“With plastic surgery, you can give patients a new, improved feature and often an accompanying boost in self-esteem.” Photos by Michael Justice
When renowned plastic surgeon Peter Bela Fodor, MD, FACS, discusses body contouring—a field he helped to pioneer—he is dynamic, authoritative, and often unapologetic. But when he discusses his family, particularly his pack of (count ’em) five Malteses, a different side of the man emerges.
Fodor’s erudite lecture tone fades and wells with emotion as he discusses the dogs he both adopted and rescued. Though these two sides of Fodor seem discordant at first, they are precisely the reason why he is considered one of the greats. His surgical precision and expertise is complemented by kindness and generosity, and, above all, sincerity. Fodor applies the same dedication to his surgeries as he does to helping his canine clan assimilate and thrive.
Born a Hungarian national in Romania, Fodor escaped the Communist regime and immigrated to the United States at age 21. He learned English as an adult and graduated first in his class from the University of Wisconsin Medical School in Madison, a mere 3 years after his arrival in the United States. He interned at Parkland Memorial Hospital in Dallas, and did both his general surgery and plastic surgery residencies at Columbia/New York Presbyterian and St Lukes/Roosevelt Hospitals in New York City.
EVOLUTION OF A PLASTIC SURGEON
Though he was enamored with general surgery, it wasn’t enough for Fodor’s creative side. “One gallbladder is the same as another gallbladder and the same for hernia operations,” he says. “Even aortic aneurysm dissections are similar—just some are bigger and some are smaller.”
Fodor never thrived in the fine arts, but he soon began to visualize an aesthetic patient as a still life, which helped him become a sculptor. “We find something attractive within the person and emphasize those features by subtraction and addition, almost like cutting a diamond in the rough,” he says.
Another perk of the specialty is that it allows surgeons to literally give something back to their patients. “With general surgery, you are always taking things away for a good reason—to make people better,” he notes. “With plastic surgery, you can give patients a new, improved feature and often an accompanying boost in self-esteem.”
He has experience in reconstructive surgery, including hand surgery, but Fodor’s Los Angeles-based Century Aesthetics is exclusively aesthetic. Since he began practicing in 1974, he has witnessed the pendulum swing back and forth, and back again.
“Less is more, especially for rhinoplasty,” he says. “It used to be that we scooped out more, and now we add more than subtract. The same is true with eyelid surgery,” he says. Facelifts have evolved as well, he adds. “The current trend is for a more natural look with limited pull and upward traction.”
BODY CONTOURING PIONEER
Fodor and his staff confer at his Century City, Calif practice.
The holy grail of aesthetic plastic surgery is increasingly natural results using minimally invasive procedures, he states. But we are not there yet, he is quick to add.
Fodor helped develop vibration amplification of sound at energy resonance (VASER) liposuction, and also pioneered a Super Wet liposuction solution that cuts down on blood loss and bruising. He is quite vocal about today’s influx of minimally invasive body-sculpting procedures.
“A lot of procedures are marketed to fix something that isn’t broken,” he says. This list includes laser-assisted lipoplasty, SmartLipo and a dozen other laser-powered devices, low-level laser therapy, external (not internal) ultrasound-assisted lipoplasty, and radiofrequency-assisted lipoplasty. “Traditional liposuction is still the gold standard,” he says.
This is not to say there is no role for certain technologies, including power-assisted lipoplasty and internal ultrasound-assisted lipoplasty, but a lot of these devices and technologies are innovative in just one way—marketing, he says.
Device manufacturers now do what drug companies do, he says. They approach noncore physicians with lasers and other expensive, high-tech gadgets such as SmartLipo, and convince them that these technologies are the latest and greatest must-haves, and will certainly increase revenue.
“The only thing smart about SmartLipo is the name,” he says. “We see many botched operations with pigmentary and sensory changes, severe surface irregularities. In large part, this is due to the manufacturer promoting their technology to noncore physicians. The manufacturers approach the noncore doctors and say you will see less bruising and swelling and smoother surfaces using our device. The device is as dangerous as the person who is using it.”
Fodor served as president of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2004 to 2005, during the heyday of plastic surgery when surgical procedures were performed in larger numbers, and it was less common to see non-plastic surgeons market themselves as expert plastic surgeons.
“At that time, the most important thing that I could contribute was to promote patient safety,” Fodor says. And this is one of the reasons that he remains outspoken about the risks of SmartLipo and other technologies that may land into unskilled hands.
TO KNOW HIM
The first time this writer ever interviewed Fodor, I was completely distracted, and not only because I was speaking to one of the nation’s top plastic surgeons. It was a phone interview, and within seconds he picked up on my lack of focus. Rather than try to cover up, I opened up. I told him that my beloved miniature schnauzer, Trixie, had been having petit mal seizures. At the time, she was less than 1 year old and had her first appointment with a neurologist scheduled for later that afternoon. Fodor said he understood and that we could reschedule our talk later in the week.
The following day, he called back. I assumed to pick up where we let off, but I was wrong. He wanted to know how Trixie’s vet appointment turned out—Trixie is now approaching her ninth birthday and is doing great. Over the years, Fodor has become a valuable source and mentor to me, as he has to so many others. He taught me everything that I know about liposuction, but it is his compassion that I will never forget.
Others echo my sentiments. William P. Adams, Jr, MD, a plastic surgeon in private practice in Dallas, says that he knew that he had “officially arrived” when he walked past Fodor at an ASAPS meeting and was greeted with a “Hi, Bill.” Currently, the two are good friends as well as colleagues. Recently, Fodor signed to serve as chairman of the medical advisory board for The Plastic Surgery Channel, an online, video-based information channel featuring leading plastic surgeons that Adams founded.
“[Fodor] is one of the most prominent surgeons around, and he takes the time to know who people are,” Adams says. “He is committed and dedicated to all of his endeavors.”
A father and grandfather, Fodor plays hard like he works hard. He is an alpine skier, tennis player, and rally car driver. In addition, he remains true to his roots. The Fodors founded a scholarship in his native city of Tirgu Mures, Romania, which provides annual assistance to 30 Hungarian medical students living in Romania.
Fodor has served as both a mentor and a colleague to Jeffrey Sebastian, MD, a board-eligible plastic surgeon in Los Angeles, since 2001. “A lot of the techniques I use stem directly from him,” says Sebastian, who often assists or is assisted by Fodor. “He puts a lot of thought into his cases, but he has a good sense of humor and always has one or two jokes to get everyone in a good mood before a case.”
A DOG PERSON
Fodor is well-known among clients and colleagues for vigorously promoting patient safety.
Fodor’s dedication is as apparent when his lighter side emerges and he discusses his dogs. But to hear his wife of 24 years, Barbara, tell it, he wasn’t always such a dog person. “I am very surprised because he had no experience with dogs and had certain preconceived—not always positive—ideas about dogs,” she says. “But I just knew that, once involved, he would be obsessed with them.”
And she was right. Fodor never had a dog while growing up in Romania—few people did. “In the old country, if you brought a stray dog home the dog was gone the next day because of parents protecting children from parasites,” he recalls.
That all changed when he moved in with his mother-in-law during the early years of his marriage. “There was an older Maltese who hated me and who considered me an intruder, but shortly after another puppy came home. I became so attached to this dog that when my mother-in-law moved, I wanted my own dog,” he recalls.
Now he has five: Farrah (age 20), Cleopatra (16, whom he refers to as Miss America), Bela (12), Csibesz (9), and Charlie (7).
“They are a little community within themselves,” he says. Fodor, a retired captain in the US Air Force, is clearly the Alpha dog in his pack, treating them only with rewards. He can even walk them without leashes within his apartment complex. “If I tell them to sit I can walk 100 feet away and they won’t move,” he says.
HOW MUCH IS THAT DOGGY IN THE WINDOW?
His Malteses all came to him at different ages and at different stages. Csibesz, for example, was outgrowing his crate at a popular New York City pet store, as other younger puppies were being sold left and right.
“Nobody would buy him because he was too big. He was in a kennel shuffle,” Fodor says. “We just could not leave him there, but we had no desire to buy a dog because we already had three.”
While Csibesz is now part of the pack, it took a while for him to feel safe and loved. “He is very needy, and we need to pay attention to him first or he barks nonstop,” Fodor says. “Although he is the largest, he is very sweet to the rest of the dogs. But once we take him outside, it is a different story,” and Csibesz becomes very protective and aggressive.
When Fodor adopted Charlie, he was emaciated and suffered seizures from years of neglect. The doting couple spent time integrating him into the pack and had to retrain the lot of them, as Charlie was untrained. “Retraining five dogs simultaneously was challenging, but we really are in good place now,” he says.
The same can be said for his aesthetic practice.
Denise Mann is a freelance health writer based in New York. Her articles regularly appear in WebMD, health.com, cnn.com, Arthritis Today, American Profile, and special sections of The Wall Street Journal. She is also the editorial director for several plastic surgery portals, including Consumer Guide to Plastic Surgery.
FODOR ON ULTRASOUND-ASSISTED LIPOPLASTY
With the wide range of liposuction methods being promoted by industry and even entrepreneurial plastic surgeons, Fodor warns that many of these methods are still in development—but some are in commercial use, too—and yet are not necessarily proven to be of tangible benefit. Physicians are bound by ethics to carefully evaluate these techniques prior to incorporating them in practice, he says.
Although many of these are promoted by the hype created by their manufacturers, Fodor favors clinical studies as a benchmark of proof that ultrasonics are effective in aesthetic treatments. He has performed a number of them, which compared these new approaches. “Patients and surgeons alike should be cautious of being lured by ‘on the cutting edge’ technologies,” Fodor notes, “Unless backed by solid evidence of their superiority.
“Ultrasonic liposuction allows us to more readily remove fat in some body areas such as the back, upper abdomen, and male breast, and to redo liposuction,” he adds.
How high a level of physician training is needed for ultrasonic work? The Ultrasound-Assisted Lipoplasty Task Force, chaired at its conception by Fodor and comprised of members from the major US-based plastic surgical societies, designed a teaching curriculum on ultrasound-assisted liposuction (UAL).
Practicing board-certified plastic surgeons who were not exposed to ultrasound liposuction during their residency training were eligible to take these courses. In recent years, training in UAL is part of residency teaching programs.
In practice, the treatments involve ultrasonic waves delivered through the cannula to emulsify or liquefy the fat. Whereas traditional liposuction requires manual effort to extract adipose tissue, ultrasonic waves target fat cells specifically, causing them to “implode” and liquefy for suction removal.
“When VASER UAL is used, the energy levels are more specific to fat cells,” Fodor notes. “Therefore, blood vessels, nerves, and lymphatics are more likely to be spared, and, therefore, tissue loss is minimized. Ultrasonic techniques make difficult fibrous areas easier to treat than traditional methods. These fibrous areas include the male breast, upper abdomen, and fatty deposits on the back, secondary (or redo) liposuction, etc.
“Traditional liposuction may cause more tissue trauma and bruising than ultrasonic techniques due to tissue destruction necessary to manually break up the fat. Ultrasound emulsifies fat with reduced damage to the adjacent tissue. Ultrasonic techniques, when properly performed, encourage postsurgical skin retraction and contraction.”
Fodor feels strongly that he did not intend his comments regarding UAL to leave the reader with the impression that traditional liposuction by itself is not an effective way to treat localized, out of proportion to the rest of the body, fat deposits. Many surgeons continue to accomplish excellent results just with the traditional technique. However, UAL is yet another tool in the surgeon’s arsenal with the ultimate goal to best serve his patients.
RISKS USING UAL
Specific risks and complications that are unique to UAL include skin burns and unknown long-term effects, according to Fodor. Improperly applied ultrasonic energy can cause burns, blisters, scars, blood clots, and peripheral nerve injury. None of the first 100 patients on whom Fodor performed UAL as part of a clinical study (which compared traditional lipo to UAL) experienced any complications.
— Jeffrey Frentzen and Cookie Lommel
