In conversation with Dr Suzan Obagi

You are one of the foremost cosmetic surgeons / dermatologists in the United States – can you tell us a little bit about your background?

I grew up in the field of cosmetic dermatology while the field was still in its infancy. However, when I began my training, the official field of ‘cosmetic dermatologic surgery’ began to emerge and I was fortunate enough to complete a fellowship in this field after my residency training. I was able to formalise my training in liposuction, lasers, peels, facelifts and eyelifts. However, the field of injectables (neuromodulators and fillers) was only just beginning.

Upon completion of my training, I decided to stay in academia since I really enjoy teaching. With this in mind, I partnered with my chairman and the University of Pittsburgh Medical School to create one of the first academically-based cosmetic surgery centres in the United States of America. My goal was to elevate the cosmetic work we do by basing it on solid science and training. It was helpful that this also happened to be around the time of amazing clinical trials and evidence-based research in the field of cosmetic surgery.

Currently, I am on faculty for both the plastic surgery and the dermatology departments at our university. I have trained many physicians and residents from all over the world and the sharing of knowledge has been truly gratifying.

Who has inspired you in your career and why?

I have to give credit to my mentor, Dr James Bridenstine for starting me down this path. While I did grow up in the field of cosmetic dermatology, Dr Bridenstine was one of the physicians active early on in the American Academy of Cosmetic Surgery (AACS), which was one of the only academies focused on training physicians in the cosmetic surgery field. He created a fellowship through the AACS, which I completed and I then successfully completed the necessary number of cases and sat for the American Board of Cosmetic Surgery exam. While I was a fellow, we completed two research projects and I wrote three book chapters with him. He pushed me to present at the annual meeting of the AACS while I was still a fellow. This was a daunting feat!

Upon completion of my fellowship, Dr Bridenstine got me involved with the AACS and the ABCS by becoming active on the boards and the committees. Currently, I am the 2018 President of the American Academy of Cosmetic Surgery.

What has been the best piece of advice that you have received in your career and what advice would you offer to those following in your footsteps?

I have trained eight fellows (one year fellowships) and close to a 100 residents over the past 18 years and what I advise them is also what I practise in everyday life. I always stress to them that to be successful, you have to be passionate about the field. If you do not come to work each day motivated and excited, you are in the wrong field. Anyone can learn the basics of cosmetic surgery or cosmetic dermatologic surgery, but the passionate ones are those that become successful. They are the ones that love the field and strive each and every day to enhance their work by seeing lots of patients and by continuing to learn about new technologies and evolving techniques.

Plastic surgery and dermatology are evolving all the time; what do you think have been the most exciting developments in recent years?

It’s very interesting to see that worldwide, the number of non-invasive cosmetic procedures has far exceeded the rate of growth in cosmetic surgery procedures. It could be because of newer technology, expanded growth in neuromodulators and fillers, and the desire of patients to have smaller procedures regularly, starting at a younger age, with the goal of putting off or avoiding the most invasive of procedures. This trend forced everyone to rethink their approach to patients. Of course, there will always be a need for rhinoplasty, breast surgeries and tummy tucks, but many patients are rethinking the desire to have a facelift. From a physician’s standpoint, we also understand the complex forces at work in the ageing face. It is not simply the descent of the face as we once thought. Instead, we understand that there is a dynamic loss of bone, muscle and fat in the aging face. With this is mind we are able to approach the patient using the four Rs of rejuvenation: resurfacing (peels and lasers), refilling (fillers or fat), relaxing (neuromodulators) and redraping (laser tissue tightening or surgery).

I would like to start everyone on thinking of the fifth R: renewal. While we do everything to get to the point that we look our best, if do not continue to force the skin to continuously renew itself, we will quickly lose some of the benefits that these procedures offer. My emphasis with all my patients is not only what to do prior to a procedure and during a procedure, but it is what they must do afterwards to maintain the results. It is akin to going to the gym. If you work out hard and get into great shape, you don’t stop going to the gym, otherwise you quickly lose the results you have achieved.

However, by carefully crafting an individualised plan for each patient using the current technology and products, the most exciting part is that we now can slow down ageing and put off more drastic procedures.

As a clinician well known for presenting at international meetings do you see this as a vital part of your work?

I feel very strongly that education is the key to being a successful cosmetic surgeon. Additionally, the sharing of knowledge across cultures and specialties is equally important. The premise of the AACS was to open the field of cosmetic surgery to sharing of knowledge across numerous specialties such as dermatology, plastic surgery, oculoplastic surgery, facial plastic surgery (ENT), oral maxillofacial surgery and other specialties from all over the world. By sharing this knowledge, I have learned as much as I have taught when I attend meetings all over the world.

We understand you presented at Achieving Aesthetic Excellence in London in June. What was the subject of your talk?

I have several colleagues in London and I was honoured to lecture to a wonderful group of cosmetic physicians. The focus of my lecture was to hone in on the true importance of managing the skin What this means is that by properly understanding skin cell functions, you can start to formulate an individualised skincare regimen for patients that really garners their skin’s ability to correct signs of ageing. Once this is achieved, it opens the doors to allowing the cosmetic physician the ability resurface, laser or peel patients safely, regardless of ethnicity or skin colour. I covered combination approaches as well. However, as with anything we discuss, I also focused on managing complications of the most common skin lasers and procedures. This will allow for quick identification and management of any emerging issues and allow for better outcomes.