Plastic surgery is a specialty where physicians talk about their love of art, their creativity, and their aesthetic eye. For Richard Fleming, MD, and Toby Mayer, MD, of Beverly Hills, Calif, their gravitation toward plastics evolved for very different reasons.
“Plastic surgery is a specialty for A-type personalities, and I’m definitely that,” Mayer says. A perfectionist, he naturally gravitated to surgery because of an innate desire to see results as soon as possible. Plastics fit his need to create and combine artistry with the engineering component required in surgical procedures.
“But the artistic part is really overrated,” he says. “A lot of plastic surgeons talk about the artistic component, and they may be really good at sculpting or painting—but many really aren’t so good at plastic surgery.”
Attention to detail is what makes a good plastic surgeon. In the operating room, Mayer is focused, quiet, and serious. “I’ve always admired surgeons who can talk while they work,” he says. “That’s not me. I prefer a quiet environment where I can really concentrate on the details of the procedure.”
Mayer is always on the hunt for the better mouse trap. He believes that a continuous pursuit of perfection means never being satisfied. “I am always thinking my results could be better,” he says. “I think I’m probably more compulsive than my patients.”
But when it comes to the day-to-day of running a successful Beverly Hills practice, he prefers to let others handle that responsibility. “I focus on the patient and on providing the best, most natural-looking result possible. Other people can manage the business a lot better than I can.”
Fleming considers his success in the plastic surgery world to be the result of a personal and professional evolution. “I didn’t wake up one day and decide to be a plastic surgeon,” he says. “I went to medical school and explored all of the specialties throughout my training, but it wasn’t until my third year that I really started to figure out my focus.”
Many specialties, while interesting and very rewarding, require a specific kind of mind-set. “For example, in neurosurgery, doctors deal with injuries, bad diseases, not fun stuff,” Fleming explains. “And in pediatrics, the kids are fantastic and wonderful and really have a lot to teach us as people, but when you have a sick child and you know there isn’t anything you can do to save them, it impacts your own emotions.”
Surgery had its own pull on Fleming. Like Mayer, he is goal-oriented and wants to see results. Fleming’s love of surgery evolved into an interest in plastic surgery, and it fits his personality and his goals for life in general.
“For the most part, we deal with happy, healthy people who have a cosmetic need, and we can help them,” he explains. “Because we are dealing with elective surgery, we can solve an issue, see immediate results, and positively impact lives on a daily basis. It’s a happy way to practice medicine.”
THERE IS NO “I” IN TEAM
Mayer and Fleming met in training in the early 1970s, and they’ve worked together ever since. The Beverly Hills Institute of Aesthetic & Reconstructive Surgery opened in 1976 and has been the go-to Institute for the Hollywood community for years.
“I can’t think of any other partners who have been together as long as we have,” Fleming says. “We keep things simple, and it works. We don’t compete, we collaborate; and we have similar goals and motivations for our patients.”
Keeping it simple seems to be the key to their success. “We split everything right down the middle—operating costs, overhead—and we split our revenue 50/50 too,” Fleming explains. “That way, we have equal skin in the game and we both win.”
For the two, “we” and “ours” are important words. “We recognize that our success is dependent upon our ability to share and our willingness to let go of our egos,” Fleming says.
While Fleming and Mayer are connected professionally, their personal lives are very different.
“When we started the practice, we were at very different places in our lives,” Fleming explains. “Toby was married with two kids, and I was a single guy. We had different friends, different lifestyles, and as a result drew different kinds of patients to the practice.”
And that’s what helped the two avoid competition. While they have the same areas of expertise, in the beginning their patients came from different places. Today, their practice and their reputations are established, and the need to compete is nonexistent. “Why bother?” Mayer says. “We both win, no matter who does the procedure, so competing would be a waste of time.”
Fleming agrees: “We’ve always promoted ourselves as a partnership, and that’s not going to change.”
REBELS WITH A CAUSE
Fleming and Mayer were seen as rebels. Rhinoplasty was a staple of their early practice, and is still a mainstay. But in the late 1970s, many experts endorsed the closed approach as safer, easier, and a technique that offered better results. Fleming and Mayer disagreed, and actively offered open rhinoplasty procedures for their patients and spoke out at industry events about the procedure.
“We really got criticized a lot by our peers at that time,” Fleming says. “But today, open rhinoplasty is accepted, common, and a standard in our specialty.”
ROLLING WITH THE CHANGES
Fleming and Mayer have been in the plastic surgery business for nearly 40 years, and over that time they have seen a lot of changes—in patients, in techniques, and in technologies. As leaders in the field, they keep a close watch on what’s happening and do their best to guide the next generation.
In particular, Mayer notes three areas where advances have made a big difference: Tissue expansion, scalp reconstruction, and facial reconstruction. Fleming recognizes that one of the biggest changes is the way patients approach plastic surgery today. Many patients have their first procedure at a much younger age and opt for smaller procedures done more frequently. Previously, many patients used plastic surgery as a way to give themselves an “overhaul” where now the trend is toward “tune-ups” along the way.
The way plastic surgeons are allowed to market their business has also changed. “When we started our practice, it was unethical to advertise,” Fleming says. “Your work—your patients and the referrals they generated—was the only tool available in terms of marketing. And so, the people who did the best work were the ones who were the most successful.”
Fleming says that when advertising became an acceptable practice, the entire business picture changed. “Advertising really went a long way toward leveling the playing field for plastic surgeons,” he says. And the Internet has changed the game even more, making it even more difficult for the patient to differentiate the good surgeons from the rest.
“There is a real need to find a way to educate the public about our field so that we protect our own reputations as well as the patients’ overall satisfaction,” Fleming says.
Fleming also notes that economics have driven changes on the professional side—given the challenging state of the US economy, more “noncore” physicians are offering cosmetic procedures to their patients, even in the absence of the comprehensive training received at accredited institutions. Access to courses that give basic knowledge has sired an entire population of physicians who think exposure is enough. Fleming and Mayer strongly disagree.
“Some doctors I know who are specialists in other fields—like pediatrics or gynecology—are now offering cosmetic procedures to their patients, and it’s a bad idea,” Fleming says. “The motivation appears to be a desire to maintain a certain lifestyle, and insurance reimbursements for their standard practice just aren’t cutting it. This kind of stuff really puts the patient at risk.”
Through the years, the two doctors have seen the plastic surgery world change and evolve. In 1976, liposuction had yet to be introduced, and there have been four or five major changes in the industry, including the introduction of lasers, an increased focus on noninvasive techniques, technology advances, and innovation in the application of standard surgical technique.
“Every innovation brings the opportunity for us to learn something new and get better at what we do,” Fleming says. “In the past almost 40 years, a lot of trends have come and gone,” Mayer adds. “But time also gives us opportunities to learn from others and find ways to improve.”
Both doctors are driven by learning and by improving. Mayer often uses a quote by Voltaire in his lectures that says, “The perfect is the enemy of the good,” which he follows with a quote of his own: “Good is often synonymous with mediocre.” And that’s the vibe you get when you interact with these experts.
And getting better sometimes means pushing the envelope—something both men are willing to do, especially if it benefits their patients.
WHAT’S TO COME?
Mayer believes that stem cells might be a real breakthrough in the plastic surgery field, but it’s a long way off. “People say they are using stem cells in procedures, but that’s really creating a misconception for patients,” he says. “The fat grafting process and harvesting of stem cells is not even close to what I think can eventually be achieved in this area.”
Mayer is also intrigued by the possibility of bioengineering body parts. “One day, a physician will be able to take pictures of a patient and feed the images into a computer,” he speculates. “The computer will be able to generate the production of custom body parts, engineered specifically for that patient.”
Fleming agrees that technology will be a big part of medicine’s future. “The progress we have made with lasers, less invasive procedures, and more controlled, less traumatic approaches has greatly affected our patients, and we continue to see advancements.”
Both doctors believe that some technologies have great marketing campaigns to promote them, but that results aren’t quite what as promised. And there are so many different kinds of technologies available that proper training is necessary to know what will be best for the patient.
“It’s like the tail is wagging the dog,” Fleming says. “To get good results you don’t need every single machine or laser ever made. But the physician must know how to use any technology appropriately and with great skill.”
For both doctors, the willingness to go against the norm and push the envelope is seen as their greatest contribution and accomplishment.
“Open rhinoplasty isn’t unique anymore, but when we started performing open procedures our peers and even our mentors were up in arms,” Fleming says.
“We helped drive that change because we got great results for our patients,” Mayer adds.
But ultimately, Fleming and Mayer want to be known not just for their results, but also their relationships with their patients. “I’m not a marketing machine,” Mayer says. “I just want to do good work and be a good guy. The results tell the story for us.”
“We’re good guys who get great results,” Fleming adds. “And in this business, that’s what matters.”
Schae Kane is a contributing writer for PSP. She can be reached at firstname.lastname@example.org.