BẢN CHÉP ÂM THANH 🔗
WEBVTT
00:00:01.197 --> 00:00:05.197
You're listening to the Confident Choice Podcast with me, Dr.
00:00:05.397 --> 00:00:10.197
Roberto Garcia, a double board certified facial plastic and reconstructive surgeon.
00:00:10.677 --> 00:00:16.157
Honest conversations and expert advice about the decisions that make you feel your best.
00:00:23.201 --> 00:00:29.501
Yeah. Well, thank you for having me. I, you know, my initial just first steps,
00:00:29.681 --> 00:00:32.401
my initial first steps were in medical school.
00:00:32.521 --> 00:00:38.161
I think much like you, you know, when you do gross anatomy and you kind of,
00:00:38.281 --> 00:00:41.721
you, you enjoy certain parts of gross anatomy.
00:00:42.081 --> 00:00:47.281
I, I certainly enjoyed anatomy of the head and neck. And that was my favorite
00:00:47.281 --> 00:00:49.921
section of gross anatomy.
00:00:50.161 --> 00:00:56.621
To me, everything seemed so small and precise and everything seemed almost like
00:00:56.621 --> 00:00:58.401
the inside of a clock or a watch.
00:00:58.561 --> 00:01:04.421
Everything just kind of was worked together in synchrony and it was fascinating.
00:01:04.461 --> 00:01:06.841
That's really where my original interest started.
00:01:06.981 --> 00:01:13.121
Then you move on to your clinical clerkships, you know, where you do pediatrics
00:01:13.121 --> 00:01:18.141
and internship or in internal medicine and surgery and whatnot.
00:01:18.161 --> 00:01:20.701
And I developed an interest in surgery.
00:01:20.921 --> 00:01:27.721
I really enjoyed the problems and the procedures that surgeons did.
00:01:27.961 --> 00:01:34.161
And then you go on and you refine and you start to see what different subspecialties
00:01:34.161 --> 00:01:35.561
there are within surgery.
00:01:36.141 --> 00:01:40.221
Otolaryngology was the one that I chose because, again, it gets back to that head and neck element.
00:01:40.901 --> 00:01:44.541
And that's where my original interest started. And then, of course,
00:01:44.561 --> 00:01:51.401
you apply for residency, and otolaryngology, as you know, is one of the more
00:01:51.401 --> 00:01:53.161
competitive residencies to do.
00:01:53.921 --> 00:01:55.861
Yeah, so sorry to interrupt you.
00:01:57.101 --> 00:02:03.101
In the year that I applied, and probably there were less people when you applied,
00:02:03.341 --> 00:02:06.581
there were 270 spots in the country. Right.
00:02:06.841 --> 00:02:12.821
In the year I applied for fellowship, there was 35 fellowship spots.
00:02:12.821 --> 00:02:14.041
I mean, it's probably close to how.
00:02:14.141 --> 00:02:18.301
Yeah. And out of those 270 spots, you probably have 900 applicants,
00:02:18.461 --> 00:02:20.781
1,000 applicants. The acceptance rate's low. Yeah.
00:02:22.058 --> 00:02:27.978
You got to, you got to understand though. And what learning intricate surgery,
00:02:28.558 --> 00:02:32.178
like otologic ear surgery, right? Where it's all microscope driven.
00:02:32.558 --> 00:02:35.298
You're learning how to be a technician. Yeah.
00:02:35.638 --> 00:02:42.798
Right. The techniques that we use that naturally fell, fell into a more natural
00:02:42.798 --> 00:02:47.038
surgery for us when we were doing say blepharoplasty or things with much finer
00:02:47.038 --> 00:02:50.598
threads for us, it was normal, right?
00:02:50.758 --> 00:02:54.878
Because we had already developed those techniques of working on our microscopes.
00:02:55.018 --> 00:02:59.638
Correct. And that's one distinguishing thing between us as otolaryngologists
00:02:59.638 --> 00:03:03.578
or head and neck surgeons is being able to work in that small environment using
00:03:03.578 --> 00:03:05.118
the small muscles of your hand.
00:03:05.218 --> 00:03:08.818
And everything is very focused. You're working in a small area.
00:03:08.818 --> 00:03:11.458
And so you develop those fine motor skills, like you said.
00:03:11.938 --> 00:03:20.958
And then back to my story, during residency, you begin to develop interests in fellowships.
00:03:21.138 --> 00:03:25.918
And, you know, where I did my residency in the Bronx, we did a lot of facial
00:03:25.918 --> 00:03:29.118
trauma. There was a lot of reconstruction and a lot of facial trauma.
00:03:29.318 --> 00:03:35.058
So that evolves into cosmetic nasal surgery, rhinoplasty.
00:03:35.578 --> 00:03:38.978
And so you want to learn more about rhinoplasty and the way you learn more about
00:03:38.978 --> 00:03:43.218
that is by doing a fellowship. And like you said earlier, the fellowships are competitive.
00:03:43.618 --> 00:03:49.438
You and I both did one of the more sought after fellowships in the country. Yeah.
00:03:49.938 --> 00:03:54.818
And we, we learned, we learned how to do rhinoplasty very well.
00:03:54.998 --> 00:03:59.978
And, and, and then of course you, you learn aging phase surgery and that kind of thing.
00:04:00.138 --> 00:04:02.598
But the point that I'm trying to make
00:04:02.598 --> 00:04:07.338
in all of this is the fact that you gradually hone in on the specialty.
00:04:08.096 --> 00:04:14.676
And you only focus on that specialty. You don't do this or do that every once in a while.
00:04:14.856 --> 00:04:19.616
You are only working in this small little circle of procedures.
00:04:19.856 --> 00:04:25.656
And like you, we do eight different procedures, seven different procedures in the face.
00:04:25.816 --> 00:04:33.196
Yeah, but you know, there's something to be said about, I almost feel that surgeons who.
00:04:34.136 --> 00:04:39.076
Don't specialize in the face, who are doing surgeries everywhere,
00:04:39.076 --> 00:04:45.436
I almost feel like it's a disservice and a disrespect to the specialty of the face.
00:04:45.596 --> 00:04:49.736
Well, you know, it's not really taken that serious.
00:04:50.056 --> 00:04:52.776
And this is something that you and I look at differently, right?
00:04:52.996 --> 00:04:59.796
Yeah. Yeah. I feel like obviously other surgeons, if they are surgeons and they
Load full transcript
00:04:59.796 --> 00:05:04.816
are board certified to do the procedures that they do, that's perfectly fine.
00:05:04.916 --> 00:05:06.776
But board certification is a minimum.
00:05:07.216 --> 00:05:10.976
Board certification just means that you have the minimum knowledge base and
00:05:10.976 --> 00:05:14.156
you've met a minimum standard to do those procedures.
00:05:14.456 --> 00:05:21.056
What differentiates one specialty from the other is the scope of your practice.
00:05:21.476 --> 00:05:28.836
And when you talk about the scope of, and I can only speak to my practice, rhinoplasty.
00:05:28.996 --> 00:05:34.816
I do rhinoplasty every week. It's a repetitive thing and over and over and over.
00:05:34.996 --> 00:05:41.056
And like anything else, when you repeat what you're doing, your misses become
00:05:41.056 --> 00:05:44.196
smaller and your details become greater.
00:05:44.396 --> 00:05:48.276
And so because of that, you're able to.
00:05:49.480 --> 00:05:52.820
Translate all that I believe into excellent results
00:05:52.820 --> 00:05:56.140
yeah and that's where where it all happens it's not that
00:05:56.140 --> 00:05:59.320
we're necessarily more intelligent or
00:05:59.320 --> 00:06:04.160
brighter than anybody else it's the repetitive nature of what we do and this
00:06:04.160 --> 00:06:08.720
this is all we do it's just one after another of the same thing or roughly the
00:06:08.720 --> 00:06:16.740
same thing well so so you get into you get into practice in north florida what year,
00:06:17.380 --> 00:06:21.940
In 2001, I started my practice two weeks, three weeks after 9-11.
00:06:22.280 --> 00:06:25.240
Yeah. October 1st, 2008. You know the start of it.
00:06:26.173 --> 00:06:34.413
So, you know, what did you, obviously, there weren't a lot of facial plastics guys doing work.
00:06:34.933 --> 00:06:41.593
No, what there were at that time were the general plastic surgeons who did everything.
00:06:41.773 --> 00:06:48.293
Yeah. And then you had some otolaryngologists who did facial plastic surgery.
00:06:48.493 --> 00:06:50.093
So a lot of these guys did.
00:06:50.333 --> 00:06:53.793
They might do a rhinoplasty. They might do a rhinoplasty every once in a while.
00:06:53.793 --> 00:06:57.793
Yeah, every great once in a while, they would do an aging face operation,
00:06:57.793 --> 00:07:03.693
but mostly they paid their bills by doing overlander gals, sinus surgery,
00:07:03.873 --> 00:07:05.893
tonsillectomies, those kinds of things.
00:07:05.893 --> 00:07:11.693
So that's where I think when I came into the community, I made a commitment
00:07:11.693 --> 00:07:19.393
to myself that I was only going to do facial plastic and reconstructive surgery.
00:07:19.793 --> 00:07:25.853
And it wasn't an easy commitment to make financially because at the time I was
00:07:25.853 --> 00:07:31.093
trying to develop a cosmetic surgery practice in the town where I was from,
00:07:31.253 --> 00:07:33.573
but nobody really knew who I was as Dr.
00:07:33.673 --> 00:07:37.873
Garcia, the facial. Well, nobody knew that a specialty called facial plastic
00:07:37.873 --> 00:07:39.033
surgery existed. Correct.
00:07:39.253 --> 00:07:46.473
I mean, I remember reading an article that back in 1992, 95% of all facial cosmetic
00:07:46.473 --> 00:07:50.553
surgeries were done by general plastic surgeons, board-certified plastic surgeons.
00:07:50.893 --> 00:07:57.953
And in 2003, they did the same study, and 94% were now done by facial plastic surgeons.
00:07:58.213 --> 00:08:00.593
Now, I'm going to speak on that for a second.
00:08:00.993 --> 00:08:07.133
You think about it. That's 180% turnaround and the volume of how things,
00:08:07.313 --> 00:08:08.973
it's a complete paradigm shift.
00:08:09.233 --> 00:08:15.333
But interestingly, the reason it happened was, you know, back when the board was created, right?
00:08:15.453 --> 00:08:17.973
1986, right? After that skim milker.
00:08:18.737 --> 00:08:22.297
82 sorry and now all
00:08:22.297 --> 00:08:25.677
of a sudden facial plastics as a
00:08:25.677 --> 00:08:28.677
specialty became prominent at the academic level
00:08:28.677 --> 00:08:33.157
yeah and now every ent program not
00:08:33.157 --> 00:08:35.917
in the 80s but eventually over the course
00:08:35.917 --> 00:08:38.817
of the next decade 15 years had a guy
00:08:38.817 --> 00:08:41.657
trained in facial plastics yeah right yeah because there
00:08:41.657 --> 00:08:44.597
have been fellowships up until that point but there wasn't
00:08:44.597 --> 00:08:47.797
a board and so now all of a sudden you had facial
00:08:47.797 --> 00:08:51.237
plastics guys in the academic institutions taking on
00:08:51.237 --> 00:08:53.957
those facial cases where before they had gone to
00:08:53.957 --> 00:08:58.477
the general guys and now the general guys are graduating and they don't have
00:08:58.477 --> 00:09:03.537
the volume and now they get into practice and they don't feel comfortable with
00:09:03.537 --> 00:09:06.677
their practice they can't do it well yeah or they feel less comfortable yeah
00:09:06.677 --> 00:09:13.017
i think that a lot of that speaks to what you said about the, the,
00:09:13.037 --> 00:09:19.537
the, the turnaround in the, the percentage of cases that our specialty does
00:09:19.537 --> 00:09:21.397
as compared to 40 years ago.
00:09:22.397 --> 00:09:26.457
And you know, you're, when you, when you try to explain something like that,
00:09:26.677 --> 00:09:33.257
it's really not that there's the majority of people in this country are under
00:09:33.257 --> 00:09:36.937
some sort of mass delusion and we've been able to delude them and to think.
00:09:37.017 --> 00:09:38.977
No, that's the only thing that existed. That's correct.
00:09:39.277 --> 00:09:43.617
So, the only other alternative is results, right?
00:09:43.877 --> 00:09:50.117
The results are really what refers patients to you if you have your best results.
00:09:50.117 --> 00:09:52.557
And that's how I've been
able to build my practice.
00:09:52.697 --> 00:09:56.097
That's how, you know, everybody else in facial plastic surgery has been able
00:09:56.097 --> 00:10:00.017
to build their practice. better results with rhinoplasty, happier patients.
00:10:00.017 --> 00:10:02.317
They tell other patients and so on and so forth.
00:10:02.477 --> 00:10:07.937
So it's just the progression of the growth in our specialty.
00:10:08.257 --> 00:10:14.297
Yeah, and I can tell you that, you know, there has been over the course of years different...
00:10:15.299 --> 00:10:19.979
And I don't like to use the word, you talk to some of these gung-ho guys in
00:10:19.979 --> 00:10:23.139
our academy, and they call it encroachment into our specialty.
00:10:24.199 --> 00:10:27.199
Anybody's free to do, I don't have that, I'm not that militant guy.
00:10:27.539 --> 00:10:30.779
You know, if you do good work, I don't care what specialty you are, you do good work.
00:10:31.079 --> 00:10:35.339
Because even within our specialty, there's guys, and you can probably attest
00:10:35.339 --> 00:10:38.919
to this, you go to a meeting, and you're looking at the presentation,
00:10:39.099 --> 00:10:41.239
and you say, which one's the before, which one's the after?
00:10:41.399 --> 00:10:45.519
Many times. You know, and you know, they got the little Ivy league logo at the
00:10:45.519 --> 00:10:46.659
bottom or whatever it is.
00:10:46.799 --> 00:10:50.019
And, and you say to yourself, okay, well, that's not going to float in the real world.
00:10:50.399 --> 00:10:54.719
And so I have met very, very, I mean, Dick Webster was a general plastic surgeon,
00:10:54.719 --> 00:10:58.499
one of the best in the game. Well, he was the first president of the American
00:10:58.499 --> 00:11:02.319
Academy of Facial Plastic Surgery, but Dick Webster was an interesting guy because,
00:11:02.539 --> 00:11:04.779
first of all, he was a very gracious guy.
00:11:04.879 --> 00:11:10.199
Dick Webster was a plastic surgeon from Boston, and he was a very gracious individual.
00:11:10.199 --> 00:11:14.159
He brought in people from all different kinds of specialties.
00:11:14.159 --> 00:11:19.339
He brought in otolaryngologists and, you know, some of the people from our lineage.
00:11:19.379 --> 00:11:25.299
He brought in people from our lineage into his practice to teach them how to
00:11:25.299 --> 00:11:27.319
do facial plastic surgery.
00:11:27.559 --> 00:11:32.639
But that was an exception in the world of plastic surgery.
00:11:32.999 --> 00:11:40.139
There were really no other Dick Websters out there. He was truly a gracious person.
00:11:40.399 --> 00:11:43.859
Well, with regards to sharing knowledge. With regards to sharing knowledge, right.
00:11:45.039 --> 00:11:47.099
The academy, like you said earlier,
00:11:49.679 --> 00:11:55.919
the board was born out of a $1.5 million lawsuit that Jack Anderson,
00:11:56.239 --> 00:11:59.239
one of the pioneers in our academy from New Orleans,
00:12:00.229 -->
00:12:05.989
One in a libel case against two general plastic surgeons in Atlanta who posted
00:12:05.989 --> 00:12:12.209
a series of articles in, I think, some kind of Georgia archives magazine.
00:12:12.469 --> 00:12:18.529
Yeah. And it might've been the, the, the journal for the Georgia medical society
00:12:18.529 --> 00:12:19.709
or something like that. Yeah.
00:12:19.829 --> 00:12:22.149
I, in my office, in one of those rooms, I have it.
00:12:22.289 --> 00:12:29.629
Yeah. And so they, they basically, they took a position that anybody who wasn't them was not real milk.
00:12:29.669 --> 00:12:32.249
It wasn't whole milk. It was skim milk that we were diluted.
00:12:32.429 --> 00:12:38.509
When in fact, you look at the history of facial plastic surgeon all the way back to Jacques Joseph.
00:12:39.425 --> 00:12:46.225
Who was one of the, if not the father of modern plastic surgery,
00:12:46.525 --> 00:12:50.205
he was an otolaryngologist from Germany who pioneered rhinoplasty.
00:12:50.605 --> 00:12:57.325
Even Harold Gillies, who was an English plastic surgeon, he was an otolaryngologist
00:12:57.325 --> 00:13:05.385
who took his practice to plastic surgery, but his original training was otolaryngology.
00:13:05.505 --> 00:13:10.805
And so when you go back to that whole history, it's really all otolaryngology
00:13:10.805 --> 00:13:16.105
based where the division happened is a group of people decided that they weren't
00:13:16.105 --> 00:13:20.225
going to be inclusive. And this was in the, in the interwar period.
00:13:20.565 --> 00:13:25.185
And they said, this is our territory and we're not going to share where we're
00:13:25.185 --> 00:13:30.165
going to create our own board, which was their right to, to create whatever
00:13:30.165 --> 00:13:31.705
group they, they wanted to,
00:13:31.925 --> 00:13:35.865
but we had to do our own thing.
00:13:36.185 --> 00:13:41.645
Our predecessors had to do our own thing because we were just as,
00:13:41.825 --> 00:13:45.125
if not more qualified to do these procedures that we do.
00:13:45.405 --> 00:13:51.505
Yeah. In that case, in the court case, they actually brought up examples of,
00:13:51.685 --> 00:13:53.045
you know, with a brow lift,
00:13:53.305 --> 00:13:59.385
an ENT is more qualified to do a brow lift because he has done osteoplastic
00:13:59.385 --> 00:14:01.845
flaps. He's done frontal sinus surgery.
00:14:02.045 --> 00:14:07.185
With a facelift they've done parotidectomies for years you know with eyelid
00:14:07.185 --> 00:14:11.665
surgery they've done trauma periocular trauma and with nasal surgery of course
00:14:11.665 --> 00:14:16.785
we've done sinus and internal uh internal nasal work so in fact.
00:14:17.757 --> 00:14:26.037
Our base, the otolaryngologic base, the ENT base, was better suited for this. Cosmetic surgery.
00:14:26.297 --> 00:14:29.597
Cosmetic surgery. It was a natural progression. Right.
00:14:29.697 --> 00:14:33.597
It's not a natural progression when you've been
doing bowel surgery for a year,
00:14:33.597 --> 00:14:36.777
and then all of a sudden you're thrown into doing a rhinoplasty.
00:14:37.037 --> 00:14:40.477
Right? Because if you remember, and I do want to get to this point,
00:14:40.737 --> 00:14:46.677
if you remember, we didn't just jump into rhinoplasty as second-year residents.
00:14:46.697 --> 00:14:51.437
Right? We started off doing septoplasties, and we'd watch a lot of rhinoplasties,
00:14:51.557 --> 00:14:57.377
but it wasn't until my chief year that I was actually doing osteotomies and moving bones.
00:14:57.877 --> 00:15:02.857
And definitely in my fellowship, you learn more. And so that's one of my biggest
00:15:02.857 --> 00:15:06.977
fears that I have now with this younger crop of physicians that's coming up.
00:15:08.457 --> 00:15:13.137
They're going to have a longer period of fear. I think every young surgeon when
00:15:13.137 --> 00:15:17.537
they graduate from residency or fellowship has a period of fear,
00:15:17.697 --> 00:15:19.957
you know, like that, holy cow, I'm on my own now.
00:15:20.137 --> 00:15:22.637
Yeah. I'm slightly looking over my shoulder. I remember those days.
00:15:22.817 --> 00:15:24.377
Yeah. Losing sleep before you're ready.
00:15:24.877 --> 00:15:27.297
You know, you're sitting there like, what if I, what if this happens?
00:15:27.437 --> 00:15:28.257
What if that happens? Whatever.
00:15:28.617 --> 00:15:34.757
And so, but you got to realize we were doing that on the heels of 4,500,
00:15:35.237 --> 00:15:39.477
maybe 5,000 cases that we had done just in the face during residency.
00:15:39.477 --> 00:15:44.797
Well, now with all the resident restriction work hours, these kids are graduating
00:15:44.797 --> 00:15:47.797
with two-thirds of the cases low data.
00:15:48.097 --> 00:15:54.077
Yeah, I think that that's inherent in what is coming out of residency right now.
00:15:54.277 --> 00:15:59.237
I don't think that the way residencies were designed when you and I were in
00:15:59.237 --> 00:16:03.357
it, I don't know that that was the best way to educate.
00:16:03.357 --> 00:16:09.357
And all of that, I'm digressing here, but all of that was born from the father
00:16:09.357 --> 00:16:12.097
of modern surgery in the United States.
00:16:13.785 --> 00:16:18.485
There's a big statue of him at Hopkins. I can't remember his name now. I don't agree with that.
00:16:18.645 --> 00:16:22.525
Well, he was a cocaine addict. No, no, no. I'm not saying him.
00:16:22.605 --> 00:16:25.805
And he was up at ungodly hours of the day. He wouldn't sleep.
00:16:25.805 --> 00:16:29.485
And so his residents wouldn't sleep either.
00:16:29.485 --> 00:16:38.045
And that whole educational system in surgical education was born out of a cocaine addict.
00:16:38.045 --> 00:16:41.925
So it became very punitive. So it became punitive and it became this,
00:16:42.105 --> 00:16:45.445
it doesn't matter how much you don't sleep or how much you do sleep.
00:16:45.525 --> 00:16:48.865
Yeah, but there's the argument though, and I'm not totally disagreeing with
00:16:48.865 --> 00:16:55.965
you, but there's the argument that a Navy SEAL is the warrior that he is because
00:16:55.965 --> 00:16:59.265
he doubted his entire existence in his training, right?
00:16:59.365 --> 00:17:02.485
That he got taken to the brain. But he got pushed to the left.
00:17:02.485 --> 00:17:06.965
And if you don't take these kids and you don't push them and have the fear in
00:17:06.965 --> 00:17:10.045
there, because right now these residents don't have the fear of being fired.
00:17:10.505 --> 00:17:14.045
That's correct. That's something that we have that fear. And every day you went
00:17:14.045 --> 00:17:17.005
into a case and if you weren't ready for it, you knew you were going to get blasted.
00:17:17.045 --> 00:17:20.865
I mean, I don't know, my fourth year of residency, one of my attendings,
00:17:21.025 --> 00:17:24.845
Rick Kelly, if you're listening to this, it was you and who I ended up loving.
00:17:24.945 --> 00:17:25.805
And he and I are good friends.
00:17:26.105 --> 00:17:29.965
He looked over at me and he goes, you might be Dr. Garcia, the dumbest person
00:17:29.965 --> 00:17:33.665
I've ever met in my life. And it was only because I didn't know one particular
00:17:33.665 --> 00:17:36.785
part of this laryngology procedure we were doing.
00:17:36.985 --> 00:17:39.705
And so you have a choice at that point. Yeah, yeah. And you can say,
00:17:39.885 --> 00:17:43.825
all right, does he really think I'm the stupidest? Like, really, the stupidest?
00:17:44.085 --> 00:17:47.425
There's guys with IQs of 50. That guy, BB?
00:17:48.302 --> 00:17:55.022
Or is he just saying it to challenge me, to make me really rethink something
00:17:55.022 --> 00:17:57.542
and never make this mistake again? And it's obviously the law.
00:17:57.802 --> 00:18:00.882
Yeah, yeah. We all know that you have to push the motor to the limit to know
00:18:00.882 --> 00:18:04.582
what the motor is capable of. I don't disagree with that part of it.
00:18:04.902 --> 00:18:11.482
The part that to me was the most distasteful part of residency was the hazing
00:18:11.482 --> 00:18:17.942
and the mental torture side of it. the, I went through this process and I'm
00:18:17.942 --> 00:18:19.342
going to make you go through this process.
00:18:19.642 --> 00:18:23.582
I thought that was totally unnecessary, but maybe it was, it was a little bit more malignant.
00:18:23.802 --> 00:18:29.122
My, my residency was malignant. It was in New York city and it was all in all.
00:18:29.262 --> 00:18:33.342
I do take away good memories from residency, but that, that was the way that
00:18:33.342 --> 00:18:36.522
the educational system was and that's, you just went through it.
00:18:36.582 --> 00:18:39.962
And it's a very important point that you brought up that, especially when I
00:18:39.962 --> 00:18:45.102
was an intern, I will, I, I'm every day that I was, I walked into the hospital,
00:18:45.362 --> 00:18:51.082
you are under fear or threat of being fired and you don't know.
00:18:51.282 --> 00:18:55.602
And if you're fired from internship, remember you're already accepted to residency,
00:18:55.602 --> 00:18:58.002
which is what you're going to do for the rest of your life.
00:18:58.142 --> 00:19:02.522
And if you're fired from that internship, there goes your entire career plan
00:19:02.522 --> 00:19:04.322
because you're no longer a resident.
00:19:04.422 --> 00:19:10.902
So you've now got, you, you've, you have to figure out. And I'll give you a quick anecdote.
00:19:11.142 --> 00:19:20.442
I got called in to the chairman of surgery's office one time because I was late to a conference.
00:19:20.862 --> 00:19:24.142
I was late because I was taking care of the patients on the floor.
00:19:24.262 --> 00:19:26.822
I mean, I had a valid reason. Somebody was crashing here.
00:19:27.342 --> 00:19:30.202
And I was late. He saw me walk in late.
00:19:30.442 --> 00:19:34.942
After the thing, he called me into his office. And I can tell you that I honestly
00:19:34.942 --> 00:19:39.842
thought I was going to get fired. and I was convinced this is it I'm done and.
00:19:41.442 --> 00:19:46.722
How much good that did to my fortitude and the creation of character.
00:19:47.102 --> 00:19:52.542
That's tough to say. I don't know, but you're absolutely correct in your assessment
00:19:52.542 --> 00:19:55.222
about pushing that engine. Yeah.
00:19:55.722 --> 00:19:59.422
Well, and look, I mean, if we were to kind of wrap this up, I,
00:19:59.502 --> 00:20:02.042
and I wanted to, I do something really cool at the end.
00:20:02.182 --> 00:20:04.022
I don't know if I've told you this, but we'll talk about it in a minute,
00:20:04.122 --> 00:20:08.642
but 20 years, 25 years later. Okay.
00:20:10.482 --> 00:20:16.322
Now patients come seeking facial plastic surgeons. Right. They come seeking the specialty. Yeah.
00:20:17.122 --> 00:20:19.982
And, you know, it's something to be proud of.
00:20:20.182 --> 00:20:25.262
Yeah. It's something to be proud of that, you know, you and I have been steadfast
00:20:25.262 --> 00:20:29.242
in our commitment to the specialty in this community and in this part of the country.
00:20:29.562 --> 00:20:36.282
Yeah. And, you know, our reputation precedes us really as individuals that were,
00:20:37.031 --> 00:20:40.331
is characteristically driven towards a particular model.
00:20:40.751 --> 00:20:44.551
And, and I think that a lot of that, and this is going to lead me into our last
00:20:44.551 --> 00:20:46.031
segment, which is perfect.
00:20:46.391 --> 00:20:51.531
Okay. You guys all laugh at it every time I do it, this all leads us to lessons
00:20:51.531 --> 00:20:53.651
that we learned from dad, you know?
00:20:53.951 --> 00:20:58.671
And so, you know, dad died. My dad, I say this every week, but our dad died
00:20:58.671 --> 00:21:01.971
last year in June, June 16th, almost a year.
00:21:02.331
--> 00:21:09.411
And dad, uh, as well, you know, dad loved to teach dad loved to talk to us and
00:21:09.411 --> 00:21:13.051
he loved to talk to everybody and along the lines.
00:21:13.151 --> 00:21:18.931
And I think this is so appropriate for this conversation was the lesson or the,
00:21:18.931 --> 00:21:24.571
the, the kind of that, that ongoing message of in order for you to succeed,
00:21:24.911 --> 00:21:26.791
you have to fail countless times.
00:21:27.711 --> 00:21:32.331
And the, you know, the idea, the Thomas Edison concept of the light bulb,
00:21:32.471 --> 00:21:34.171
right? Failed, I don't know how many times.
00:21:34.651 --> 00:21:39.111
And I tell patients all the time, I said, you know, the surgeon that I was at
00:21:39.111 --> 00:21:42.051
the beginning of my career, it's a completely different surgeon than I am now.
00:21:42.411 --> 00:21:48.431
And really not only in the medical field, but in a personal, right?
00:21:48.811 --> 00:21:52.011
Interactions with my employees, interaction with friends, interaction with family.
00:21:52.971 --> 00:21:56.251
You, you learn, okay, that's not the right way to talk to that person.
00:21:56.411 --> 00:22:00.271
That's not the right thing to say. Let me correct that. And let me get a little bit better.
00:22:00.371 --> 00:22:07.491
But the difference in dad spoke about this, you can't be hubris.
00:22:07.931 --> 00:22:11.111
And when you make a mistake, you have to own it.
00:22:11.251 --> 00:22:15.991
You have to make a correction and you have to adjust and become a better person
00:22:15.991 --> 00:22:19.991
because the goal of this isn't a scoreboard at the end of life where,
00:22:19.991 --> 00:22:21.451
you know, where God says, or St.
00:22:21.611 --> 00:22:23.831
Peter at the gate says, all right, Roberto, good job.
00:22:24.031 --> 00:22:29.191
You won 5,650 times, but the people around you, the world around you hate you.
00:22:29.311 --> 00:22:32.211
You know, that's not how it is. There's no scoreboard.
00:22:32.511 --> 00:22:36.331
What matters is that as you're going along and you make a mistake,
00:22:36.331 --> 00:22:38.671
and to our point about our specialty.
00:22:39.516 --> 00:22:42.396
The details get tighter, right?
00:22:42.516 --> 00:22:46.676
And so now, you know, whenever there's something that you're seeing at three,
00:22:46.896 --> 00:22:51.596
six months after surgery, you can, in your mind say, I know exactly why that
00:22:51.596 --> 00:22:55.836
happened because your, your window of error is this tight.
00:22:56.016 --> 00:22:59.876
Yeah. You pay attention to more details. The big stuff has worked itself out
00:22:59.876 --> 00:23:04.076
throughout your career and you pay attention to those little details a lot more.
00:23:04.076 --> 00:23:08.856
And it makes you better at being, being more effective and
00:23:09.056 --> 00:23:11.856
having better results but if if i may
00:23:11.856 --> 00:23:14.936
say something about dad the the
00:23:14.936 --> 00:23:17.796
thing that in in your segment the thing
00:23:17.796 --> 00:23:26.796
that i i still remember dad telling me is nobody owes you anything and i still
00:23:26.796 --> 00:23:35.176
remember multiple conversations about you know when i finished residency i finished fellowship.
00:23:35.756 --> 00:23:40.296
And, and I said, okay, dad, I'm ready to start my practice.
00:23:40.696 --> 00:23:46.296
And I remember dad saying, and now's when the work starts.
00:23:46.636 --> 00:23:53.476
And that's because he always taught me and I knew as well that you're only as
00:23:53.476 --> 00:23:55.076
good as what you did yesterday.
00:23:55.963 --> 00:23:59.823
Everything can come crashing to an end today.
00:24:00.183 --> 00:24:07.883
You have to have the humility to realize that and to understand that you're
00:24:07.883 --> 00:24:10.023
not owed anything in life,
00:24:10.243 --> 00:24:15.183
certainly in our field, in our specialty, in our practices.
00:24:15.583 --> 00:24:19.543
Nobody owes you anything. You have to work every day and you have to challenge
00:24:19.543 --> 00:24:23.123
yourself every day and, and always be attentive.
00:24:23.363 --> 00:24:27.383
Never take your eye off the ball because there's nothing here for granted.
00:24:27.663 --> 00:24:30.783
So that's my lesson from that. That's beautiful.
00:24:31.183 --> 00:24:36.983
That's exactly right. Yeah. Well, listen, man, it has been absolute honor having you here.
00:24:37.163 --> 00:24:40.663
I really appreciate you coming out here. I know you're busy and we,
00:24:40.783 --> 00:24:43.103
this is honestly, this may be the best one.
00:24:43.563 --> 00:24:48.103
Okay. I know we said that last week. It's because it's me. But it's my bro. Sorry, Patrick.
00:24:48.423 --> 00:24:51.703
But it's my brother. And I do think this one took the cake.
00:24:52.083 --> 00:24:57.323
So any of you thinking about watching the Confident Choice, you want to go to this one first.
00:24:57.743 --> 00:25:02.743
So next week, we're going to be talking about, let me get my card, revision surgery.
00:25:03.303 --> 00:25:08.083
And how is it that we accept not the best results?
00:25:08.323 --> 00:25:13.103
And where do we go as surgeons to that next step? Do we wait a little bit?
00:25:13.263 --> 00:25:15.863
Do we go ahead and get, do we intervene a little bit sooner?
00:25:16.263 --> 00:25:19.623
And how do we plan the proper revision surgery for whatever it is.
00:25:19.963 --> 00:25:22.043
And, folks, I'm going to tell you something. I'll get into this next week.
00:25:22.263 --> 00:25:24.983
Any surgeon who tells you he doesn't have revision surgeries,
00:25:25.363 --> 00:25:28.203
he's either lying to you or hasn't done enough of them. That's a fact.
00:25:29.063 --> 00:25:33.923
And it has nothing to do with the surgeon. It has to do with the way the cookie
00:25:33.923 --> 00:25:36.323
crumbles sometimes. Results happen.
00:25:37.283 --> 00:25:40.223
Biology is different between person A, B, C, and D.
00:25:40.543 --> 00:25:44.523
So we'll dive in a little bit deeper into that next week. And remember,
00:25:44.763 --> 00:25:45.943
Alyssa's going to get me here.
00:25:46.663 --> 00:25:50.383
Better decisions make better information. What is it? Good decisions always
00:25:50.383 --> 00:25:53.263
come from good and free. And good.
00:25:54.307 --> 00:25:58.407
Good decisions always come from good information. We're signing out.
00:25:58.507 --> 00:25:59.447
Have a great week, everybody.