September 20, 2024 • 62 mins
What if the future of plastic surgery could be revolutionized by artificial intelligence and robotic suturing? Join us as we sit down with Dr. Edward Lee, the division chief of plastic surgery at Rutgers, New Jersey Medical School, to explore this exciting possibility. Dr. Lee shares his journey from private practice to academia, detailing his innovative work in microsurgery and targeted muscle re-innervation for amputee patients. Learn about his pioneering efforts in developing cutting-edge clinics and his visionary outlook on the future of plastic surgery.
Curious about the evolution of surgical training and mentorship? Dr. Lee's reflections on the shift from traditional techniques to advanced methods in breast reconstruction and orthopedic oncology provide a rich narrative on how surgical education has transformed. Delve into the importance of both formal and informal mentorship as Dr. Lee recounts invaluable lessons from his mentors. Discover how personal connections and structured learning opportunities shape a medical career in profound ways.
Struggling with burnout in the medical field? Dr. Lee's insights on managing burnout and maintaining a productive mindset are invaluable. He emphasizes self-awareness and the support of friends and family as critical mechanisms for overcoming professional fatigue. This episode also highlights the importance of teamwork in the operating room, the role of music in creating a conducive atmosphere, and Dr. Lee's ongoing goals to enhance research and patient outcomes. Whether you're a medical professional or simply intrigued by the intricacies of plastic surgery, this episode offers a treasure trove of wisdom and practical advice.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
As you listen to my next guest, dr Edward Lee,
plastic surgeon, it may onlytake you a minute before you
recognize him as a big thinker.
He is the rarest of plasticsurgery animals, someone who
started his career in privatepractice and then found his way
back into academia at a largemedical center.
He climbed to the top of themountain as division chief of
plastic surgery at Rutgers, newJersey, medical School and
(00:26):
residency program director.
But this particular big thinkeris not a passive ivory tower
brahmin, even though he did goto Yale and Georgetown, two
elite organizations.
Dr Lee is a doer, a dynamicmover and shaker, training
future plastic surgeons in thefield of microsurgery, managing
multiple teams of surgeons andclinics, working on big ideas
(00:48):
such as re-innervating muscle inamputee patients and, as you
will hear, even speculatingabout future advances such as
artificial intelligence inplastic surgery, coupled with
technological advances such asrobotic suturing.
Dr Lee is a leader in ourspecialty who is simultaneously
hoping to dramatically widen thescope of plastic surgery, as
well as render much of what wedo as antiquated, which is both
(01:12):
wonderful and scary at the sametime.
His approach is practical, downto earth, and he is a master at
seeing situations from both theground level as well as the
10,000 foot level.
Dr Lee approaches challengeswith inclusivity, finding ways
to lead his division, communityand those around him without
leaving anyone out.
It was fascinating to cover somany different topics about
(01:35):
surgery and life with Ed and Iknow you will find him as
thought-provoking as I didspeaking with him.
Thank you very much.
All right, welcome to anotherepisode of Botox and Burpees,
the surgical series.
And I have with me my veryspecial guest, dr Edward Lee.
And Dr Edward Lee I've knownhim for a long time is the
residency training programdirector of plastic surgery at
(01:57):
Rutgers, new Jersey MedicalSchool.
He's an associate professor ofsurgery and Dr Lee grew up in
North Brunswick, so he's a NewJersey guy and he attended the
Lawrenceville School for highschool.
Dr Lee graduated from YaleUniversity with a double major
in philosophy and molecularbiochemistry and biophysics, and
(02:18):
then you completed your MD fromGeorgetown University School of
Medicine.
You did your plastic surgeryresidency at University of
Pittsburgh and you have been atNew Jersey Medical School for
how many years now?
Speaker 2 (02:35):
It's been quite a while.
So I actually started out inprivate practice for three years
.
Okay, so I was based inEnglewood Cliffs, family was
around there and then you know Iactually really enjoyed the
academic side of things.
So I attended the Grand Roundsand enjoyed teaching and Mark
Granik, who was the divisionchief there and is still there,
(03:00):
asked me if I wanted to take ajob.
So I took a part-time job atthe VA hospital.
Asked me if I wanted to take ajob, so I took a part-time job
at the VA hospital, reallyenjoyed my time there and then
ended up moving on to join theuniversity full-time in 2018.
So I've actually only beenfull-time at the university for
about six years now, so it'sbeen great I've taken over the
(03:22):
role as the residency programdirector.
I started that back in 2011 or2012.
And then division chief over atRutgers, New Jersey Medical
School.
Their residency, their program,their division.
Speaker 1 (03:50):
What are you guys?
Speaker 2 (03:50):
at this point we're division within the Department
of Surgery.
Speaker 1 (03:54):
So that's a lot of hats.
You're a busy man, Dr Lee.
Speaker 2 (03:59):
Yeah, it's a few too many hats really, but no, I mean
, I've got great partners right.
So Mark Granik is still there.
Ramazi Datiashvili, who youprobably remember from your time
at NJMS, is still there and thetwo of them are phenomenal
partners as well, as you know,leaders in thought in terms of
(04:20):
what they do.
And so Mark's interest in woundcare technology is phenomenal.
He's constantly runningdifferent clinical trials and so
he's very involved with thestudents in the residence as
well.
And then Ramazi is one of theworld's leaders in replant,
whether it's digital replants ormajor limb replantation.
(04:43):
So it's great to have those two.
And then we've hired a coupleof new people.
So we have got a guy, ashleyIgnachuk, who is a well-trained
hand surgeon.
He's Canadian, so of course youknow he's a nice guy, but he
runs a very interesting clinicwe put together as a team.
We put together something calledthe Targeted Muscle
(05:05):
Re-Innervation Clinic.
So it's a new procedure thatpeople were doing to try to
reduce phantom limb pain aftermajor limb amputation, so below
knee, above knee and then upperextremity amputation.
So we have a specific clinicwhere we partnered with the
Hanger Clinic, a prostheticscompany, in order to better
(05:27):
serve these patients Right.
So we track them from the timeof their amputation, whether
it's traumatic, oncologic orvascular and then we will do TMR
or RPNI at the time of theiramputation and then track them
as they go through, and we'veseen some very good results for
them.
So it's a multidisciplinaryclinic.
(05:49):
We have a physiatrist, we haveour prosthetist and rehab people
there as well, so it's a greatclinic that he runs.
And then we've recently hiredStephen Ovadia, who's a gender
affirmation specialist as wellas craniofacial specialist, so
that'll be a great source ofexperience for the residents and
(06:13):
service to the community.
And then in April we actuallyhave Alex Wong coming on board.
I don't know if you know Alex,but he's a microsurgery director
at USC and then City of Hopeand also has a translational
science lab that's NIH funded,oh wow.
Speaker 1 (06:31):
So what is your clinical focus, Ed?
What do you focus on surgically?
Speaker 2 (06:35):
You know, my focus really is on traumatic and
oncological reconstruction.
So I would say most of mypractice comes from either the
orthopedic oncology or surgicaloncology world and then the
orthopedic trauma or generaltrauma surgery world.
You know they've tried to.
I guess people have created abucket for it of complex
(06:57):
reconstruction is the term thatthey're using for it, and I kind
of wonder.
Like there were two when I waswas training there were two
surgeons.
One had a practice that weconsidered kind of elite
reconstruction and the other onehad a practice that we kind of
considered bottom of the barrelreconstruction.
But honestly, both of them weredoing the same procedures.
(07:18):
It was just slightly differentgroups of patients and I think
that I cover the full spectrumof both of those you know.
So it's going from wounddebridements to deep flaps for
breast reconstruction or, youknow, really nice like
orthopedic, planned outorthopedic oncology procedures
(07:41):
where we're doing free flaps for, you know, muscle
re-innervation andreconstruction as well as soft
tissue coverage over themegaprostheses that they'll use.
Speaker 1 (07:51):
How much is your practice micro?
Speaker 2 (07:55):
I would say probably about 20% of my practice is
micro.
I really like doing it buthonestly we kind of move away
from it.
It so a lot of our traumaticreconstruction uh, because dr
granik is such, has such a focuson wound care technology.
We do use a lot of wound caretech, uh, whether it's the
advanced wound care productslike um, solera, somagen, uh,
(08:19):
integra things are things thatsort of downgrade the intensity
of surgery that's needed.
So, going from requiring a freeflap to here's a product, put
it on the wound, vac it for aweek or two and suddenly you
have a granulation bed where youdidn't think you would have one
(08:40):
.
Speaker 1 (08:42):
So you mentioned how you had mentors or people who
you trained with, who did fancypantsy, reconstruction and then
more of the blue collar stuff.
What other kind of memorabletraining experiences or stories
do you remember from when youtrained that might have been
formative or really sort of putyou on the path to where you are
(09:03):
?
Speaker 2 (09:04):
today.
You know, I think they're allformative.
I mean, that was part oftraining, right?
I mean it was.
You know, when I started the80-hour work week, I hadn't
quite caught on yet and most ofus, honestly, as trainees,
(09:28):
didn't believe in the 80 hourwork week.
We felt that it was better tospend more time in order to see
more.
So we were happy to ignore the80 hour work week and keep going
.
But I think, you know, honestly,the training has gotten better.
We've moved away from it, andpart of it is that we, as
educators, we've developedopportunities to learn rather
(09:48):
than waiting for opportunitiesto come along.
So it used to be you're just inthe hospital so long you'll see
every type of case throughoutyour residency.
But since you're not going tostay in the hospital that long
now, now we have to create anopportunity for you to learn
about it, whether it's throughsimulation, um, additional
(10:10):
didactic time, uh, you know,courses that you'll go to in
order to see it, mission tripsthat uh residents will go on in
order to see more of the cleftlip, palate or other congenital
issues.
So I think the education hasgotten better and so the
experience has gotten better Now, formative experiences, like I
(10:31):
said and you've been there itwas kind of like war, right.
You're like in boot camps forfive, six years, and so all of
them are formative experiences.
What really stands out?
There's so many cases that arejust mind-boggling and a little
(10:54):
bit crazy.
You know, I think really someof the formative experiences
were not in the hospital though,right, it's like when an
attending who you admire takesyou aside and says, hey, let's
go grab lunch.
Speaker 1 (11:11):
Or hey, you know why don't you?
Speaker 2 (11:12):
come over to dinner.
Tonight I'm having some otherpeople over for dinner and so.
I remember one of my attendingsdid that for me, you know,
invited me out.
There were a couple of otherattendings there with him in
different specialties and youknow it.
It was a.
He was very much into wine, soit was a wine tasting dinner and
the first thing I thought wasoh my god, that's a lot of
(11:34):
bottles of wine for.
Very well, you know, by thetime you're like a PGY5 or 6 res
, like you haven't really hadanything to drink for years
because you're in the hospitalso much, and especially as
you're doing more microsurgery.
Yeah, I don't know about you,but for me if I drink and then I
(11:58):
try to do micro, it's just alittle bit off and I don't like
that feeling little bit off andI don't like that feeling.
It's probably similar to youfor other surgeries or, or you
know, a hardcore, um hardcoreworkout right, like you don't
want to go in a little bit hungover, like that would be awful.
Speaker 1 (12:16):
Did they finish all the bottles that night?
Uh?
Speaker 2 (12:18):
they did.
I stopped after a little bitcause I I couldn't hang with
them.
Speaker 1 (12:24):
Yeah, those, uh, those attendings back then.
Yeah, that was old school beingable to do that.
So what kind of mentor?
Do you remember anyone inparticular that was really
special to you during that time?
Speaker 2 (12:37):
Yeah, I mean there were a number of people and they
were mentors in different waysso you know, there was a guy,
joe Losey.
Oh yeah, he is our residencyprogram director and he's a
craniofacial surgeon and stillis.
He's one of the most meticulousguys you know and so like,
dedicated to his patients, tohis students, to his residents
(13:00):
and to his craft and he's alwaysimproving it.
But you know, I strive to bemore and more like him, but I
know I never will be um and butthen the guy who actually
probably had the most impact onme was a guy named jimra savage.
He's the guy that you'll neverhear about because he rarely
publishes, but is was by far thebest plastic surgeon I've ever
(13:24):
worked with.
You know, the guy's kind oflike the A-team.
You remember the slogan for theA-team?
It's like if you have a problem, bad enough, if there's nobody
to help, call who do you call?
You call Jim Rizabic.
They also call him the pizzaman because he always delivers.
(13:49):
But you know, this is one of theguys who was oral maxillofacial
surgery trained, then generalsurgery trained, then plastic
surgery and microsurgery trained, and it was one of those things
where his attitude and hisability to train residents was
phenomenal.
And one of his attitudes reallywas how do I?
(14:11):
His quote was I asked him whydoes he stay and train us?
Because he would sleep on thecouch for hours while we're
operating, till the wee hours ofthe morning, and then, if
there's's any issues, he'd comein and fix whatever it is.
But no matter what it was, hecould fix it, and we knew he
could finish way faster withoutus.
And you're kind of like, well,why are you doing this?
(14:33):
And he said his argument.
One, you should train everybody.
So no matter who it is, ifthey're, if they're slow, if
they're bad, it's your job tomake them better.
And two, he was like he waslike one day I'm gonna be old or
I'm gonna get injured and I'mgonna look up and and if I know
(14:55):
that you were a bad surgeon andI hadn't trained you, that's
gonna fall on me.
It's like.
So you know you want yourfriends to, when they go to see
a plastic surgeon, to know thatthey're good and the only way
that you know that they're goodis if you've helped train them
and make them better.
Wow, that's awesome.
Speaker 1 (15:14):
Oh my God, yeah, I mean that resonates with me on a
couple levels.
One is that selfless dedicationthat that I've encountered as
well in mentors, the fact thathe would let you operate, and
then, uh, the fact that, uh, hewould let you operate and then
be able to fix anything thatwasn't right.
And then also the multi, thetriple threat, the OMS, general
(15:34):
surgery, plastics, micro.
I mean I knew a couple of thoseguys and they were in training
until they were almost 40.
And yet they were the bestsurgeons I had ever seen in my
life, like the ones who had gonethrough all that training.
I don't know what it was aboutthem, but crazy, crazy,
impressive.
So.
And the fact that he wasn'tlike a flashy academic, like big
(15:58):
shot guy, like they were in thetrenches teaching, like I feel
like the best clinicalspecialists are the ones that I
have seen not be like up onpodiums, you know, like
presenting, doing all that kindof stuff, like these were the
guys that were really busyclinically and like a lot of the
unsung heroes of residencyprograms I feel like are guys
(16:19):
just like your mentor for sure,like that means a lot.
So, um, so, tell me, uh, inyour journey to becoming where
you are.
Give me a one method or waythat you became better as a
surgeon.
Uh, for yourself.
Speaker 2 (16:40):
Um, you know, I I saw this question and I kind of
ignored it, Because it's one ofthose things that's a little bit
hard to answer, right, yeah?
Speaker 1 (16:51):
it is hard.
Speaker 2 (16:53):
I think, more than a method, it's sort of a mindset,
right?
And it's one of these mindsetsof always being humble, always
being curious, right, how do youget better at something?
You have to accept that you'renot good at it, or, if you are
good at it, that you're not thebest and there's a better way to
(17:13):
do it, and to be curious to say, hey, well, how is someone else
doing it and how can I do thatbetter?
And so I think it's more ofthat mindset than any particular
technique.
You know, all of us read booksin all sorts of different
aspects of the world.
We're not focused just onmedicine or plastic surgery.
(17:35):
Right, you'll read, you knowsomething from what's his name?
Adam Grant.
Or you know the guy who wroteBlink.
Like, these are great books andhow do you apply that then to
medicine?
And you know, like it's that, Ithink, that mindset to say how
(17:55):
can I be better?
More than any particulartechnique.
You take that concept, youfocus it on what it is that
you're doing and then try to, Iguess, adjust it or make sure
that it is safe.
Whatever it is that you'redoing, that it's safe for your
(18:17):
patients.
You're not going to wholesalechange exactly what you're doing
.
You want to do it in a measuredcapacity that you're able to
then sort of see what theresults are or what the change
is.
Speaker 1 (18:29):
Have you done something where you saw
something and said you know what, I think I can make this better
, and you played around with itand figured out something that
made that operation a betteroperation, for example, for
yourself, for myself?
I mean you know because wealways say in our hands, so you
know.
Speaker 2 (18:51):
Yeah, I mean, I think we're constantly playing around
with it a little bit, you know.
So, even something as simple asyou know I don't want to say
simple as common as a breastaugmentation, you know how are
you choosing where to put yourincision for an inframammary
fold?
You know there are a number ofpapers about how to do it right.
There's the IE method, there'sI-5, and they're all slightly
(19:15):
different measurements, and soyou keep playing with it until
you're like well, this one kindof matches what I do and how I
would do it, and so you knoweven something like that yeah,
that's worked out, and same forand then.
So I guess, what have I?
Speaker 1 (19:32):
changed.
Speaker 2 (19:33):
Yeah, so how do you?
Speaker 1 (19:34):
do your breast augmentation incision planning
then.
Speaker 2 (19:38):
Honestly, I let the residents choose no, no.
We go through.
We go through all of thedifferent steps for it, I see,
and the different methods, andthen usually we end up choosing
sort of along the high five plan.
Speaker 1 (19:56):
Okay, got it.
Speaker 2 (19:57):
Yeah, so it's nothing where I would like them to read
what other people have done,analyze their data and then
compare it to their own methods,and so oftentimes I'll have
them mark the patients.
We talk about it ahead of time.
They get to see the patientsahead of time in the operating
(20:18):
room.
We're doing the operationstogether.
And then if they are not inpost-op clinic, then I'll send
them pictures from post-opclinic so that way that they can
see sort of what the resultsare and how it matches what they
thought it would be.
Speaker 1 (20:32):
That's awesome.
What is one of your favoritesurgical procedures that you
really still enjoy doing at thistime?
Speaker 2 (20:42):
You know I got to say I'm probably a little bit burnt
out at this point.
No, honestly I I like operatingum and I enjoy like it.
Historically I really lovedmicrosurgery.
I loved seeing the anatomy comeapart and then I loved seeing
(21:03):
the anatomy go back togetheragain.
I felt like it was one of thosegreat expressions of a plastic
surgeon where you're actuallytaking one body part, molding it
and making it a different bodypart, whether it's a deep flap,
a free fibula that you're thenmaking a jaw out of, or a free
fibula that you're taking toreconstruct a femur or humerus
(21:23):
withosteomyelitis.
Like it's pretty neat, um, andvery few people get to do that
sort of thing.
Yeah, um, at this point, I thinkwhat I actually enjoy doing
more is kind of seeing some ofthese technologies and how
things are a little bitdifferent.
Uh, so one of the things we'replaying around with now is
(21:45):
there's a I think it'slyophilized placental tissue and
sort of what growth factorsdoes that sort of bring to the
field or cause the field tosecrete that will improve wound
healing?
And it's one of those thingslike you kind of don't believe
(22:06):
it at first, like you see thepapers and you're like and just
another thing, that somebody touse it, like you know, like the
paper was clearly paid for bythe company, but then you, you,
you trial it and you're like,actually my patient's wound does
look better.
So then what's going on with it?
So that's where having a guylike Alex Wong coming in who has
(22:28):
a research lab who can thenstart playing around with you
know, sort of breaking it downto what are the processes that
are going on, is incrediblyvaluable.
Yeah.
Speaker 1 (22:39):
No, we definitely see a lot of potions and things in
plastic surgery.
Someone always has somethingnew, but if you find something
that actually works, that'sinvaluable for sure.
I've talked to a bunch ofsurgeons and surgeons our
generation I think a little bitof burnout is really really
common and it's kind of funnybecause ostensibly we're at the
(23:00):
peak of our surgical skill,knowledge, experience.
We have years and years andyears under our belt.
We're still very physically onpoint.
So why do you think so many ofus are a little burnt out and
how do we combat that at thispoint when supposedly we should
be at our I don't know mostproductive or at the peak of
(23:21):
where we are surgically?
Maybe I don't know.
Speaker 2 (23:24):
Yeah, I don't know, yeah, I don't know.
It's something that we talkabout a lot, particularly in
academic medicine, because thereis burnout and obviously we
worry about our residentsburning out and the training for
it.
Sometimes, when I think aboutmy own like how I feel tired, my
dad's voice pops into my headand basically he's just telling
(23:48):
me I'm lazy and keep going.
Yes, I hear that all the time,and so then I wonder how much
burnout was there in previousgenerations?
Because nobody really measuredit and they just sort of kept
going and work through it.
It's kind of like when you'reworking out, right right, you're
in a crossfit workout, you feelthat burn, do you say, yeah, I
(24:12):
gotta stop this.
Or is there a level where yousay, okay, I can maintain this.
Or you know you're gonna bonkand you're you know you're
you're gonna use up all of yourglycogen stores and then you
can't yeah, you can't finish theworkout and so I think being
able to measure when is thestress leading to greater
productivity or greater growth,versus when is that stress going
(24:36):
to harm you?
And I think that's the question.
So are you really burnt out orare you a little bit tired
because you are growing andgrowing is hard?
Speaker 1 (24:48):
That's true.
That's a really good point.
I think previous generations itwas survival.
If they didn't do what they hadto do, they would basically
have nothing, like their familywouldn't eat and like it'd be a
real problem.
So I think we have the luxury,a little bit, of being able to
look at ourselves and say, wow,you know, am I like you said?
Am I, is this real?
(25:09):
Is this something where I'mchanging or is this something
where I really it's affecting mein some, some negative way?
But you're right, I think it'stough and how do you feel like
you manage it better, like whatis your way of sort of
identifying it and then sort ofmanaging it?
Speaker 2 (25:30):
yeah, I, I kind of rely on friends to tell me that
one of my friends says as I walkaround the hospital, he can see
me hunching over more and more.
He'll tell me when I seem to behunched over more and it looks
like you need some time off.
But I think that's a joke, butit's not.
(25:54):
How do we?
And I think one of the ways weknow is our interactions with
others, your interactions withfamily, interactions with others
, right, like your interactionswith family.
And and I think that's one ofthose areas where burnout, uh,
is most destructive, because ifyou're not enjoying the work
that you're doing and then youcome home and you're upset, but
(26:18):
you're even more tired now andthen you're kind of, you have no
reserve for the people that youlove the most your family,
friends then unfortunately theydo suffer with it.
And I think that's where tryingto identify burnout, trying to
deal with it, is the mostbeneficial, not necessarily for
(26:40):
our careers or for developmentas a surgeon, but for
development as a human being.
And so how do I deal with it?
You know, when I'm feelingburnt out, I think I do try to
carve out more time for myself.
Then you know whether it's amorning workout or taking a
(27:00):
weekend off to go away somewherejust to have some peace and
quiet, turn the phone off, avoid, you know, whatever social
media or other things thatyou're supposed to be reading or
doing, and then, really, thisyou know how to again, I don't
(27:20):
want to blame my parents, butyou know because we should have
out we should have outgrown ourparents conditioning by by now,
but it's hard not to hear theirvoices, right, yeah, yeah and uh
.
You know.
One of the things, though, wasalways that you can always do
more, you can always study more,you can work harder, um, but
you know the that, I think,leads to burnout.
(27:43):
It can push you to do better,but that can also lead to
burnout.
So the idea of self-acceptancehey, what I did was great, I can
do better, but right now Ican't and to accept what it is
that you've done, who you are atthat moment in time and just
sort of being present in thatmoment in time, I don't want to
(28:07):
get too like new world new ageum you know, but, uh, you know
that sort of uh Buddhist thoughtof just being present, uh and
accepting everything as it is,uh, I think is very valuable
yeah that is Um.
Speaker 1 (28:24):
So when you're in the operating room I know you work
a lot with residents.
That's such a huge focus foryou Do you have any rituals or
any sort of things that you doin the operating room which are
always the same or very similarevery time you do something in
the operating room?
Speaker 2 (28:44):
I mean the most consistent is going to be when
you do something in theoperating room, I mean the most
consistent is going to be whenyou do your microcircular
anastomosis.
I see you know you want to havethe same setup.
You want to have your handspositioned properly, your body
positioned properly, you wantthe field to be totally dry so
that there's no bleeding, or ifthere's anything oozing, it's
(29:07):
controlled through a suctiondrain.
You just want it to look like apicture textbook of what an
anastomosis should look like andthen get started so that it's
exactly the same.
I think for me.
I do a lot of different cases,so my practice is very broad,
(29:33):
and so I don't think I do things.
I don't think I enforce or amas rigid sometimes, and so I'm
willing to go with the flow.
We often have a different teamin the OR for each case because
of whatever union contracting orwhat have you.
(29:55):
We often have a different scrub, a different circulator,
different anesthetist from themorning case to the afternoon
case, and so some of thoseroutines are hard to maintain.
But within yourself, like forme, I always think about doing
the operation.
They do the operation threetimes in your head before you
(30:16):
actually start, right.
So you do the operation in yourhead.
When you see the patient You'relike okay, this is what I'm
going to do, but you're not asdetailed about it.
Um, and then do the operationthe night before and then do the
operation as you're scrubbingit.
So this way you're reviewingthe process of it and I think
this, this is something that Itry to impress to the residents.
(30:40):
Um, you know, it used to be thatwe would have to sit there and
read a textbook, and you have.
You have to imagine the anatomy,right, because it's hard to
find a great picture of some ofthe anatomy.
You would look back at theanatomy textbooks and then try
to find cross-cut sections ofwhere things are, because
oftentimes it's easy to see thelongitudinal and latitudinal
(31:03):
orientation of anatomy as it'sdrawn out in a net or textbook,
but then there's like depth toit and like kind of coming
around a muscle or around thebone, and the only way you can
really think about that isthrough your imagination.
Right, there were now I feellike video is great, and all of
my residents, honestly, theyprobably YouTube more of their
(31:26):
study than anything else.
But most of the videos, whenyou look at them, they lay out
the anatomy for you.
But it's laid out for you sowell because they've chosen a
great video and a great exampleof what it is that they're doing
, that you're not using yourbrain to think about.
(31:48):
Okay, well, as I'm cutting ormoving through this layer of
tissue, what is it that I expectto see before I see?
so like, let's say you're,you're looking for a perforator
coming out for a deep flap, youknow, as you dissect there.
Or even like as you're liftingthe pec muscle to do a sub-pec
(32:09):
aug, right, what will that looklike as I'm getting closer to
those internal mammaryperforators that I don't want to
ding because they'll bleed likestink and then you're in a lot
of trouble?
Or what will it look like asI'm coming across the uh
insertion or origin of the pack,because there's always, like
that, one vessel that bleeds,like sort of the central aspect
(32:33):
of it, like what is that goingto look like before I hit it?
so that way I know to grab itwith, you know an insulated
debakey or something, or or slowdown so that I can cauterize it
nicely before I come through it, I think that's so true.
Speaker 1 (32:49):
I remember as residents looking at Netter or
Mathis in the high and trying tofigure out, but, like you said,
the approach will change yourperspective on finding that
particular muscle or thatdissection or that plane that
you're looking for.
It does take a lot ofimagination to do that and I
think we never had the benefitof YouTube so we never were able
(33:11):
to see any videos like that.
The pre-vis, I think, issomething that I hear a lot of
surgeons talk about.
Pre -visualization of thesurgery.
I'd love that.
Times three aspect of it and,uh, I never thought of it that
way and and I probably that's aI might actually start thinking
of it that way.
(33:31):
That's a really, really goodtip.
Three times is, uh is a reallygood way of sort of approaching
the pre-visualization of surgery.
Um, that's amazing, that'spretty cool stuff.
Um, what do you listen to inthe OR then when you're doing
all of these different types ofcases?
Speaker 2 (33:51):
yeah, I gotta say I let the residents choose the
music.
You know I work with so manydifferent residents.
I like to hear what they'relistening to.
Often times, honestly, theyhave better taste in music than
I do.
Speaker 1 (34:05):
What do they play?
Do you, what do they?
What do they play that youhappen to like, like?
What is it that they might?
Speaker 2 (34:09):
choose.
Not like like just yesterday orwas it two days ago, yeah, they
were listening to some vibeylounge music.
But if it was like, perfect forthe case that I was, but but I
would never have chosen that I'dprobably choose something like
classical, classic rock.
I do listen to a lot of, likepop music, um, but it's nice to
(34:30):
hear what they're doing and,honestly, when I'm operating, um
, I actually am not listening tothe music at all.
Um, it's kind of like for me,uh, you know, when I used, when,
when I was in college, uh, Ilike to go to like a cafe to
study, I like to have backgroundnoise as I'm doing things, but
(34:53):
I, what the what the noise isdoesn't necessarily matter, and
so, honestly, like, if it's anintense case, I won't even know
what's playing or not playing.
It can be on repeat a thousandtimes and I won't recognize that
until that intense portion isover, and that intense portion
(35:15):
may be hours, so I don't reallynotice it.
And if any of my college friendswatch this.
They will laugh because they'llsay I never studied in college.
Speaker 1 (35:25):
Yes, I think the smartest people I knew in
college never seemed to studyever.
So you are one of those guysfor sure, I'm sure.
So, as part of your team,either in the OR or out of the
OR, who's really important interms of your success as a
surgeon, who is integral to whatyou do?
Speaker 2 (35:48):
Um, I mean, honestly, everybody is like you know,
it's uh, it's such a team sportnow.
I think surgery used to.
Surgery used to be more of a um, a captain running the ship and
being in charge of everyone andcontrolling everybody around
them.
But I think medicine as a wholehas moved so much more to a team
(36:11):
sport and so, like in theaesthetic world, things may be a
little bit different, becauseyou're coming in, you have a
very consistent team, yourpatients are a little more
consistent, the operations aremore consistent, but a number of
my patients are very sickpatients, and so I'm often
operating with another surgeonand we're doing two or three
(36:31):
different.
There may be two or threedifferent surgeons involved in
the case doing differentportions of the case, and so and
our anesthesiologist isincredibly important obviously
you know the people who are inthe room with you circulators,
scrub techs are all veryimportant.
And then you know the peoplewho are in the room with you
circulators, scrub techs are allvery important.
And then you know the medicalteam who's taking care of the
(36:51):
patient, whether it's me, myresidents, my PA they're all
incredibly valuable.
So I don't think there's oneperson that I would point out as
being particularly valuable tomy, to sort of the success of
the operation, but I reallythink it is everybody.
I do think it is important thatthere is somebody who is sort
(37:14):
of calling the shots and runningeverything.
You know there is a guy who isthat guy from SEAL Team 6?
Jocko Willink.
Yes, I mean, he wrote that book.
It was like an extremeownership Right and the idea
that you have to take ownershipand understand and really be in
(37:39):
charge of every part of what'sgoing on.
You can ask people to do stuff,but you got to know exactly
what they're doing, and I thinkthat is very much appropriate
for the operating room.
But it's still a team.
It's not an individual doingeverything.
Every team member really needsto be invested and they all have
to buy into that investment inthe care of the patient.
Speaker 1 (38:04):
You're now division chief, you're a program director
, you've sort of achieved thepinnacle of what most plastic
surgeons would aspire to.
So what are your future goalsnow, at this point of your life,
now that you've achieved theseachievements, at this point?
Speaker 2 (38:25):
It's funny that you say that.
I told you I'm a little bitburned out, so every now and
then I do buy a lottery ticket.
I get it, but I think thatthere's lots of little goals.
So there's lots of things toimprove on.
(38:48):
And maybe this is somethingthat you were talking about with
how do you become a bettersurgeon.
It's the same sort of thing andyou know it'll be one of those
things I write out.
This is what I'd like to do infive years or 10 years, but
(39:11):
there's lots of little thingsthat I want to improve.
So, like I, like I said, wejust hired Alex Wong, who's a
good friend of mine, who'scoming to Rutgers, so that's
phenomenal because he brings aresearch component to it.
But then we've got to add moreright, it would be great, like I
work in Newark, right, and wehave a number of underserved
(39:34):
patients.
We have a large minoritycomponent.
It's a majority minoritycommunity there.
So why do we not have morepatient reported outcome
measures that are focusing onthe outcomes for reconstructive
surgery for minority patients?
Because that is a large area ofresearch and a way that we can
(39:59):
become better.
We know that outcomes are worsefor minorities in many ways,
but how do we make that better?
So I think teasing out some ofthat would be exciting.
You know, the other excitingthing to me really is AI.
I mean, what a fascinatingtechnology, and how are we going
to utilize it in health care?
(40:20):
You know, the hardest part isthat you know, with health care
you worry about hurting anyone.
Right, like even something assimple as if you use an AI
(40:46):
technology to like decidewhether or not to get an X-ray
for a patient.
There's a judgment call that'sbeing made by a computer, and
will it be right, everybodyusing an EMR to start using
decision support software, whichis slightly different than an
AI program?
Right, it's, the decisionsupport software has, like, an
(41:07):
algorithm built in.
But it would not surprise me ifthey quickly moved to an AI
technology that can then scan orread through the latest
literature in order to updatewhat it's suggesting as an
appropriate study for a patient.
But when we look at AI, we alsoknow that AI has what they call
(41:30):
hallucinations right when, forsome reason, it will go off the
deep end for an unknown reason,for an unknown question, and so
like, governance of the AI isimportant.
So how do we know what data itwas looking at, how it made its
decision and how it producedthat outcome is something that
(41:52):
people are still are spending alot of time and a lot of energy
working on.
But I think that would befascinating, like wouldn't it be
great if you had a chatbotslash AI that could do the
intake for your patients andthen convert all of that to
(42:13):
ICD-10 and CPT coding, all ofthat to ICD-10 and CPT coding?
Or you know, for the case ofaesthetics, the different
options for operations and say,okay, well, you know you can do
X, y or Z and that's going to be, this is the gold.
You know the gold package, thesilver package and the bronze
package and why they're betteror worse, and then generate a
(42:35):
picture outcome of what eachmight look like right.
So for like facial rejuvenationyeah you can get the facelift
with that grafting or you canhave a chemical peel.
The chemical peel improves yourskin a little bit, but it's not
going to tighten much more thanX, y or Z but be able to
generate those different outcomepictures for the patient.
Speaker 1 (42:58):
That's crazy.
That is, both thosepossibilities are science
fiction within the realm ofreality very soon, like the fact
that our EMR could actuallyhelp us with charting, billing,
coding, like I know people arechomping at the bit for that,
like yesterday.
Like, yeah, with emr, uh, foraesthetic medicine to be able to
(43:21):
say, scan a person's body andthen say, here are the 20
different treatments you couldopt for and this is what it
might look like and here you go,would be amazing.
Uh, I think it does sound likesomething that I might have even
seen in a movie like 15 or 20years ago.
So that's that's.
(43:41):
I had not actually thoughtabout that for aesthetic
medicine, but that would totallybe within the realm of
possibility within the nextcouple of years, I would imagine
.
So that's crazy.
Speaker 2 (43:50):
Yeah, I think it would be cool.
You know, you get so manypatients who come in and they're
like, oh, I just wantliposuction, and you're looking
at them and you're going that isnot going to fix this problem,
that's right.
Speaker 1 (44:00):
You're right.
Speaker 2 (44:01):
But to be able to have a generative AI.
You take a picture and you say,okay, liposuction will do this,
liposuction plus abdominoplastywill do this, right.
Or abdominoplasty followed byliposuction would look like this
, right.
And you know, because theproblem is that oftentimes
you're trying to tell a story tothe patient and even if you
(44:23):
show them other patients' photos, they'll look at it and be like
, no, no, I'm different, right,but you're looking at it and
they're like no, no, this is theproblem that will happen.
Speaker 1 (44:36):
That's right, that's amazing, so okay.
So if you have little goals andsome other bigger program and
institutional and society goals,how long do you envision
yourself operating being asurgeon doing what you do at
this point?
Speaker 2 (44:57):
It depends on if my lottery numbers hit.
Speaker 1 (45:01):
Those lotto numbers better hit, I guess pretty soon.
Speaker 2 (45:05):
No, I mean honestly, I'm actually in a pretty good
place.
I say I'm a little bit burntout, but it's not bad.
It's more along the lines of Ithink this is a steady state
that I could do for a long time,but I'm not sure.
Right, right, right.
You know, as you're goingparticularly like I hate.
I hate the erg, the rowingmachine.
Speaker 1 (45:29):
Yeah, the concept.
Speaker 2 (45:31):
I rode in college and you know it was like the bane
of my existence.
Being out on the water is fine,being in the tank was fine, but
the hurricane.
There's something about it, andI think part of it is that as
you're going, you're listeningto that hum and that wine and
you see your split times andyou're like, ah, this feels
pretty good.
Speaker 1 (45:50):
You go a minute in, five minutes in and then you're
like, oh no, oh no, no, thispace was too much we recently
did a 2k row for time at our inour gym, and that was one of the
worst experiences anyone hasever had.
Like we always say, the best pryou will have will be the first
time you do a 2k row for time,because the next time you don't
(46:11):
want to go.
You don't want to go to thatplace to uh uh, cause it just
hurts so much.
So I I understand, but likeyou're ostensibly at the peak of
your surgical powers, you haveall the experience in the world
at this point, Do you seeyourself operating like this for
another five years, another 10years?
Like is that something we know?
(46:32):
Surgeons who will operate untilthey physically cannot operate
anymore?
And then we also know surgeonswho will operate until they
physically cannot operateanymore.
And then we also know surgeonswho will say listen, this is
enough, I don't want to sit herefor eight or 10 hours doing
this case anymore, and theypivot.
So what sort of is yourperspective with that?
Speaker 2 (46:52):
You know my perspective with it is it's a
little bit different, I guess,than most people, so one I think
the medical licensing processthat we go through in the US is
it tries to be protective, butit is not.
It is not progressive at all.
The fact that you go from, oh,you were a medical student to
(47:41):
now you finished one year ofresidency and you can, falls
under that um and.
But we all know that there areresidents and there are
colleagues who you're like youknow you probably shouldn't do
that procedure, that's.
It's a little more complicatedand I think, we, we all come up
with that on our own right.
Like you look at things, andlike I will not do a cleft lip
or palate I didn't do afellowship in it.
(48:02):
Could I do one and could I do anice job of it, maybe.
But like there are people whoare so much better at it, why
wouldn't I send it to them?
Um, and so like I think thatthe medical licensing is to all
or none right, like why don't wehave something that says well,
you can be a great lumps andbumps surgeon.
(48:24):
Well, how did you do lumps andbumps?
You know you can do?
Uh, you know some other gradedcomplexity?
um you know, instead of saying,oh yeah, you have a medical
license, you can do.
Uh, you know, like these bblsthat are being done down in
florida, there's like that onecounty that has like the highest
(48:45):
mortality rate, right, and it'slike a outlier in the nation,
like that, that's kind ofridiculous, all right.
Same thing, I think, for thewind down of the career, right.
Like at some point, I thinkeverybody, like most plastic
surgeons I know a lot of peoplewere doing free flaps- right and
then at some point they say youknow what I, I don't really
want to do that anymore.
(49:06):
okay, well, you can voluntarilyopt to not do that.
Or should there be like adecreased sort of uh, licensing
almost that goes with it.
And so like I think, over timethe number of procedures that
you do and the complexity of thealmost that goes with it, and
so I think over time the numberof procedures that you do and
the complexity of the proceduresthat you do slowly decreases.
So I could see myself notwanting to do free flaps after
(49:26):
about 10 years, because thatwill put me at around 60.
Or if I find that there areother people in my practice who
are doing it way better than Iam, great, go see them.
And like I think that goes alongwith that sort of humility or
being humble about who you areand accepting who you are, so
(49:49):
yeah, so I could see that sortof winding down.
But then the other part of itto me is we should be inventing
technologies to make surgeryeasier.
So one of the jokes right nowis, uh, going around the or is
button surgery right?
So have you ever used theversaget?
Speaker 1 (50:10):
yeah, yeah, yeah yeah , yeah, it's the uh instrument
that has the uh, high pressurewater, that's.
That is almost like a scalpel.
You could use it as a scalpel.
Speaker 2 (50:20):
It will basically plane the tissues using a
high-pressure water jet, so ittakes out the technical
component of retracting on thetissue, creating traction and
counter-traction.
In order to use a knife or ascissor to cut through the
tissue, right, you just kind ofrub over it, you press the
(50:41):
button with your foot and rubover it, but then there's a lot
of bleeding right.
So then how do you stop thebleeding?
Well, you have to like dry andpat and use your bovie is more.
But or you can use the aquamantis, which is uh, it's a uh
radio frequency, uh, irrigatingbipolar.
(51:02):
Yeah.
So basically, instead of havingto wipe away the blood, it just
irrigates the blood away foryou and the bipolar.
It just runs between the tips,so you just run it over the
tissues, so you versaged it andthen you bipolar it and look,
well, lo and behold, it's alldebrided and it's all cauterized
that's pretty cool why do wenot have more button surgery?
(51:26):
it gets rid of the technicalaspect of surgery.
So like, for instance, whenyou're when you're watching or
looking at robotic surgery right, it's pretty amazing what
they're doing with roboticsurgery, but why is there not a
button to push, like when youhave things kind of lined up,
let's say, for a microvascularanastomosis and they want to put
(51:48):
a stitch, why can we not lineit up?
Speaker 1 (51:52):
point on the screen put the needle here.
Speaker 2 (51:57):
Put the needle here put the needle here and you push
a button and it's a segmentalportion of the operation that
the robot then commits to on itsown and goes, puts in a stitch,
ties it right, that makes sense.
Speaker 1 (52:13):
Like if you could 3D image it, put the dots where you
want, the sutures, and then hit, go.
Then it's like a sewing machine.
It just like does the knots and, you know, does the like the
three stitches you want orwhatever number you want.
Like that sounds feasible to me.
I don't know, has that beeninvented yet?
Speaker 2 (52:33):
I don't know, I haven't heard about it, but I'm
sure it's coming.
I mean, there's a bunch ofrobotic companies and those
robots are not cheap, so, um,and the other thing is, you know
, like, looking at very taskspecific robots, right like to
me, the fact that we stillsuture skin in the same way that
the ancient egyptians, it's alittle bit crazy.
(52:56):
We have better materials.
Speaker 1 (52:57):
It's very crazy.
I think about that every timeI'm suturing, like an
abdominoplasty or somethingwhere there's like a million
inches of skin to sew, I'm like,yes, we got to do something
better for this.
Speaker 2 (53:11):
Yeah, and we came up with the stapler right, the skin
stapler Right, and then there'sthe subcutaneous stapler, the
Inzorb, but honestly it's notthat great.
So even a task-specific robotto do that, if you can set it up
so that it does it nicely, itwould be incredibly valuable,
right?
Then you take the art ofplastic surgery in terms of skin
(53:35):
closure and you've nowmechanized it to a robot so that
it then democratizes it so thateverybody can use it.
So your er doc, when they haveto show up a laceration, they're
like oh, bring over the robot.
They numb it up, set it up forthe robot.
The robot goes ahead and closesit.
They get a plastic surgeryclosure for the cost of the
(53:55):
robot.
Speaker 1 (54:03):
You're technologicalizing our specialty
out of business.
Basically, that would be yourgoal in the future, which is a
great goal.
Honestly, I would love forplastic surgeons to take their
intellect and ability and applyit to the next level of things
to do for sure.
Speaker 2 (54:14):
Yeah, I think taking some of that technical I don't
want to take the technical skillaway from it, but being able to
, uh, uh, what's it called?
Mechanize it, I think it'svaluable, like when you look at
so.
So, for instance, if you lookat, like, thoracic surgery,
right, um, the ravage stapler,it didn't decrease the amount of
(54:37):
thoracic surgery being done.
If anything, it increased whateverybody was doing and the
complexity of what they weredoing, because now suddenly,
well, this part where we were soworried about it leaking, so
worried about bleeding.
That's all passé.
I no longer have to focus onhow I'm doing that, how I'm
(54:59):
doing doing that.
We can focus on why and improvewhat else is going on with it.
The fact that we don't haveanything great to improve scars
still right like we have.
There's a lot of stuff on themarket for scar care, but
nothing is really proven to tomake that much better.
Instead of spending our timelearning to suture, we could be
learning about all of thedifferent growth factors and
(55:22):
methods to try to improve thatscar healing and wound healing.
Speaker 1 (55:28):
Good goals.
I like that.
So you do train a lot ofresidents.
You do work with a lot ofmedical students and other
people who are learning.
What do you tell them when theylook at you or they're like you
?
Know what?
I want to be like you someday,dr Lee.
I want to do what you do.
I want to be in the situationthat you're in.
(55:50):
What kind of advice do you givefor for your young students?
Speaker 2 (55:58):
um, you know, one of the things I tell them is that,
uh, you know, oftentimes thestudents are coming in earlier
and earlier, right, so they?
They used to come in somewhereduring third year then?
Second year, then first yearand now we even get a bunch of
college students who are eagerand excited about plastic
surgery and you know my adviceto them is to go after
(56:20):
everything with 110% energy.
Be passionate about what it isthat you're doing, and so if
your interest is plastic surgery, that's fantastic.
Do it 110%.
But always have an open mind,because you may see something
that suddenly captivates you andyou're then very passionate
(56:43):
about that or excited about that, and that's okay.
You're young, you're early on.
Even when you're later in yourcareer.
If there's something that'sthat captivating, give it some
time to percolate in the back ofyour mind.
But if you want to go afterthat instead, do it.
And it's not that you wastedthe time that you were excited
about plastic surgery and goingafter it.
(57:05):
Whatever you learn during thatperiod is translatable right If
it's a different field ofmedicine.
The way that you learn to study, the way you learn to think
about a problem and then try toanswer that problem those are
all valuable skills, you know.
(57:25):
That's my advice to them.
Usually, you know theapplications process for
residency really is getting moreand more challenging.
I mean, it's like an arms race.
Speaker 1 (57:40):
How much harder is it now than it was back in the day
, when we were playing A lotharder, really.
Speaker 2 (57:49):
Basically, anytime you set a standard or a goal and
you have a number of highachieving, high energy
individuals, they will find waysto exceed that goal and keep
building on it.
And so you keep setting the barhigher and higher.
Uh, but is it at the detrimentof the, their development, of
(58:13):
other aspects of their life?
It's similar to if you'reworking so hard at your job and
then you come home kind of burntout with less to give to your
family.
Is that a cool thing.
Speaker 1 (58:27):
I don't know.
Speaker 2 (58:31):
I think there's a lot of people in education who are
really focusing on that questionand trying to answer that
question.
I think a lot of it comes downto who you are as a person and
just trying to build up theperson that you are, not
necessarily the plastic surgeonthat you are.
You know, it's a lot of how doI put it?
(58:54):
Just I don't want to say yourmoral compass, it's more just
like your, your baseline, yourbaseline sort of thoughts, and
you know how do you, how do youapproach life, right?
Speaker 1 (59:14):
So that's true.
Wow Well, ed, approach liferight.
So that's true.
Wow well, ed, you have doneamazing things over the past.
I don't know, was it 10, 15years that you've been at
rutgers?
You've, you've taken it to thenext level.
You've, you've put your stampon it.
It's been uh, and I can see howmuch you've accomplished there.
(59:36):
I I see the residents comingout, I see how successful you
are and how the program has been, and I am I am in awe, because
for you to um, to be able to dothat uh shows a lot of skillsets
, not just as a surgeon, as anadministrator, as a team builder
, as someone as an educator,like.
(59:57):
I think a lot of people wouldlook at you, um, who have
started or are starting insurgery and look at your life as
a blueprint and be like this isa pretty good way to achieve
some amazing success.
So I really hope that anyonewho listens to this or watches
this sort of takes a look andlistens to what you have done
and said and you know, sort oftake that advice and your
(01:00:20):
experiences to heart, becausethat I think it means a lot.
I think there aren't that manypeople that can do that and it's
just super impressive.
Speaker 2 (01:00:29):
Well, thanks, sam.
I really appreciate you takingthe time to talk with me and
inviting me to be part of yourshow.
I think it's phenomenal to seewhat you do.
You know, I mean looking.
Speaker 1 (01:00:43):
Oh, you mean finding successful people and talking to
them and see what they do.
Speaker 2 (01:00:47):
Like, yes, well, what is it?
What is it?
It's humility, it's curiosity,it's those two things.
It's curiosity, it's those twothings.
And you know the.
And part of that humility isyou taking on a new venture,
like we were joking abouttechnology and difficulties with
technology, and you know you'repodcasting.
(01:01:07):
When.
When did you start?
Five years ago, six years ago?
Yeah, to take on that challenge.
I, I think, is admirable.
And you know the whole CrossFitjourney.
I mean, honestly, I wish Ilooked like you.
Speaker 1 (01:01:28):
Thank you very much.
Speaker 2 (01:01:30):
I went to a CrossFit class, probably four years ago
after my first class class.
Probably what?
Four years ago after my firstclass?
Uh, it was the, it was what,what is it?
Emom every minute.
On the minute it was rowingburpees and then moving on to
like sit-ups and then pull-upsor thrusters or something, and I
got in my car to drive home andI felt like I had had a stroke.
(01:01:54):
I pulled over after about aminute of driving and laid down
in the back of my car and fellasleep for about half an hour.
Speaker 1 (01:02:04):
If you ever decide to try it again, I would be happy
to do something that would bemore appropriate.
That would be a horribleworkout for anyone.
That sounds like they reallyput you through the ringer,
there's no doubt.
Speaker 2 (01:02:19):
But it was fun, it was fun and.
I really should get back to it,but my goodness, well, I
understand.
Speaker 1 (01:02:27):
Thank you so much, Ed , and I hope to see you soon,
and.
I really appreciate you takingthe time today.
All right, take care, Seth.
Thank you.
As you listen to my next guest, dr Edward Lee,
plastic surgeon, it may onlytake you a minute before you
recognize him as a big thinker.
He is the rarest of plasticsurgery animals, someone who
started his career in privatepractice and then found his way
back into academia at a largemedical center.
He climbed to the top of themountain as division chief of
plastic surgery at Rutgers, newJersey, medical School and
(00:26):
residency program director.
But this particular big thinkeris not a passive ivory tower
brahmin, even though he did goto Yale and Georgetown, two
elite organizations.
Dr Lee is a doer, a dynamicmover and shaker, training
future plastic surgeons in thefield of microsurgery, managing
multiple teams of surgeons andclinics, working on big ideas
(00:48):
such as re-innervating muscle inamputee patients and, as you
will hear, even speculatingabout future advances such as
artificial intelligence inplastic surgery, coupled with
technological advances such asrobotic suturing.
Dr Lee is a leader in ourspecialty who is simultaneously
hoping to dramatically widen thescope of plastic surgery, as
well as render much of what wedo as antiquated, which is both
(01:12):
wonderful and scary at the sametime.
His approach is practical, downto earth, and he is a master at
seeing situations from both theground level as well as the
10,000 foot level.
Dr Lee approaches challengeswith inclusivity, finding ways
to lead his division, communityand those around him without
leaving anyone out.
It was fascinating to cover somany different topics about
(01:35):
surgery and life with Ed and Iknow you will find him as
thought-provoking as I didspeaking with him.
Thank you very much.
All right, welcome to anotherepisode of Botox and Burpees,
the surgical series.
And I have with me my veryspecial guest, dr Edward Lee.
And Dr Edward Lee I've knownhim for a long time is the
residency training programdirector of plastic surgery at
(01:57):
Rutgers, new Jersey MedicalSchool.
He's an associate professor ofsurgery and Dr Lee grew up in
North Brunswick, so he's a NewJersey guy and he attended the
Lawrenceville School for highschool.
Dr Lee graduated from YaleUniversity with a double major
in philosophy and molecularbiochemistry and biophysics, and
(02:18):
then you completed your MD fromGeorgetown University School of
Medicine.
You did your plastic surgeryresidency at University of
Pittsburgh and you have been atNew Jersey Medical School for
how many years now?
Speaker 2 (02:35):
It's been quite a while.
So I actually started out inprivate practice for three years
.
Okay, so I was based inEnglewood Cliffs, family was
around there and then you know Iactually really enjoyed the
academic side of things.
So I attended the Grand Roundsand enjoyed teaching and Mark
Granik, who was the divisionchief there and is still there,
(03:00):
asked me if I wanted to take ajob.
So I took a part-time job atthe VA hospital.
Asked me if I wanted to take ajob, so I took a part-time job
at the VA hospital, reallyenjoyed my time there and then
ended up moving on to join theuniversity full-time in 2018.
So I've actually only beenfull-time at the university for
about six years now, so it'sbeen great I've taken over the
(03:22):
role as the residency programdirector.
I started that back in 2011 or2012.
And then division chief over atRutgers, New Jersey Medical
School.
Their residency, their program,their division.
Speaker 1 (03:50):
What are you guys?
Speaker 2 (03:50):
at this point we're division within the Department
of Surgery.
Speaker 1 (03:54):
So that's a lot of hats.
You're a busy man, Dr Lee.
Speaker 2 (03:59):
Yeah, it's a few too many hats really, but no, I mean
, I've got great partners right.
So Mark Granik is still there.
Ramazi Datiashvili, who youprobably remember from your time
at NJMS, is still there and thetwo of them are phenomenal
partners as well, as you know,leaders in thought in terms of
(04:20):
what they do.
And so Mark's interest in woundcare technology is phenomenal.
He's constantly runningdifferent clinical trials and so
he's very involved with thestudents in the residence as
well.
And then Ramazi is one of theworld's leaders in replant,
whether it's digital replants ormajor limb replantation.
(04:43):
So it's great to have those two.
And then we've hired a coupleof new people.
So we have got a guy, ashleyIgnachuk, who is a well-trained
hand surgeon.
He's Canadian, so of course youknow he's a nice guy, but he
runs a very interesting clinicwe put together as a team.
We put together something calledthe Targeted Muscle
(05:05):
Re-Innervation Clinic.
So it's a new procedure thatpeople were doing to try to
reduce phantom limb pain aftermajor limb amputation, so below
knee, above knee and then upperextremity amputation.
So we have a specific clinicwhere we partnered with the
Hanger Clinic, a prostheticscompany, in order to better
(05:27):
serve these patients Right.
So we track them from the timeof their amputation, whether
it's traumatic, oncologic orvascular and then we will do TMR
or RPNI at the time of theiramputation and then track them
as they go through, and we'veseen some very good results for
them.
So it's a multidisciplinaryclinic.
(05:49):
We have a physiatrist, we haveour prosthetist and rehab people
there as well, so it's a greatclinic that he runs.
And then we've recently hiredStephen Ovadia, who's a gender
affirmation specialist as wellas craniofacial specialist, so
that'll be a great source ofexperience for the residents and
(06:13):
service to the community.
And then in April we actuallyhave Alex Wong coming on board.
I don't know if you know Alex,but he's a microsurgery director
at USC and then City of Hopeand also has a translational
science lab that's NIH funded,oh wow.
Speaker 1 (06:31):
So what is your clinical focus, Ed?
What do you focus on surgically?
Speaker 2 (06:35):
You know, my focus really is on traumatic and
oncological reconstruction.
So I would say most of mypractice comes from either the
orthopedic oncology or surgicaloncology world and then the
orthopedic trauma or generaltrauma surgery world.
You know they've tried to.
I guess people have created abucket for it of complex
(06:57):
reconstruction is the term thatthey're using for it, and I kind
of wonder.
Like there were two when I waswas training there were two
surgeons.
One had a practice that weconsidered kind of elite
reconstruction and the other onehad a practice that we kind of
considered bottom of the barrelreconstruction.
But honestly, both of them weredoing the same procedures.
(07:18):
It was just slightly differentgroups of patients and I think
that I cover the full spectrumof both of those you know.
So it's going from wounddebridements to deep flaps for
breast reconstruction or, youknow, really nice like
orthopedic, planned outorthopedic oncology procedures
(07:41):
where we're doing free flaps for, you know, muscle
re-innervation andreconstruction as well as soft
tissue coverage over themegaprostheses that they'll use.
Speaker 1 (07:51):
How much is your practice micro?
Speaker 2 (07:55):
I would say probably about 20% of my practice is
micro.
I really like doing it buthonestly we kind of move away
from it.
It so a lot of our traumaticreconstruction uh, because dr
granik is such, has such a focuson wound care technology.
We do use a lot of wound caretech, uh, whether it's the
advanced wound care productslike um, solera, somagen, uh,
(08:19):
integra things are things thatsort of downgrade the intensity
of surgery that's needed.
So, going from requiring a freeflap to here's a product, put
it on the wound, vac it for aweek or two and suddenly you
have a granulation bed where youdidn't think you would have one
(08:40):
.
Speaker 1 (08:42):
So you mentioned how you had mentors or people who
you trained with, who did fancypantsy, reconstruction and then
more of the blue collar stuff.
What other kind of memorabletraining experiences or stories
do you remember from when youtrained that might have been
formative or really sort of putyou on the path to where you are
(09:03):
?
Speaker 2 (09:04):
today.
You know, I think they're allformative.
I mean, that was part oftraining, right?
I mean it was.
You know, when I started the80-hour work week, I hadn't
quite caught on yet and most ofus, honestly, as trainees,
(09:28):
didn't believe in the 80 hourwork week.
We felt that it was better tospend more time in order to see
more.
So we were happy to ignore the80 hour work week and keep going
.
But I think, you know, honestly,the training has gotten better.
We've moved away from it, andpart of it is that we, as
educators, we've developedopportunities to learn rather
(09:48):
than waiting for opportunitiesto come along.
So it used to be you're just inthe hospital so long you'll see
every type of case throughoutyour residency.
But since you're not going tostay in the hospital that long
now, now we have to create anopportunity for you to learn
about it, whether it's throughsimulation, um, additional
(10:10):
didactic time, uh, you know,courses that you'll go to in
order to see it, mission tripsthat uh residents will go on in
order to see more of the cleftlip, palate or other congenital
issues.
So I think the education hasgotten better and so the
experience has gotten better Now, formative experiences, like I
(10:31):
said and you've been there itwas kind of like war, right.
You're like in boot camps forfive, six years, and so all of
them are formative experiences.
What really stands out?
There's so many cases that arejust mind-boggling and a little
(10:54):
bit crazy.
You know, I think really someof the formative experiences
were not in the hospital though,right, it's like when an
attending who you admire takesyou aside and says, hey, let's
go grab lunch.
Speaker 1 (11:11):
Or hey, you know why don't you?
Speaker 2 (11:12):
come over to dinner.
Tonight I'm having some otherpeople over for dinner and so.
I remember one of my attendingsdid that for me, you know,
invited me out.
There were a couple of otherattendings there with him in
different specialties and youknow it.
It was a.
He was very much into wine, soit was a wine tasting dinner and
the first thing I thought wasoh my god, that's a lot of
(11:34):
bottles of wine for.
Very well, you know, by thetime you're like a PGY5 or 6 res
, like you haven't really hadanything to drink for years
because you're in the hospitalso much, and especially as
you're doing more microsurgery.
Yeah, I don't know about you,but for me if I drink and then I
(11:58):
try to do micro, it's just alittle bit off and I don't like
that feeling little bit off andI don't like that feeling.
It's probably similar to youfor other surgeries or, or you
know, a hardcore, um hardcoreworkout right, like you don't
want to go in a little bit hungover, like that would be awful.
Speaker 1 (12:16):
Did they finish all the bottles that night?
Uh?
Speaker 2 (12:18):
they did.
I stopped after a little bitcause I I couldn't hang with
them.
Speaker 1 (12:24):
Yeah, those, uh, those attendings back then.
Yeah, that was old school beingable to do that.
So what kind of mentor?
Do you remember anyone inparticular that was really
special to you during that time?
Speaker 2 (12:37):
Yeah, I mean there were a number of people and they
were mentors in different waysso you know, there was a guy,
joe Losey.
Oh yeah, he is our residencyprogram director and he's a
craniofacial surgeon and stillis.
He's one of the most meticulousguys you know and so like,
dedicated to his patients, tohis students, to his residents
(13:00):
and to his craft and he's alwaysimproving it.
But you know, I strive to bemore and more like him, but I
know I never will be um and butthen the guy who actually
probably had the most impact onme was a guy named jimra savage.
He's the guy that you'll neverhear about because he rarely
publishes, but is was by far thebest plastic surgeon I've ever
(13:24):
worked with.
You know, the guy's kind oflike the A-team.
You remember the slogan for theA-team?
It's like if you have a problem, bad enough, if there's nobody
to help, call who do you call?
You call Jim Rizabic.
They also call him the pizzaman because he always delivers.
(13:49):
But you know, this is one of theguys who was oral maxillofacial
surgery trained, then generalsurgery trained, then plastic
surgery and microsurgery trained, and it was one of those things
where his attitude and hisability to train residents was
phenomenal.
And one of his attitudes reallywas how do I?
(14:11):
His quote was I asked him whydoes he stay and train us?
Because he would sleep on thecouch for hours while we're
operating, till the wee hours ofthe morning, and then, if
there's's any issues, he'd comein and fix whatever it is.
But no matter what it was, hecould fix it, and we knew he
could finish way faster withoutus.
And you're kind of like, well,why are you doing this?
(14:33):
And he said his argument.
One, you should train everybody.
So no matter who it is, ifthey're, if they're slow, if
they're bad, it's your job tomake them better.
And two, he was like he waslike one day I'm gonna be old or
I'm gonna get injured and I'mgonna look up and and if I know
(14:55):
that you were a bad surgeon andI hadn't trained you, that's
gonna fall on me.
It's like.
So you know you want yourfriends to, when they go to see
a plastic surgeon, to know thatthey're good and the only way
that you know that they're goodis if you've helped train them
and make them better.
Wow, that's awesome.
Speaker 1 (15:14):
Oh my God, yeah, I mean that resonates with me on a
couple levels.
One is that selfless dedicationthat that I've encountered as
well in mentors, the fact thathe would let you operate, and
then, uh, the fact that, uh, hewould let you operate and then
be able to fix anything thatwasn't right.
And then also the multi, thetriple threat, the OMS, general
(15:34):
surgery, plastics, micro.
I mean I knew a couple of thoseguys and they were in training
until they were almost 40.
And yet they were the bestsurgeons I had ever seen in my
life, like the ones who had gonethrough all that training.
I don't know what it was aboutthem, but crazy, crazy,
impressive.
So.
And the fact that he wasn'tlike a flashy academic, like big
(15:58):
shot guy, like they were in thetrenches teaching, like I feel
like the best clinicalspecialists are the ones that I
have seen not be like up onpodiums, you know, like
presenting, doing all that kindof stuff, like these were the
guys that were really busyclinically and like a lot of the
unsung heroes of residencyprograms I feel like are guys
(16:19):
just like your mentor for sure,like that means a lot.
So, um, so, tell me, uh, inyour journey to becoming where
you are.
Give me a one method or waythat you became better as a
surgeon.
Uh, for yourself.
Speaker 2 (16:40):
Um, you know, I I saw this question and I kind of
ignored it, Because it's one ofthose things that's a little bit
hard to answer, right, yeah?
Speaker 1 (16:51):
it is hard.
Speaker 2 (16:53):
I think, more than a method, it's sort of a mindset,
right?
And it's one of these mindsetsof always being humble, always
being curious, right, how do youget better at something?
You have to accept that you'renot good at it, or, if you are
good at it, that you're not thebest and there's a better way to
(17:13):
do it, and to be curious to say, hey, well, how is someone else
doing it and how can I do thatbetter?
And so I think it's more ofthat mindset than any particular
technique.
You know, all of us read booksin all sorts of different
aspects of the world.
We're not focused just onmedicine or plastic surgery.
(17:35):
Right, you'll read, you knowsomething from what's his name?
Adam Grant.
Or you know the guy who wroteBlink.
Like, these are great books andhow do you apply that then to
medicine?
And you know, like it's that, Ithink, that mindset to say how
(17:55):
can I be better?
More than any particulartechnique.
You take that concept, youfocus it on what it is that
you're doing and then try to, Iguess, adjust it or make sure
that it is safe.
Whatever it is that you'redoing, that it's safe for your
(18:17):
patients.
You're not going to wholesalechange exactly what you're doing
.
You want to do it in a measuredcapacity that you're able to
then sort of see what theresults are or what the change
is.
Speaker 1 (18:29):
Have you done something where you saw
something and said you know what, I think I can make this better
, and you played around with itand figured out something that
made that operation a betteroperation, for example, for
yourself, for myself?
I mean you know because wealways say in our hands, so you
know.
Speaker 2 (18:51):
Yeah, I mean, I think we're constantly playing around
with it a little bit, you know.
So, even something as simple asyou know I don't want to say
simple as common as a breastaugmentation, you know how are
you choosing where to put yourincision for an inframammary
fold?
You know there are a number ofpapers about how to do it right.
There's the IE method, there'sI-5, and they're all slightly
(19:15):
different measurements, and soyou keep playing with it until
you're like well, this one kindof matches what I do and how I
would do it, and so you knoweven something like that yeah,
that's worked out, and same forand then.
So I guess, what have I?
Speaker 1 (19:32):
changed.
Speaker 2 (19:33):
Yeah, so how do you?
Speaker 1 (19:34):
do your breast augmentation incision planning
then.
Speaker 2 (19:38):
Honestly, I let the residents choose no, no.
We go through.
We go through all of thedifferent steps for it, I see,
and the different methods, andthen usually we end up choosing
sort of along the high five plan.
Speaker 1 (19:56):
Okay, got it.
Speaker 2 (19:57):
Yeah, so it's nothing where I would like them to read
what other people have done,analyze their data and then
compare it to their own methods,and so oftentimes I'll have
them mark the patients.
We talk about it ahead of time.
They get to see the patientsahead of time in the operating
(20:18):
room.
We're doing the operationstogether.
And then if they are not inpost-op clinic, then I'll send
them pictures from post-opclinic so that way that they can
see sort of what the resultsare and how it matches what they
thought it would be.
Speaker 1 (20:32):
That's awesome.
What is one of your favoritesurgical procedures that you
really still enjoy doing at thistime?
Speaker 2 (20:42):
You know I got to say I'm probably a little bit burnt
out at this point.
No, honestly I I like operatingum and I enjoy like it.
Historically I really lovedmicrosurgery.
I loved seeing the anatomy comeapart and then I loved seeing
(21:03):
the anatomy go back togetheragain.
I felt like it was one of thosegreat expressions of a plastic
surgeon where you're actuallytaking one body part, molding it
and making it a different bodypart, whether it's a deep flap,
a free fibula that you're thenmaking a jaw out of, or a free
fibula that you're taking toreconstruct a femur or humerus
(21:23):
withosteomyelitis.
Like it's pretty neat, um, andvery few people get to do that
sort of thing.
Yeah, um, at this point, I thinkwhat I actually enjoy doing
more is kind of seeing some ofthese technologies and how
things are a little bitdifferent.
Uh, so one of the things we'replaying around with now is
(21:45):
there's a I think it'slyophilized placental tissue and
sort of what growth factorsdoes that sort of bring to the
field or cause the field tosecrete that will improve wound
healing?
And it's one of those thingslike you kind of don't believe
(22:06):
it at first, like you see thepapers and you're like and just
another thing, that somebody touse it, like you know, like the
paper was clearly paid for bythe company, but then you, you,
you trial it and you're like,actually my patient's wound does
look better.
So then what's going on with it?
So that's where having a guylike Alex Wong coming in who has
(22:28):
a research lab who can thenstart playing around with you
know, sort of breaking it downto what are the processes that
are going on, is incrediblyvaluable.
Yeah.
Speaker 1 (22:39):
No, we definitely see a lot of potions and things in
plastic surgery.
Someone always has somethingnew, but if you find something
that actually works, that'sinvaluable for sure.
I've talked to a bunch ofsurgeons and surgeons our
generation I think a little bitof burnout is really really
common and it's kind of funnybecause ostensibly we're at the
(23:00):
peak of our surgical skill,knowledge, experience.
We have years and years andyears under our belt.
We're still very physically onpoint.
So why do you think so many ofus are a little burnt out and
how do we combat that at thispoint when supposedly we should
be at our I don't know mostproductive or at the peak of
(23:21):
where we are surgically?
Maybe I don't know.
Speaker 2 (23:24):
Yeah, I don't know, yeah, I don't know.
It's something that we talkabout a lot, particularly in
academic medicine, because thereis burnout and obviously we
worry about our residentsburning out and the training for
it.
Sometimes, when I think aboutmy own like how I feel tired, my
dad's voice pops into my headand basically he's just telling
(23:48):
me I'm lazy and keep going.
Yes, I hear that all the time,and so then I wonder how much
burnout was there in previousgenerations?
Because nobody really measuredit and they just sort of kept
going and work through it.
It's kind of like when you'reworking out, right right, you're
in a crossfit workout, you feelthat burn, do you say, yeah, I
(24:12):
gotta stop this.
Or is there a level where yousay, okay, I can maintain this.
Or you know you're gonna bonkand you're you know you're
you're gonna use up all of yourglycogen stores and then you
can't yeah, you can't finish theworkout and so I think being
able to measure when is thestress leading to greater
productivity or greater growth,versus when is that stress going
(24:36):
to harm you?
And I think that's the question.
So are you really burnt out orare you a little bit tired
because you are growing andgrowing is hard?
Speaker 1 (24:48):
That's true.
That's a really good point.
I think previous generations itwas survival.
If they didn't do what they hadto do, they would basically
have nothing, like their familywouldn't eat and like it'd be a
real problem.
So I think we have the luxury,a little bit, of being able to
look at ourselves and say, wow,you know, am I like you said?
Am I, is this real?
(25:09):
Is this something where I'mchanging or is this something
where I really it's affecting mein some, some negative way?
But you're right, I think it'stough and how do you feel like
you manage it better, like whatis your way of sort of
identifying it and then sort ofmanaging it?
Speaker 2 (25:30):
yeah, I, I kind of rely on friends to tell me that
one of my friends says as I walkaround the hospital, he can see
me hunching over more and more.
He'll tell me when I seem to behunched over more and it looks
like you need some time off.
But I think that's a joke, butit's not.
(25:54):
How do we?
And I think one of the ways weknow is our interactions with
others, your interactions withfamily, interactions with others
, right, like your interactionswith family.
And and I think that's one ofthose areas where burnout, uh,
is most destructive, because ifyou're not enjoying the work
that you're doing and then youcome home and you're upset, but
(26:18):
you're even more tired now andthen you're kind of, you have no
reserve for the people that youlove the most your family,
friends then unfortunately theydo suffer with it.
And I think that's where tryingto identify burnout, trying to
deal with it, is the mostbeneficial, not necessarily for
(26:40):
our careers or for developmentas a surgeon, but for
development as a human being.
And so how do I deal with it?
You know, when I'm feelingburnt out, I think I do try to
carve out more time for myself.
Then you know whether it's amorning workout or taking a
(27:00):
weekend off to go away somewherejust to have some peace and
quiet, turn the phone off, avoid, you know, whatever social
media or other things thatyou're supposed to be reading or
doing, and then, really, thisyou know how to again, I don't
(27:20):
want to blame my parents, butyou know because we should have
out we should have outgrown ourparents conditioning by by now,
but it's hard not to hear theirvoices, right, yeah, yeah and uh
.
You know.
One of the things, though, wasalways that you can always do
more, you can always study more,you can work harder, um, but
you know the that, I think,leads to burnout.
(27:43):
It can push you to do better,but that can also lead to
burnout.
So the idea of self-acceptancehey, what I did was great, I can
do better, but right now Ican't and to accept what it is
that you've done, who you are atthat moment in time and just
sort of being present in thatmoment in time, I don't want to
(28:07):
get too like new world new ageum you know, but, uh, you know
that sort of uh Buddhist thoughtof just being present, uh and
accepting everything as it is,uh, I think is very valuable
yeah that is Um.
Speaker 1 (28:24):
So when you're in the operating room I know you work
a lot with residents.
That's such a huge focus foryou Do you have any rituals or
any sort of things that you doin the operating room which are
always the same or very similarevery time you do something in
the operating room?
Speaker 2 (28:44):
I mean the most consistent is going to be when
you do something in theoperating room, I mean the most
consistent is going to be whenyou do your microcircular
anastomosis.
I see you know you want to havethe same setup.
You want to have your handspositioned properly, your body
positioned properly, you wantthe field to be totally dry so
that there's no bleeding, or ifthere's anything oozing, it's
(29:07):
controlled through a suctiondrain.
You just want it to look like apicture textbook of what an
anastomosis should look like andthen get started so that it's
exactly the same.
I think for me.
I do a lot of different cases,so my practice is very broad,
(29:33):
and so I don't think I do things.
I don't think I enforce or amas rigid sometimes, and so I'm
willing to go with the flow.
We often have a different teamin the OR for each case because
of whatever union contracting orwhat have you.
(29:55):
We often have a different scrub, a different circulator,
different anesthetist from themorning case to the afternoon
case, and so some of thoseroutines are hard to maintain.
But within yourself, like forme, I always think about doing
the operation.
They do the operation threetimes in your head before you
(30:16):
actually start, right.
So you do the operation in yourhead.
When you see the patient You'relike okay, this is what I'm
going to do, but you're not asdetailed about it.
Um, and then do the operationthe night before and then do the
operation as you're scrubbingit.
So this way you're reviewingthe process of it and I think
this, this is something that Itry to impress to the residents.
(30:40):
Um, you know, it used to be thatwe would have to sit there and
read a textbook, and you have.
You have to imagine the anatomy,right, because it's hard to
find a great picture of some ofthe anatomy.
You would look back at theanatomy textbooks and then try
to find cross-cut sections ofwhere things are, because
oftentimes it's easy to see thelongitudinal and latitudinal
(31:03):
orientation of anatomy as it'sdrawn out in a net or textbook,
but then there's like depth toit and like kind of coming
around a muscle or around thebone, and the only way you can
really think about that isthrough your imagination.
Right, there were now I feellike video is great, and all of
my residents, honestly, theyprobably YouTube more of their
(31:26):
study than anything else.
But most of the videos, whenyou look at them, they lay out
the anatomy for you.
But it's laid out for you sowell because they've chosen a
great video and a great exampleof what it is that they're doing
, that you're not using yourbrain to think about.
(31:48):
Okay, well, as I'm cutting ormoving through this layer of
tissue, what is it that I expectto see before I see?
so like, let's say you're,you're looking for a perforator
coming out for a deep flap, youknow, as you dissect there.
Or even like as you're liftingthe pec muscle to do a sub-pec
(32:09):
aug, right, what will that looklike as I'm getting closer to
those internal mammaryperforators that I don't want to
ding because they'll bleed likestink and then you're in a lot
of trouble?
Or what will it look like asI'm coming across the uh
insertion or origin of the pack,because there's always, like
that, one vessel that bleeds,like sort of the central aspect
(32:33):
of it, like what is that goingto look like before I hit it?
so that way I know to grab itwith, you know an insulated
debakey or something, or or slowdown so that I can cauterize it
nicely before I come through it, I think that's so true.
Speaker 1 (32:49):
I remember as residents looking at Netter or
Mathis in the high and trying tofigure out, but, like you said,
the approach will change yourperspective on finding that
particular muscle or thatdissection or that plane that
you're looking for.
It does take a lot ofimagination to do that and I
think we never had the benefitof YouTube so we never were able
(33:11):
to see any videos like that.
The pre-vis, I think, issomething that I hear a lot of
surgeons talk about.
Pre -visualization of thesurgery.
I'd love that.
Times three aspect of it and,uh, I never thought of it that
way and and I probably that's aI might actually start thinking
of it that way.
(33:31):
That's a really, really goodtip.
Three times is, uh is a reallygood way of sort of approaching
the pre-visualization of surgery.
Um, that's amazing, that'spretty cool stuff.
Um, what do you listen to inthe OR then when you're doing
all of these different types ofcases?
Speaker 2 (33:51):
yeah, I gotta say I let the residents choose the
music.
You know I work with so manydifferent residents.
I like to hear what they'relistening to.
Often times, honestly, theyhave better taste in music than
I do.
Speaker 1 (34:05):
What do they play?
Do you, what do they?
What do they play that youhappen to like, like?
What is it that they might?
Speaker 2 (34:09):
choose.
Not like like just yesterday orwas it two days ago, yeah, they
were listening to some vibeylounge music.
But if it was like, perfect forthe case that I was, but but I
would never have chosen that I'dprobably choose something like
classical, classic rock.
I do listen to a lot of, likepop music, um, but it's nice to
(34:30):
hear what they're doing and,honestly, when I'm operating, um
, I actually am not listening tothe music at all.
Um, it's kind of like for me,uh, you know, when I used, when,
when I was in college, uh, Ilike to go to like a cafe to
study, I like to have backgroundnoise as I'm doing things, but
(34:53):
I, what the what the noise isdoesn't necessarily matter, and
so, honestly, like, if it's anintense case, I won't even know
what's playing or not playing.
It can be on repeat a thousandtimes and I won't recognize that
until that intense portion isover, and that intense portion
(35:15):
may be hours, so I don't reallynotice it.
And if any of my college friendswatch this.
They will laugh because they'llsay I never studied in college.
Speaker 1 (35:25):
Yes, I think the smartest people I knew in
college never seemed to studyever.
So you are one of those guysfor sure, I'm sure.
So, as part of your team,either in the OR or out of the
OR, who's really important interms of your success as a
surgeon, who is integral to whatyou do?
Speaker 2 (35:48):
Um, I mean, honestly, everybody is like you know,
it's uh, it's such a team sportnow.
I think surgery used to.
Surgery used to be more of a um, a captain running the ship and
being in charge of everyone andcontrolling everybody around
them.
But I think medicine as a wholehas moved so much more to a team
(36:11):
sport and so, like in theaesthetic world, things may be a
little bit different, becauseyou're coming in, you have a
very consistent team, yourpatients are a little more
consistent, the operations aremore consistent, but a number of
my patients are very sickpatients, and so I'm often
operating with another surgeonand we're doing two or three
(36:31):
different.
There may be two or threedifferent surgeons involved in
the case doing differentportions of the case, and so and
our anesthesiologist isincredibly important obviously
you know the people who are inthe room with you circulators,
scrub techs are all veryimportant.
And then you know the peoplewho are in the room with you
circulators, scrub techs are allvery important.
And then you know the medicalteam who's taking care of the
(36:51):
patient, whether it's me, myresidents, my PA they're all
incredibly valuable.
So I don't think there's oneperson that I would point out as
being particularly valuable tomy, to sort of the success of
the operation, but I reallythink it is everybody.
I do think it is important thatthere is somebody who is sort
(37:14):
of calling the shots and runningeverything.
You know there is a guy who isthat guy from SEAL Team 6?
Jocko Willink.
Yes, I mean, he wrote that book.
It was like an extremeownership Right and the idea
that you have to take ownershipand understand and really be in
(37:39):
charge of every part of what'sgoing on.
You can ask people to do stuff,but you got to know exactly
what they're doing, and I thinkthat is very much appropriate
for the operating room.
But it's still a team.
It's not an individual doingeverything.
Every team member really needsto be invested and they all have
to buy into that investment inthe care of the patient.
Speaker 1 (38:04):
You're now division chief, you're a program director
, you've sort of achieved thepinnacle of what most plastic
surgeons would aspire to.
So what are your future goalsnow, at this point of your life,
now that you've achieved theseachievements, at this point?
Speaker 2 (38:25):
It's funny that you say that.
I told you I'm a little bitburned out, so every now and
then I do buy a lottery ticket.
I get it, but I think thatthere's lots of little goals.
So there's lots of things toimprove on.
(38:48):
And maybe this is somethingthat you were talking about with
how do you become a bettersurgeon.
It's the same sort of thing andyou know it'll be one of those
things I write out.
This is what I'd like to do infive years or 10 years, but
(39:11):
there's lots of little thingsthat I want to improve.
So, like I, like I said, wejust hired Alex Wong, who's a
good friend of mine, who'scoming to Rutgers, so that's
phenomenal because he brings aresearch component to it.
But then we've got to add moreright, it would be great, like I
work in Newark, right, and wehave a number of underserved
(39:34):
patients.
We have a large minoritycomponent.
It's a majority minoritycommunity there.
So why do we not have morepatient reported outcome
measures that are focusing onthe outcomes for reconstructive
surgery for minority patients?
Because that is a large area ofresearch and a way that we can
(39:59):
become better.
We know that outcomes are worsefor minorities in many ways,
but how do we make that better?
So I think teasing out some ofthat would be exciting.
You know, the other excitingthing to me really is AI.
I mean, what a fascinatingtechnology, and how are we going
to utilize it in health care?
(40:20):
You know, the hardest part isthat you know, with health care
you worry about hurting anyone.
Right, like even something assimple as if you use an AI
(40:46):
technology to like decidewhether or not to get an X-ray
for a patient.
There's a judgment call that'sbeing made by a computer, and
will it be right, everybodyusing an EMR to start using
decision support software, whichis slightly different than an
AI program?
Right, it's, the decisionsupport software has, like, an
(41:07):
algorithm built in.
But it would not surprise me ifthey quickly moved to an AI
technology that can then scan orread through the latest
literature in order to updatewhat it's suggesting as an
appropriate study for a patient.
But when we look at AI, we alsoknow that AI has what they call
(41:30):
hallucinations right when, forsome reason, it will go off the
deep end for an unknown reason,for an unknown question, and so
like, governance of the AI isimportant.
So how do we know what data itwas looking at, how it made its
decision and how it producedthat outcome is something that
(41:52):
people are still are spending alot of time and a lot of energy
working on.
But I think that would befascinating, like wouldn't it be
great if you had a chatbotslash AI that could do the
intake for your patients andthen convert all of that to
(42:13):
ICD-10 and CPT coding, all ofthat to ICD-10 and CPT coding?
Or you know, for the case ofaesthetics, the different
options for operations and say,okay, well, you know you can do
X, y or Z and that's going to be, this is the gold.
You know the gold package, thesilver package and the bronze
package and why they're betteror worse, and then generate a
(42:35):
picture outcome of what eachmight look like right.
So for like facial rejuvenationyeah you can get the facelift
with that grafting or you canhave a chemical peel.
The chemical peel improves yourskin a little bit, but it's not
going to tighten much more thanX, y or Z but be able to
generate those different outcomepictures for the patient.
Speaker 1 (42:58):
That's crazy.
That is, both thosepossibilities are science
fiction within the realm ofreality very soon, like the fact
that our EMR could actuallyhelp us with charting, billing,
coding, like I know people arechomping at the bit for that,
like yesterday.
Like, yeah, with emr, uh, foraesthetic medicine to be able to
(43:21):
say, scan a person's body andthen say, here are the 20
different treatments you couldopt for and this is what it
might look like and here you go,would be amazing.
Uh, I think it does sound likesomething that I might have even
seen in a movie like 15 or 20years ago.
So that's that's.
(43:41):
I had not actually thoughtabout that for aesthetic
medicine, but that would totallybe within the realm of
possibility within the nextcouple of years, I would imagine
.
So that's crazy.
Speaker 2 (43:50):
Yeah, I think it would be cool.
You know, you get so manypatients who come in and they're
like, oh, I just wantliposuction, and you're looking
at them and you're going that isnot going to fix this problem,
that's right.
Speaker 1 (44:00):
You're right.
Speaker 2 (44:01):
But to be able to have a generative AI.
You take a picture and you say,okay, liposuction will do this,
liposuction plus abdominoplastywill do this, right.
Or abdominoplasty followed byliposuction would look like this
, right.
And you know, because theproblem is that oftentimes
you're trying to tell a story tothe patient and even if you
(44:23):
show them other patients' photos, they'll look at it and be like
, no, no, I'm different, right,but you're looking at it and
they're like no, no, this is theproblem that will happen.
Speaker 1 (44:36):
That's right, that's amazing, so okay.
So if you have little goals andsome other bigger program and
institutional and society goals,how long do you envision
yourself operating being asurgeon doing what you do at
this point?
Speaker 2 (44:57):
It depends on if my lottery numbers hit.
Speaker 1 (45:01):
Those lotto numbers better hit, I guess pretty soon.
Speaker 2 (45:05):
No, I mean honestly, I'm actually in a pretty good
place.
I say I'm a little bit burntout, but it's not bad.
It's more along the lines of Ithink this is a steady state
that I could do for a long time,but I'm not sure.
Right, right, right.
You know, as you're goingparticularly like I hate.
I hate the erg, the rowingmachine.
Speaker 1 (45:29):
Yeah, the concept.
Speaker 2 (45:31):
I rode in college and you know it was like the bane
of my existence.
Being out on the water is fine,being in the tank was fine, but
the hurricane.
There's something about it, andI think part of it is that as
you're going, you're listeningto that hum and that wine and
you see your split times andyou're like, ah, this feels
pretty good.
Speaker 1 (45:50):
You go a minute in, five minutes in and then you're
like, oh no, oh no, no, thispace was too much we recently
did a 2k row for time at our inour gym, and that was one of the
worst experiences anyone hasever had.
Like we always say, the best pryou will have will be the first
time you do a 2k row for time,because the next time you don't
(46:11):
want to go.
You don't want to go to thatplace to uh uh, cause it just
hurts so much.
So I I understand, but likeyou're ostensibly at the peak of
your surgical powers, you haveall the experience in the world
at this point, Do you seeyourself operating like this for
another five years, another 10years?
Like is that something we know?
(46:32):
Surgeons who will operate untilthey physically cannot operate
anymore?
And then we also know surgeonswho will operate until they
physically cannot operateanymore.
And then we also know surgeonswho will say listen, this is
enough, I don't want to sit herefor eight or 10 hours doing
this case anymore, and theypivot.
So what sort of is yourperspective with that?
Speaker 2 (46:52):
You know my perspective with it is it's a
little bit different, I guess,than most people, so one I think
the medical licensing processthat we go through in the US is
it tries to be protective, butit is not.
It is not progressive at all.
The fact that you go from, oh,you were a medical student to
(47:41):
now you finished one year ofresidency and you can, falls
under that um and.
But we all know that there areresidents and there are
colleagues who you're like youknow you probably shouldn't do
that procedure, that's.
It's a little more complicatedand I think, we, we all come up
with that on our own right.
Like you look at things, andlike I will not do a cleft lip
or palate I didn't do afellowship in it.
(48:02):
Could I do one and could I do anice job of it, maybe.
But like there are people whoare so much better at it, why
wouldn't I send it to them?
Um, and so like I think thatthe medical licensing is to all
or none right, like why don't wehave something that says well,
you can be a great lumps andbumps surgeon.
(48:24):
Well, how did you do lumps andbumps?
You know you can do?
Uh, you know some other gradedcomplexity?
um you know, instead of saying,oh yeah, you have a medical
license, you can do.
Uh, you know, like these bblsthat are being done down in
florida, there's like that onecounty that has like the highest
(48:45):
mortality rate, right, and it'slike a outlier in the nation,
like that, that's kind ofridiculous, all right.
Same thing, I think, for thewind down of the career, right.
Like at some point, I thinkeverybody, like most plastic
surgeons I know a lot of peoplewere doing free flaps- right and
then at some point they say youknow what I, I don't really
want to do that anymore.
(49:06):
okay, well, you can voluntarilyopt to not do that.
Or should there be like adecreased sort of uh, licensing
almost that goes with it.
And so like I think, over timethe number of procedures that
you do and the complexity of thealmost that goes with it, and
so I think over time the numberof procedures that you do and
the complexity of the proceduresthat you do slowly decreases.
So I could see myself notwanting to do free flaps after
(49:26):
about 10 years, because thatwill put me at around 60.
Or if I find that there areother people in my practice who
are doing it way better than Iam, great, go see them.
And like I think that goes alongwith that sort of humility or
being humble about who you areand accepting who you are, so
(49:49):
yeah, so I could see that sortof winding down.
But then the other part of itto me is we should be inventing
technologies to make surgeryeasier.
So one of the jokes right nowis, uh, going around the or is
button surgery right?
So have you ever used theversaget?
Speaker 1 (50:10):
yeah, yeah, yeah yeah , yeah, it's the uh instrument
that has the uh, high pressurewater, that's.
That is almost like a scalpel.
You could use it as a scalpel.
Speaker 2 (50:20):
It will basically plane the tissues using a
high-pressure water jet, so ittakes out the technical
component of retracting on thetissue, creating traction and
counter-traction.
In order to use a knife or ascissor to cut through the
tissue, right, you just kind ofrub over it, you press the
(50:41):
button with your foot and rubover it, but then there's a lot
of bleeding right.
So then how do you stop thebleeding?
Well, you have to like dry andpat and use your bovie is more.
But or you can use the aquamantis, which is uh, it's a uh
radio frequency, uh, irrigatingbipolar.
(51:02):
Yeah.
So basically, instead of havingto wipe away the blood, it just
irrigates the blood away foryou and the bipolar.
It just runs between the tips,so you just run it over the
tissues, so you versaged it andthen you bipolar it and look,
well, lo and behold, it's alldebrided and it's all cauterized
that's pretty cool why do wenot have more button surgery?
(51:26):
it gets rid of the technicalaspect of surgery.
So like, for instance, whenyou're when you're watching or
looking at robotic surgery right, it's pretty amazing what
they're doing with roboticsurgery, but why is there not a
button to push, like when youhave things kind of lined up,
let's say, for a microvascularanastomosis and they want to put
(51:48):
a stitch, why can we not lineit up?
Speaker 1 (51:52):
point on the screen put the needle here.
Speaker 2 (51:57):
Put the needle here put the needle here and you push
a button and it's a segmentalportion of the operation that
the robot then commits to on itsown and goes, puts in a stitch,
ties it right, that makes sense.
Speaker 1 (52:13):
Like if you could 3D image it, put the dots where you
want, the sutures, and then hit, go.
Then it's like a sewing machine.
It just like does the knots and, you know, does the like the
three stitches you want orwhatever number you want.
Like that sounds feasible to me.
I don't know, has that beeninvented yet?
Speaker 2 (52:33):
I don't know, I haven't heard about it, but I'm
sure it's coming.
I mean, there's a bunch ofrobotic companies and those
robots are not cheap, so, um,and the other thing is, you know
, like, looking at very taskspecific robots, right like to
me, the fact that we stillsuture skin in the same way that
the ancient egyptians, it's alittle bit crazy.
(52:56):
We have better materials.
Speaker 1 (52:57):
It's very crazy.
I think about that every timeI'm suturing, like an
abdominoplasty or somethingwhere there's like a million
inches of skin to sew, I'm like,yes, we got to do something
better for this.
Speaker 2 (53:11):
Yeah, and we came up with the stapler right, the skin
stapler Right, and then there'sthe subcutaneous stapler, the
Inzorb, but honestly it's notthat great.
So even a task-specific robotto do that, if you can set it up
so that it does it nicely, itwould be incredibly valuable,
right?
Then you take the art ofplastic surgery in terms of skin
(53:35):
closure and you've nowmechanized it to a robot so that
it then democratizes it so thateverybody can use it.
So your er doc, when they haveto show up a laceration, they're
like oh, bring over the robot.
They numb it up, set it up forthe robot.
The robot goes ahead and closesit.
They get a plastic surgeryclosure for the cost of the
(53:55):
robot.
Speaker 1 (54:03):
You're technologicalizing our specialty
out of business.
Basically, that would be yourgoal in the future, which is a
great goal.
Honestly, I would love forplastic surgeons to take their
intellect and ability and applyit to the next level of things
to do for sure.
Speaker 2 (54:14):
Yeah, I think taking some of that technical I don't
want to take the technical skillaway from it, but being able to
, uh, uh, what's it called?
Mechanize it, I think it'svaluable, like when you look at
so.
So, for instance, if you lookat, like, thoracic surgery,
right, um, the ravage stapler,it didn't decrease the amount of
(54:37):
thoracic surgery being done.
If anything, it increased whateverybody was doing and the
complexity of what they weredoing, because now suddenly,
well, this part where we were soworried about it leaking, so
worried about bleeding.
That's all passé.
I no longer have to focus onhow I'm doing that, how I'm
(54:59):
doing doing that.
We can focus on why and improvewhat else is going on with it.
The fact that we don't haveanything great to improve scars
still right like we have.
There's a lot of stuff on themarket for scar care, but
nothing is really proven to tomake that much better.
Instead of spending our timelearning to suture, we could be
learning about all of thedifferent growth factors and
(55:22):
methods to try to improve thatscar healing and wound healing.
Speaker 1 (55:28):
Good goals.
I like that.
So you do train a lot ofresidents.
You do work with a lot ofmedical students and other
people who are learning.
What do you tell them when theylook at you or they're like you
?
Know what?
I want to be like you someday,dr Lee.
I want to do what you do.
I want to be in the situationthat you're in.
(55:50):
What kind of advice do you givefor for your young students?
Speaker 2 (55:58):
um, you know, one of the things I tell them is that,
uh, you know, oftentimes thestudents are coming in earlier
and earlier, right, so they?
They used to come in somewhereduring third year then?
Second year, then first yearand now we even get a bunch of
college students who are eagerand excited about plastic
surgery and you know my adviceto them is to go after
(56:20):
everything with 110% energy.
Be passionate about what it isthat you're doing, and so if
your interest is plastic surgery, that's fantastic.
Do it 110%.
But always have an open mind,because you may see something
that suddenly captivates you andyou're then very passionate
(56:43):
about that or excited about that, and that's okay.
You're young, you're early on.
Even when you're later in yourcareer.
If there's something that'sthat captivating, give it some
time to percolate in the back ofyour mind.
But if you want to go afterthat instead, do it.
And it's not that you wastedthe time that you were excited
about plastic surgery and goingafter it.
(57:05):
Whatever you learn during thatperiod is translatable right If
it's a different field ofmedicine.
The way that you learn to study, the way you learn to think
about a problem and then try toanswer that problem those are
all valuable skills, you know.
(57:25):
That's my advice to them.
Usually, you know theapplications process for
residency really is getting moreand more challenging.
I mean, it's like an arms race.
Speaker 1 (57:40):
How much harder is it now than it was back in the day
, when we were playing A lotharder, really.
Speaker 2 (57:49):
Basically, anytime you set a standard or a goal and
you have a number of highachieving, high energy
individuals, they will find waysto exceed that goal and keep
building on it.
And so you keep setting the barhigher and higher.
Uh, but is it at the detrimentof the, their development, of
(58:13):
other aspects of their life?
It's similar to if you'reworking so hard at your job and
then you come home kind of burntout with less to give to your
family.
Is that a cool thing.
Speaker 1 (58:27):
I don't know.
Speaker 2 (58:31):
I think there's a lot of people in education who are
really focusing on that questionand trying to answer that
question.
I think a lot of it comes downto who you are as a person and
just trying to build up theperson that you are, not
necessarily the plastic surgeonthat you are.
You know, it's a lot of how doI put it?
(58:54):
Just I don't want to say yourmoral compass, it's more just
like your, your baseline, yourbaseline sort of thoughts, and
you know how do you, how do youapproach life, right?
Speaker 1 (59:14):
So that's true.
Wow Well, ed, approach liferight.
So that's true.
Wow well, ed, you have doneamazing things over the past.
I don't know, was it 10, 15years that you've been at
rutgers?
You've, you've taken it to thenext level.
You've, you've put your stampon it.
It's been uh, and I can see howmuch you've accomplished there.
(59:36):
I I see the residents comingout, I see how successful you
are and how the program has been, and I am I am in awe, because
for you to um, to be able to dothat uh shows a lot of skillsets
, not just as a surgeon, as anadministrator, as a team builder
, as someone as an educator,like.
(59:57):
I think a lot of people wouldlook at you, um, who have
started or are starting insurgery and look at your life as
a blueprint and be like this isa pretty good way to achieve
some amazing success.
So I really hope that anyonewho listens to this or watches
this sort of takes a look andlistens to what you have done
and said and you know, sort oftake that advice and your
(01:00:20):
experiences to heart, becausethat I think it means a lot.
I think there aren't that manypeople that can do that and it's
just super impressive.
Speaker 2 (01:00:29):
Well, thanks, sam.
I really appreciate you takingthe time to talk with me and
inviting me to be part of yourshow.
I think it's phenomenal to seewhat you do.
You know, I mean looking.
Speaker 1 (01:00:43):
Oh, you mean finding successful people and talking to
them and see what they do.
Speaker 2 (01:00:47):
Like, yes, well, what is it?
What is it?
It's humility, it's curiosity,it's those two things.
It's curiosity, it's those twothings.
And you know the.
And part of that humility isyou taking on a new venture,
like we were joking abouttechnology and difficulties with
technology, and you know you'repodcasting.
(01:01:07):
When.
When did you start?
Five years ago, six years ago?
Yeah, to take on that challenge.
I, I think, is admirable.
And you know the whole CrossFitjourney.
I mean, honestly, I wish Ilooked like you.
Speaker 1 (01:01:28):
Thank you very much.
Speaker 2 (01:01:30):
I went to a CrossFit class, probably four years ago
after my first class class.
Probably what?
Four years ago after my firstclass?
Uh, it was the, it was what,what is it?
Emom every minute.
On the minute it was rowingburpees and then moving on to
like sit-ups and then pull-upsor thrusters or something, and I
got in my car to drive home andI felt like I had had a stroke.
(01:01:54):
I pulled over after about aminute of driving and laid down
in the back of my car and fellasleep for about half an hour.
Speaker 1 (01:02:04):
If you ever decide to try it again, I would be happy
to do something that would bemore appropriate.
That would be a horribleworkout for anyone.
That sounds like they reallyput you through the ringer,
there's no doubt.
Speaker 2 (01:02:19):
But it was fun, it was fun and.
I really should get back to it,but my goodness, well, I
understand.
Speaker 1 (01:02:27):
Thank you so much, Ed , and I hope to see you soon,
and.
I really appreciate you takingthe time today.
All right, take care, Seth.
Thank you.
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