April 19, 2024 • 41 mins
"Life in plastic, it's fantastic." This iconic line from the 1997 hit song "Barbie Girl" by Europop band Aqua alludes to the Barbie doll that debuted in 1959. Barbie has long been the paradigm of societal attractiveness through physical features, as confirmed by a survey report by Fairmont State College professor Albert M. Magro. In the same year as the song was released, Magro published the paper "Why Barbie is Perceived as Beautiful" with reasons such as a thinner body frame, longer limbs, elongated neck, square shoulders, and larger eyes. Research studies throughout the decades have shown Barbie's mixed influences on body image and the rise of cosmetic-altering procedures to achieve these physical ideals that have been pushed as societal norms, such as liposuction, breast augmentation, and rhytidectomy (or a facelift). This has placed the medical domains of plastic and cosmetic surgery in a narrowed and misconstrued light of mere vanity and the pursuit of physical "perfection."
However, there is more to the field of plastic surgery than cosmesis - with power and necessity in its own right by bestowing self-confidence and resulting quality of life. The field of plastic and reconstructive surgery daily changes, improves, and saves lives through surgeries such as cleft lip and palate repair, breast reconstruction secondary to breast cancer mastectomy, reduction mammoplasty to relieve Intertrigo, facial reconstruction after physical trauma, skin grafting to treat burn wounds, and much more.
Today, we are joined by sixth-year plastic surgery resident physician Dr. Alex Sun to speak about the often misunderstood beauty of the field. He received his BS in Biomedical Engineering from Duke University, where he was a Research Fellow at Duke University Orthopaedic Bioengineering Laboratory, and MD/MHS from Yale University School of Medicine, where he was an NIH-CTSA-funded Plastic Surgery Research Fellow. Dr. Sun is currently completing his Plastic Surgery Residency at the Johns Hopkins Hospital Department of Plastic and Reconstructive Surgery. He has also served as the Senior Staff Fellow and Medical Officer of the FDA Division of General Surgery Devices and the Division of Infection Control and Plastic and Reconstructive Surgery.
Livestream Air Date: July 27, 2023
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Thankful to the season's brand partners: Covry, House of M Beauty, Nguyen Coffee Supply, V Coterie, Skin By Anthos, Halmi, By Dr Mom, LOUPN, Baisun Candle Co., RĒJINS, Twrl Milk Tea, 1587 Sneakers
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi friends, how are you all doing? I'm in LA this week for my cousin Kyle's, our cousin
(00:10):
Kyle at this point, graduation from his Masters in OT program. Yay! Can you believe it? Two
years flew by. I'm enjoying not only the sun here in California, but the time I have
been spending here with family and friends. Anyways, wow, this season flew by, didn't
it? Such a bittersweet thing to think about. But I am beyond excited for all of you to
(00:32):
listen to today's episode. What year were you guys born? I'm so curious. Well, if you're
curious about mine, I was born in 1997. Just the best year, humbly. The world got its earliest
camera phone and function in Wi-Fi. Ellen DeGeneres came out on TV. The first book of
the Harry Potter series was published. And for K-pop stans, it was also the year that
(00:55):
the supreme 97 line of Jungkook, Mingyu, and Cha Eun Woo were born. And it was the year this
song with this line was released. Dive in plastic, it's fantastic. Well, he knows it.
Yes, this iconic line is from the 1997 released hit song, Barbie Girl by Europop band Aqua.
(01:17):
This song overtly alluded to the also iconic Barbie doll that debuted in 1959. The same
year the song 1997, a paper by Fairmont State College Professor Albert M. Magro was also
released and titled Why Barbie is perceived as beautiful. The Barbie doll has long been
the paradigm of societal attractiveness through her physical features. The paper was formed
(01:38):
through a survey report. And we were given the reasons why quote unquote, Barbie is beautiful,
a thinner body frame, longer limbs, elongated neck, square shoulders, and larger eyes. Research
studies throughout the decades have shown Barbie's mixed influences and body image
and the rise of cosmetic altering procedures to achieve these physical ideals that have
been pushed to societal norms, such as liposuction, breast augmentation, injectables, and erudite
(02:04):
me or a facelift. This has placed the medical domains of plastic and cosmetic surgery in
a narrowed and misconstrued light of mere vanity in the pursuit of physical perfection.
However, there is more to the field of plastic surgery than cosmesis, with power and necessity
in its own right by bestowing self-confidence and the resulting quality of life. We have
(02:26):
had previous episodes on the podcast with facial plastic and cosmetic surgeons who have
opened their eyes to the power of the cosmetic aspect of the field of plastics. I will never
forget the story of the patient who was previously in an abusive relationship and was left with
a disfigured nose. Daly reminded of the horrors in the mirror. A cosmetic procedure was her
only way out of this trauma. But beyond this, the field of plastic and reconstructive surgery
(02:50):
truly daily changes, improves, and saves lives through surgeries such as clove lift and palate
repair, breast reconstruction secondary to breast cancer mastectomy, reduction mammoplasty
to relieve intertrigo, facial reconstruction after physical trauma, skin grafting to treat
burn wounds, and so much more. Today, we are joined by sixth-year plastic surgery resident
(03:12):
physician and my dear friend and co-food adventurer, Dr. Alex Sun to speak about the often misunderstood
beauty of the field. He received his bachelor in biomedical engineering degree from Duke
University and MD from Yale University School of Medicine, where he was an NIH-funded plastic
surgery research fellow. Dr. Sun is currently completing his plastic surgery residency at
(03:34):
the Johns Hopkins Hospital Department of Plastic and Reconstructive Surgery. There is so much
to learn and so much to find out in today's episode. I hope you enjoy it.
(04:09):
Thank you so much for being here with me as I soon close the season of the third season
of my podcast. It's such an honor to have you. If you could just first introduce yourself
to everybody. Thank you so much.
(04:30):
My name is Alex. I am currently a resident at Johns Hopkins in Baltimore in plastic and
reconstructive surgery. I'm currently in my sixth year. So normally plastic surgery is
six years, but we have a research year. So I still have one year after this year.
Wow. It's such a short program. Anywho, I started this edgy live stream series, turn
podcast series several years ago just to really just dissect the lives of healthcare workers,
(04:55):
right? Just to see their daily lives and also to their ventures within and also outside
of medicine. And Alex and I met for the very first time, time flight, I think a year ago
during our photo shoot with the club, right? Yeah.
Literally. And it's just crazy how time flies. And I guess that's true for your life in general,
(05:17):
right? I mean, you've been in training for six years now and prior to that training,
you've been in school for, I guess, most of your life, right? Can you relay that journey
to us within medicine?
I feel like, yeah, time flies, but it also feels like forever ago that I've started.
So I went to, you know, you go to four years of college. I took a year off after college,
actually, to put together my med school application. Wasn't entirely ready at the time and didn't
(05:42):
have enough letters. And I also wanted to do some research. So I took a year off and
then I started medical school right after research year. And then for med school, I
also took another research year during med school just because for plastic surgery, I
heard that, you know, you kind of need a lot of research or you need a lot of commitment
to the specialty. And so I found a great mentor in med school and I spent a year with him
(06:03):
doing research. And so that was five years in med school. It also helped that. So our
class was a hundred people and I think like 80 some took that extra research year. So
it basically felt normal to take a research year and we were all around. It was very social.
So it was great. And then I started residency and yeah, so I've been in residency since
then.
I feel tired thinking of going through that journey. Like you said, you're a plastic
(06:27):
surgery resident, which we'll talk more about the field of plastic surgery. I think you
wanted to talk about medicine as a whole. You know, we've had over 50 guests now in
our podcast, counting this third season, there's almost a hundred, actually a hundred guests.
And one thing I like asking is the inspirations behind what someone does, right? And I want
to know what's your inspiration in pursuing medicine? Is it like family, friends or personal
(06:50):
experience?
Actually, I think I was thinking about this and I think my first inspiration was actually
middle school. We had to read gifted hands by Ben Carson. And obviously he went on to
do a lot of other things after writing his books. But so he was a neurosurgeon at Hopkins
and I just really loved the way he was describing surgeries. And I really liked what he was
doing. And so for the longest time, I thought I wanted to go into neurosurgery. And then
(07:13):
in college I was pre-med, but I wasn't really that set on medicine. I was kind of just checking
out engineering, checking out other fields. In college, I decided to start shadowing physicians
and I randomly decided to shadow a plastic surgeon. And actually I was also randomly
matched up with a pediatric plastic surgeon. So I really enjoyed seeing the types of procedures
that the surgeon was doing and also the types of conditions that you could help fix. And
(07:37):
so I really enjoyed that. And so going into med school, I knew I was interested in plastic
surgery and obviously I thought about other specialties, but I was pretty much set on
plastic surgery.
Yeah. I mean, like we said, we've been planning to do this live for I think over a year now,
right? But I think the push that really gave me to like, when I texted you the other day
(07:57):
and I said, I'm like, can we go on the live stream? You know, last week was Barbie weekend,
right? And if no one knew you're living under a rock because everyone in New York city was
wearing pink. I watched Joyride with my friends last weekend and someone in the S player was
wearing pink. It's like, is it breast cancer awareness month that's going on? No, it was
Barbie weekend. And thinking of Barbie, I haven't watched it yet, but I think growing
(08:21):
up thinking about the Barbie doll and the Ken doll, right? I think what's tied to that
is the word ideals, right? Like physical ideals. And I mean, even the song in itself, like
I grew up like Barbie girl, right? It says life in plastic. It's fantastic, right? We
all know the song and in healthcare plastic is a connotation of plastics, right? Which
(08:41):
is the field of plastic surgery. So that's why I was like, you know what? I think it's
just right that we talk about plastic surgery and commemoration of Barbie weekend. And outside
of that, it's such a very special and very insightful field, right? Well, I mean, you
were already saying how you kind of knew why you wanted to do plastic surgery as opposed
(09:02):
to why you wanted to go into it. I guess what makes you stay in plastic surgery? What was
the reason you think that this field is really what you want? Yeah, that's a great question.
I think the thing I like the most is that it's such a diverse field and literally every
day is a different procedure. I don't normally talk about the procedures we do on Instagram
just for like privacy reasons, but I feel like in med school, it's things that you literally
(09:25):
are not exposed to. And like, you don't realize that we're doing these different, you know,
crazy reconstructive procedures, but you're operating on, you know, different parts of
the body every day. You're operating on different age groups, different diseases. And so I think
it's just, everything feels, you know, fresh and new all the time. And so it's also a field
where you just feel like you're constantly learning and there's always things to improve
on. So I think it's that that really drives me.
(09:51):
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Talking about plastic surgery, again, it can become very cloudy, right? When it comes to
(13:00):
this field, I think there's a clash between inherently what the field is and what it stands
for and also the societal view that people have had for decades about the field. What
is the premise of plastic surgery for you? Great question. So plastic, what do you think
plastic means? I'm asking you. Oh my gosh. Am I the guest now? The guest now. Wow. The
(13:26):
tables have turned on me. Yeah. What does plastic mean? So I didn't actually realize
this, but I thought, you know, you think plastic means like synthetic, like polymers that you're
putting into people, right? But plastic, it comes from Greek, it means to mold or to reshape.
And so essentially the field deals with reshaping the body, doing different kinds of procedures
(13:48):
to reconstruct or recreate what was there or what should have developed. And so for
plastic surgery, I think the biggest thing for us is really understanding every part
of the body, understanding the blood supply, the innervation, the development of different
parts of the body and using what we have to reconstruct what's missing. And so when I
(14:11):
work with medical students, I tell them, the other thing we care about the most is blood
supply. Always. It's always blood supply. It's keeping tissue alive. You know, whether
you're just moving tissue around locally in the area where it's from, or literally lifting
up a giant piece of tissue, moving it somewhere else and reconnecting the blood vessels, it's
always about keeping it alive and figuring out what the anatomy is or something. So I
didn't realize that's what plastic meant until I was in med school or started plastic surgery.
(14:36):
So it is, I would say it is tissue handling. It's, you know, tissue reconstruction, tissue
handling, all tissue types. Yeah, I see it's very different when let's say, you know, those
tech talk videos where they go up to someone and ask them a question. I feel like what
you just asked me, definitely that would not be the answer. Like it's really not what people
(14:59):
know plastics or plastic surgery or reconstructive surgery to be about. Right. It's so beautiful.
And I guess I also want to ask when it comes to the surgeries itself, I know you said that
you don't really share online with surgeries you do, but can you take us, let's say on
a day to day basis, it's like the bread and butter of your work. Would you say that there
(15:20):
is a common, the most common surgeries that you would do? Yeah, for sure. So I think it's
also different whether you're in like a hospital based practice or whether you're in private
practice and doing like elective aesthetic surgery. Generally, you know, my exposure
is working in a hospital. And so we have a few different like hospital services and each
(15:40):
one kind of has a different focus based on the attendings that are on that service. Rather
than butter, I would say, you know, things like body surgery. So whether it's panicolectomies,
tummy tucks, breast surgery, breast reconstruction, after breast cancer, we work a lot with orthopedic
surgeons and vascular surgeons for limb salvage. And so after like trauma or a large sarcoma
(16:01):
resection or something, you know, instead of pursuing amputation, you know, giving patients
options for reconstructing soft tissue or providing bony coverage or hardware coverage,
we have transgender surgery as a part of what we do, whether that's top surgery, bottom
surgery or facial surgery. There's craniofacial surgery, which is both craniofacial trauma
and also congenital craniofacial conditions. So whether those are skull deformities or
(16:27):
soft tissue deformities in children. And hand surgery is shared by plastic surgery and orthopedic
surgery. So we have elective hand surgeries, whether that's like carpal tunnel releases
or taking out cysts, or also more complex hand reconstruction and upper extremity reconstruction
surgery. And I guess also, since we are like kind of like a big center, we do a lot of
(16:49):
peripheral nerve stuff. So for patients with spinal cord injury or different kinds of brachial
plexus injury or whatever, either doing nerve transfers or tendon transfers to help rehabilitate
movement and function in your legs and your arms.
Yeah, see, these are surgeries that probably people wouldn't think that plastic surgery
does, right? Again, I feel like we have a very, I guess in a society, it'll be a very
(17:09):
clouded image of what plastic surgery is. And I think it kind of gives me the feeling
of, I guess sometimes when patients come in and they're like, I have this problem, which
kind of doctor do I see? Right? What type of doctor do I see? And I guess some of the
surgeries that you listed, right? People would not think that it's a plastic surgeon who
would do those, right? Would you say that you have a favorite surgery to do?
(17:34):
That's a good question. I really enjoy local flaps, like whether that's Mohs reconstruction
or even like moving muscles around, because I think it's interesting because like if you
have a patient and you have a defect, like if they had either a skin defect or they had
some part of their body taken out, thinking about all your options for reconstruction,
I think it's a really cool exercise thinking about all the muscles that are nearby that
(17:57):
you could lift up and rotate to fill in that area. Or, you know, if those aren't options,
what tissues are on the body? Can you sacrifice and move to fill in that defect? So I think
those are really cool just like to think about because you have to think about, you know,
the patients, what they do for work, if they need like certain functions for work, or if
they're older and you can't sacrifice certain muscles because they need it for mobility,
(18:20):
or what kinds of surgeries they've had, you know, have they had surgeries that have gone
through the blood supplies of different muscles or different tissues that you need. And so
I think those are all, it just really is fun to think about. And so I do enjoy that the
most.
Yeah, I feel like with surgery, I think really was the crux of it all is very anatomical
knowledge, right? Like this expertise in anatomy and medicine, we have like time is the brain
(18:43):
and stuff like that, right? And really in that moment in your sacred space in the OR,
right? During that surgery in the procedure, it's like, yes, all hands on deck. And it's
like, your brain is just working like, second by second, right? What would be your advice
that say to somebody or a medical student or a resident training to right? Who wants
(19:04):
to be within the surgical sphere? What would be your biggest advice to them as a surgeon?
Yeah, I think depending on what level you are, it is a good idea to shadow and always
just get exposure to surgery. And first of all, like what they do and what their lifestyle
is like, and whether that's the kind of environment for you. Because unfortunately, you know,
most medical students don't actually rotate until their third year of med school right
(19:26):
before they have to apply for a specialty. And at that point, you know, you're making
these decisions about the rest of your life really late. And a lot of students, you know,
I'll meet them and then they'll say like, you know, they're worried about, first of
all, like, whether this is the right choice. And second of all, if they can get a position
applies like thinking about the so late in their career. And so I think it's always good
to just like shadow early, you know, whether you're in college and you can shadow at your
(19:48):
local hospital or a hospital near your house, or if you're a medical student, you can always
shadow you know, early on also, you might not get the scrub in and might be kind of
boring standing there. But at least you can just get a feel for what being an OR is like.
And the more as you progress, the more role that you can have during those surgeries.
Any suturing tips? The last time I tried to see, I thought I was gonna get a carpal tunnel.
(20:11):
Oh, really? Suturing tips. I don't have anything with me. But um, I guess you want to hold
the pickups like a, like a pencil, you know, you don't hold them above and below. We generally
are very careful with skin. So you don't want to crush skin you want to, because again,
we care about blood supply, you don't want to crush the blood supply, you want to be
(20:32):
careful what part of the skin you're holding on to, how much tension you're applying to
it, or even if you're suturing anything, you know, careful about how you're holding it.
And then for the needle drivers, I actually like to, I think I like to keep my thumb in
it and use the rest of my hand to palm it. I don't palm the entire needle driver, I think.
You'll figure it out. Our next episode will be a master class with Alex. You know, you
(20:57):
mentioned about lifestyle, right? When it comes to surgery, and I think this is, uh,
what that many memes and jokes online, right? When it comes to lifestyle, when it comes
to surgeons, right? How would you say your life or your lifestyle, your social life is
affected by being in the field of surgery? I mean, we, I think a few weeks ago, I saw
(21:20):
this TikTok where a neurosurgeon dad left their kid, oh, I'm going to go to work. And
then when he comes back home, the kid is already like 12 years old. So we hear these things
of, oh, you know, if you're a surgeon, you won't have any life, you're having a social
life. How true is that for you?
I think residency is its own special place. And so I can't really speak to what the lifestyle
(21:45):
is like once you're out of residency. I'm sure it is much better and much more normal.
Also depending on, you know, what you want your own career to look like, because some
people, you know, don't take any call and some people still continue call. So I don't
actually know what that lifestyle will be like. But in residency, I would say our first
three years are extremely busy. It's very high stress because you're just held to expectations
(22:08):
by every single person in the hospital. And, you know, you're doing like three people's
jobs and you can't fail anyone. And then as you get on, you do get more and more time,
I think as a senior, you know, because at this point, you know, we're doing more elective
time, more time to see different kinds of specialties that we're interested in. And
you have less in-house call responsibilities, you still take a lot of home call. So it changes
throughout residency. But I think, you know, it is easy to still do the things you like
(22:33):
because you technically have like this 80 hour work week. And so you do have time after
work. You're not always working 80 hours. And so I felt like even as an intern, I, you
know, still had time for myself after work every day. And so it depends on how much sleep
you want. But, you know, I felt like I saw the few hours every night.
Yeah. And outside of lifestyle, I think there's a running idea in the forums and online that
(22:54):
the OR sphere can be quite toxic, they say, with different types of personalities. I mean,
if you think about it, it's a very crucial moments, right? It's a very pressurized moments.
How do you think you manage those pressures? I mean, do you believe in the idea that there
is toxicity in the OR or how do you manage it?
Yeah, that's a good question. I think definitely there's that stigma, especially as a med student,
(23:19):
you're thinking about, you know, oh, you're going to OR, it's going to be toxic and you're
just going to be like yelled at by everyone. I think the OR actually can be really great,
especially if you're working with the same team every day and you're seeing all the same
faces, it could be a really fun place to be. I wouldn't say that it's toxic. Generally,
everything's very pleasant. You know, there's music playing, people are, you know, there's
teaching going on, there's, you know, it's great. But I do think that in the middle of
(23:40):
a surgery, you know, there are crucial moments where things have to be precise. And if something
happens, you know, you want to like be focused. And so there are moments when things are tense,
I wouldn't call it toxic. It obviously depends on who the surgeon is and who everyone else
is like, who the nurses, the anesthesia team is as well.
Got it. And a surprise question for you, what song do you like playing in the OR?
(24:03):
I play a pop playlist and I always do the same one because it's like seven hours long.
Can you think of one song that's inside that playlist?
Okay, it starts with Ed Sheeran. I honestly can't think of which song it was. There's
Ed Sheeran on there. There's some 80s on there also. But yeah, it's, yeah, that's always
the same playlist for me.
Exciting. I mean, I think the other day I walked into our surgeon playing K-pop and
(24:28):
I was like,
Oh yeah, there is, I think there's like two BTS songs on my playlist.
Yeah. You know, we've been talking a lot about plastic surgery in general, right? And also
surgery as a whole and life as a surgical resident. I wanted to veer deeper and deeper
into someone said black pink. Deeper, deeper, new jeans and
(24:48):
Oh yeah, ditto's on there too.
Ditto, ditto.
Yeah.
Deeper into plastic surgery, right? The American Society of Plastic Surgeons and their website
divides most of their surgeries into cosmetic and reconstructive. What do you think of that
division? Are there really like surgeries that you would place under the cosmetic label
and then under reconstructive labels and maybe examples of both? I know you've given examples.
(25:12):
Yeah, I think there is a distinction because of insurance. And so, so any case could be,
there's elements of both. I feel like the distinction isn't that set because obviously
everything we do, we have some kind of aesthetic sense into what we're doing. You want things
to look good in the end. And aesthetic surgery itself is reconstruction in a way because
you're trying to reproduce how things, you know, may have looked before or should look.
(25:34):
And so for the distinction, it really is based on insurance and it also depends on what kind
of setting you're operating in. But if it is a place that charges based on time, there's
literally a point where the surgeon will say, okay, you know, cosmetic time starts now and
then the timer will start. And then that way you can charge only the cosmetic portion to
the patient. And you know, then insurance will pay for reconstructive portion. So for
(25:56):
example, for Bluffer Plastic or eyelid surgery, the upper eyelids can be covered by insurance,
you know, depending if they're affecting your vision and covering your, if you're getting
visual field tests and it's demonstrating some kind of impact on your vision. But then
the lower eyelids are not covered by insurance just because it really isn't a functional
impact. And so if someone is getting both, then you would want to distinguish, you know,
(26:17):
when one starts and when one ends.
Got it. So interesting. It's interesting how the upper eyelid versus the lower eyelid
would be covered or not by insurance, right?
It's also like kind of silly sometimes like for breast reductions, for example, you know,
there's some insurance companies will have kind of like a arbitrary weight that they
say like this many grams of tissue need to be removed for it to be considered like unnecessary
(26:38):
insured procedure. And then if it's less than that, then you know, they may need to get
paid for it themselves or go through a private practice or something.
Wow. That's so exact. So, and so interesting, right? As a surgeon, I want to get your insights
on do you tackle or do you enter those rooms differently? I guess inherently wise, whether
(27:00):
it's cosmetic or reconstructive. I know that mostly it's based on insurance, but I guess
there's really no within like the essence of the surgeries itself, right? Like there's
really no subdivision line, right? Like you said, it's not, it can become reconstructed,
right? They are in nature. Is there a difference in how you approach these two?
(27:24):
I wouldn't say that there is, you mean, in terms of like planning or in the procedure
itself, I don't think that there really is. It's just that sometimes if it is a, you know,
very complex reconstructive case, like for trauma or for cancer, then you have different
priorities going on. And so then you kind of have to weigh like what's important and
what's not important. And sometimes, you know, having the best closure isn't important because
(27:48):
you don't have enough tissue or you can't bring enough skin or enough whatever to fill
in the defect, or you might have to sacrifice some kind of function to give them a reconstruction.
So the priorities are different, but that's about it. It really depends on, you know,
what the specific case is and what's going on with the patient.
Got it. Viewing even deeper, I wanted to really tackle cosmetic surgeries, right? You kind
(28:10):
of mentioned something earlier before how, well, the insurance companies would be the
qualifier of what is deemed as probably a surgery that's health benefit versus one
that is not, right? Or one that is more life saving or whatnot versus one that is more
of the patient's like, I want to do this more for like very cosmetic reasons, right? When
(28:30):
it comes to how something physically looks. And I guess this is where it roots from where
society has placed a lot of stigma and taboo when it comes to plastic surgery, right? And
I guess even a distant cousin of plastic surgery, which is cosmetics and aesthetics, right?
Do you think there's a demarcation line between plastic surgery versus someone who wants to
(28:57):
get a surgery more for attaining a certain physical ABO?
You mean from like the surgery perspective or the surgery perspective? So I guess the
only demarcation I can think of is that, you know, there are cosmetic surgeons who aren't
plastic surgeons. So there's the American Board of Plastic Surgery, which is the board
for plastic and reconstructive surgeons. And so that's part of the American Board of Medical
(29:21):
Specialties. So it's recognized by the ABMS. But then there's also another board of cosmetic
surgery that's actually not recognized by the American Board of Medical Specialties. And
so I don't know what the requirements are to be a cosmetic surgeon. But I think, I don't
know, I think it might be even like a one year fellowship. And I don't know if you need
to be a surgeon to take that fellowship. And so obviously, many are surgeons already. And
(29:42):
so they can still operate safely. But I think there is just a little bit less maybe, I honestly
don't know what the requirements are. So I can't speak to that. But there is a distinction
between you know, a cosmetic surgeon versus a plastic surgeon. And so I only know about
the plastic surgery side.
Yeah, and I guess when talking about the essence of the surgery itself, right outside of the
surgeon who's doing it, you use the word stigma before, right? I think it's true, right? There's
(30:07):
a lot of stigma when it comes to the field, which is why I guess I am the main reason
why I wanted to do this live because again, it's Barbie weekend. And I guess if you scroll
through the forums online, sometimes the word Barbie is it's happened that right? Sometimes
it's a compliment, sometimes it's not a compliment, right? So I feel like it's a very divided world.
(30:34):
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I guess when it comes to plastic surgery and cosmetic surgery, I was talking to a facial
plastic surgeon before too and she was saying how sometimes, I guess, which is what you
(33:41):
mentioned as well, sometimes you don't see how the cosmesis side of it is actually very
reconstructive, not just physically, but a very psychosocial effect on the patient, right?
So it's like you don't know if the scar revision surgery was something, she said that she had
a patient before who was going through physical abuse, right, from their partner. And that
(34:03):
scar reminds them every day of those traumatic times. And in that sense, plastic surgery
was her way out to peace, right, from trying to tackle all of that. And also she said,
you don't know if someone's decision to have breast augmentation or breast reduction is
rooting from bullying that they've gone through back in their life, right? What would you
(34:26):
say about those moments where, I guess, as a plastic surgeon, right, I mean, you're not
just dealing with the body and the physical, but I guess you really have a very big role
and also in someone's mental health and psychosocial being, right?
Yeah, I totally agree. I think that's something I saw during medical school because my mentor
(34:47):
was training in craniofacial surgery, you know, was operating mostly on children, you
know, doing these crazy skull reshaping surgeries, but then he also did cosmetic surgery also,
like aesthetic surgery. And a lot of people do that. And the line between what is reconstructive
versus what is aesthetic is not necessarily that distinct. And, you know, doing something
elective and aesthetic for a patient really can change the way they see themselves and
(35:09):
really affect their lives. Yeah, I think that's, no, that's exactly right. I think even things
that everyone has their own goals for themselves and their own ideals of, you know, what they
value as important. And we can't necessarily speak to what someone else should look like
or what they should feel about themselves. So I totally agree with that. I think, you
know, for things like transgender surgery also, you know, it's at least in Maryland,
(35:32):
I believe, I don't know which parts, but most parts are covered by insurance. And so it's,
you know, the same idea. It's if you feel a certain way about how you should look or,
you know, whatever, then you're still doing that as a service for the patient. Yeah. And
I think sometimes it really boils down to quality of life, right? I mean, you were talking
about hand surgeries and I guess there's some classic surgeries, so also do like orthodontic
(35:55):
surgeries, right? And I guess you're also like skin cancer, right? Like remote surgery.
I think also like really targeting the quality of life is such an important thing, right?
I mean, some things that we take for granted, like the ability to move our hands, right?
To, I guess, turn the doorknob. Some people can't do that, right? And so this plastic
surgery is the way that they can really achieve the restoration of those, I guess, basic abilities
(36:21):
for the general population we take for granted, right? Well, I guess I want to ask, what do
you think is your most favorite part about being a surgeon? And I guess a plastic surgeon.
It's a great question. I think my favorite part is, so we like cooperate a lot with different
surgical specialties. We actually, I feel like we work with medicine, internal medicine,
(36:45):
like the least. I think we work with every other surgical specialty the most. And so
my favorite part is really working with other specialties, cooperating a lot, being able
to tackle something together with another surgical service. I think that's really enjoyable
in coordinating your procedures. I think it's that collaboration I really enjoy. And also,
you are able to be a part of someone's bigger picture procedure. So I really enjoy that.
(37:06):
That's beautiful. And as a physician, as a surgeon, definitely people's lives and not
just lives, but there's trust in your hands, right? Whether it's cosmetic or for reconstructive,
whether it's the ability to maybe fulfill the physical idea that someone wants. There's
also, also reconstruction, which are very life saving, right? Or really wants that,
(37:30):
I guess, restore someone's quality of life. I guess it's so much responsibility, right?
And I can't imagine the amount of not just physical, but I guess also emotional toll
that it can take on a surgeon. How do you decompress from work, from all of this?
I was thinking of that responsibility thing just to back up. I was thinking about that
recently where as a resident, you feel like you have so much responsibility and you're
(37:55):
being harassed in all directions by everyone. But then I feel like in recent years, I've
come to realize it's actually going to be completely different when you're the attending,
you're actually responsible for literally everything. And so I'm curious what that's
going to feel like in a few years. But yeah, how I decompress, I really enjoy spending
time with people. I feel like I have, again, I'm able to do stuff outside of work. I think
(38:17):
I still have hobbies. I feel like most people lose hobbies when they start residency. Maybe
I did when I started residency, but I think I still am able to set aside time for other
things.
Yeah. Well, I remember you told me he's a plant zaddy. He's a plant zaddy with his
plants that I remember you told me you killed during medical school. But I have more time
in residency. And guess what I also see is like food, right? We're having food, which
(38:43):
we will have soon here in New York City. This was a talk that I've always wanted to have
because I think it's important to, I think, break down the walls when it comes to taboo
and I guess stigmatize topics, because there's people who may want to go through it, but
are afraid of, I guess, the reception of the people in the world around them, right? I
(39:06):
guess I'll ask you questions. What would be your message as a plastic surgeon to someone
out there who may want to need the help of a plastic surgeon, but are afraid of, I guess,
the societal view about the field?
I think, you know, ultimately it's your life. You know, if this is something that you feel
like would, it's something that you have thought about and it's something you've, I don't know
(39:30):
what the reason is that other people are telling you not to. You know, you want to find a surgeon
who kind of identifies with your same goals. You want someone who understands what you're
talking about and also agrees and is able to do the same thing. Because one thing is
like a surgeon might have different ideals for, you know, if this is like a cosmetic
surgery, a surgeon might have different ideals of what something should look like than what
(39:50):
you want. And so you also want someone to be on the same page as you. And so eventually,
you know, finding the right surgeon is important, but I think, you know, finding maybe your
family or friends are actually doing a good job warning you, but, you know, making sure
that this is the right decision for you. And ultimately it is your own decision.
I love that. Alex, I love this conversation so much. I can't believe it took us a year,
(40:11):
but thank you to Barbie. Yeah, exactly. Thank you to Barbie for making this happen. Well,
Alex, thank you again so much. I learned so much and I don't think I'll ever forget that
plastics, you know, what you're saying about to mold, right? I mean, not just molding someone
like physically and I guess they are ideals for themselves, but really plastic surgery
is molding the life that someone deserves and wants and deserves for themselves, right?
(40:38):
I guess even deeper than skin level, right? Being able to change someone's confidence
and someone's perceptions of themselves and I guess their whole quality of life. So it's
such an honor having this conversation. Yeah, that was very eloquent. Thank you so much
for having me. Thank you. Thank you everyone for joining and thank you, Alex. I'll see
(40:58):
you next week.
Hi friends, how are you all doing? I'm in LA this week for my cousin Kyle's, our cousin
(00:10):
Kyle at this point, graduation from his Masters in OT program. Yay! Can you believe it? Two
years flew by. I'm enjoying not only the sun here in California, but the time I have
been spending here with family and friends. Anyways, wow, this season flew by, didn't
it? Such a bittersweet thing to think about. But I am beyond excited for all of you to
(00:32):
listen to today's episode. What year were you guys born? I'm so curious. Well, if you're
curious about mine, I was born in 1997. Just the best year, humbly. The world got its earliest
camera phone and function in Wi-Fi. Ellen DeGeneres came out on TV. The first book of
the Harry Potter series was published. And for K-pop stans, it was also the year that
(00:55):
the supreme 97 line of Jungkook, Mingyu, and Cha Eun Woo were born. And it was the year this
song with this line was released. Dive in plastic, it's fantastic. Well, he knows it.
Yes, this iconic line is from the 1997 released hit song, Barbie Girl by Europop band Aqua.
(01:17):
This song overtly alluded to the also iconic Barbie doll that debuted in 1959. The same
year the song 1997, a paper by Fairmont State College Professor Albert M. Magro was also
released and titled Why Barbie is perceived as beautiful. The Barbie doll has long been
the paradigm of societal attractiveness through her physical features. The paper was formed
(01:38):
through a survey report. And we were given the reasons why quote unquote, Barbie is beautiful,
a thinner body frame, longer limbs, elongated neck, square shoulders, and larger eyes. Research
studies throughout the decades have shown Barbie's mixed influences and body image
and the rise of cosmetic altering procedures to achieve these physical ideals that have
been pushed to societal norms, such as liposuction, breast augmentation, injectables, and erudite
(02:04):
me or a facelift. This has placed the medical domains of plastic and cosmetic surgery in
a narrowed and misconstrued light of mere vanity in the pursuit of physical perfection.
However, there is more to the field of plastic surgery than cosmesis, with power and necessity
in its own right by bestowing self-confidence and the resulting quality of life. We have
(02:26):
had previous episodes on the podcast with facial plastic and cosmetic surgeons who have
opened their eyes to the power of the cosmetic aspect of the field of plastics. I will never
forget the story of the patient who was previously in an abusive relationship and was left with
a disfigured nose. Daly reminded of the horrors in the mirror. A cosmetic procedure was her
only way out of this trauma. But beyond this, the field of plastic and reconstructive surgery
(02:50):
truly daily changes, improves, and saves lives through surgeries such as clove lift and palate
repair, breast reconstruction secondary to breast cancer mastectomy, reduction mammoplasty
to relieve intertrigo, facial reconstruction after physical trauma, skin grafting to treat
burn wounds, and so much more. Today, we are joined by sixth-year plastic surgery resident
(03:12):
physician and my dear friend and co-food adventurer, Dr. Alex Sun to speak about the often misunderstood
beauty of the field. He received his bachelor in biomedical engineering degree from Duke
University and MD from Yale University School of Medicine, where he was an NIH-funded plastic
surgery research fellow. Dr. Sun is currently completing his plastic surgery residency at
(03:34):
the Johns Hopkins Hospital Department of Plastic and Reconstructive Surgery. There is so much
to learn and so much to find out in today's episode. I hope you enjoy it.
(04:09):
Thank you so much for being here with me as I soon close the season of the third season
of my podcast. It's such an honor to have you. If you could just first introduce yourself
to everybody. Thank you so much.
(04:30):
My name is Alex. I am currently a resident at Johns Hopkins in Baltimore in plastic and
reconstructive surgery. I'm currently in my sixth year. So normally plastic surgery is
six years, but we have a research year. So I still have one year after this year.
Wow. It's such a short program. Anywho, I started this edgy live stream series, turn
podcast series several years ago just to really just dissect the lives of healthcare workers,
(04:55):
right? Just to see their daily lives and also to their ventures within and also outside
of medicine. And Alex and I met for the very first time, time flight, I think a year ago
during our photo shoot with the club, right? Yeah.
Literally. And it's just crazy how time flies. And I guess that's true for your life in general,
(05:17):
right? I mean, you've been in training for six years now and prior to that training,
you've been in school for, I guess, most of your life, right? Can you relay that journey
to us within medicine?
I feel like, yeah, time flies, but it also feels like forever ago that I've started.
So I went to, you know, you go to four years of college. I took a year off after college,
actually, to put together my med school application. Wasn't entirely ready at the time and didn't
(05:42):
have enough letters. And I also wanted to do some research. So I took a year off and
then I started medical school right after research year. And then for med school, I
also took another research year during med school just because for plastic surgery, I
heard that, you know, you kind of need a lot of research or you need a lot of commitment
to the specialty. And so I found a great mentor in med school and I spent a year with him
(06:03):
doing research. And so that was five years in med school. It also helped that. So our
class was a hundred people and I think like 80 some took that extra research year. So
it basically felt normal to take a research year and we were all around. It was very social.
So it was great. And then I started residency and yeah, so I've been in residency since
then.
I feel tired thinking of going through that journey. Like you said, you're a plastic
(06:27):
surgery resident, which we'll talk more about the field of plastic surgery. I think you
wanted to talk about medicine as a whole. You know, we've had over 50 guests now in
our podcast, counting this third season, there's almost a hundred, actually a hundred guests.
And one thing I like asking is the inspirations behind what someone does, right? And I want
to know what's your inspiration in pursuing medicine? Is it like family, friends or personal
(06:50):
experience?
Actually, I think I was thinking about this and I think my first inspiration was actually
middle school. We had to read gifted hands by Ben Carson. And obviously he went on to
do a lot of other things after writing his books. But so he was a neurosurgeon at Hopkins
and I just really loved the way he was describing surgeries. And I really liked what he was
doing. And so for the longest time, I thought I wanted to go into neurosurgery. And then
(07:13):
in college I was pre-med, but I wasn't really that set on medicine. I was kind of just checking
out engineering, checking out other fields. In college, I decided to start shadowing physicians
and I randomly decided to shadow a plastic surgeon. And actually I was also randomly
matched up with a pediatric plastic surgeon. So I really enjoyed seeing the types of procedures
that the surgeon was doing and also the types of conditions that you could help fix. And
(07:37):
so I really enjoyed that. And so going into med school, I knew I was interested in plastic
surgery and obviously I thought about other specialties, but I was pretty much set on
plastic surgery.
Yeah. I mean, like we said, we've been planning to do this live for I think over a year now,
right? But I think the push that really gave me to like, when I texted you the other day
(07:57):
and I said, I'm like, can we go on the live stream? You know, last week was Barbie weekend,
right? And if no one knew you're living under a rock because everyone in New York city was
wearing pink. I watched Joyride with my friends last weekend and someone in the S player was
wearing pink. It's like, is it breast cancer awareness month that's going on? No, it was
Barbie weekend. And thinking of Barbie, I haven't watched it yet, but I think growing
(08:21):
up thinking about the Barbie doll and the Ken doll, right? I think what's tied to that
is the word ideals, right? Like physical ideals. And I mean, even the song in itself, like
I grew up like Barbie girl, right? It says life in plastic. It's fantastic, right? We
all know the song and in healthcare plastic is a connotation of plastics, right? Which
(08:41):
is the field of plastic surgery. So that's why I was like, you know what? I think it's
just right that we talk about plastic surgery and commemoration of Barbie weekend. And outside
of that, it's such a very special and very insightful field, right? Well, I mean, you
were already saying how you kind of knew why you wanted to do plastic surgery as opposed
(09:02):
to why you wanted to go into it. I guess what makes you stay in plastic surgery? What was
the reason you think that this field is really what you want? Yeah, that's a great question.
I think the thing I like the most is that it's such a diverse field and literally every
day is a different procedure. I don't normally talk about the procedures we do on Instagram
just for like privacy reasons, but I feel like in med school, it's things that you literally
(09:25):
are not exposed to. And like, you don't realize that we're doing these different, you know,
crazy reconstructive procedures, but you're operating on, you know, different parts of
the body every day. You're operating on different age groups, different diseases. And so I think
it's just, everything feels, you know, fresh and new all the time. And so it's also a field
where you just feel like you're constantly learning and there's always things to improve
on. So I think it's that that really drives me.
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Talking about plastic surgery, again, it can become very cloudy, right? When it comes to
(13:00):
this field, I think there's a clash between inherently what the field is and what it stands
for and also the societal view that people have had for decades about the field. What
is the premise of plastic surgery for you? Great question. So plastic, what do you think
plastic means? I'm asking you. Oh my gosh. Am I the guest now? The guest now. Wow. The
(13:26):
tables have turned on me. Yeah. What does plastic mean? So I didn't actually realize
this, but I thought, you know, you think plastic means like synthetic, like polymers that you're
putting into people, right? But plastic, it comes from Greek, it means to mold or to reshape.
And so essentially the field deals with reshaping the body, doing different kinds of procedures
(13:48):
to reconstruct or recreate what was there or what should have developed. And so for
plastic surgery, I think the biggest thing for us is really understanding every part
of the body, understanding the blood supply, the innervation, the development of different
parts of the body and using what we have to reconstruct what's missing. And so when I
(14:11):
work with medical students, I tell them, the other thing we care about the most is blood
supply. Always. It's always blood supply. It's keeping tissue alive. You know, whether
you're just moving tissue around locally in the area where it's from, or literally lifting
up a giant piece of tissue, moving it somewhere else and reconnecting the blood vessels, it's
always about keeping it alive and figuring out what the anatomy is or something. So I
didn't realize that's what plastic meant until I was in med school or started plastic surgery.
(14:36):
So it is, I would say it is tissue handling. It's, you know, tissue reconstruction, tissue
handling, all tissue types. Yeah, I see it's very different when let's say, you know, those
tech talk videos where they go up to someone and ask them a question. I feel like what
you just asked me, definitely that would not be the answer. Like it's really not what people
(14:59):
know plastics or plastic surgery or reconstructive surgery to be about. Right. It's so beautiful.
And I guess I also want to ask when it comes to the surgeries itself, I know you said that
you don't really share online with surgeries you do, but can you take us, let's say on
a day to day basis, it's like the bread and butter of your work. Would you say that there
(15:20):
is a common, the most common surgeries that you would do? Yeah, for sure. So I think it's
also different whether you're in like a hospital based practice or whether you're in private
practice and doing like elective aesthetic surgery. Generally, you know, my exposure
is working in a hospital. And so we have a few different like hospital services and each
(15:40):
one kind of has a different focus based on the attendings that are on that service. Rather
than butter, I would say, you know, things like body surgery. So whether it's panicolectomies,
tummy tucks, breast surgery, breast reconstruction, after breast cancer, we work a lot with orthopedic
surgeons and vascular surgeons for limb salvage. And so after like trauma or a large sarcoma
(16:01):
resection or something, you know, instead of pursuing amputation, you know, giving patients
options for reconstructing soft tissue or providing bony coverage or hardware coverage,
we have transgender surgery as a part of what we do, whether that's top surgery, bottom
surgery or facial surgery. There's craniofacial surgery, which is both craniofacial trauma
and also congenital craniofacial conditions. So whether those are skull deformities or
(16:27):
soft tissue deformities in children. And hand surgery is shared by plastic surgery and orthopedic
surgery. So we have elective hand surgeries, whether that's like carpal tunnel releases
or taking out cysts, or also more complex hand reconstruction and upper extremity reconstruction
surgery. And I guess also, since we are like kind of like a big center, we do a lot of
(16:49):
peripheral nerve stuff. So for patients with spinal cord injury or different kinds of brachial
plexus injury or whatever, either doing nerve transfers or tendon transfers to help rehabilitate
movement and function in your legs and your arms.
Yeah, see, these are surgeries that probably people wouldn't think that plastic surgery
does, right? Again, I feel like we have a very, I guess in a society, it'll be a very
(17:09):
clouded image of what plastic surgery is. And I think it kind of gives me the feeling
of, I guess sometimes when patients come in and they're like, I have this problem, which
kind of doctor do I see? Right? What type of doctor do I see? And I guess some of the
surgeries that you listed, right? People would not think that it's a plastic surgeon who
would do those, right? Would you say that you have a favorite surgery to do?
(17:34):
That's a good question. I really enjoy local flaps, like whether that's Mohs reconstruction
or even like moving muscles around, because I think it's interesting because like if you
have a patient and you have a defect, like if they had either a skin defect or they had
some part of their body taken out, thinking about all your options for reconstruction,
I think it's a really cool exercise thinking about all the muscles that are nearby that
(17:57):
you could lift up and rotate to fill in that area. Or, you know, if those aren't options,
what tissues are on the body? Can you sacrifice and move to fill in that defect? So I think
those are really cool just like to think about because you have to think about, you know,
the patients, what they do for work, if they need like certain functions for work, or if
they're older and you can't sacrifice certain muscles because they need it for mobility,
(18:20):
or what kinds of surgeries they've had, you know, have they had surgeries that have gone
through the blood supplies of different muscles or different tissues that you need. And so
I think those are all, it just really is fun to think about. And so I do enjoy that the
most.
Yeah, I feel like with surgery, I think really was the crux of it all is very anatomical
knowledge, right? Like this expertise in anatomy and medicine, we have like time is the brain
(18:43):
and stuff like that, right? And really in that moment in your sacred space in the OR,
right? During that surgery in the procedure, it's like, yes, all hands on deck. And it's
like, your brain is just working like, second by second, right? What would be your advice
that say to somebody or a medical student or a resident training to right? Who wants
(19:04):
to be within the surgical sphere? What would be your biggest advice to them as a surgeon?
Yeah, I think depending on what level you are, it is a good idea to shadow and always
just get exposure to surgery. And first of all, like what they do and what their lifestyle
is like, and whether that's the kind of environment for you. Because unfortunately, you know,
most medical students don't actually rotate until their third year of med school right
(19:26):
before they have to apply for a specialty. And at that point, you know, you're making
these decisions about the rest of your life really late. And a lot of students, you know,
I'll meet them and then they'll say like, you know, they're worried about, first of
all, like, whether this is the right choice. And second of all, if they can get a position
applies like thinking about the so late in their career. And so I think it's always good
to just like shadow early, you know, whether you're in college and you can shadow at your
(19:48):
local hospital or a hospital near your house, or if you're a medical student, you can always
shadow you know, early on also, you might not get the scrub in and might be kind of
boring standing there. But at least you can just get a feel for what being an OR is like.
And the more as you progress, the more role that you can have during those surgeries.
Any suturing tips? The last time I tried to see, I thought I was gonna get a carpal tunnel.
(20:11):
Oh, really? Suturing tips. I don't have anything with me. But um, I guess you want to hold
the pickups like a, like a pencil, you know, you don't hold them above and below. We generally
are very careful with skin. So you don't want to crush skin you want to, because again,
we care about blood supply, you don't want to crush the blood supply, you want to be
(20:32):
careful what part of the skin you're holding on to, how much tension you're applying to
it, or even if you're suturing anything, you know, careful about how you're holding it.
And then for the needle drivers, I actually like to, I think I like to keep my thumb in
it and use the rest of my hand to palm it. I don't palm the entire needle driver, I think.
You'll figure it out. Our next episode will be a master class with Alex. You know, you
(20:57):
mentioned about lifestyle, right? When it comes to surgery, and I think this is, uh,
what that many memes and jokes online, right? When it comes to lifestyle, when it comes
to surgeons, right? How would you say your life or your lifestyle, your social life is
affected by being in the field of surgery? I mean, we, I think a few weeks ago, I saw
(21:20):
this TikTok where a neurosurgeon dad left their kid, oh, I'm going to go to work. And
then when he comes back home, the kid is already like 12 years old. So we hear these things
of, oh, you know, if you're a surgeon, you won't have any life, you're having a social
life. How true is that for you?
I think residency is its own special place. And so I can't really speak to what the lifestyle
(21:45):
is like once you're out of residency. I'm sure it is much better and much more normal.
Also depending on, you know, what you want your own career to look like, because some
people, you know, don't take any call and some people still continue call. So I don't
actually know what that lifestyle will be like. But in residency, I would say our first
three years are extremely busy. It's very high stress because you're just held to expectations
(22:08):
by every single person in the hospital. And, you know, you're doing like three people's
jobs and you can't fail anyone. And then as you get on, you do get more and more time,
I think as a senior, you know, because at this point, you know, we're doing more elective
time, more time to see different kinds of specialties that we're interested in. And
you have less in-house call responsibilities, you still take a lot of home call. So it changes
throughout residency. But I think, you know, it is easy to still do the things you like
(22:33):
because you technically have like this 80 hour work week. And so you do have time after
work. You're not always working 80 hours. And so I felt like even as an intern, I, you
know, still had time for myself after work every day. And so it depends on how much sleep
you want. But, you know, I felt like I saw the few hours every night.
Yeah. And outside of lifestyle, I think there's a running idea in the forums and online that
(22:54):
the OR sphere can be quite toxic, they say, with different types of personalities. I mean,
if you think about it, it's a very crucial moments, right? It's a very pressurized moments.
How do you think you manage those pressures? I mean, do you believe in the idea that there
is toxicity in the OR or how do you manage it?
Yeah, that's a good question. I think definitely there's that stigma, especially as a med student,
(23:19):
you're thinking about, you know, oh, you're going to OR, it's going to be toxic and you're
just going to be like yelled at by everyone. I think the OR actually can be really great,
especially if you're working with the same team every day and you're seeing all the same
faces, it could be a really fun place to be. I wouldn't say that it's toxic. Generally,
everything's very pleasant. You know, there's music playing, people are, you know, there's
teaching going on, there's, you know, it's great. But I do think that in the middle of
(23:40):
a surgery, you know, there are crucial moments where things have to be precise. And if something
happens, you know, you want to like be focused. And so there are moments when things are tense,
I wouldn't call it toxic. It obviously depends on who the surgeon is and who everyone else
is like, who the nurses, the anesthesia team is as well.
Got it. And a surprise question for you, what song do you like playing in the OR?
(24:03):
I play a pop playlist and I always do the same one because it's like seven hours long.
Can you think of one song that's inside that playlist?
Okay, it starts with Ed Sheeran. I honestly can't think of which song it was. There's
Ed Sheeran on there. There's some 80s on there also. But yeah, it's, yeah, that's always
the same playlist for me.
Exciting. I mean, I think the other day I walked into our surgeon playing K-pop and
(24:28):
I was like,
Oh yeah, there is, I think there's like two BTS songs on my playlist.
Yeah. You know, we've been talking a lot about plastic surgery in general, right? And also
surgery as a whole and life as a surgical resident. I wanted to veer deeper and deeper
into someone said black pink. Deeper, deeper, new jeans and
(24:48):
Oh yeah, ditto's on there too.
Ditto, ditto.
Yeah.
Deeper into plastic surgery, right? The American Society of Plastic Surgeons and their website
divides most of their surgeries into cosmetic and reconstructive. What do you think of that
division? Are there really like surgeries that you would place under the cosmetic label
and then under reconstructive labels and maybe examples of both? I know you've given examples.
(25:12):
Yeah, I think there is a distinction because of insurance. And so, so any case could be,
there's elements of both. I feel like the distinction isn't that set because obviously
everything we do, we have some kind of aesthetic sense into what we're doing. You want things
to look good in the end. And aesthetic surgery itself is reconstruction in a way because
you're trying to reproduce how things, you know, may have looked before or should look.
(25:34):
And so for the distinction, it really is based on insurance and it also depends on what kind
of setting you're operating in. But if it is a place that charges based on time, there's
literally a point where the surgeon will say, okay, you know, cosmetic time starts now and
then the timer will start. And then that way you can charge only the cosmetic portion to
the patient. And you know, then insurance will pay for reconstructive portion. So for
(25:56):
example, for Bluffer Plastic or eyelid surgery, the upper eyelids can be covered by insurance,
you know, depending if they're affecting your vision and covering your, if you're getting
visual field tests and it's demonstrating some kind of impact on your vision. But then
the lower eyelids are not covered by insurance just because it really isn't a functional
impact. And so if someone is getting both, then you would want to distinguish, you know,
(26:17):
when one starts and when one ends.
Got it. So interesting. It's interesting how the upper eyelid versus the lower eyelid
would be covered or not by insurance, right?
It's also like kind of silly sometimes like for breast reductions, for example, you know,
there's some insurance companies will have kind of like a arbitrary weight that they
say like this many grams of tissue need to be removed for it to be considered like unnecessary
(26:38):
insured procedure. And then if it's less than that, then you know, they may need to get
paid for it themselves or go through a private practice or something.
Wow. That's so exact. So, and so interesting, right? As a surgeon, I want to get your insights
on do you tackle or do you enter those rooms differently? I guess inherently wise, whether
(27:00):
it's cosmetic or reconstructive. I know that mostly it's based on insurance, but I guess
there's really no within like the essence of the surgeries itself, right? Like there's
really no subdivision line, right? Like you said, it's not, it can become reconstructed,
right? They are in nature. Is there a difference in how you approach these two?
(27:24):
I wouldn't say that there is, you mean, in terms of like planning or in the procedure
itself, I don't think that there really is. It's just that sometimes if it is a, you know,
very complex reconstructive case, like for trauma or for cancer, then you have different
priorities going on. And so then you kind of have to weigh like what's important and
what's not important. And sometimes, you know, having the best closure isn't important because
(27:48):
you don't have enough tissue or you can't bring enough skin or enough whatever to fill
in the defect, or you might have to sacrifice some kind of function to give them a reconstruction.
So the priorities are different, but that's about it. It really depends on, you know,
what the specific case is and what's going on with the patient.
Got it. Viewing even deeper, I wanted to really tackle cosmetic surgeries, right? You kind
(28:10):
of mentioned something earlier before how, well, the insurance companies would be the
qualifier of what is deemed as probably a surgery that's health benefit versus one
that is not, right? Or one that is more life saving or whatnot versus one that is more
of the patient's like, I want to do this more for like very cosmetic reasons, right? When
(28:30):
it comes to how something physically looks. And I guess this is where it roots from where
society has placed a lot of stigma and taboo when it comes to plastic surgery, right? And
I guess even a distant cousin of plastic surgery, which is cosmetics and aesthetics, right?
Do you think there's a demarcation line between plastic surgery versus someone who wants to
(28:57):
get a surgery more for attaining a certain physical ABO?
You mean from like the surgery perspective or the surgery perspective? So I guess the
only demarcation I can think of is that, you know, there are cosmetic surgeons who aren't
plastic surgeons. So there's the American Board of Plastic Surgery, which is the board
for plastic and reconstructive surgeons. And so that's part of the American Board of Medical
(29:21):
Specialties. So it's recognized by the ABMS. But then there's also another board of cosmetic
surgery that's actually not recognized by the American Board of Medical Specialties. And
so I don't know what the requirements are to be a cosmetic surgeon. But I think, I don't
know, I think it might be even like a one year fellowship. And I don't know if you need
to be a surgeon to take that fellowship. And so obviously, many are surgeons already. And
(29:42):
so they can still operate safely. But I think there is just a little bit less maybe, I honestly
don't know what the requirements are. So I can't speak to that. But there is a distinction
between you know, a cosmetic surgeon versus a plastic surgeon. And so I only know about
the plastic surgery side.
Yeah, and I guess when talking about the essence of the surgery itself, right outside of the
surgeon who's doing it, you use the word stigma before, right? I think it's true, right? There's
(30:07):
a lot of stigma when it comes to the field, which is why I guess I am the main reason
why I wanted to do this live because again, it's Barbie weekend. And I guess if you scroll
through the forums online, sometimes the word Barbie is it's happened that right? Sometimes
it's a compliment, sometimes it's not a compliment, right? So I feel like it's a very divided world.
(30:34):
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I guess when it comes to plastic surgery and cosmetic surgery, I was talking to a facial
plastic surgeon before too and she was saying how sometimes, I guess, which is what you
(33:41):
mentioned as well, sometimes you don't see how the cosmesis side of it is actually very
reconstructive, not just physically, but a very psychosocial effect on the patient, right?
So it's like you don't know if the scar revision surgery was something, she said that she had
a patient before who was going through physical abuse, right, from their partner. And that
(34:03):
scar reminds them every day of those traumatic times. And in that sense, plastic surgery
was her way out to peace, right, from trying to tackle all of that. And also she said,
you don't know if someone's decision to have breast augmentation or breast reduction is
rooting from bullying that they've gone through back in their life, right? What would you
(34:26):
say about those moments where, I guess, as a plastic surgeon, right, I mean, you're not
just dealing with the body and the physical, but I guess you really have a very big role
and also in someone's mental health and psychosocial being, right?
Yeah, I totally agree. I think that's something I saw during medical school because my mentor
(34:47):
was training in craniofacial surgery, you know, was operating mostly on children, you
know, doing these crazy skull reshaping surgeries, but then he also did cosmetic surgery also,
like aesthetic surgery. And a lot of people do that. And the line between what is reconstructive
versus what is aesthetic is not necessarily that distinct. And, you know, doing something
elective and aesthetic for a patient really can change the way they see themselves and
(35:09):
really affect their lives. Yeah, I think that's, no, that's exactly right. I think even things
that everyone has their own goals for themselves and their own ideals of, you know, what they
value as important. And we can't necessarily speak to what someone else should look like
or what they should feel about themselves. So I totally agree with that. I think, you
know, for things like transgender surgery also, you know, it's at least in Maryland,
(35:32):
I believe, I don't know which parts, but most parts are covered by insurance. And so it's,
you know, the same idea. It's if you feel a certain way about how you should look or,
you know, whatever, then you're still doing that as a service for the patient. Yeah. And
I think sometimes it really boils down to quality of life, right? I mean, you were talking
about hand surgeries and I guess there's some classic surgeries, so also do like orthodontic
(35:55):
surgeries, right? And I guess you're also like skin cancer, right? Like remote surgery.
I think also like really targeting the quality of life is such an important thing, right?
I mean, some things that we take for granted, like the ability to move our hands, right?
To, I guess, turn the doorknob. Some people can't do that, right? And so this plastic
surgery is the way that they can really achieve the restoration of those, I guess, basic abilities
(36:21):
for the general population we take for granted, right? Well, I guess I want to ask, what do
you think is your most favorite part about being a surgeon? And I guess a plastic surgeon.
It's a great question. I think my favorite part is, so we like cooperate a lot with different
surgical specialties. We actually, I feel like we work with medicine, internal medicine,
(36:45):
like the least. I think we work with every other surgical specialty the most. And so
my favorite part is really working with other specialties, cooperating a lot, being able
to tackle something together with another surgical service. I think that's really enjoyable
in coordinating your procedures. I think it's that collaboration I really enjoy. And also,
you are able to be a part of someone's bigger picture procedure. So I really enjoy that.
(37:06):
That's beautiful. And as a physician, as a surgeon, definitely people's lives and not
just lives, but there's trust in your hands, right? Whether it's cosmetic or for reconstructive,
whether it's the ability to maybe fulfill the physical idea that someone wants. There's
also, also reconstruction, which are very life saving, right? Or really wants that,
(37:30):
I guess, restore someone's quality of life. I guess it's so much responsibility, right?
And I can't imagine the amount of not just physical, but I guess also emotional toll
that it can take on a surgeon. How do you decompress from work, from all of this?
I was thinking of that responsibility thing just to back up. I was thinking about that
recently where as a resident, you feel like you have so much responsibility and you're
(37:55):
being harassed in all directions by everyone. But then I feel like in recent years, I've
come to realize it's actually going to be completely different when you're the attending,
you're actually responsible for literally everything. And so I'm curious what that's
going to feel like in a few years. But yeah, how I decompress, I really enjoy spending
time with people. I feel like I have, again, I'm able to do stuff outside of work. I think
(38:17):
I still have hobbies. I feel like most people lose hobbies when they start residency. Maybe
I did when I started residency, but I think I still am able to set aside time for other
things.
Yeah. Well, I remember you told me he's a plant zaddy. He's a plant zaddy with his
plants that I remember you told me you killed during medical school. But I have more time
in residency. And guess what I also see is like food, right? We're having food, which
(38:43):
we will have soon here in New York City. This was a talk that I've always wanted to have
because I think it's important to, I think, break down the walls when it comes to taboo
and I guess stigmatize topics, because there's people who may want to go through it, but
are afraid of, I guess, the reception of the people in the world around them, right? I
(39:06):
guess I'll ask you questions. What would be your message as a plastic surgeon to someone
out there who may want to need the help of a plastic surgeon, but are afraid of, I guess,
the societal view about the field?
I think, you know, ultimately it's your life. You know, if this is something that you feel
like would, it's something that you have thought about and it's something you've, I don't know
(39:30):
what the reason is that other people are telling you not to. You know, you want to find a surgeon
who kind of identifies with your same goals. You want someone who understands what you're
talking about and also agrees and is able to do the same thing. Because one thing is
like a surgeon might have different ideals for, you know, if this is like a cosmetic
surgery, a surgeon might have different ideals of what something should look like than what
(39:50):
you want. And so you also want someone to be on the same page as you. And so eventually,
you know, finding the right surgeon is important, but I think, you know, finding maybe your
family or friends are actually doing a good job warning you, but, you know, making sure
that this is the right decision for you. And ultimately it is your own decision.
I love that. Alex, I love this conversation so much. I can't believe it took us a year,
(40:11):
but thank you to Barbie. Yeah, exactly. Thank you to Barbie for making this happen. Well,
Alex, thank you again so much. I learned so much and I don't think I'll ever forget that
plastics, you know, what you're saying about to mold, right? I mean, not just molding someone
like physically and I guess they are ideals for themselves, but really plastic surgery
is molding the life that someone deserves and wants and deserves for themselves, right?
(40:38):
I guess even deeper than skin level, right? Being able to change someone's confidence
and someone's perceptions of themselves and I guess their whole quality of life. So it's
such an honor having this conversation. Yeah, that was very eloquent. Thank you so much
for having me. Thank you. Thank you everyone for joining and thank you, Alex. I'll see
(40:58):
you next week.
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