Dr. Malcolm Z. Roth is Chief of Plastic Surgery at the Albany Medical Center in Albany, New York, and former president of the American Society of Plastic Surgeons, the New York State Society of Plastic Surgeons the New York County Medical Society and the New York Society for Surgery of the Hand. A practicing board certified plastic surgeon for 29 years he is passionate about his profession and one of it’s most articulate spokesmen.
Dr. Roth has been interviewed many times about changing consumer attitudes towards plastic surgery and about changes in the field itself.
What is most rewarding about being a plastic surgeon?
We restore and enhance lives. We perform procedures in the reconstructive area that make people function better. A woman who has had a mastectomy, for example, can go to the beach looking as she did before and sometimes even better. We help children born with deformities and cardiac patients who have infected wounds after heart surgery. We make people feel better about their appearance and more confident about themselves.
What would you like to tell a woman who sees something she doesn’t like with her face or body, but is anti plastic surgery?
Plastic surgery is a beauty-for-life thing. We can best counsel women on their range of options, not all of them involving surgery. Options can go from simple skin care, to minimally and non-invasive modalities, and finally surgery. Even if the surgeon doesn’t work with the appropriate laser that he feels can best treat a woman, he can send her to someone who does use it. On the other hand, if you see a doctor who only uses lasers, and doesn’t have complete plastic surgery training, he or she will likely recommend the laser.
Let’s say a woman is bothered by something with her skin. Doesn’t she automatically think of going to see a dermatologist?
Although dermatologists often are the first specialists a woman thinks of, plastic surgeons should be the go to specialists for rejuvenation and cosmetic enhancement. Plastic surgeons know what the dermatologists know about skin rejuvenation, but also they have the ability to offer other treatment that the dermatologists aren’t trained in.
What is a crucial piece of advice you’d like to give women about their skin?
No matter what her age, a woman must use sunscreen at all times. A long-term study definitely revealed that women who used sunscreen didn’t experience the same aging of their skin as woman who didn’t use it. Use of sunscreen also reduced their risk of developing skin cancer.
What are the tell tale signs of aging and the treatments to reduce or eradicate them?
Let me walk you up the ladder, starting at the bottom of the face:
- A. In the lower face, creases and indentations can develop around the chin.
- B. Jowls are the hanging skin and fat that occur in aging and change the straight, crisp jawline of youth.
- C. Crow’s feet are the wrinkles at the corners of the eyes that are more pronounced when we smile.
- D. Besides fine lines, there are the nasolabial folds, which extend from the sides of the nose down to the corners of the mouth, and the marionette lines, which are the wrinkles extending downward from the corners of the mouth.
- E. Bunny lines are the wrinkles on the upper portion of the nose.
- F. The glabella is the region between the eyebrows where we develop worry lines or “11 lines”, the vertical lines between the eyebrows.
- G. In the upper face, creases run across the forehead, especially when we lift our eyebrows.
- H. Fine lines and deeper wrinkles can develop above the upper lip and on the chin.
- I. And there are fine wrinkles and age spots that can develop anywhere on the face.
Some of these issues, particularly the upper wrinkles, are best treated with neurotoxins, such as Botox and Dysport, that temporarily prevent the muscles that, with animation, create these tell-tale signs of aging. The deeper wrinkles on the lower face are typically treated with one of the many fillers available, which usually last a minimum of six to eight months, up to two years, depending on what is used. The fine wrinkles and age spots can sometimes be treated simply with creams and lotions, lasers and other types of light therapy or radio frequency devices.
Then you get into the area of surgery, including eyelid tucks, also known as blepharoplasty, brow and neck lifts, facelifts, short-scar facelifts, fat grafts instead of off-the-shelf fillers. Liposuction is performed to take a patient’s fat from an unwanted area followed by injecting the patient’s own fat to rejuvenate places such as the jaw line and eliminate nasolabial folds, plump up the lips and restore the fullness of the upper cheeks or create the appearance of high cheek bones, even if the patient never had this in youth.
Increasingly, different types of doctors offer Botox and filler injections. What are your thoughts about this?
Dermatologists typically have not had the full gamut of plastic surgery training, and even if they’ve had some training following their dermatology training, they still are not board certified in plastic surgery.
At least six years of training is required to become board certified in plastic surgery, in addition to passing written and oral exams. You can’t even take your oral boards until you’ve practiced for a while and have satisfactorily completed a certain number of cases within the field of plastic surgery.
Despite the stringent requirement, most states have not yet passed Truth in Education laws, so essentially anyone who has a medical license can claim that they are a plastic surgeon! In other words, you don’t have to be a plastic surgeon to claim you’re a plastic surgeon. You can be a radiologist, gynecologist, even a pathologist and still call yourself a plastic surgeon. Having a license to practice medicine is all you need. Even if you’ve never held a knife in your training, you can call yourself a plastic surgeon. Many non-physicians also call themselves doctors. Nurses, for example, may call themselves a ‘doctor of nursing.’ Only six states (Florida, Louisiana, Texas, California, Maryland and Utah) require doctors, when advertising, to name the specialties in which they’ve been trained and the boards to which they belong if they claim they’re ‘board certified.’
Dentists are doing Botox and general practitioners are doing liposuction and lasers, because it’s lucrative. They take online courses and weekend seminars, as opposed to six years of training in plastic surgery.
Most importantly, board certified plastic surgeons can assess problems that arise and treat complications; other physicians can’t.
What would you tell a woman who is afraid of plastic surgery, even though she knows she’d benefit?
Don’t be put off because the word surgeon is in my title, because there are other things we offer today that could benefit you. If a patient isn’t ready emotionally or financially for an operation or she can’t take the time off, we can give her the short-term, non-surgical options. We can buy time to make her look refreshed and rejuvenated and put off surgery.
Have you seen a change in women’s attitudes about plastic surgery from 10 to 20 years ago?
No question. So many women have had their faces improved by neurotoxins or fillers. Lasers, too, have become a big part of what we do. We have an increasing number of options that we didn’t have 20 years ago. And now that we have these options, women are asking for treatments at younger ages. A woman at 40, for example, who took care of her skin, could be a great candidate for neurotoxins or fillers. Minimally invasive treatments can’t stop gravity, however.
Well-trained, board-certified plastic surgeons also have evolved. We’re constantly learning new and more sophisticated techniques that produce more natural results. Down time for major procedures can be as little as a few days. We’re making better, shorter incisions and not putting as much tension on the skin, so we can avoid that over-operated look.
Should a woman consider location when she’s deciding what plastic surgeon to use or should she be open to seeing a doctor a few hours away from her home?
I’m in Albany, NY, but I have patients who see me from hundreds of miles away. Patients can stay in the hotel that is connected by a bridge to the hospital. Out-of-state patients and patients who do not want to go to Manhattan do that all the time. The most important things to consider when choosing a plastic surgeon is:
1.) Whether he or she is board certified and stays up to date on the latest procedures. Medical education in patient safety is part of our continuing education and 2.) Does the doctor hear what you want and is the doctor on the same page as you?
Do you do on-line consults?
I do not. If a doctor does online consults with someone from another state, it could be considered practicing medicine in that state. And unless you have a license to practice in the other state, you shouldn’t do it.
Skype and Face Time are options, but there is nothing like being able to put your hands on a patient’s face, examine the patients body in person, and to see what the skin is like. It’s difficult to have a meaningful consultation unless you do it in person. It’s also important to have an opportunity to learn a patient’s “psychological profile” and for the patient to see if the doctor is right for them.
Are there new non-invasive procedures that you especially like today?
I tend to be more cautious. There are many procedures today that offer non-invasive technology or use laser and radio frequency procedures, but many people could walk away disappointed after having these procedures. Doctors need to be cautious about salesmanship. Just because a procedure involves less downtime and is less expensive doesn’t mean a patient will be happy with the results. With these devices that sound too good to be true, they usually are exactly that. 20 percent of people will get a significant result, 40 percent won’t see a difference after a week or two and many will never see a difference.
Although there’s a reasonable chance a patient will have some improvement, no downtime and no scars after a non-invasive procedure, it’s not going to be anywhere as effective as a facelift or liposuction. It may sound good, but if you spend thousands of dollars and don’t get a significant result, you’ll be an unhappy patient. When you come down to it, anything that sounds too good to be true usually is, and the cost benefit ratio might actually lead you to spending more, because you usually get what you paid for.
Some people are absolutely not candidates for non-invasive procedures, and some might not be candidates for operations. Regardless, it’s hard to predict the results with complete certainty, so a frank discussion with a plastic surgeon is absolutely necessary before embarking on any treatment plan.
Ask a lot of questions and listen carefully. You might hear what you want to hear: “No down time, no risk, no pain and it costs less than surgery.” But what you should really ask is: “Is this going to be worth my money, the risk and the down time?” If your expectations are reasonable and appropriate—and you know the range of results—you won’t be disappointed.