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  • So you want to be a plastic surgeon.

  • You like the idea of making millions, working with celebrities, doing boob jobs and facelifts. Not so fast.

  • We're going to debunk the public perception myths of what it means to be a plastic surgeon, and give it to you straight.

  • This is the reality of plastic surgery, and we'll help you decide if it's a good field for you.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in the So You Want To Be series.

  • In this series, we highlight a specific specialty within medicine,

  • such as plastic surgery, and help you decide if it's a good fit for you.

  • You can find the entire list on our So You Want To Be playlist.

  • A lot of you have asked for plastic surgery in the last video,

  • so that's what we're covering here.

  • If you want to see what being a plastic surgeon actually looks like,

  • check out my second channel Kevin Jubbal, M.D., where I do a second series in parallel titled a Day in the Life.

  • We'll be doing a day in the life of a plastic surgeon soon,

  • so make sure you're subscribed so that you don't miss it.

  • Plastic surgery is all about using plastic to make people look pretty, right?

  • No, and never repeat those words.

  • The word plastic comes from the Greek wordplastikos“, meaningto mold”,

  • a reference to how plastic surgery is involved in the reshaping and manipulation of tissues.

  • Generally speaking, plastic surgeons focus on soft tissue such as skin, muscle, and fat,

  • rather than bones, which are in the territory of orthopedic surgeons.

  • Plastic surgery is far more diverse than what you probably expect.

  • The public is most familiar with aesthetic, or cosmetic plastic surgery that has been popularized by celebrities and showbiz,

  • but the overwhelming majority of actual surgical procedures in plastic surgery are reconstructive in nature.

  • In 2018, there were 5.8 million reconstructive surgical procedures in the U.S.,

  • compared to only 1.8 million cosmetic surgical procedures.

  • That being said, non-surgical minimally invasive cosmetic procedures, like botox or fillers, are extremely popular.

  • In 2018 alone, there were 15.9 million non-surgical cosmetic procedures.

  • So what's the difference between cosmetic and reconstructive plastic surgery?

  • Cosmetic plastic surgery includes procedures involved with enhancing one's appearance.

  • The most popular cosmetic surgical procedures include breast augmentation or "boob job", liposuction,

  • rhinoplasty or "nose reshaping",

  • blepharoplasty or "eyelid surgery", and

  • abdominoplasty or "tummy tuck".

  • The most popular cosmetic non-surgical procedures include botox injections, soft tissue fillers,

  • chemical peels, laser hair removal, and microdermabrasion.

  • Reconstructive plastic surgery is highly diverse, and in my personal opinion, far more fascinating.

  • Recon includes surgical procedures to correct facial and body abnormalities

  • that can be caused by birth defects, like cleft lip, or cleft palate,

  • injury, like soft tissue reconstruction for severe traumatic injuries,

  • disease, like breast reconstruction after mastectomy for breast cancer, or aging.

  • Plastic surgery is on the cutting edge of innovation in medicine, with radical procedures like face and hand transplants,

  • or even gender reassignment surgeries that are so convincing you wouldn't believe it.

  • The first surgical case I saw was an animated latissimus dorsi transfer where we created a makeshift bicep,

  • or rather elbow flexor, out of a patient's lat muscle in their back.

  • With the beauty of neuroplasticity in the brain, the patient was able to train themselves to bend the elbow

  • by focusing on activating their latissimus dorsi muscle.

  • I talked more about this first case and how I fell in love with plastic surgery in a previous video.

  • Link in the description.

  • Another one of my favorites was doing a nerve graft to treat Bell's palsy hemifacial paralysis.

  • In short, one side of the patient's face was paralyzed,

  • so we harvested the sural nerve from their leg and using microsurgical techniques,

  • grafted it to their face to reanimate to the paralyzed side.

  • I know. Straight science fiction.

  • Between cosmetic and reconstructive practices,

  • one isn't necessarily better than the other, but there are pros and cons which we'll get to shortly.

  • I was obviously enamored by the complex recon,

  • and would sometimes tease my cosmetic-focused colleague

  • that I'm at least helping the world and not just trying to make a quick buck.

  • To which he responded,

  • "I'm also making the world a better place, one pair of breasts at a time."

  • In the hospital, we call plastic surgeons the "surgeon's surgeon",

  • as they are the most relied upon by other surgical specialists.

  • Anytime a neurosurgeon, urologist, general surgeon, orthopedic surgeon, otolaryngologist,

  • or any other surgeon needs help with complex coverage in reconstruction,

  • they call in the plastic surgeons. Unlike any other surgical specialty, plastic surgery is unrestricted by body part.

  • They work on any part of the body, from head to toe, hands to feet, eyelids to genitalia.

  • To become a plastic surgeon, there are two paths of training after completing medical school.

  • The first called the Integrated Path,

  • whereby you complete 6 years of plastic surgery residency, and this is the path that I took.

  • This is consistently the number one or number two most competitive specialty to match into.

  • To give you a sense of just how competitive this is,

  • one of my colleagues went into neurosurgery, another very competitive field because he said plastics was too competitive.

  • If the integrated path is out of reach, all hope is not lost.

  • There is also the Independent Path,

  • whereby you first complete 5 years of general surgery residency and then apply for an additional 3 years of independent plastic surgery residency,

  • for a total of eight years.

  • This route is best suited for those who either did not know they wanted to go into plastic surgery when they were applying to residency,

  • or those who were unable to match into the Integrated Path.

  • After completing residency, you can practice as a plastic surgeon, or choose to sub-specialize further with 1 to 2 years of fellowship.

  • These are the main pockets of self specialization you can choose from:

  • Plastic surgeon specializing in breast obviously can do breast augmentation,

  • but also a major part of their practice includes breast cancer reconstruction.

  • After the general surgeon removes the tumor,

  • the plastic surgeon comes in with a variety of techniques and procedures to restore a woman's anatomy.

  • Breast surgeons also do breast reductions and lifts, among other procedures.

  • Craniofacial trained plastic surgeons specialize in soft tissue reconstruction of the head and face.

  • Their bread and butter includes pathologies like cleft lip and cleft palate, or craniosynostosis,

  • whereby sutures in the skull fuse prematurely resulting in abnormal head shapes and babies,

  • and they'll even fix your broken jaw.

  • Microsurgery is the most innovative and sci-fi sub-specialization within plastic surgery.

  • The "micro" in microsurgery refers to the microscopes used when connecting blood vessels or nerves together.

  • This allows for moving tissues around the body, like the nerve graft for facial reanimation in Bell's palsy.

  • Microsurgical cases are some of the longest, with some lasting over 24 hours, and it also comes with a challenging call schedule.

  • For that reason, we say microsurgery is a young man's sport.

  • It's probably not the ideal lifestyle when you're 50 years old with a family and kids.

  • Hand was what I fell in love with and was planning on specializing in.

  • The hand has some of the most complex, intricate and beautiful anatomy in the entire human body.

  • Hand surgery includes pathologies, like carpal tunnel, fractures, contractures, and resections and reconstruction.

  • Burn is the black sheep of the family and is not nearly as precise, meticulous, or fun as the rest of plastic surgery.

  • That being said, It's incredibly important as burn victims are in great need.

  • And last, aesthetic plastic surgery,

  • which is what you're likely most familiar with. Breast augmentation, rhinoplasty,

  • abdominoplasty, and liposuction are some of the most common procedures performed.

  • If you couldn't already tell,

  • I'm enamored with plastic surgery.

  • The diversity and variety you'll experience in plastics is second to none.

  • Additionally, it's the most innovative field in medicine, period.

  • Much of it still seems to be science fiction.

  • If you like precision, meticulousness, and obsession with details, plastic surgery may be a good fit.

  • No other specialty obsesses over the most precise way to close an incision to optimize healing and minimize scarring.

  • In medical school, I found myself reading books on how to suture

  • or tie better knots while everyone else was more concerned with their shelf exams.

  • If you're the type of person to take interest in such detail, plastics is probably for you

  • Pay is more variable than other specialties, and no, you're not guaranteed to be driving around in a Ferrari or Lambo.

  • Recon, especially in the academic settings, doesn't pay nearly as well as aesthetic practices.

  • That being said, you'll still have quite a good lifestyle, as compensation is above average, most surgeries are not urgent, and call isn't so bad.

  • However, if you do choose microsurgery or handle face trauma,

  • then your call will be far more taxing.

  • Lastly, changes in health care and reimbursement are worrisome to attending physicians of all specialties.

  • Luckily for plastic surgeons, they always have the option of going to a cash-based aesthetic practice,

  • thus granting them relative immunity to possible decreases in reimbursement on a systemic scale.

  • No specialty is perfect, and plastic surgery is no exception.

  • In terms of personalities, plastic surgery is a mixed bag.

  • Because it's a diverse field, the prospect of making millions as an aesthetic surgeon attracts a small number of trainees

  • who are more concerned with money and appearances than actual substance.

  • I'm going to teach you something that most doctors don't even know. There's a great deal of confusion with plastic surgeons versus cosmetic surgeons,

  • and this isn't so much a problem with plastic surgery as it is a problem with branding.

  • if you want to get cosmetic work done,

  • you should go to a board-certified plastic surgeon.

  • Plastic surgeons are the masters of all cosmetic procedures,

  • as they've gone through a minimum of 6 to 8 years to earn their distinction of being board certified in plastic surgery.

  • Cosmetic surgeons, on the other hand, do not have rigorous standards for training.

  • I've seen non-surgical doctors of various specialties, from OB GYN to anesthesia, emergency medicine to primary care,

  • and more touting themselves as cosmetic surgeons after completing a weekend course on how to do botox.

  • They obviously have no business doing any cosmetic procedures, but greed is a powerful force.

  • It's dangerous quackery like this that gives cosmetic surgery a bad wrap

  • and results in the horror stories of patients having severe complications or even dying.

  • There's also a common misconception that plastic surgery is a highly creative and artistic field.

  • Don't get me wrong, compared to anything else in medicine,

  • It definitely is, especially if you go into aesthetics.

  • You're incorporating the art and science of beauty into your surgical treatment.

  • That being said, it's not like you can go in and creatively wing it and do something new.

  • For any defect or goal and treatment,

  • there are only a few standards of care to choose from that have tolerable risk profiles and high rates of success.

  • Plastic surgery isn't for everyone,

  • but how can you know if it's right for you?

  • First, make sure you actually enjoy the bulk of plastic surgery.

  • I wasn't personally in love with burn,

  • but everything else was so incredibly innovative and cool.

  • Shadow more than just one plastic surgeon, as the field is so diverse and varied.

  • Scrubbing into a microsurgical case will feel entirely different than doing aesthetics or even craniofacial.

  • In terms of personality, you should be comfortable

  • with almost painfully precise attention to detail and meticulousness.

  • If the thought of mastering the art of suturing bores you, or you prefer the use of staples and closures,

  • which is blasphemy to a plastic surgeon, then look elsewhere.

  • Lastly, you have to be willing to work your tail off. Plastic surgery is so insanely competitive that if you're allergic to hard work,

  • you might as well look elsewhere.

  • That doesn't just mean top grades in class,

  • but also crushing your standardized tests, having multiple publications, a strong personal statement, and of course, killer interview skills.

  • But you don't have to go at it alone.

  • At Med School Insiders,

  • we've distilled our expertise into a systematic and repeatable process that delivers results.

  • Using these same principles,

  • I got a 99.9th percentile score on my MCAT, full tuition scholarship to a top medical school,

  • aced my USMLE, was prolific in research with over 60 publications and matched into the ultra-competitive specialty of plastic surgery.

  • As you know, I'm a firm believer that systems produce results.

  • That's why my team and I at Med School Insiders obsessed over how to become the best admissions consulting and tutoring company for future physicians.

  • At Med School Insiders,

  • our mission is to empower a generation of happier, healthier, and more effective future doctors.

  • From medical school or residency application health to crushing your MCAT or USMLE,

  • we've got your back.

  • And our results speak for themselves.

  • We've become the fastest-growing company in the space with the highest satisfaction ratings.

  • See for yourself and learn more at MedSchoolInsiders.com.

  • What type of surgeon should I cover in the next So you want to be video?

  • Let me know with a comment down below.

  • If you enjoyed the video, please give us a thumbs-up as it keeps the YouTube gods happy.

  • As always, thank you all so much for watching.

  • Much love to you all, and I will see you guys in that next one.

So you want to be a plastic surgeon.

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So You Want to Be a PLASTIC SURGEON [Ep. 4]

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    Summer posted on 2020/06/08
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