Today, January 5th, 2018, marks exactly 13 years since my first day in independent practice.
Exactly 13 years ago, almost to the minute that I am writing this, is when I first nervously threw open the doors of my first office, located in the basement of the Cambridge Memorial Hospital.
The rooms I occupied then had been abandoned for ages, and it was only because my other office plans fell through at the last minute that I begged the hospital to let me rent some space. The rooms were tiny and bare. The water that came out of the taps was brown. The heat sometimes worked, but mostly didn’t, and all the faxes that referring doctors sent me were mysteriously rerouted to various offices throughout the hospital.
I had just one assistant, Lori, who held everything together for us in those early days. She assembled the new furniture, set up the filing system, navigated the hospital bureaucracy and figured out the computers. I still don’t know how she did it.
So much has changed since then.
The Cosmetic Surgery Clinic is now in the beautiful Seagram’s house in Waterloo. The staff has grown to 20 people, including two surgical colleagues, two nurse injectors, one laser nurse, one Coolsculpting specialist, a full time post-operative care nurse, a full time operating room manager, a full time scrub nurse, a team of recovery room nurses, a full time anesthesiologist, a patient coordinator, a patient liaison, and a fabulous office manager, to name just a few.
We have our own accredited surgical facilities, and we routinely operate four or five days per week. We have undertaken a few rounds of renovations to make even more beautiful space to keep up with the ever-increasing number of patients who generously continue to see us for treatment.
When I look back at all the changes, including those to the physical space, and the staff, and the sheer number of patients we see, one change stands out among them all.The surgical procedures I do now bear little more than a vague resemblance to the procedures I did in my residency training and my early days of practice.
The pace of aesthetic surgery changes rapidly, and all of us at The Cosmetic Surgery Clinic have changed with it.
Take breast augmentation as a perfect example. It is the most common procedure we do, but now I use implants and techniques that didn’t exist when I trained. Gone are the days of saline implants. Gone (thank goodness!) are the days of putting in huge implants, just because it was possible. Gone are the days of having to put every implant under the chest muscles, just because there was no other choice. Gone are the days of seeing a patient with a ruptured implant almost every consult day.
We now have cohesive silicone gel implants that almost never break. We now routinely do “composite” breast augmentations which place the implants above the chest muscle, leaving it intact and in place, and we touch up the upper pole of the breast with a bit of fat graft. The result is as beautiful as any sub-muscular implant, and all without the added pain, swelling, bleeding risk, and guarantee of unnatural movement of the implants with muscle contraction that came with placing the implants under the muscle.
Implant sizing has become a measurement-based process that matches the best implant size to each woman’s anatomy.
Choosing the right implant is no longer a guessing game. And thankfully, I almost never see implant ruptures anymore.
My tummy tucks have also been re-invented, as I stopped using drains a few years ago. They were useless, and everyone hated them. I don’t miss them at all. I also now use a local anaesthetic “pain pump” which makes the post-op period much more comfortable. I use progressive tension sutures to take the tension off the skin closure, reduce the risk of wound healing problems, and get a much better scar. We still call it a tummy tuck, but it sure isn’t the same operation I learned as a resident.
Today, I do so much gynecomastia surgery that it is challenging other popular procedures for the top spot on our list. Calculating the number of these cases I did as a resident and in my early years of practice was pretty easy, because the number was ZERO!
The list of procedure changes goes on and on. The way I do a facelift now is completely different from years gone by. The same is true for eyelid surgery. The same is also true for liposuction surgery.
All of the changes have brought better results, fewer complications, and a much higher level of patient satisfaction.
When I reflect on my first 13 years and practice, I can’t help but be amazed and appreciative of how much my beautiful profession has changed and how important it is for me to stay on top of all the newest, latest, and greatest procedures. Lifelong learning is a critical part of being any kind of professional, and it is especially true in the field of aesthetic plastic surgery.
So, 13 years later, I have come a long way from the cold rooms and brown tap water that greeted me at my first office 13 years ago. My physical location has changed. My staff has changed. My procedures have changed. But what has not changed is my dedication to giving my patients the best possible I can give them.
Thank you for sticking with me for the first 13 years. Let’s see what the future holds!