For centuries, millions of Chinese girls had to endure foot binding—their toes were broken and bound with bandages. This translated to a lifetime of terrible foot and ankle problems.
Why risk perfectly good health for aesthetic gain? Simple: for the sake of beauty and for the ability to fit into 3-inch golden lotuses.
Binding was outlawed in 1912. At the time, Americans could not understand how a woman could do that to her feet. However, now we do the same thing surgically.
The saying, “If it’s not broken, don’t fix it,” really doesn’t apply anymore. More Americans are electing to have cosmetic foot and ankle procedures when the only thing wrong with their feet is their own perception of them.
However, not all cosmetic foot procedures are done just to make something look better. Just ask Bobby Pourziaee, DPM, a podiatrist who also uses cosmetic surgery techniques in at least half of his cases. There are surgical reconstructions to correct congenital deformities, he says, as well as to correct damage done to the feet in accidents and even surgical errors.
Pourziaee is little-known outside of Los Angeles, where he has built a solid reputation in his field for incorporating aesthetic techniques into his practice. He is one of a large number of noncore physicians who have entered the aesthetic field.
PRACTICE AT A GLANCE
Name: Pourziaee Foot Spa
Owner: Bobby Pourziaee, DPM
Location: Los Angeles
Specialty: Cosmetic surgery of the foot
Years in practice: 8
Patients seen per day: 25 (max)
New patients per year: 1,000
Days worked per week: 5 to 6
Days surgery performed per week: 1
Number of employees in practice: 11
Office square footage: 1,200
Pourziaee is passionate about his work and understands the need for treating his patients with extra care, and the very best in customer service is key in maintaining a healthy practice in the current recession.
Whether it’s cosmetic, corrective, or reconstructive, foot surgery is a growing trend. This is likely due to the fact that a large segment of the US population is growing older and acquiring foot-related injuries or other problems.
Patients never tolerate foot pain well, so when Pourziaee first consults someone who needs cosmetic or reconstructive work on his feet, the first order of business is a declaration: Making a patient’s feet feel better and healthy again will lead to an overall improvement in his or her health.
According to many experts, signs of illness that may affect all areas of the body often manifest themselves first in the feet.
Pourziaee has spent the last 8 years building his Los Angeles-based practice as a three-pronged service to patients. In addition to running his podiatry practice, which incorporates fashionable cosmetic surgery procedures, he offers an on-site medical spa and sells an exclusive line of private-label foot-health products, including moisturizers specially blended for the feet.
Clearly, he excels in expressing respect for his patients, who invariably come to him in pain—sometimes excruciating pain—and are drawn in by his calm demeanor and professionalism. He promotes an office environment that immediately puts his patients at ease.
Prior to this interview, for example, one grateful patient (who asked to remain anonymous) remarked in Pourziaee’s waiting room, “Dr Bobby and his staff are very friendly and fast. Imagine you are a race car and they are your pit crew. I feel as though they were waiting on me.”
Adding to the relaxed environment, the office boasts low-key lighting and an aquarium featuring a darting damselfish that seems to enjoy playing hide-and-seek with the waiting patients.
In his nicely apportioned facility in the Westwood district, Pourziaee reflects on how his background and studies led him to embrace cosmetic surgery as a foundation for much of his business.
Although he is a member of the American Academy of Podiatric Sports Medicine and the International Aesthetic Foot Society, he is not a board-certified plastic or cosmetic surgeon.
Pourziaee represents a breed of practitioner who has incorporated aesthetic medicine as part of a non-plastic surgery practice. There was no high drama behind his decision to help people who have foot and toe problems.
“I got my bachelor’s degree from Pepperdine University, and after that I went to podiatry school in Chicago,” he says. “Once I finished that, I did a residency in foot surgery. That was down at Anaheim General Hospital. Once I finished my residency, I worked for somebody for about 2 years. I found that was not what I wanted. I saw the way he ran his practice and didn’t want to go that direction.
“I had always envisioned having a surgical-based practice,” he continues, “but also develop the aesthetics part of a practice and the medical spa option. So, I just basically quit and went out and started my own practice from scratch. I rented space, I got a loan, and just went out on my own and started finding patients. My practice has grown slowly, and it’s at a wonderful point now. The vision of the practice and the spa is fully realized, and it works so well together. “
What drove him to incorporate so much cosmetic surgery in his podiatry practice?
“It came from living in Los Angeles and having a lot of my friends who, in addition to having bunions, in addition to having hammer toes, they were worried about, say, getting toenail fungus at a salon. They wanted their feet to fit into their heels. This came basically from my social group and the people I knew. I talked with them and really listened,” he adds.
|Adding to the relaxed ambience of Pourziaee’s office is an aquarium that features a shy dartfish.|
THE FEET HAVE IT
Even though the American Orthopaedic Foot & Ankle Society (AOFAS) has come out against any type of cosmetic surgery on the foot, claiming the inherent risks can far outweigh the benefits, the organization’s recent survey of its podiatric surgeon members found that 51% say their patients are asking for cosmetic procedures on their feet.
“Surgery of any type has risks,” Pourziaee claims. “I inform my cosmetic and noncosmetic patients of all the risks and potential complications. And it is up to the patient to determine if the potential benefits outweigh the risks. I believe for most patients, they do.”
Cosmetic and reconstructive surgery of the foot has a specific goal: to restore a foot to normalcy, both aesthetically and functionally.
Pourziaee not only performs cosmetic surgery on the foot and toe, he treats all manner of toe abnormalities, including claw toes, hammer toes, trigger toes, mallet toes, and trigger toes. In addition, he has successfully used metatarsal osteotomy—distal shortening osteotomy of the lesser metatarsals—in treating metatarsalgia.
Another procedure—nail matrixectomy—corrects ingrown nails, a congenital condition caused by an overcurvature of the nail or an imbalance between the width of the nail plate and the nail bed. Digital fusion can correct fractures of the toe or, as in the case of implant arthroplasty, can increase the stability of the toe after arthroplasty. The bone ends are removed and repositioned together, uniting the bones.
Other procedures include the treatment of ulcers, corns, and calluses; wart removal via laser surgery; and overlapping toes.
In the cosmetic surgery vein, Pourziaee works on common indications that combine his podiatry and aesthetic training.
For example, “Brachymetatarsia is a condition that presents with short toes,” he says. “Usually, these patients have a short metarsal bone and the phalanges tend to be normal in size. This is much more common in women than in men. The treatment involves making a surgical cut in the bone and using an external fixation device that slowly extends the metatarsal. Over a 12-week period, new bone is formed as the metatarsal is distracted with the device. The device is taken off after the desired length is achieved.”
Pourziaee recalls one of his most challenging cases involved a female patient with congenital brachymetatarsia and then some.
“Correction involved one-stage lengthening with intercalary bone graft or gradual lengthening by callotasis,” he says. “Essentially, what’s happening is the metatarsal is a lot smaller, and what you have to do is you have to make a cut to the bone and you have to slowly extract the metatarsal. Usually, it’s one toe. But I had a patient come to me and she had three toes on each side that had this condition. Just the complexity of that was really involved and challenging.
“There are these three external fixators on top of the foot, and you have to move these things millimeters at a time, weekly,” he continues, “in order to make sure you’re doing things correctly and make sure the contour of the foot looks right and the length of the metatarsals is right. She turned out great, but I remember that with that process and the level of technical complexity, I was a little worried at the time that it would [not] turn out alright. You have to make sure the toes extend to the right point, and so forth.”
|Pourziaee’s medical spa provides patients with a comfortable place for follow-up visits.|
Cosmetic improvements for feet have a special name: “foot facelifts.” The term embraces a variety of procedures that also happen to be Pourziaee’s specialties. Some patients have fat removed from their feet in order to not only fit into high-heeled shoes but to make their feet look better and, more important, feel better. Other patients get their toes shortened—as described above—and some have fat added to the balls of their feet.
In the case of callus-blasting microdermabrasion, the patient presents corns and calluses that show a thickening of the outer layer of the skin in response to friction.
“The corns and callus treatment is a multiple-layered approach to keep the feet from becoming abrasive,” Pourziaee says. “The first step involves using a sterile surgical blade to remove the thicker areas of callused skin. Next, skin is further debrided using a microdermabrasion machine. Afterward, a 60% Glycolic peel is applied to the foot. This is finished off with a foot massage.”
Another popular procedure, foot plumping, involves the use of a dermal filler. “I do use Juvederm injections for the balls of the feet,” he explains. “Many women lose the fat pad on the balls of the foot as they age. This can be exacerbated with the use of high-heeled shoes. When wearing high-heeled shoes, the weight of the body is transposed anteriorly onto the balls of the feet. This, in turn, puts a lot of pressure on the balls and can lead to pain. The injections plump up the balls of the feet, thereby decreasing the pressure at the metatarsal heads. Think ‘pillow for the feet.’ “
See also “The Entrepreneur” by Rich Smith in the November 2006 issue of PSP.
Surgical toe shortening is one of the most-requested procedures, according to Pourziaee. “The most common toe that the procedure is done to is the second toe. This is due to the fact that this toe is most often longer than the first toe, thus sometimes preventing appropriate fitting of a shoe, especially a high-heeled shoe.
“The procedure involves making an incision on the top of the toe. There are three bones that are called phalanxes that make up the toe. A section of the middle phalanx is resected, thus shortening the entire toe. A wire is put through the toe to allow the bone to heal in the correct position. The wire is then removed at the 6-week mark. The removal of the wire can easily be done in the office under local anesthesia,” he notes.
Pourziaee also performs a procedure he calls the sterile pedicure. “One of the most common complaints I see in my office is toenail fungus,” he says. “When looking into [the patient’s] history, most of them got pedicures at the local salon. So, to give them another option, we started providing sterile pedicures. We sterilize the tools and the environment like an operating room. The treatment includes a soak, scrub, toenail and shaping, polish and a massage. It is our most popular treatment.”
Shannon Triplett Leade is a contributing writer for PSP. She can be reached at firstname.lastname@example.org.
Spotlight on Bobby Pourziaee, DPM
PSP: How is the current economy affecting your practice?
Pourziaee: I haven’t seen that big of a drop-off. Patients are coming in a little less frequently, but they’re still coming. The spa business is still doing well. People still need their nails done, they still need haircuts, they still need to take care of their feet.
As far as insurance and the medical part of it, if it’s a big out-of-pocket portion, then some patients who might have done their surgery before—well, those patients are not doing surgery right now. If insurance covers certain things and there isn’t a big out-of-pocket expense, those patients are scheduling their surgeries. I have a nice balance.
PSP: Your experience seems to be contrary to that of other surgeons, even in the Los Angeles area, who are experiencing a serious downturn in business.
Pourziaee: A strong commitment to customer service is critical to maintaining the practice, at this point. The proper evaluation of the patient, their lifestyle, medical history. Be sure to inform them of the procedures and potential risks, and have them really think about it before you proceed.
PSP: Did the medspa side of your business grow out of your podiatry practice?
Pourziaee: No. It was always part of my plan from the beginning. I designed my practice with the spa being a large part of it. When I went out on my own, it was always something that I wanted included.
PSP: What percentage of your business is cosmetic and reconstructive surgery?
Pourziaee: I’d say about 40% to 50%.
PSP: Among your colleagues, do you see them getting into the cosmetic surgery field even though they didn’t necessarily train in that area?
Pourziaee: Absolutely. I have seen some of my colleagues do that. It’s become fashionable. Personally, I was lucky because in my residency training the doctor I trained under saw quite a few patients that had cosmetic concerns. As a result, I got that training. And I wouldn’t take my mother to anyone who hadn’t done hundreds and hundreds of procedures.
PSP: What inspired you to develop your practice with your own products and a spa?
Pourziaee: Let’s face it—visiting a doctor can be nerve-racking. People hear “doctor’s office” and immediately start thinking “cold, clinical, impersonal.” Before they even step one foot in the door, they’re already uneasy. Nobody wants to feel like that. So along with my practice, I just thought it would be great to add something that encourages comfort and relaxation; and that’s what spas are all about. Also, as far as spas go, unfortunately I’ve heard my fair share of horror stories. Some patients I see have come in specifically to treat infections they got through a bad spa experience. It’s important to have a spa that’s not just relaxing but also medically safe and hygienic.
PSP: And your private-label skin care line?
Pourziaee: One thing I’ve noticed is that many foot and nail care issues can be improved or completed avoided with a good care regimen. There are lots of good products on the market, but sometimes those products are packed full of synthetic ingredients. Many people are sensitive to synthetics. I went to a chemist, and we created products with an emphasis on using natural ingredients.
The needs of the foot are essentially different from the needs of the rest of your body. The skin on the foot is different. And a lot of the products out there—over-the-counter and even the prescription ones—weren’t really addressing those needs.
For example, the skin on the bottom of the foot is much thicker, and a lot of moisturizers wouldn’t penetrate deep enough. You would put it on, and within an hour or two the skin would be dry again. Along those same lines, people who get calloused heels will get skin that cracks, and with deep fissures. A product that we’re still in development with has an anesthetic in it as well as a moisturizer. You apply it to the heel fissures, and it will numb the pain associated with the fissures and moisturize the heel as well.