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The plastic surgeon who keeps his clients’ secrets.

When I meet someone, I’m always looking at the underlying structure, bone structure, muscle and fat, skin structure. I won’t say it comes as an analytical process, like if I’m at a cocktail party I’m evaluating everybody. I don’t want people to get paranoid about talking to plastic surgeons. I would say it’s more having a discussion with an artist, but they shouldn’t feel uncomfortable, like they’re a piece of marble I’m going to chisel into a statue.

When I go to family get-togethers, or other parties, I get lots of questions. In fact, it’s kind of hard on my wife, when people find out that she’s married to a plastic surgeon, all of a sudden, they’re looking her up and down, “OK, what did you have done?”

I have to be discreet when I’m out in public. When I see a patient, I can’t just say, hi, how ya doing, because there’s an association. Their friends are going to say, “Hey, how do you know him?” All those questions come up.

This town is very secretive. Southern California is like the mecca for plastic surgery. Here in Honolulu, 10 years ago, the demand was to make the improvement, make it subtle and nobody needs to know about this, and they did it for themselves because they wanted to feel good about how they looked. Today, there is still an underlying need for secrecy and being confidential, but I do see a little more freedom in terms of who they’re going to tell. I think that’s part of the media, there’s more exposure to what can be done.

A lot of surgical cosmetic procedures are popular with the Koreans, such as facial surgeries, the Japanese tend to go for more nonsurgical procedures, such as Botox. The Chinese are an up-and-coming group. The industry in China is starting to boom, as they get more affluent. For Caucasians, it’s all about their fair skin. They start aging faster and their skin is more sensitive to sun damage.

Eighty percent to 90 percent of my patients are women. There are the 18- to 20-year-olds who are just getting out of high school, about to go to college. Parents are saying, “Maybe you want a nose job, maybe get your breasts pumped up.” Some parents will give them this as a graduation present, and I’m not being judgmental that that’s good or bad.

Women in their mid-40s come in. After the moms have had their children and breast-fed, they find that their breasts shrink or basically deflate. So they come in for “mommy makeovers.” They’re either getting their breasts lifted so they’re perky again, or refilled with implants. They have some loose skin from the pregnancy that they’d like to have tucked. A lot of what we do is like tailoring, in a sense. If the suit’s too big, we take it in to make it fit, and we can sometimes put fillers in, like shoulder pads in a jacket to smooth out a garment.

A phenomenon in the last few years has been the Brazilian butt lift where people are getting liposuction and they’re saving the fat and actually having it injected into their butt to create the Kim Kardashian look, the J.Lo look.

Women who get through their 50s, some of them are widowed or divorced and they’re looking to look and feel better about themselves. So facial rejuvenation is popular. We do a lot of eyelids—bags under the eyes—face lifting, brow lifting, neck lifting. I’ve had patients up to their 80s getting facial rejuvenations.

It’s not uncommon to see patients really get a boost in their confidence and self-image, and that makes them want more work. Certain patients read something in a women’s magazine or see something on an infomercial, and they’ll come in and ask me about it, and sometimes I have to turn them down. If there is more risk than benefit, I’m not doing it. I always have to look at the risk-benefit ratio, particularly if they’re on multiple medications, blood thinners. I’ve mostly had a good group of patients who are reasonable, but I have some that are unreasonable, and I’ll have to tell them that this is not something I can do for them.

Plastic surgeons also deal with psychosocial mental issues. Somebody could look at what we do and say, “Oh, how shallow.” There is a level of vanity and shallowness there, but there are also some deep-seated issues that can be brought out.

Somebody may have had their older sister say something about their nose when they were young and they can’t let that go. There are issues that come up that can be addressed that I believe are healing. I always look for those opportunities because that’s where I make the biggest impact. For me, it may be a half-hour of work. For them, it’s the rest of their lives.

—As told to Tiffany Hill