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| Home > Reviews > Confessions of a Park Avenue Plastic Surgeon |
| Confessions of a Park Avenue Plastic Surgeon | | Date Created: Dec 09, 2005, 11:51 PM |
I’m not sure why I wanted to read this book. I told my wife of 26 years that I was reading, Confessions of a Park Avenue Plastic Surgeon by Cap Lesesne M.D. and she didn’t ask who the plastic surgeon was or why I was reading it. She asked, “Why did he write it.” I said I didn’t know because I was only part way through it, but now that I’ve finished it I still don’t know the answer.
I think I’m a reasonable person to review this book. I’m a board certified plastic surgeon in solo practice doing nearly exclusively cosmetic plastic surgery. Of course I’m a Boulder area plastic surgeon, not a Park Avenue one. I also come from the midwest and graduated from Princeton four years ahead of Cap Lesesne. When I went to medical school, like the author, I was sure I didn’t want to be a surgeon. I was also drawn to plastic surgery by exposure to burn cases. We had similar training in general surgery and plastic surgery. I’ve also done the thousand cases or more Dr. Lesesne feels is appropriate to comment on the field.
I know a lot of the things he’s gone through and have had some experience with celebrities and ethnic patients although nothing like dating Katie Couric. Which brings up another difference between us. My father wasn’t a doctor. I’ve also been married since plastic surgery residency and have two children. Dr. Lesesne had an internist for a father and apparently still isn’t married.
I was certainly interested in what my colleague had to say but I’m not sure who the book is for or who would enjoy it. It’s not a dirt dishing tell-all. Dr. Lesesne appropriately maintains a level of privacy for most of his celebrity patients although I’m sure his descriptions might be discoverable to someone who is heavily into the celebrity name game. There is a lot of autobiography that may or may not be interesting to non-surgeons. There are no titillating pictures or emphasis on graphic descriptions of surgery. Generally it is personal and plastic surgical philosophy using cases and anecdotes. How else could you tell the tale and maintain your medical integrity?
Dr. Lesesne does more facelifting and I do more breast surgery and body contouring but I agree on a number of issues of surgical and professional philosophy and I have some areas of disagreement. This is probably also to be expected. Here’s what I disagree with.
Some of this may be semantics or relatively trivial, but Cap seems to confuse cosmetic procedures with elective surgery. This is a common misconception of patients but surprising in surgeons. All cosmetic procedures are elective but not all elective procedures are cosmetic. Dr. L understands the reconstructive ladder for evaluating reconstructive procedure options but it would be helpful if he defined cosmetic procedures and how they differ from reconstructive procedures and not confuse things with the term elective which really just means you can “elect” when to do them.
Dr. Lesesne doesn’t seem to understand the difference between “healing” and “scarring”. He says, “Pale Irish skin heals better than thicker negroid skin.” It is not clear to me that “negroid” skin is thicker but Irish skin certainly doesn’t heal better, it tends to scar better. He also says “heal the best” when he means scar the best.
I think cosmetic plastic surgery can be discussed without using terms like “dissect on”, “creep me out”, “nose job”, and “lipo on”. At least he doesn’t call breast surgery a boob job. You don’t have to use overly technical terms to avoid such unprofessional terminology.
I’m really amazed by Dr. Lesesne’s seriously outmoded statements about breast surgery. He says, “when we measure a breast for ptosis (sag) we measure the distance from the sternal notch to the nipple.” This is just wrong. Ptosis is defined by the position of the nipple relative to the inframmammary crease (fold under the breast). He also says that it is “all the rage to put breast implants under the pec muscle”, implying that this is a fad or incorrect. There are actually several good reasons to put implants (particularly saline implants) below the pec major muscle and no good reasons to put them above. Those who think otherwise are ignoring experience and probably don’t know how to properly position implants under the pectoralis muscle.
I also disagree with Dr. Cap’s insistence on seeing younger pictures of patients before facial restorative procedures like facelifts. If you put the tissues back where they were and don’t alter, distort, or add/subtract tissues or implants, you should get a normal looking result. Pictures don’t really help or determine what you do.
And finally I don’t agree with Dr. Lesesne’s attitude about anesthesia. He seems to have the typical confusion of anesthesia and sedation. A surgeon actually can operate under local anesthesia with intravenous sedation without needing an anesthesiologist or nurse anesthetist. I do it all the time. The anesthesia is local which I’m perfectly capable of doing and the intravenous sedation is just so the patient doesn’t have to be aware of putting in the local anesthetic or carrying out the procedure. The patient can be easily monitored by appropriate sensors, looking at the patient directly, and with the assistance of an RN not scrubbed into the procedure.
The Park Avenue plastic surgeon does make some interesting, provocative, and principled statements that I agree with. I don’t know if he is correct that there are more gay surgeons in plastic surgery than other surgical specialties. That might be how it looks in NYC. I do agree that there are some surgeons who shouldn’t be surgeons and that “volume is not indicative of quality.”
I would sign on to the statement that “the best plastic surgeons are neither too fast nor too slow.” Another statement I like is, “Outside the OR, surgeons are often reflective and even filled with self-doubt. In the OR they’re decisive.”
Some excellent words of wisdom and experience are “do not treat without a diagnosis.” “First you’re a scientist.” and “sort out the problem. Think it through.” He properly condemns badmouthing another plastic surgeon. He also stresses follow-up of patients and “learn, learn, learn.”
Dr. Lesesne’s advice to patients is quite good. “If you still don’t understand after it’s been explained to you, then ask again, or ask more pointed questions. If your doctor can’t explain clearly what’s going on then he or she doesn’t understand the situation well enough. Get a new doctor.” Another line is, “when a surgeon advises you not to operate. Consider it seriously.” In general: “Before you take any new drug or undergo any new procedure, wait at least one full year after it’s been on the market, especially if it’s elective surgery.” For the surgeon: “Do make the patient look good. Don’t make it obvious why she looks good.” Dr. Lesesne opposes the patient directing the surgeon although he seems to fall prey to this if there is enough money or power involved. He also seems to violate this when patients are choosing a breast implant.
And finally, I agree with his statement that, “I never forget that I’m a physician as well as a plastic surgeon.” His final word is, “I can’t help myself. This is who I am.” So why did he write the book. I guess that’s who he is. I don’t even know why I wrote the review... |
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