ASK THE EXPERT: Dr. Mossi Salibian
Tell me about your background as a plastic surgeon, education, training, experience.
I trained in New York both in General Surgery and then in Plastic and Reconstructive Surgery where we learn the whole gamut of Cosmetic and Reconstructive Plastic Surgery. Academically the School of Plastic Surgery is one of the oldest specialties in Surgery; established in 1938, with its fast “break out” or advancements in techniques during the first and second World Wars where ballistic injuries sustained by soldiers in combat were the trigger in advancing the science of Plastic Surgery in devising ways to best reconstruct these maimed soldiers. The various branches of Plastic Surgery then flourished as well as the repair of congenital defects in new born babies and adults, reconstruction post cancer ablation of facial and body parts as in breast reconstruction and last but not least Cosmetic Plastic Surgery all at the same time. The principles learned and applied in tissue rearrangement for reconstructive needs were easily transposed to Cosmetic Surgery where the outcome was to improve the appearance and quality of life for a patient in addition to the functional parameters.
After completing my training in Plastic Surgery, I completed a Fellowship in Cancer Reconstruction at M.D. Anderson Cancer Center in Houston, TX which gave me an invaluable technical skill and knowledge base in complex reconstruction of the head and neck, chest, breast and body and extremity post both in form and function and cosmetic appearance after major resection of these body parts due to the ravages of various stages of cancers. I then was hired at a large Medical Group in Los Angeles which is how I moved here in 2002 and was busy practicing my craft. I basically hit the ground running as I was able to implement many of my learned skills into practice as the opportunity was ripe in a very short period of time. I completed my Board Certifications in Plastic Surgery during those two years working as a full time Plastic Surgeon and thereafter began my Private Practice here in West Hollywood in 2004. Having been in Private Practice now for fifteen years, and in fact 25 years in Surgery, I feel immensely fortunate to have consistently forged the trust and loyalty of an ever growing cadre of loyal and grateful patients who come from all walks of life and whose strength of character and courage inspires and humbles us on a daily basis.
Do you focus on specific specialties in your practice? For example, do you tend to do more breast augmentations? Rhinoplasty? Facelifts?
No I do not do one procedure over another, I specialize in not specializing as I love doing all types of procedures and I fine-tune each procedure to achieve the best outcome for each patient. In addition to breast augmentation, whether it be primary or secondary (i.e. revisions), I also do a very large number of nose surgeries again as primary or those who need revisions and face and neck lifts for men and women.
I do have a special niche in addition to all the wonderful procedures that we do in Plastic Surgery in reconstructive surgery for those patients who have Poland Syndrome. Poland Syndrome is a congenital anomaly where a portion or all of the Pectoral muscle is absent resulting in an asymmetrical appearing chest more commonly seen in men vs. in women. I usually reconstruct by creating a custom made implant that is therefore unique for each patient which is then inserted from the axilla to achieve the best symmetry for each patient. Therefore it combines the art of sculpting with surgery in plastic surgery. As Plastic Surgeons, most of us do a fair amount of liposculpting when we do liposuction for example in routine liposuction to achieve a more aesthetically appealing result. Liposculpting is also used with dramatic results for our trans-female and trans-male patients.
Is it ever too early to get plastic surgery if it isn’t a necessity due to an accident or other medical issues?
The timing to have a specific procedure depends on the procedure and the purpose for that procedure at that specific time. Therefore, I cannot make a blanket statement whether a said plastic surgery that is for cosmetic purposes is too early for that said individual or not. I usually consult with the patient on more than one occasion and with a responsible guardian if they are minors, to assess their maturity level, their reasons for their desired change and other options that may be available to them. Most of the time, the procedures if they are purely cosmetic would need to wait until their bodies and / or their maturity level have reached a certain milestone before proceeding with surgery.
Who are your typical clients? Do you have typical clients?
Our typical clients I would say are women ranging in age from 30s to late 60s and men with the same age ranges. I probably do see more men in my practice than other plastic surgeons in our area. I do have a fair amount of patients in the entertainment industry as expected; the patients contact our office primarily because of word of mouth referrals by our existing patients, by our colleagues and friends.
What do you look for when a new potential client walks in your office?
I look to see if their desire for a specific change is a realistic one, another was to say it is if they have realistic expectations and assess if that would make a positive difference in their appearance and whether that expectation can be met. I also look to see if they have an open mind to hear and understand my recommendations. The time spent during the consultation and the quality of that consultation itself is a key factor in establishing rapport and win their trust.
Are there any red-flags that you look for when interviewing a potential client?
Two main red flags would be if they have seen several similarly qualified plastic surgeons and have a barrage of negative comments about their experiences with the other surgeons. The second is if their expectations are unrealistic and if they hone in on insignificant or minute details that would not make a difference in the overall picture yet they are focused on the wrong things and keep bringing that up as their concern and are never truly satisfied. Usually these patients may also suffer from an element of Body Dysmorphic Disorder that would need to be addressed by the proper channels in mental health counseling and therapy. Patients need to also understand that there is no “perfect” result or “perfection” we certainly strive for that ideal for our patients, however, people need to remember that we are dealing with living, breathing and changing medium, our bodies, our tissues that is, that is also subject to the ravages of the environment, our lifestyle, gravity, sun damage and aging in general.
What are some new innovations in plastic surgery that the public may not be familiar with?
There are a myriad of new procedures and upgraded laser platforms and non – surgical products that are out in the market. The gamut is wide to discuss here, however they include but are not limited to procedures that are constantly improving in the breast cancer reconstructive arena, in facial transplantation, trans – gender surgical arena both in male to female and female to male, in cosmetic facial fillers and lasers, fat grafting and fat reduction among others.
What are a few frequently requested procedures in the last few years? Why do you think they are popular?
Fat grafting to the buttocks has been an evolving trend due to some celebrities who have popularized it here in LA. Fat grafting is not a novel procedure as it has been done for decades by plastic surgeons. Direct to implant breast reconstruction or single stage implant based breast reconstruction is another relatively new trend which was also performed in the late sixties and seventies; which in fact was how silicone breast implants were invented and came on to the World market as women with fibrocystic breast condition were having subcutaneous mastectomies and implant based breast reconstruction. As expected, the procedure has evolved through the years with advances in breast cancer diagnosis and genetic screening as well as in the various new biomedical devices and tools that we now use to reconstruct breasts and can at times make them appear even better than the native breast prior to the mastectomies.
Not all plastic surgeons are astute in doing face-lifts on men. Are there are particular challenges or points for men to keep in mind when considering a face-lift?
Yes, the worst thing that could happen when a man is having is facelift is when they appear feminized. The masculine face and features need to be carefully studies and incisions placed at correct areas of the face to not only hide the evidence of having had a face lift but also knowing how to rearrange the sagging tissue for example of the neck to achieve a youthful contour afterwards or how much to elevate the brows or remove eyelid skin so the eyes do not look “done” Aging is not simply sagging of ones’ skin and loss of elasticity. There are other factors that are sometimes ignored as the volume loss with aging not only in the skin and fat but also with bony osteoporosis and thinning of bony framework that needs to be accounted for with surgical rejuvenation of a man’s face.
Are your clients more female or male?
We do indeed see more female patients; however, I do have probably more male patients than other plastic surgeon in town. I also see a fair number of trans-male and trans-female patients for facial, chest, breast and body procedures. I do not perform “bottom” surgeries however, as that needs the expertise of a Urological or Urogynecological and Plastic Surgical trained specialists.
Are there any notable trends in plastic surgery today?
Fat is valuable especially as we age; therefore one of the most popular trends is fat grafting for tissue loss with aging and deflation of facial features and body contour. The importance besides know how to do the procedure safely, is knowing how much fat to graft to make an attractive change vs. an over grafted, over filled and fat looking face or body part that looks grotesque and caricature like.
There are always new laser modalities and less “invasive” procedures that come to the Cosmetic market that are not always worth the expenses as the outcomes do not last or even affect an appreciable change. There is heavy marketing that is done with new products that have not stood the test of time and people need to be wary of the false advertisements.
How much do Hollywood and the entertainment industry affect people’s desire for plastic surgery?
The industry does indeed influence especially younger girls in our town. There is a constant barrage of advertisement on social media, bill boards, TV and print where girls are portrayed as flawless and “sexy” where in reality there is no “perfect” appearance. I wish each and every single person regardless of one’s sex would look inside to find their inner beauty and sense of purpose and self-esteem and not be influenced with the science of marketing and advertisements. We as plastic surgeons do made a difference in people’s lives and appearance, however, the deeper contentment in one’s life would need to come from within the exterior and have a life purpose to lead a happy and fulfilling life.
What should people consider when screening a plastic surgeon?
First and foremost, they need to make sure if the doctor has had training in Plastic Surgery. This is the first check mark that needs to be a “yes” before proceeding any further. There are many “cosmetic” surgeons in our town who have not had the proper residency training in Plastic Surgery and yet market constantly on Instagram and other social media avenues as the “busiest” liposuction “surgeon” where they have had absolutely zero training in surgery let alone Plastic Surgery, which is an intense curriculum of years of practice and scientific training that is tested and re tested at every progressive milestone of one’s residency training and beyond. Therefore they need to be careful in how they are choosing their “trusted” surgeon and allowing this person to operate on their body and / or face. Second, they can ask former patients and colleagues about the satisfaction with their experiences and check on various physician rating apps on line about the practice and the surgeon.
Who, if anyone, should not have plastic surgery?
Patients who are poor candidates due to their medical illnesses and other medical and mental health issues that could preclude them to have a safe and successful outcome. There are specific categories of questions that we address during the consultation to assess a patients’ candidacy for procedures in addition to the procedure itself. We obtain medical clearances routinely by the patients’ primary medical doctors and if need be involve other specialists if they have other medical issues that need to be addressed prior to their elective plastic surgery. It is important that all T’s are crossed and I’s dotted and medical work up is checked and double checked by several trained pairs of eyes before a patient is put to sleep. And then there is the execution of the surgery with all the safety parameters in check and recovery and post recovery close follow up regimen. These are basic medical and surgical safety guidelines that are not over looked in any instance.
Would you like to add anything else? Questions not asked? Closing statement?
Have a clear understanding as to why you desire a specific procedure and what are your expected outcome. Have an open mind as to what is to what procedure is needed as what you may think you need is in fact not what would make the desired outcome. Your trust in your Plastic Surgeon and his recommendations and how to achieve them is key in obtaining a satisfactory final outcome.
How can people get in touch with you for a consultation?
By calling our office at 310.550.0750
Address 9201 West Sunset Boulevard, Suite 917, West Hollywood, CA 90069
Similarly on RealSelf.com at https://www.realself.com/find/California/West-Hollywood/Plastic-Surgeon/Mossi-Salibian