Dr. Malcolm Roth is Chief of Plastic Surgery at the Albany Medical Center in Albany, New York, and former president of the American Society of Plastic Surgeons. A practicing board certified plastic surgeon for 25 years he is passionate about his profession and one of it’s most articulate spokesmen.
FOF talked to Dr. Roth about changing consumer attitudes towards plastic surgery and about changes in the field itself.
What is most rewarding about being a plastic surgeon?
We restore and enhance lives. We perform procedures in the reconstructive area that make people function better. A woman who has had a mastectomy, for example, can go to the beach looking as she did before. We work on children born with deformities and on cardiac patients who have infected wounds after heart surgery. We make people happier about their appearance and more confident about themselves.
What would you like to tell a woman who sees something she doesn’t like with her face or body, but is anti plastic surgery?
Plastic surgery is a beauty-for-life thing. We can best counsel women on their range of options, not all of them involving surgery. Options can go from simple skin care, to minimally and non-invasive modalities, and finally surgery. Even if the surgeon doesn’t work with the appropriate laser that he feels can best treat a woman, he can send her to someone who does use it. On the other hand, if you see a doctor who only uses lasers, and doesn’t have complete plastic surgery training, he or she will likely recommend the laser.
Let’s say a woman is bothered by something with her skin. Doesn’t she automatically think of going to see a dermatologist?
Yes, dermatologists often are the first specialists a woman thinks of. We’d like to change that. Plastic surgeons know what the dermatologists know, but also they have the ability to offer other treatment that the dermatologists aren’t trained in.
What is a crucial piece of advice you’d like to give women about their skin?
No matter what her age, a woman must use sunscreen at all times. A long-term study definitely revealed that women who used sunscreen didn’t experience the same aging of their skin as woman who didn’t use it. Use of sunscreen also reduced their risk of developing skin cancer.
What are the tell tale signs of aging and the treatments to reduce or eradicate them?
Let me walk you up the ladder, starting at the bottom of the face:
- Besides fine lines, there are the nasolabial folds, which extend from the sides of the nose down to the corners of the mouth, and the marionette lines, which are the wrinkles extending downward from the corners of the mouth.
- Crow’s feet at the corners of the eyes
- ‘11 lines,’ the little vertical lines between the eyebrows
- Forehead creases running across the forehead
- Bunny lines, the transverse cross lines on the upper portion of the nose
- Fine wrinkles and age spots
Some of these issues, particularly the upper wrinkles, are best treated with Botox or Dysport. The deeper wrinkles on the lower face are typically treated with one of the many fillers available, which usually last a minimum of six to eight months, up to two years, depending on what is used.
The fine wrinkles and age spots can be treated with creams and lotions, lasers, and other light therapy and radiofrequency.
Then you get into the area of surgery, including brow and neck lifts, facelifts, short-scar facelifts, fat grafts instead of off-the-shelf fillers (liposuction on one area followed by use of a patient’s own fat to rejuvenate places such as the jaw line and eliminate nasolabial folds) and eyelid surgery.
Increasingly, different types of doctors offer Botox and filler injections. What are your thoughts about this?
Dermatologists typically have not had the full gamut of plastic surgery training, and even if they’ve had some training following their dermatology training, they still are not board certified in plastic surgery.
At least six years of training is required to become board certified in plastic surgery, in addition to passing written and oral exams. You can’t even take your oral boards until you’ve practiced for a while and have satisfactorily completed a certain number of cases within the field of plastic surgery.
Despite the stringent requirement, you don’t have to be a plastic surgeon to claim you’re a plastic surgeon. You can be a radiologist, gynecologist, even a pathologist and still call yourself a plastic surgeon. Having a license to practice medicine is all you need. Even if you’ve never held a knife, you can call yourself a plastic surgeon. Many non-physicians also call themselves doctors. A nurse, for example, will call herself a ‘doctor of nursing.’ Only six states (Florida, Louisiana, Texas, California, Maryland and Utah) require doctors, when advertising, to name the specialties in which they’ve been trained and the boards to which they belong if they claim they’re ‘board certified.’
Dentists are doing Botox and general practitioners are doing liposuction and lasers, because it’s lucrative. They take online courses and weekend seminars, as opposed to six years of training in plastic surgery.
Most importantly, board certified plastic surgeons can assess problems that arise and treat complications; other docs can’t.
What would you tell a woman who is afraid of plastic surgery, even though she knows she’d benefit?
Don’t be put off because the word surgeon is in my title, because there are other things we offer today that could benefit you. If a woman isn’t ready emotionally or financially for an operation or she can’t take the time off, we can give her the short-term, non-surgical options. We can buy time to make her look refreshed and rejuvenated and put off surgery, even though it will provide the best result.
Have you seen a change in women’s attitudes about plastic surgery from 10 to 20 years ago?
No question. Botox recently had its 10th anniversary and so many women have had their faces improved by neurotoxins or fillers. Lasers, too, have become a big part of what we do. We have an increasing number of options that we didn’t have 20 years ago. And now that we have these options, women at younger ages are seeing us. A woman at 40, for example, who took care of her skin, could be a great candidate for neurotoxins or fillers. Minimally invasive treatments can’t stop gravity, however.
Well-trained, board-certified plastic surgeons also have evolved. We’re constantly learning new and more sophisticated techniques that produce more natural results. Down time for major procedures can be as little as one to two weeks. We’re making better, shorter incisions and not putting as much tension on the skin, so we can avoid that over-operated look.
Should a woman consider location when she’s deciding what plastic surgeon to use or should she be open to seeing a doctor a few hours away from her home?
I’m in Albany, NY, but I saw someone today from Western Massachusetts. She can stay in the hotel right next to the hospital. Out-of-state patients do that all the time. The most important things to consider when choosing a doctor is: A) Whether he or she is board certified and stays up to date on the latest procedures. Medical education in patient safety is part of our continuing education and B) Really hears what you want and is on the same page as you.
Do you do online consults?
I do not. If a doctor does online consults with someone from another state, it could be considered practicing medicine in that state. And unless you have a license to practice in the other state, you shouldn’t do it.
Skype is a good option, but there is nothing like being able to put your hands on a patient’s face and on her body and to see what the skin is like. It’s difficult to have a meaningful consultation unless you do it in person. It’s also important to have an opportunity to learn a patient’s “psychological profile” and for the patient to see if the doctor is right for them.
Are there new non-invasive procedures that you especially like today?
I tend to be more cautious. There are many procedures today that use laser and radiofrequency, but many people could walk away disappointed after having these procedures. Doctors need to be cautious about salesmanship. Just because a procedure involves less down time and is less expensive doesn’t mean a patient will be happy with the results. If 20 percent of people will get a significant result, 40 percent won’t see a difference after a week or two and many will never see a difference, it might not be a reasonable cost/benefit analysis.
Although there’s a reasonable chance a patient will have some improvement, no downtime and no scars after a non-invasive procedure, it’s not going to be anywhere as effective as a facelift or liposuction. It may sound good, but if you spend $5,000 and don’t get a significant result, you’ll be an unhappy patient.
Some people are absolutely not candidates for non-invasive procedures. Some may be candidates, but it’s hard to predict the results with complete certainty.
Ask a lot of questions and listen carefully. You might hear what you want to hear: ‘No down time, no risk, no pain and it costs less than surgery.’ But what you should really ask is: ‘Is this going to be worth my $5,000?’ If your expectations are reasonable and appropriate—and you know the range of results—you won’t be disappointed.
Of course, doctors show potential patients their best before and after photos. I’ve heard of some who even show photos that aren’t their own patients. Do your research thoroughly.