Malcolm D. Paul, MD, FACS, keeps learning—to help him teach upcoming plastic surgeons
What’s the surest way to curtail practice growth? Stop learning. Malcolm D. Paul, MD. FACS, contends that it behooves plastic surgeons striving for greater success to attend as many lectures, symposia, and training courses as possible every year. After all, continuous learning has been very much a key to the ever-increasing popularity of his own practice in Newport Beach, Calif.
“The more you learn, the more in-demand you’ll be,” he predicts. “The most important things you possess are your skills—and it’s not possible to pick those up intuitively. You can’t just read the textbook, then go out and perform a new type of procedure and expect a good result. Someone has to show you in the operating room [OR] how it’s done.”
Paul—a past president of the American Society for Aesthetic Plastic Surgery, the immediate past president of the California Society of Plastic Surgeons, and the current US national secretary for the International Society for Aesthetic Plastic Surgery—offers as an example his learning about liposuction back in 1982. “The first thing I did after reading up on it was hop a plane to Paris to see how it was actually done,” he says.
Staple of Practice
That degree of eagerness to learn has been a staple of Paul’s practice life right from its beginning in 1975, the year he hung out his shingle. “I’ve always made it a point to attend every symposium I could get to,” he says.
Indeed, during the first quarter of this year alone,
he was the cochairman and moderator of a panel on aesthetic plastic surgery suture-suspension techniques at New Horizons in Cosmetic Surgery in Indian Wells, Calif, in January;
he was the moderator of a panel on comprehensive facial rejuvenation, also at New Horizons; and
he participated in a Mazatlan, Mexico, aesthetic plastic surgery symposium in February involving courses on contemporary upper one-third facial rejuvenation—including barbed-suture-suspension-technique options in lower-eyelid support and lateral canthopexy—and obicularis oculi muscle-sling aesthetic plastic surgery tools. He also performed demonstrations as a guest surgeon.
“Whether I moderate a panel or I am a presenter, I still learn because I’m there hearing and seeing what my peers have to impart,” he says, adding that he gets to do a fair amount of knowledge imparting of his own each week in his capacity as a full clinical professor of surgery at nearby University of California, Irvine (UCI)—where he also holds the title of codirector of aesthetic plastic surgery resident training at UCI’s Aesthetic and Plastic Surgery Institute.
Paul considers himself a face specialist, but he also routinely performs body aesthetic surgery procedures. “Contouring with barbed sutures is perhaps my currently most cutting-edge procedure of the face,” he says.
His practice occupies 1,500 square feet of leased space in a medical office building situated just a stone’s throw from the Newport Beach Surgery Center, where most of his OR work takes place. He also sometimes operates at UCI and at Hoag Memorial Hospital in Newport Beach.
The outpatient facility—which he co-owns with about 30 other physicians from different disciplines—consists of five operating rooms, suites for endoscopy and other minimally invasive procedures, and a pair of overnight recovery rooms.
The staff includes five board-certified anesthesiologists. Approximately 700 elective and nonelective surgeries are performed there per month by all of the physicians—Paul and the UCI residents he trains as part of a plastic surgery rotation among them. “The participating residents receive unparalleled exposure to what’s going on at the cutting edge of this field,” says Paul, who helped establish the rotation.
Speaking of the cutting edge, Paul’s office was among the first in his area to begin to use electronic medical records (EMRs) exclusively. This, he says, has greatly helped with the efficiency of his business operations.
“I sit on the board of directors for an insurance trust. As the member in charge of its education program, I was asked to evaluate an EMR system earlier this year. To do so, I had it installed in my office and have been working with it ever since,” he offers to explain how the technology was introduced to his practice.
“As long as I have access to the Internet and don’t forget my security pass code, I can look at my patients’ records and images. I can do this from home, on the road, or in the operating room; and I can get what I need the moment I need it.
“EMR technology also makes it possible for patients to submit forms electronically so that they do not have to manually key them into the system. In fact, anything fed electronically into the system—images, progress notes, referring letters, lab work, you name it—is automatically captured and added to the patient chart. It’s very user-friendly and a real time and labor saver.”
Paul’s attorney wife, Pamela, also has access to the system as part of her responsibility for overseeing the practice’s financial aspects. She set aside a full-time career in law to help her husband make a go of the practice and to raise their five children (now all grown and some bringing up families of their own).
“Pam is a terrific asset,” Paul says, adding that she dispenses legal advice whenever Paul requests it—such as in the course of conducting due-diligence investigations of business or professional opportunities that come his way.
After Surgery, More Care
A hallmark of Paul’s practice is the aftercare provided to patients.
“It’s customary that one of my staff—usually a nurse—will call the patient at home after surgery to check for problems, to verify that prescribed medications are being taken as directed, that the patient is refraining from activity, and so forth,” he says. “In addition to making sure everything is going well, it’s also a way for us to let the patient know we care. It’s remarkable how so simple a gesture can do so much good for a practice in terms of the favorable view patients have of it.”
Minimizing postoperative pain is a big part of Paul’s aftercare efforts. Accordingly, he expresses a preference for pretreating patients by giving them an enzyme package that includes arnica and bromelain—the latter a pineapple extract judged by the American Society of Plastic Surgeons (ASPS) to be an effective anti-inflammatory agent.
Patients begin taking this package before their surgeries and continue using it for about 1 week afterward as a holistic way to reduce postoperative swelling. Often, though, that’s not enough, which is why he also frequently prescribes prednisone tablets.
Paul uses pain-medication pumps (or simply “pain pumps”) in every one of his breast augmentations and abdominoplasties, as well as in brow-lift cases. “Patients really love the way pain pumps virtually eliminate discomfort in those first days after surgery,” he says.
Despite having an excellent staff of three full-timers and an independently contracted aesthetician, Paul insists on performing many of the tasks that other plastic surgeons might more expediently delegate to the support team. “I do every botulinum toxin Type A and soft-tissue filler injection; I do all the imaging and computer work on every new patient,” he says. “Patients respond with delight when the physician takes this much direct, personal interest in their care.”
Certainly, that’s the type of care he remembers when he was a youth growing up in Baltimore. “I developed a mild chronic illness that required periodic visits from the family physician,” he says. “Those visits gave me an opportunity to experience good bedside manner. That was during the mid-1940s—in those days, physicians made house calls.”
Paul says he can recall how he marveled at the sight of the stethoscope and other fascinating-looking instruments as they emerged from the physician’s black leather bag. All of that impressed him so much that he decided to become a physician when he grew up.
From Coast to Coast
Paul attended the University of Maryland in College Park as a psychology major, class of 1965. He then advanced to medical school at the University of Maryland, Baltimore, and, upon completing it in 1969, Paul went on to perform a general surgery internship at Mount Sinai Hospital in New York City. One year later, he began his general surgery residency training, also at Mount Sinai, with the intention of becoming a pediatric surgeon.
After 12 months of general surgery training, Paul transferred to George Washington University Medical Center in Washington, DC. “Initially, the goal was to complete training as a pediatric surgeon. However, what impressed me was the perfect plastic surgery residency program had just been founded,” he says.
But to enter it, Paul had to complete 2 extra years of training as a general surgery resident. Thus, it was not until 1973 that his plastic surgery training began.
When it came time to enter practice, Paul opted for Southern California’s well-to-do Orange County. “I had family already living there, and it always struck me as such a beautiful place to live and work,” he says.
Pivotally, there was also abundant opportunity for a young practitioner. As it happened, Fountain Valley Regional Medical Center had not long before opened its doors and needed an additional plastic surgeon; the facility at the time had one board-certified plastic surgeon, and only on a part-time basis at that. “I spent the next 5 years there covering the emergency room every night to get my practice going,” Paul relates.
During his first year of practice, Paul also struck up an affiliation with UCI. But he rejected the notion of formulating his practice along purely academic lines.
“I tried to achieve a balance,” he says. “I wanted a conventional private practice, yet at the same time, I wanted a practice that reflected my extensive involvement with the university.”
Paul originally located his practice in the city of Fountain Valley, a less affluent neighbor of wealthy Newport Beach. He subsequently added an office in Irvine, then, about 14 years ago, he moved to his current office in Newport Beach.
No Need to Advertise
In terms of disposable income and consumer willingness to spend lavishly on combating the effects of aging, the Newport Beach market is not much different from that in Beverly Hills, about 1 hour’s drive north. However, a perception of the market is that the surgeons in Newport Beach tend to be early adopters of scientifically scrutinized, state-of-the-art technologies and techniques.
“That, I believe, is one of the reasons we attract people from other cities,” Paul says. “There is a recognition that this part of Orange County is where good things in plastic surgery are happening.”
Paul’s high-volume practice attracts mainly women. However, he has recently noticed a rise in the number of new male patients. Credit for that belongs in no small part to the crop of reality programs that dots the television landscape these days.
“The shows have helped boost awareness among men and women alike of what plastic surgery can accomplish,” he says. “More and more people—especially those living healthy, athletic lifestyles—are seeing aesthetic surgery as a way to look as good as they feel.”
Paul says he has never found it necessary to advertise his services, beyond being listed on Web sites operated by some of the national and state associations to which he belongs. Mainly, he relies on satisfied patients to spread the word about his practice.
One of the things that help draw prospective patients is Paul’s relationship with UCI. “That tells them that by choosing me as their plastic surgeon they’re going to be getting someone with academic credentials—and to a lot of consumers interested in obtaining the most advanced care possible, those credentials say a lot.”
Another way he generates referrals—and, at the same time, expands his knowledge—is by never saying no when asked to participate in professional-society activities. That’s how he came to hold almost all of the 40 or so leadership posts listed in his curriculum vitae.
“Membership in professional organizations can pay huge dividends when it comes to helping practices grow or make a smooth, successful leap to the next level,” Paul explains. “The networking that goes on among members of the societies and associations provides a way to quickly obtain answers to questions you’ll have about clinical matters or business concerns.
“And the more you network, the more your colleagues get to know you. And the more they get to know you, the more your referral base widens.”
The Value of Belonging
Involvement with the professional societies, especially at the leadership level, also turns out to be enormously gratifying, Paul says. “You feel good because you’re making a difference in the direction and momentum of plastic surgery in terms of scientific and legislative efforts at the state, national, and global level.”
Where Paul makes the biggest difference is his investments of time and energy in putting together symposia here, there, and everywhere under the auspices of one body or another. Among Paul’s earliest such forays was his involvement in a 1985 symposium in Rome on the topic of breast reconstruction. Since then, he has organized, conducted, and presented at a multitude of symposia.
Just last year, he taught a course on the use of contour threads in facial rejuvenation at the ASPS annual meeting in Chicago; and he delivered encores this year in Las Vegas, Atlanta, Boca Raton, Fla, and Rio de Janeiro. He is scheduled to conduct it yet again this month in Buenos Aires, Argentina. All of this is in addition to his July participation in a course conducted in Los Angeles on lipolysis—the technique of dissolving stored fat cells with the use of injectables that trigger seven transmembrane (7TM) receptors to activate the production of adenylate cyclase.
“I had heard about lipolysis but didn’t know much about it—certainly not enough to add it to my practice,” he says. “So, I read up on the procedure, then got in contact with plastic surgeons I greatly respect who were already offering it in their own practices, saw some of their results, and urged them to come to Los Angeles to share their knowledge and experiences with my colleagues here. It was a 2-day weekend event, and I learned a great deal from the presentations.
“There is always a degree of apprehensiveness about trying something new. But, you can’t allow that skittishness to prevent you from being the only practitioner in your community who does not do, say, soft-tissue fillers or doesn’t know how to use an endoscope to do a brow lift.
“It’s awfully easy to pull the curtain around yourself and proclaim that you’re going to keep doing what you did 20 years ago. You’ve got to be willing to change, to update. But none of that can happen unless you make the commitment to keep learning.”
Rich Smith is a contributing writer for Plastic Surgery Products.