A childhood injury is as partially responsible for American Dr Richard Westreich becoming a plastic surgeon and today, 18 years into his profession, he offers advice on the safe way to have these surgeries done even as he brushes aside criticisms that they are not necessary, are risky and a waste of time.
The father of two, who is also musician with his own band, believes people should be able to make changes to their bodies as they see fit, as long as it is not a case of them having some kind of disorder that fuels their desire to be under the knife repeatedly.
He advises that as the summer is approaching persons should avoid “resurfacing procedures, laser treatments, body surgery and neck treatments… Summer is the time for noninvasive face and body treatments since you can’t cover up.” He added that breast augmentations can be done year round, and laser treatments should be planned for October or November.
However, the New York based surgeon warned that whatever procedure is being considered “due diligence is still the best defence against potential post-op problems”.
As a child Dr Westreich played soccer and during one game he had a nasty collision with another player. As a result, his orbital rim was cut all the way down to the bone. Then 16 years old, he thought he was going to be disfigured for the rest of his life and was “scared out of my mind,” he related.
After waiting three hours for the plastic surgeon, he was really impressed by the way he was able to “fix me and it was like nothing really happened. The funny thing is that the eye that had the injury is now my better looking eye because I don’t have a bag [under that eye]…” he said during a virtual interview with this newspaper.
The experience of having someone take care of that injury and making him whole again, fueled his desire to become a plastic surgeon.
When he hit medical school, however, Dr Westreich recalled being told “that’s not a good thing to do, don’t do that…” In addition, according to him, the plastic surgeons where he trained were “really nasty people”.
Asked to expound on this, Dr Westreich said it was not a case of “plastic surgeons being nasty” but more of an institutional issue, as he trained at the Bellevue Hospital in New York City which was a very aggressive place to work and it was not just the doctors but the patients, nurses and the technicians.
“And the plastic surgeons were very like world renowned and I think the combination of the aggression of the institution and a little bit of self-importance made a lot of them really intolerable,” he explained.
This turned him off plastic surgery and instead he specialised in the ear, nose and throat.
“But within ear, nose and throat there is facial plastic surgery and while I was going through my training it just sort of resonated with me and I came full circle back to it [plastic surgery], he said.
At the time he could not pinpoint why but now looking back he believes it was because he is a “fairly artistic persons in terms of my left brain needs simulation”, he said, ending with a small laugh. But also, according to the plastic surgeon, he sees plastic surgeries as unique. With other types of surgery, “… you do the recipe and as you go in your career your goal is maybe to get faster but it is like you are doing the same thing over and over,” he said.
“The value there is that you can master it so there is a feeling of mastery when you get really comfortable when you are doing the same thing over and over. But plastic surgery is very different because even though you are doing the same basic structure over and over again, the procedure itself is completely different every time you do it because people are different or the results that they want are different. And so every case winds up being different for me.”
It is special for him as it is not a case of putting patients back the way they were before, but rather he gets to experience enhancing patients’ life experiences, making them feel more confident and taking something away that might have been causing them anxiety.
He shared that he gets to practice medicine in a way where the goal is to make patients better versions of themselves when it is all done.
“I think that is really special…,” he commented.
Not always cheaper
Asked about people choosing to have cosmetic surgery outside of the US and other western countries because of the cost, Dr Westreich pointed out that many times when one factors in the cost of travel and stay in those countries it might not necessarily be cheaper.
He noted that he was not an expert on the regulatory requirements of other countries in terms of medical procedures, operating room and anaesthesia and was not saying they don’t have safe practices, but patients should find out whether the practices are safe before travelling to the country of their choice. Also, one has to assume that in some countries the regulatory practices may not be as rigorous as in the US and while people may not like red tape, the rules are there to provide the safest possible environment for them to have their procedures.
People should also consider the standard of care in those countries and whether they can easily access care if the need arises.
Then there is the issue of if a problem crops up and it is not easy to go back to see that surgeon. They may then have to find someone where they live to take care of them and it may not be as easy.
“And you know I am not so keen on taking over somebody’s care that somebody else operated on. Number one, I don’t really know what they did and I am not in the optimal position to help this person. And then number two from like a selfish point of view… that problem becomes my problem and if it goes south then that’s on me and just emotionally you only want to have to deal with your problems,” Dr Westreich said.
He said people who are going to access medical tourism should at least consult and introduce themselves to someone local… , “so they have your history and your photo from before the procedure and in the event that you do have a problem it might be easier to just go and see that person”.
Dr Westreich advises patients to make sure any doctor they schedule through a virtual visit allows them to cancel after an in-person meeting for surgery, as there is no substitute for face to face.
He pointed out that surgery is very intimate experience and there are times when after a face-to-face there is a different impression than that of the virtual meeting and the patient should have a right to walk away without any penalties.
People do unnecessary things all the time
Responding to criticism that plastic surgeries are unnecessary and a waste of money, Dr Westreich commented that people do things all the time that they don’t need.
“Like, I don’t need a haircut. I don’t need a new shirt. I don’t need a lot of things. I do those things because they make me feel good about me and I don’t think plastic surgery is any different. I think the vast majority of the people come in to have one procedure and then they leave. Most people aren’t the plastic surgery junkies that want procedure, procedure, procedure… Most people don’t have body dysmorphic disorder or some kind of psychiatric illness…,” he pointed out.
On the contrary, most of his patients have something they want to get fixed if it is reasonable and safe and if they get it fixed they are happy and their self-confidence is improved. He pointed out as well that in the present digital world it would be very stressful for a people who have things on their faces they don’t like; it does not make them vain but rather they have an issue and once it is fixed their move on.
“I get to have wonderful experiences with people removing that barrier and to get them to feel good about themselves and just watching how they just blossom, their personality, their self-confidence and they wind up most of the times doing new jobs or other things just because of that self-confidence boost,” he shared.
For him people who denigrate those who have plastic surgeries don’t really understand the issue and it is somewhat hypocritical as they do and get stuff that they don’t need. Told that getting
a haircut or manicure is not as risky as going under the knife, the plastic surgeon said that everyone has risk tolerance and risk is assumed as soon as they walk out of the door. He said getting anaesthesia and an elective procedure is just about one of the safest things one can do on the planet if the numbers are to be compared. He himself had liposuction about ten years ago.
“It is not my job to tell you whether you should or should not do something, it is my job to tell you whether it is possible and whether it is risky,” he pointed out.
If people start returning for procedure after procedure, Dr. Westreich said, as a surgeon you just have to say no, as not only is it wrong to operate on someone who has psychological issues but “you are not going to be able to cure this person”. It is morally and ethically wrong and he would recommend they seek the help they need, though they might not really be happy about it and might not even take the advice.
The plastic surgeon said while he has had complications in his practice before, what really matters is how they are dealt with. When a patient has a complication, he/she becomes the most important patient in the practice.
He said his practice sees about 30 patients a day, translating to about 500 patients a month, but some of them are follow-up patients. During the busy season he does surgeries three times a week and twice a week when it’s less busy.
‘Zoom boom’
And surprisingly Dr Westreich said plastic surgeons saw their patient lists grow significantly after the COVID-19 pandemic hit, as a ton of plastic surgeries were being done during what is now called “the Zoom boom”.
He believes it was because people had to be in Zoom meetings and see their faces “on that little window” constantly and engage on social media. Some had more flexibility from a work standpoint; others had more money because for a while there was nothing to do recreationally, and some just wanted to do something for themselves.
He had closed his office for five weeks and when it reopened things were slow but after about two months the patient list grew tremendously.
COVID-19 also saw Dr Westreich reconnecting with his artistic side; he started painting, writing and singing and considers himself an accomplished artist and musician. He is the lead vocalist in his band, Big Rich Energy, which has six members. The band is currently on tour around the Manhattan area.
Dr Westreich graduated Magna Cum Laude with a BA in Biological Basis of Behavior, Neuroscience concentration in 1995 from the University of Pennsylvania and completed his medical school training at the New York University School of Medicine in 1999 with an MD and Honors in Cell Biology Research. He did his post-graduate training in Facial Plastic Surgery and Otolaryngology at the prestigious Mount Sinai Hospital in New York City. Dr Westreich can be contacted through moremediahits@gmail.com
