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Join Mossi Salibian, a plastic surgeon, as he shares his journey from a background in biochemistry to becoming a successful practitioner in the field. Mossi delves into the intersection of art and science in plastic surgery, the importance of patient empathy, creative approaches to achieving desired outcomes, and the significance of maintaining integrity in his work.

Mossi Salibian is a plastic surgeon.

He discusses the KevinMD article, “Top tips to find success as a plastic surgeon, according to an industry veteran.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Mossi Salibian. He’s a plastic surgeon. Today’s KevinMD article is titled “Top tips to find success as a plastic surgeon, according to an industry veteran.” Mossi, welcome to the show.

Mossi Salibian: Thank you, Kevin. Thanks for having me on the show.

Kevin Pho: So tell me, what are some of your motivations for going into plastic surgery?

Mossi Salibian: Well, first of all, as you know, I love the sciences. I was interested in the life sciences more than anything, and plastic surgery allows you, once you’ve understood the foundations of medicine, anatomy and physiology, to be more creative in the ways you do things, as long as you understand the basics and what will work with the different types of challenges and presentations that you’re faced with. Compare that with, let’s say, surgical oncology or urology, which are more based on algorithms for specific cancers and their stages. The reconstructive aspect allows you to depend more on your own creativity: what is the best way to reconstruct for this specific situation, whether it’s a breast or a facial melanoma that’s been excised. So there are different options to be able to serve in this specialty.

It also allows you to connect. We see patients for a long time, not just from the consult. The surgical oncologist, let’s say, does the procedure and sees them a few times until it’s healed, but as plastic surgeons we see them for a much longer period, because a lot of our surgeries may be staged. So we connect with people, we connect with the family. It’s a totally different game and a different way of practicing.

Kevin Pho: So you are a successful plastic surgeon, and your KevinMD article is titled “Top tips to find success as a plastic surgeon, according to an industry veteran.” Tell us, how did your article come together?

Mossi Salibian: It’s amazing how the years have gone by. It’s been 20, 22, 23 years already. And so there are the basics we learn in medical school, how to be empathetic and listen to patients. Those foundations you learn, or you have to have in you as well, right? We all choose to go into medicine because we want to help people and be compassionate with whatever ailments they present with.

In plastic surgery you’re dealing with patients’ self-esteem, their sense of what bothers them and why. So basically it’s about quality of life. We’re not saving lives the way a trauma surgeon or an oncology surgeon would; we’re helping with patients’ quality of life. So you need to be able to listen and understand where the patient is coming from, what issues bother them first, second and third, and how many of those we can really address. You need to understand their level of expectation. Some people think that we can transform them completely. They may be in their late 60s and think they can look like they’re in their 20s. Some things are just not possible, and that applies not just to the face but to body parts too. So we need to understand their expectations and how to navigate that journey.

Kevin Pho: Now, plastic surgery is one of the fields that you see more on the internet than other physician specialties, right? From a patient standpoint, when they’re bombarded with so many advertisements from plastic surgeons on social media, on the internet and on Google, how can they make sense of who they should go to? What kind of questions should they ask to know who is a reputable plastic surgeon?

Mossi Salibian: That’s a great question. You’re right, people are bombarded, and a lot of it is because of marketing and the democratizing of cosmetic procedures. And a lot of what I think you’re getting at is procedures performed by people who are not trained, who don’t have the traditional residency training in plastic surgery. We see primary care physicians doing them, because the companies that make things like laser lipo, or other minimally invasive technologies, advertise to specialties that aren’t trained in them: “It’s easy to do, you don’t need anesthesia.” And they advertise heavily, so patients are confused. The ad says this is the best liposuction or liposculpting surgeon, and things like that.

What patients need to understand is that it’s much easier now to research a physician than it was, let’s say, 20 years ago, because technology is moving so fast. So there’s really no excuse not to research the physician rather than rely only on their marketing of what they say they do. First of all, patients can look for certification. What have they trained in, and is what they’re advertising congruent with that? Have they trained in plastic surgery, have they graduated, and do they have their boards? It may take a few years to get your boards, and that’s fine, but have they at least done the training? That’s the minimum.

Then you want to look at experience, depending on the procedure you’re having done. Some people may think breast augmentation is simple, so you have non-plastic surgeons doing breast augmentation. But complications can happen in the best of hands, so patients need to understand that they’re trusting their body to somebody who is experienced and knows there’s a plan A, B, C and D should there be an issue. As plastic surgeons we see complications, and not just from overseas, where people come back with infections, but wrong-size implants, the wrong plane of dissection, asymmetries, all types of problems, done by people who are not trained.

It’s easy to look people up, but with the bombardment of advertising, patients need to be able to weed it out. Look at the American Board of Plastic Surgery. It has a whole website that tells you when each candidate got certified, and then there’s recertification every 10 years. That’s one. Another is looking at the American Society of Plastic Surgeons website to see if they’re members. Those are some of the basic things, besides their credentials and when they went to school.

Then, as far as experience, how many years of practice they have. I would say five years out of training, even though I finished a fellowship. That’s a total of eight years in a surgical residency program: five years of general surgery, two years of plastics and one year of fellowship. So lots of surgical training, but the first five years after residency, probably in any specialty, is really your own private sort of fellowship, where you’re seeing patients from all walks of life. So experience does count.

And the last thing I would say is talking to a physician’s patients. One of the best compliments I have is that patients volunteer to talk to other people and even meet them. So that is a great thing. It’s not just what the surgeon says. After the consult, people can ask, “I would like to talk to your patients, is it OK to make a call?” And some patients may even volunteer to meet with them, so that’s important.

Kevin Pho: You said earlier that one of the secrets, and I hate to say secrets, it’s not really a secret, to your success is listening to patients. In the context of plastic surgery, I know that there are a lot of psychological components as well for people who come to you. What are some specific ways that you can show that you’re listening and address some of these accompanying psychological concerns?

Mossi Salibian: Great question. You need to be able to understand whether it’s a complex issue, and basically help them navigate what is important: how to correct a deformity, let’s say, or how to improve an appearance, and whether it’s cosmetic or reconstructive. A lot of the time it is actually combined. We do functional work as well. Let’s say it’s a rhinoplasty and some people cannot breathe. So we basically dissect the issues that the patient presents with and explain them to the patient: We can address this and that, but not the third issue they’re presenting with. That’s how you gain their confidence, because you’re taking your time and explaining surgical nuances, with timing based on their medical presentation. And we always ask them to come back for another consultation to establish a better rapport if they need to.

Kevin Pho: Now tell us some tips that you could share with other plastic surgeons and surgical subspecialists on how they can maintain their success and longevity. Any tips from your own experience that you could share with other surgeons?

Mossi Salibian: I think one of the tips I would give is to stay in touch with your patients. Practice managers are trained so that once a patient is booked and the surgery is done, it’s done. There’s a term for it, “book to follow.” But it’s not just that they had the surgery; you should follow up with them too. That’s important, because you never know where your referrals come from, in any subspecialty.

I’ve had a referral from a technician in pathology, just based on the specimens from breast reductions that he received. He told his mom that she should go to Dr. Salibian, because every time he got specimens from my breast reductions they were so nicely done that he knew which part of the breast each specimen came from. So you never know where your referrals come from. You need to keep an open mind and be respectful when you’re out in the community engaging with people.

And be available. In surgical specialties, availability is key: your phone, your office. It’s so annoying when you call some practices and it’s a recording, and then somebody answers who is answering for three other people. It’s not personal. So you need availability, you need to be personable, and your staff needs to be well versed in what you’re offering your patients, regardless of what type of plastics you practice, because some people just do breasts, some just do noses, some do everything, and there’s hand surgery. Your staff needs to be able to engage and have a conversation with patients. I’m not saying about clinical things, but at least be able to have that conversation.

Kevin Pho: We’re talking to Mossi Salibian. He’s a plastic surgeon. Today’s KevinMD article is titled “Top tips to find success as a plastic surgeon, according to an industry veteran.” Mossi, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Mossi Salibian: The most important thing, as we talked about earlier, is listening. Be engaged with patients, manage their expectations, and offer the best that you can offer given your resources as a surgeon. Make sure that all the safety modalities are checked and double-checked, from something as simple as pre-op clearance. We do pre-op clearance for everyone, regardless of age and how they present. Obviously if someone is older and has a history of cardiac issues, they get full cardiac clearance. But my point is you need to follow the patient pre-op, perioperatively and postoperatively, and check everything, because first and foremost we are physicians. So we make sure the patient is healthy medically, psychologically and mentally for procedures.

And remember, a lot of this is elective. I did a lot of trauma reconstruction in the beginning of my practice, but a lot of what we do, even breast reconstruction, can be elective. So patients have lots of options, and you need to navigate the journey with them at the right time, always keeping patient safety at the forefront, and then executing your procedures well, always having plan A, B and C in your mind, ready should you be presented with an unforeseen situation.

We all have complications in surgery. We say the people who don’t have complications are the ones who don’t operate, right? So it’s how you deal with the complications. We’ve had complications, and it’s interesting: Patients who have had complications have referred their loved ones, because of how we dealt with that complication. It doesn’t mean the end of your career. It’s not like being a performance artist who has one bad day. People do give us second chances, and it’s very humbling. It’s a profession that you grow with, so keep your academics up to par.

Kevin Pho: Mossi, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Mossi Salibian: Thank you, Kevin.