Dr. Paul Nassif, Dr. Michael Niccole and Dr. David Shafer have appeared in the media – you probably see them sometimes in magazines, your favorite celebrity “did they or didn’t they have work done?” gossip sites and on programs such as The Doctors and Dr. Oz. Of the three, Dr. Nassif and Dr. Niccole have bridged the gap between medicine and reality with their appearances on the “Real Housewives” franchise. But what a short TV snippet doesn’t reveal is how much thought, planning, education, work and long hours is part of every procedure. Each surgeon discussed what their careers are like when the cameras stop rolling and provided useful information if you are interested in cosmetic surgery.
Dr. Paul Nassif
As Seen On: The Real Housewives of Beverly Hills
Spalding Plastic Surgery
Beverly Hills / New York
Of all the specialties available for physicians, why did you want to become a plastic surgeon?
An experience I had as an ENT (Otolaryngology) resident helped me decide what I wanted to do in medicine. A six-year-old boy came into the hospital suffering from multiple dog bites on his face. I spent the next two years with this child — in and out of the hospital working to reconstruct his face. This was the most fulfilling part of my entire residency and led me to become a facial plastic and reconstructive surgeon.
On TV, plastic surgery gets produced like an in and out service. Five minutes later, somebody has had a full surgery performed and within a second, they are all healed. Magic! And it isn’t like that. If you were in control of your own program all about showcasing your line of work, being your own producer, what would you do?
I’d love the opportunity to produce a TV show on plastic surgery where we could show the entire process of healing at different points in time. It’s really important for people to see and understand what’s involved with different procedures, what people look and feel like immediately afterwards and in the months to come. For example, the initial recovery period from rhinoplasty is two weeks but often you don’t see the final results of how the nose looks for a year.
Your bio talks about you being known for fantastic revision rhinoplasty work. When you are correcting someone’s original surgery, what do you do so the patient will not need a third surgery?
Rhinoplasty is the most complex aspect of facial plastic surgery and it has a higher revision rate than other cosmetic procedures. As a revision rhinoplasty specialist, patients come to me who are unhappy about either the appearance of their nose or with difficulty breathing after a prior surgery. First of all, I carefully diagnose any abnormalities that will cause trouble. Thats the key. I take a conservative approach because the more cartilage you remove, the more abnormalities you will see in the future – sometimes up to 20 years. Also, I take my time and don’t rush. My goal is to strengthen the remaining cartilage that’s left in place so that it won’t collapse in the future.
What do you wish people would know about your professional life off camera? Or life in general?
I set a very high bar for myself as a surgeon and I’m always reaching for perfection. I get tremendous fulfillment from running a leading-edge surgical center that is recognized nationally and internationally and working with patients who come to me from around the world.
What boggles my mind is women in New York always ramble about how they aim to look natural and do say, small breast implants instead of mid-sized or fuller, or a subtle nose job, but to my eye, I can always see the work done anyway and don’t see the point of doing something halfway if you see it done…anyway! Despite me never having met them before! Because whether someone goes with a more noticeable surgery procedure or a in their minds, “natural” one, you shouldn’t be able to tell? How can people avoid the tell tale signs?
I believe achieving natural results comes down to great surgical technique combined with an aesthetic sensibility attuned to creating overall facial harmony for each individual. You can’t have a cookie-cutter approach. If you take a look at my nose jobs, you’ll see noses that look like the patients were born with them. In other words, the nose is shaped to fit each individual face. With aging face surgery, the patients look rested and rejuvenated as opposed to looking “done.”
You have a business degree. How did that play a role in your medical career? Are you expanding your business any to include products?
Getting a business degree gave me a chance to learn about something different before going to medical school. Understanding business has certainly helped me establish and grow my practice. Today, I’m looking to expand my business in multiple ways. I’m working on a skin care line and I expect to open offices in the Middle East soon.
Working all those hours takes a toll on someone. How do you cope with this?
Performing surgery is physically demanding, but I’ve been doing it a long time and my body is used to it. However, I make it a priority to take good care of myself – eating well, getting a good amount of sleep and exercising regularly. It also helps that I love what I do. I’m excited every day I go into the office to see patients.
When you were teaching, what did students need to do to ensure they were incredible, things that set outstanding surgeons apart from the mediocre ones?
To stand out as a plastic surgeon, you have to first have the technical skill and eye. Beyond that, it takes heart, desire and stamina to truly excel. I teach my students and the fellows who work with me to take pride in what they do and constantly push them to strive for perfection.
What are you most proud of at work?
I feel particularly proud of taking a “nasal failure” and making them better. Someone who has had multiple rhinoplasties, can’t breathe and their nose looks horrible with all the cartilage removed and the nose pinched. Rebuilding the nose, reconstructing it so that the patient can have a functional (great breathing) and back-to-normal looking nose: this gives me great pleasure.
My parents really wanted me to be a plastic surgeon for years because I was good at both science and artsy things like cupcake decorating. At first, I loved the idea. But having your surgeon cry at the sight of blood and hide under an operating table isn’t a good impression for patients. When someone is looking to become a plastic surgeon, what should go on in their minds before they take the final step of studying medicine?
I recommend that before starting down the long path of becoming a surgeon, a person volunteer in an emergency room or a doctor’s office. This type of experience will help you know if this is a career for you. And beyond all the medical training, it’s a job you have to love to be good at it.
In your experience, when the work is all done, what makes your patients smile the most?
It’s so rewarding when I see a big smile on a patient’s face. Sometimes it’s because you’ve really listened to them. Other times that smile comes when they see how natural their nose or facelift looks. Ultimately, the smiles are the result of helping patients feel good inside and out.
Dr. David Shafer
As Seen In: W Magazine, Gotham Magazine
Shafer Plastic Surgery
You are always really calm, in contrast to the very stressed out physicians I meet sometimes. When you are meeting with patients, how can someone make a good impression? And what signs should patients look for if they should not have surgery with a physician? Is it OK to trust your gut feelings about disliking someone during a consultation?
Well, you have love what you do. I love being a plastic surgeon and treatment for my patients. If I were miserable or unhappy, I would feel stressed out too. Many doctors did not become plastic surgeons for the right reasons. Being a doctor and a surgeon is not easy and if you do not love every minute of it, you would quickly become stressed. My philosophy with patients is to treat them like like family. I get to know every patient and help them feel comfortable in a setting that may not be familiar to them. I am around surgery all day long, but for many patients, it is their first time in a surgeon’s office or in an operating room. I stand by their side from their first consultation to performing their surgery to their follow up care. If a surgeon does not seem interested in your welfare or seems constantly distracted, then they might not be the right choice for you. If your gut feelings are telling you to get out as fast as you can, then I would suggest trusting your feelings. I encourage patients to go to several consultations and make sure they are completely comfortable with having surgery. I also encourage patients to email questions or come back for a second consultation to make sure all of their questions are answered.
You frequently get quoted by entertainment magazines and websites like MakeMeHeal.com’s popular plastic surgery blog. Obviously, you don’t treat any one person, so we cannot know for sure, but who are some well known people you think have had plastic surgery recently?
HIPAA regulations and my own person privacy ethics make it so that I can’t tell you who my famous patients are. However, I think patients are attracted to my attention to detail and natural looking results. My goal for patients is to have others tell them they “look great” and not ask then “what work did you have done?…” When looking at celebrities, it is much easier to identify those that have had bad plastic surgery or unnatural looking results. The vast majority of people having plastic surgery have nice results but no one would ever guess. Also, celebrities are blessed with good looks, nice bone structure, smooth skin – all a product of good genes and, of course, a lot of effort in making themselves beautiful. Also, what defines “plastic surgery” has really changed with the introduction of Botox, Fillers and Lasers. Non-invasive treatments are very effective and likely used by most celebrities while “going under the knife” is reserved for those requiring more aggressive treatment such as liposuction, breast implants/lift and facelift procedures.
If someone wants plastic surgery procedures done but cannot afford everything, what do you recommend? Should someone have something else done instead of a face lift or liposuction, like doing it in steps? Or are there alternatives?
Patients should only have plastic surgery if they can afford it. However, there are often less invasive or minor procedures which can be spread out over time which are very effect but may be less expensive. For instance if a patient cannot afford a facelift, they may wound to consider Botox and Fillers. However, there should be no misunderstanding and the patient needs to understand that these are temporary treatments and are not equivalent to surgery. Also, if the price of fillers are added up over time, it may actually be more cost effective to have surgery.
Half of your patients come from overseas. Impressive! How do you go about coordinating initial consultations for say, liposuction or a chin implant, when someone lives in Europe? What procedures can people come in and out for and still fit in work or fun during their New York visit?
For our international patients, we use advanced technology such as Skype or other video conferencing for their initial consultation. Through our Fly-In program, we are then able to arrange their pre-operative visit the day they arrive, perform surgery the following day, then follow them in our recovery hotel with private duty nursing. Patient enjoy our private operative suite and special attention from our nurses. For breast implants or liposuction, patients can expect a day or two of recovery and then head out and see the city. Other procedures, such as tummy tuck or facelift are popular fly in procedures but may require several days recovery before venturing out of the hotel.
You share an office with a dentist. Do you ever work together with patients who want a full cosmetic makeover: plastic surgery and a new smile? Do you offer any discounts together or plan to?
Yes, a good smile makes a huge difference in a person’s appearance. I work with several doctors from various specialities to maximize results for my patients. When patients combine procedures from different specialities, they save on anesthesia fees and can recover from all the procedures at the same time.
Some time ago, you were in “W Magazine.” Would you ever do a reality show? You seem like you would be a good choice as the “nice guy” character. You may be shy, but some of what you say in casual conversation is naturally pretty pretty funny, without producers feeding you lines.
Reality shows are fun and entertaining. If I were involved with a show, I would want to make sure that it was informative for patients and stressed the need for patient safety and eduction in addition to the entertaining aspects of the plastic surgery world. I often feel like I live in a reality show… everyday we have the most amazing patients, exciting stories and transforming results which change each patients life.
How did you found your own plastic surgery office?
Things seem to happen for a reasons and I was in the right place at the right time. I love my office, up in the sky looking over the skyline of Manhattan. It’s a unique office with the right touch of privacy, modern technology, amazing views and central location.
You have a lot of wonderful experience. You worked at Mayo Clinic, teach residents and have a DVD instructional series for physicians learning about Botox. For some reason, despite all the media reports about questionable physicians, people continue going to shady offices for buttocks injections, Botox and so on. What can go wrong if someone injects Botox the wrong way? It can’t be worth saving a couple hundred dollars if you become disfigured or sick.
I always find it amazing when I am seeing a patient in consultation for a botched plastic surgery and I find out they had surgery in someone’s basement or kitchen. I cannot stress enough that patients need to check the credentials of their doctor including board certification. My training at the remarkable Arizona Burn Center, the world-famous Mayo Clinic and Manhattan Eye Ear and Throat Hospital gave me the best foundation for plastic surgery. That combined with my creativity and ingenuity has helped me create a world class plastic surgery destination. The recent addition of our Upper East Side surgical office offers patients a private atmosphere to have their surgery away from the often chaotic atmosphere of the hospital.
As you may recall, I believe I may have told you my fear, “I’m probably going to die immediately with something really mean said about me and an ugly Bozo the clown style photo for my newspaper obituary” if I did a rhinoplasty. You know I’ve been chatting with you about how my nose is skinny-fat, though actually quite small in person, and I want the tip made less rounded, This is not that I distrust you as a great physician or that I am disinterested, but I am a panicky chicken recently hatched from my egg. For people like me who want to do something eventually but are scared for ridiculous reasons, what do you want to remind us?
With any procedure, it is important for patients to feel completely comfortable with their plastic surgeon. If you feel like you are unable to ask your questions or feel like you are not getting enough of the doctor’s time, then you may not be with the right doctor. Before your procedure, the office should review the risks and benefits, possible complications and expected results. While it is impossible to predict exactly how a patient with respond to a procedure, the doctor can give their best estimate of what you can expect. As a patient, you should wait until the time is right for you, when you have a good support system at home to help with your recovery and feel comfortable with your decision to have surgery.
Why do you feel plastic surgery is a rewarding career?
As I said earlier, I love each and every day. In what other profession can I meet such amazing people from all over the world and every walk of life? Where can I make such a huge impact on people’s lives, boosting their self-esteem and improving their self image? Being a plastic surgeon is not just a job, but it is a life. The road is not easy and is not for everyone, but I am so glad I chose this career path.
Dr. Michael Niccole
As Seen On: The Real Housewives of Orange County
Corona del Mar, California
When you are appearing on a TV show like “Real Housewives,” are you nervous at all? Your work is under a microscope for the whole country to see!
Not at all, I have been working on celebrities and patients for 25 years. When I am in the operating room or doing a consultation, I treat every patient as if they were a family member. Everyone who comes through my door gets the best care possible.
People judge everyone on TV a lot, and with the Housewives, a lot of people bash them for having had “too much” plastic surgery or say it looks bad just because it is them. Whereas if someone like Steven Spielberg were to have his nose and cheek implants done, and he talked about his wonderful experiences on a reality show, people would congratulate him. Viewers might say, “He looks amazing.” When is it OK for people to talk about their work done, and when is it not, if people worry about someone making fun of them?
I think if someone looks very plastic and looks like they have had too much work done, that’s when they tend to get questions and stares. Where you can really notice someone has overdone their procedures is in their lips. My work is very conservative, I want people looking their best I don’t want them sticking out. Patients should have a natural, subtle result to the point that they look great but their friends probably won’t even know they’ve had surgery!
On the flip side, what if someone naturally has fuller lips or a positive physical quality some people think everyone attains through surgery now with plastic surgery’s huge presence in the media and supermarket tabloids, and he or she constantly deals with rude strangers asking if something is fake? Not where you are lying because you don’t want people to know but something genuinely natural you get asked about a daily basis until you feel annoyed? What is the right thing to tell rude friends, co-workers or family? And what should someone do if a stranger like a Walgreens cashier, department store clerk, mechanic, etc. is asking you?
If you’re fortunate enough to have natural lips — embrace it and tell people when they ask! Plastic surgery is so prevalent today and so many people have embraced it that it no longer carries the stigma it once did.
You have performed many operations. How do you select which patients will appear under your samples?
I chose patients that are totally satisfied with how they look. They are happy to share their before and after photos because they look amazing. I also like to chose patients that I am particularly proud of in terms of their results.
How does the Orange County aesthetic differ from patients coming from other countries, like your site mentions, Israel, Europe, etc?
In general, American women want larger breasts that those from Europe or South America. The demand for surgery in a place like Orange County is far greater than where those patients are flying in from. Because of the competition in our marketplace they are looking for surgeons who have excellent reputations.
When you are dealing with a perfectionist patient, who does not want to have a redo in his future, who has a very specific look in mind, say, a man on TV who doesn’t want to have a new jawline that looks simply spectacular like another regular guy might be satisfied with but might but a chin implant turning him into a “Sexiest Man Alive” other world of attractiveness, how do you work with patients like this? How do you go from an idea in someone’s mind that may be hard to describe with photos to having a great outcome, no redos at all?
I have to be very cautious when a patient tells me that want to look like a celebrity. If someone wants to look completely different, I will not perform the surgery on them. I want patients to be able to look like the best versions of themselves. Often a patient will refer to a specific body part of a celebrity, I may make suggestions on how to achieve something similar so if fits with the patient’s natural beauty. Plastic surgery is a purely individual choice and I only perform procedures that enhances ones beauty.
The media once made a big deal over you operating on your daughter. On occasion, my dad has had to provide me prescriptions like anti-bacterials when I have not had the time to get booked by a physician – sometimes, you cannot get an appointment for weeks someplace – and we are in a state in which he is licensed. Other doctors do the same. As long as what you are doing is not anything outrageous you would not do on a patient, it doesn’t seem all that bad. Why do you think people on TV and across the pond, in The Daily Mail, created a story out of nothing? Some plastic surgeons operate on their wives.
I know that in my hands, my daughter will receive the best care possible. Although there are many fine plastic surgeons out there, I trust my abilities above all others.
What are some options people should consider before finally resorting to plastic surgery? Makeup? The gym? What can men and women do before they try everything and know they are making the right decision with plastic surgery?
I recently notice a lot of people, women and men, coming to me after a major life change — divorce or break-up, turning 50, re-entering the workforce — looking for a pick-me-up as these life obstacles take a toll on their appearance. Often these people are very low on self-esteem and I suggest eating better and implementing better hygiene before seriously considering surgery. When they are ready, I offer what I called the “2nd Chapter Lift” for patients finding themselves at a major crossroads.
It consists of removing fat from undesired areas (stomach, back, thighs etc.) and redepositing it into desirable areas (cheekbones, jawline, etc.). The procedure involves stem-cell fat transfer. The results last longer than previous methods, are safer than implanting foreign material and patients are getting more natural looking results.
If you wanted to have plastic surgery done this year, what would you do being a bit wiser as a physician yourself, in looking for a fellow surgeon?
Above all else, I look for a surgeon who is board certified by the American Society of Plastic Surgeons. I would then look at photos of their past work on the body part I was interested in so I can see their artistry. I want to know that they have good reputations in the community, are often given referrals and has been interviewed by the media as an expert.
Nobody on TV talks about the wonderful charitable things you do when you aren’t working at your day job. Please share what they are!
A portion of the revenue generated at CosmetiCare is donated to the Magic Mirror Foundation, a nonprofit that has brought no-cost plastic surgery services to those in need including domestic abuse and accident victims and children from third world countries living with abnormalities.