-growing aesthetic garden.

Patient Education: AccuLift was featured on the TV Show “The Doctors”, where I demonstrated the concept of The 30 Minute Facelift. The procedure came about when I learned the unique properties the AccuSculpt laser offered and I developed it to create a particularly new and beneficial option for facial contouring. Appearing on TV is a great way to educate patients on surgical procedures. At my practice we also conduct monthly patient seminars and keep up with our patients on a regular basis through our social media outreach. An informed patient is a happy patient.

Another personal favorite for my patient base is the dual-pulsed Q-switched Nd:YAG SPECTRA™ because it offers a variety of facial applications such as melasma and active acne treatment, as well as works on pigmented and vascular lesions and tattoo removal (which is a rapidly growing market as the population ages). We are very pleased with our newest acquisition the LUTRONIC ADVANTAGE, which is a reengineered, high energy pulsed diode laser system; it is the icing on the cake for hair

removal and permanent hair reduction and is driving growth in my patient base. Finally, the Lutronic eCO2 fractional CO2 laser has been an invaluable workhorse for laser skin rejuvenation and resurfacing. I rely on a combination of these family of products to ensure patient satisfaction, especially given the year-round beautiful weather and outdoor lifestyle in Florida.

Physician Education:

I love to be constantly learning and have found in recent years that I am as equally passionate about passing on that knowledge. I have been honored to travel quite extensively, teaching and training other physicians on the new techniques in facial rejuvenation I have developed. In the future, I hope to be developing webinars for physicians so they too can learn more about different approaches to patient treatment. The use of webinars and other on-line training programs is of immense benefit to doctors as it cuts down on travel time and expenses and allows them to have more productive time in the office.

It’s also relatively simple as all they need is a computer, a wide screen monitor and internet access. There are currently some great on-line learning opportunities open to physicians that are interested to not only expand their practice brand, but expand their mind too! It may take work to water a garden, but the rewards can be great.

Before and After AccuLift™ procedure performed by Dr. Holcomb.

Why You Need A NipTuck Coach In Your Corner!

With so many patients shopping for surgery these days, and so many doctors to choose from, we began to wonder just how does a patient decide who is going to perform their elective surgery procedure, and how can a doctor make sure that they are on that patient’s list? BIG Medicine Magazine™ talked with NipTuck Coach Michele Garber to learn more about the value of working with a professional who can be a liaison between you and a prospective patient.

How does a Cosmetic Surgery Coach work with a patient?

There are only a handful of qualified coaches or consultants that liaise between patients and doctors. While I believe that other consultants work in a similar way to me I can only speak for myself. I provide cosmetic consulting services, education, treatment planning, guidance and surgeon referrals to prospective patients. I help them prepare to meet with a doctor and guide them through the process, referring them to qualified, trained, board certified surgeons who are experts at the procedure that patient is seeking. Safety being a key concern.

How does a Cosmetic Surgery Coach work with a doctor?

Cosmetic surgery, and other elective procedures, has really become a “buyers market” and buyers want to be sold to. Most doctors are not sales people and selling surgery is difficult. Like many people, doctors are not always comfortable boasting about their qualifications, expertise and results, or at asking detailed questions about the patient’s desires or expectations of surgery. That’s where I step in. Patients from all across the USA and, thanks to the Internet, other countries, hire me to help them find the right doctor for them and guide them through this life changing journey. In turn, the doctors I work with have been previously screened by me to ensure that they and the patient are the right fit.

Basically a doctor just has to make sure that his name is in my little black book, for which there is, of course, a procedure.

What does it take for a doctor to be listed in your Little Black Book?

I have a criteria that a doctor must meet in order for me to refer a patient. I do not rely on online review sites. First they have to be board certified in the procedures they say they perform, must have minimum amount of four years in practice, plus skills, education, hospital affiliations, etc. are also very important. They must not have any blemishes on their record, i.e. no malpractice judgments or current litigation suits. I don’t charge doctors to be in my Little Black Book but I do expect them to give my referrals VIP treatment. Generally I will give the patient a choice of three (3) doctors and let them make the final decision.

Does a Coach or Consultant benefit a doctor?

Yes! Elective surgery is competitive and more and more doctors are turning to cosmetic surgery and elective surgery as a way to earn a better living. With further changes in insurance payouts and premiums, the playing field will become even more competitive, however, with a Coach such as myself in your corner, you will have a greater edge. Also, when a patient consults with me first, they have already received a thorough education about the doctor and the procedure, therefore, the doctor’s job is easier and they can spend more quality time getting to know the patient and discussing surgery and medical particulars.

Who pays for your services?

The patient (client) pays me directly. I do not receive any compensation or consideration (trades or gifts) from physicians, medical facilities or any other entity connected to the doctor such as medical device manufacturers or pharmaceutical companies. Nowadays, there is so much confusion about board certification and unqualified or unskilled doctors are offering plastic/cosmetic surgery procedures that often result in the need for revision surgery, or worse. My coaching is the most cost-effective way for the patient to do it once, and do it right with the best qualified expert.

Do you provide any post-op or follow-up services?

Yes. Patients occasionally require non-medical hand-holding and support after surgery. My services include coordinating post-op care in their home, follow-up emails, and any other non-medical care to make their recovery more comfortable. These additional services are coordinated with the doctor’s staff. I have privacy documents signed by the patient and physician to ensure that all HIPAA laws are met.

What kind of medical advice do you offer?

None. I discuss surgical options with patients but I do not provide any medical advice, and ensure all patients seek medical advice from their surgeon of choice. I tell each patient under my referral to speak to their surgeon regarding any and all medical related issues.

How do you see the future of the Nip Tuck profession?

I feel I am filling an important need. As the pressures of insurance reforms increase, the need for out-of-specialty doctors to earn money in the elective market will grow. Therefore, we will see an even higher volume of unnecessary botched plastic surgery patients. My role as a NipTuck Coach will be even more in demand as prospective patients begin to see that they need an unbiased advocate to help them through their surgery.

Tired Of Seeing Doctors Less Qualified Than You On TV? The Seven Deadly Media Sins

By Giles Raine Over the past 20 plus years or so, I have worked extensively coordinating media placements for members of the medical community. During that time, I have placed many physicians on television. Now, with the popularity of reality based TV shows, more physicians than ever are enjoying what Andy Warhol called the “15 minutes of fame” moment. However, when the media’s huge appetite for patient surgery stories is combined with surgeons who have been trained to perform surgery rather than stand in front of a camera and pretend to act, the results can sometimes be less than enjoyable - or expected - for the reporter or producer, and for the physician. These are real stories based on real-life incidents retold to me by members of the media about surgeons with whom they have worked.

(Not surgeons that I have worked with.) I can hear you saying, “I would never do that!” - but these surgeons did. You probably don’t even know who these surgeons are - or do you?

Don’t change your surgical techniques midstream

Whereas learning new techniques and surgical skills is a must for any surgeon, practicing those new skills for the first time is generally daunting to most-and it is not something you want to do on national television. Luckily for Dr. X, this was something he learned during a taped interview rather than a live one. While filming a segment for a national television show, Dr. X - who was demonstrating a new facelift technique, commented while a patient was bleeding profusely, “I usually don’t do it this way. I just learned this technique last week.” The producer was ready to pack up his equipment right there and then!

Make sure your equipment works

This holds true for any new equipment purchases. Recently, a Chicago-based producer told me about a surgeon who had bragged about being the “only” surgeon in his area to obtain a new laser for liposuction. Of course, the producer wanted to have the surgeon on his show as soon as possible - but he didn’t expect that the surgeon would not have at least tried the laser a few times before going live on the morning news. It turned out to be a complete mess because the laser was not working properly, replacement fibers were not available, and the surgeon did not have any patient testimonials of his own yet. Not only did the surgeon look completely incompetent on the air, he also jeopardized the opportunity to ever be invited back on the television show again.

Mum’s the word. Don’t be a gossip!

Although I am glad to say that this is not something I hear often, I have heard and witnessed it firsthand. Don’t gossip about your competition to a reporter!

Please remember that when a television crew or writer from a newspaper comes into your office to interview you, they are also (and always) on the look-out for other stories. As friendly and innocent as they appear this is still a business situation, and sometimes getting the “scoop” or “dirt” on another surgeon can make for a great future story. I’m a firm believer that what goes around comes around. So, as tempted as you may be to divulge a little tidbit of information that may make you appear to be “in the know,” remember that someone else might be just as tempted to reveal a little something about you.

Nod, nod, wink, wink- keep it to yourself When you invite a television crew into your office to film a procedure, remember that they will walk away with more than a glimpse into your life. Ensure that they leave with a true picture of you, your core values, and your professional expertise. That includes not flirting with the reporter. No matter how innocent a joke may seem, in this day and age it can easily be interpreted as a form of sexual harassment that might not necessarily land you in hot water, but will seriously harm your reputation. And trust me, on this front I have heard it all: From the producer of a national morning show who, after flying from New York, elected to permanently shelve a 4-hour facelift shoot and then added the surgeon’s name to an internal blacklist for others to see; to a female staff reporter for an internationally televised entertainment show who almost filed a lawsuit against the show after filming a breast implant story, during which the surgeon repeatedly made silly jokes and off-color remarks. Remember that no matter how casual and friendly members of the media seem, they are doing a job. It is always better to keep things professional.

Is the patient really a patient?

Marketing 101 teaches us to find out who our competitors are. In the realm of medical television shows, not only do your competitors know who you are, they also know who works for you. A successful Miami surgeon who was scrambling to find a patient for a story on fat injection to the hands for the local ABC affiliate innocently thought, “Oh well; we will just use Jane, our office manager. She’s a good candidate for this procedure.”

And she was! Her hands looked fantastic afterward. However, when the story aired during a news program later that week; an extremely jealous competitor called the station manager questioning the surgeon’s integrity and stating that viewers should be made aware when a surgeon uses his or her own staff members rather than unbiased patients to show the results of his or her work. All I can say is that the surgeon was never invited back on that news program again.

Who’s the Diva now?

Popular TV Show Scrubs is a great parody of life in medicine. To have a real life medical career and a presence on TV as an expert you do have to be a bit more serious.

“Let me do that shoot again, please”

A rather handsome, suave, and debonair young surgeon has really been enjoying the media attention he has received since relocating to Beverly Hills, CA - so much so that he believes he is not only the “star” of the show on which he appears, but also it’s director.

Recently, a producer friend of mine told me “that” was the last time she would work with this man. Apparently, the crew spent more time reshooting the surgeon at various angles so they could get his “good side” than they spent actually filming the patient and the procedure.

While all of us want to look our best, especially because the camera is generally not kind, remember that the purpose of the shoot is to gain valuable media exposure for your practice regarding your surgical skills - which are shown through patient results. If you would prefer to spend more time telling notable movie producer Cecil B. DeMile that you are ready for your “close-up”-as actress Gloria Swanson did in the movie Sunset Boulevard – you might want to consider switching careers.

We all know who the divas of the television talk shows are. However, the aesthetic industry has a few divas of its own - men and women - who have upset quite a few reporters and show hosts in their time.

One particular Dr. Diva always seems to think the show will wait for him. Believe me when I say it will not. You must make it to the show on time, and allow yourself ample time to find a parking spot, or to navigate the limousine drop-off area.

Another Dr. Diva believes she has every right to share make-up artists and have the luxury of several wardrobe “try-ons” before sitting down for an interview.

Nope. That is not the case. I encourage you to bring an extra shirt or blouse, or suit jacket, in case of accidental spills, but you should arrive in what you expect to wear on the show. And please do your best to act and look like a surgeon.

PR

TR E N D S

Contributors

biopelle www.biopelle.net Sir Richard Branson www.virgin.com Beth Collins, M.D. www.bethcollinsmd.com

Beauty & Grooming The Eyes Never Looked So Good!

It’s a hard job but someone has to do it. Once again the Beauty & Grooming investigative team were out in the retail trenches doing the dirty work and finding great new products to keep you looking young. We know that doctors pull a lot of “late nights” and are very busy running a medical practice, but don’t despair, we have tested the latest in eye products so you don’t have to.

Bruce Connell, M.D. Theodore Diktaban, M.D. www.drdiktaban.com Brian Evans, M.D. drbrianevansplasticsurgery.com Facebook www.facebook.com Pierre Fournier, M.D. Michele Garber www.niptuckcoach.com David Holcomb, M.D. www.srqfps.com iS Clinical www.isclinical.com LinkedIn www.linkedlin.com Lutronic www.lutronic.com Christopher Lyon, M.D. www.lyoneyecosmetic.com James C. Marotta, M.D. www.marottamd.com Jon E. Mendelsohn, M.D. www.351face.com

Now this isn’t about just about what eye products you should use personally, but also which ones might be a good fit in your practice. These top practice product picks will be loved by you, your staff and your patients. We think your patients will be thanking you for introducing them to these new anti-agers, and you will love seeing your profit margin increase each month!

Biopoelle Tensage Radiance Eye Cream: Our favorite part is that it has a slight tint that covers up dark circles while firming up the skin. It also has the slight sci-fi edge us nerdy types at BIG Medicine Magazine™ need in our skin care products with antioxidants and growth factor properties.

Scott Miller, M.D. www.millercosmeticsurgery.com Timothy Neavin, M.D. www.artisanofbeauty.com Old Operating Theater www.thegarrett.org.uk Oxygenetix www.oxygenetix.com Alfredo Ponce, M.D. www.dralfredoponce.com Giles Raine www.theprofessionalimage.com John Renucci, M.D. www.psa-gr.com Remus Repta, M.D. www.aaaplasticsurgery.com Sean Simon, M.D. www.drsimonplasticsurgery.com Rich Tepper, M.D. www.njplasticsurgerygroup.com If you want to become a contributor to BIG Medicine Magazine™, or if there is a medical topic you would like to see covered in this magazine, send your ideas to: storyideas@bigmedicinemagazine.com.

iS Clinical Youth Complex: Our pick for patients pre-procedure and post procedure. Patients will love feeling prepared before their procedure and it complements other patient treatments. It’s a win-win!

To feature your product contact 949.768.1051

The Professional Image, Inc.

TIRED OF SEEING DOCTORS LESS QUALIFIED THAN YOU ON TV?

Practice Consulting Public Relations Social Media Marketing

Helping Doctors Grow Their Medical Practices Since 1988

The Professional Image, Inc.

949.768.1522

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MEDICINE MAGAZINE™ The Magazine for Big Thinkers

WHAT OUR READERS ARE SAYING Kudos to Angela O’Mara, Giles Raine, Enna Ruiz and all the team for having the guts, initiative and foresight to bring forth the “BIG Medicine Magazine™”. True to form, as befits “The Professional Image, Inc.” this production is classy, professional, well laid out, pleasing to the eye and an easy read. Let me tell you why I subscribed.

BIG Medicine Magazine’s upbeat tone is more than welcome in this era of gloom and doom in medicine. Its authors bubble over with enthusiasm, insights, optimism and resourceful pearls for those who still believe that private practice provides the best quality care for our patients. All critiques rest upon one’s reference points garnered through life. Please allow me to share mine.

An upbringing under Britain’s socialist National Health Service provides my perspective, lacking in those for whom US medicine was the norm. This, coupled with the onerous NHS stamp taxes imposed on small businessmen such as my father, was a forerunner of the Supreme Court mandated tax that hovers US businesses under Pelosi’s Obamacare.

Notwithstanding a lifetime of taxes, when my father’s adenocarcinoma of the lung was finally diagnosed late in its course, he was dumped unwittingly and unknowingly into the “Liverpool Pathway” for terminal “care”. His visiting nurse deprived him of his ‘costly and too addictive’ pain killers. So he ended his days relieving his misery by sucking on a bottle of Johnnie Walker.

My volunteer work in faraway places such as Burma, Cambodia, Laos, the Philippines and Thailand under the auspices of THE BLINDNESS FOUNDATION www.blindcure.com provides me with yet additional references. Participation in a multitude of differing and constantly evolving health care systems, with politics ranging from military dictatorships to nominal democratic monarchies, yields insights unknown to our leaders in Washington.

Over the past 20 years I have watched these political systems evolve, alongside their native healthcare systems. THE BLINDNESS FOUNDATION has helped cure cataract blindness in over 50,000 people, working hand in hand with local Doctors. This work itself evolved into oculofacial repairs for landmine victims in Cambodia, and of course cosmetic repairs to enable local Doctors to be selfsustaining in their very own practices. One common denominator across all these countries, also including the UK and the USA is that evinced by even that arch-conservative Churchill himself, who planned to buy votes in 1944, by underpaying Doctors’ labors. And so it goes on, as Thailand bought the popular vote by giving the peasants’ health care for one dollar a visit.

The counterbalance and hope that exudes from the pages of BIG Medicine Magazine, for the endurance and prospering of independent private practice, encouraged me to sign up for my subscription. Tuning out and turning off the baleful news media sure helps, but BIG Medicine Magazine writers go one step further to achieve balance: their faith in the survival of our private practices, fulfilling our patients’ needs, validates our own belief in our chosen profession.

Lifting us up out of the slough of despond, BIG Medicine Magazine’s messages help us recognize the wisdom of some of our fellow colleagues who have foresworn all insurances, with their coercive strictures mandating intrusive electronic records of our very own intellectual property, and all the potential loss of privacy that entails. These brave souls have reverted to the days of yore with cash and carry payments only.

Yet, at the end of the day it is not just the size of your portfolio that makes life wonderful, but the opportunity, the privilege, on an hour-by-hour basis of doing one of the most fulfilling and satisfying lifestyles that life can offer: genuinely helping others in a way that no-one but a real Doctor can. Nothing else comes close. BIG Medicine Magazine is a pathfinder, lighting the way to enriching and achieving that goal.

Thank you Angela!

Review by Dr. Christopher Lyon www.lyoneyecosmetic.com