13 Things I Wish I Knew Before I Became a Plastic Surgeon
Originally published in Cosmopolitan, Dr. Keagle dishes in an interview with Kate Beckman — and goes a lot more than skin deep.
The majority of your patients aren't celebrities.
1. It takes a lot of very unglamorous training to become a plastic surgeon. When I was training to be a plastic surgeon, everyone thought it was glamorous. But it took me 10 years of training. It was not glamorous. We worked over 100 hours a week and I was in the hospital overnight every second or third night for on-call shifts. Everyone thought I was doing Beverly Hills cosmetic surgery from the get-go and I wasn't. My mom [didn't understand] why was I working so hard. It's 100 percent underestimated because there's so much to plastic surgery. I went to med school, I did a general surgery residency, I did two years of basic science research, I did a fellowship in plastic surgery, and then I did another specialized fellowship in craniofacial surgery which specializes in plastic surgery of the head, face, and neck. A lot of people would ask if I was done yet, thinking I was in cosmetology school.
2. Even in Hollywood, you'll rarely operate on celebrities, if ever. There's so much training that goes into it and it's not all doing stuff for movie stars. In fact, a very small percentage of people that do that. I'm not in Beverly Hills, but I was surprised in L.A. by the lack of movie stars. I've had some celebrities, but the majority are not movie stars.
3. If you have kids, you'll be in the minority. I had my first child, my son, my last year of fellowship at UC-San Francisco and I only got a month off of maternity leave. I had a really amazing nanny who worked 12 hours a day and I couldn't have done it without her. I showed up at my first job pregnant with my second child and they weren't very friendly and I ended up leaving that job to start my own private practice in L.A. to have a more flexible schedule. It's hard because a lot of the guys in plastic surgery have their wives run their practice, but I do all the mom stuff on top of doing my practice. I typically operate once or twice a week starting at 7:30 a.m., so I'll do that all day. If I don't see my kids in the morning, then I try to be home for dinner. Then I see patients three half days a week and do non-invasive treatments twice a week. A lot of plastic surgeons don't have kids or if they do, they just have one and they usually have full-time help. I have two kids, and we don't have full-time help, but my husband works from home, which is so helpful. We try to split everything up, but a lot of the fine details still fall to me. So I spend my non-patient time managing my office, paying office bills, going grocery shopping, arranging the kids' schedules, and taking the kids to soccer practice.
“I’ve gotten Botox, I’ve gotten laser on my face, I’ve gotten CoolSculpting on my belly. People don’t believe that I’ve had stuff done, and that’s how I want it to be for my patients.”
4. Running your own practice has advantages, but it will come with a big set of challenges. When I started my practice, I kind of just dove in and figured things out as I went along. You have to pay for all your benefits, and your malpractice and liability insurance yourself. You don't have a salary, so if you have a slow month, you pay for your own staff and then you pay for yourself. Luckily, I've never had a dead month where I couldn't pay myself, but there are practices that have closed down. A lot of doctors work together in groups because it can be so hard. My least favorite part of my job is all the paperwork I have to do. I have to do a lot to get an insurance company to pay me and you would be surprised by the amount of hoops you need to jump through.
5. There's no such thing as a "typical" plastic surgery patient. I was pleasantly surprised when I started a private practice in L.A. that my patients were generally nice people. I operate on kids who aren't even a year old, on teens, and on adults of all ages. It's just regular people who want a little something done, or teenagers who want their noses done or breast reconstruction, or kids with moles or cleft lip and cleft palate. And I see a lot of moms and women, because there are actually very few women in L.A. that are plastic surgeons and I think they definitely feel more comfortable with me. The people that get stuff done are just regular, really cool people. They get it done so it looks natural, so no one can even tell they've had work done — they just look better. And then people say, "Oh you look so well-rested." Plastic surgeons are trained to operate all over the body, though I can operate more on the face than others because of my fellowship in craniofacial surgery. Botox and fillers are the very low end of the spectrum, training-wise. We do everything, so we have patients come to us for a lot of different reasons.
“You’re not just changing patients’ looks. You’re changing their perspective on life.”
6. Surgery time is just a fraction of the time you spend with patients. A lot of people are decided before they even come in because they've done a bunch of research on the Internet, but sometimes the research they do is a little off, so you need to talk to them. We are medical doctors, so you have to find out the problem, you have to find out if they smoke because that can affect their surgery results, you have to examine them, and you have to make sure all their health maintenance stuff is up to date before you operate on them. Then we have them watch a video from the American Society of Plastic Surgeons so they can know what to expect from the surgery, because it's helpful to hear it from another source in addition to me. After that, they go through the planning stages, with my office staff answering any questions they have leading up to the surgery. And I see them at least twice before surgery, once to answer any questions that come up and another time to order their implants or work out any final stuff. Depending on what it is, the actual surgery usually takes about two to three hours. After the surgery, we see our patients pretty frequently. I either see them the day after surgery or the second day, and then I see them weekly or biweekly or every two weeks for the first two months. For every surgery, we do a three-month visit, a six-month visit, and then a yearly visit. The swelling takes at least six to nine months to go down all the way, so sometimes there's a lot of stressing about things that end up going away. Those follow-up appointments ease a lot of anxiety.
7. You need to be able to balance what the patient wants with what's actually best for them. We do a lot of consultation with patients before we agree to do the surgery. We screen them with some questionnaires before they even come in to make sure they don't have unrealistic expectations or that they're coming in for the wrong reasons. For example, if they want this to keep their husband or their fiancé is bringing them in to change their breast size, we're trained to see those red flags. We usually still meet with them, but I'm pretty honest with them and say I don't know if they're going to get the results they're looking for, and I'll refer them to a psychologist that I use if necessary. We turn down patients all the time. You don't want to attach your name to something that's not OK.
8. Patients won't always be happy with their results, but you shouldn't always take it personally. I wish I could say I have no unhappy patients, but everybody has some patients unhappy with the work they've gotten done. It's not like an outfit you try on and can take off — it's anatomy. I have the women choose their own size [for breast implants] so it's their decision, and then they come back and want to change their size. Or sometimes it really comes down to the expectations of the patients. Even though we check for red flags before the surgery, they come back and they're unhappy even though they have a great result because they just can't see past their own anxiety or there's something else going on that you didn't know about. You have to show them the before and after pictures and show the difference. You just have to try to make people happy as much as possible and try to identify where these thoughts are coming from. I tell my patients if they're not happy within a year with the cosmetic surgery they paid for, I'll fix it for them for free.
9. Many people don't believe that you're actually helping people. There are people that think all I do is operate on stars and make people look weird. I always have to explain that I do so many real things. I take trauma calls and reconstruct people's faces in the middle of the night, I work with kids who have cleft lip and cleft palate, I cover broken bones with muscle slabs, I do breast cancer reconstruction. The people who have duck lips make us look bad. But those people probably aren't going to plastic surgeons certified by the American Board of Plastic Surgery.
“The people who have duck lips make us look bad. But those people probably aren’t going to plastic surgeons certified by the American Board of Plastic Surgery.”
10. You'll sometimes have to fix other doctors' mistakes. There are people going to Asia or Russia to get plastic surgery, but we're pretty close to Tijuana, so we see people going there and getting stuff done because it's so much cheaper. And then they come back and have complications. I've seen people that have gotten butt injections with lard, implants that are put in too big so the skin breaks down, infections in tummy tucks that need to be dealt with right away. But even in the L.A. area, there are a lot of people who are not board-certified plastic surgeons, and people get stuff done and it no longer looks like normal anatomy. I've done a lot of redos on noses for people. I actually enjoy going in and fixing things.
11. If you're a woman, people will have a hard time believing you're a surgeon.Like most surgery, plastic surgery is very a male-dominated field. About half of medical students are women, but you don't see them going into surgery as often. I did a fellowship in the beginning of my career where they took on one person a year, and I was the third woman out of 37 years to do this fellowship. Nobody ever believes I'm a doctor. Or a surgeon. Even if I'm wearing a coat, they just think I'm a physical therapist or a nurse practitioner. Sometimes patients will ask, "What do they do in surgery?" and I'm like, "They? It's me."
12. How you present yourself will affect your brand as a plastic surgeon. Being a plastic surgeon is like having your own boutique. I try to dress nicely. I try to always have good shoes and nice nails. And I do treatments because I want to be able to tell patients what it feels like. I've gotten Botox, I've gotten laser on my face, I've gotten CoolSculpting on my belly. People don't believe that I've had stuff done, and that's how I want it to be for my patients.
13. You're not just changing patients' looks — you're changing their perspective on life. I did reconstructive surgery for a teen girl with really asymmetric breasts because she wanted to look good in a prom dress. That was her only wish. She recently wrote me from college saying how happy she was and grateful she was. You can help people breathe better or fit in clothes better or have less back pain. It feels weird to say it, but we do change lives.