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Plastic Surgery Unplugged with Dr. Raghu Athré: Episode 1

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Here at Athré Facial Plastics we want you to feel confident that you’re in the best hands. Dr. Athré and our expert team of estheticians have years of experience and skill doing what we’re passionate about—helping people reveal their inner beauty with gorgeous, natural-looking results. This is why we’ve started a podcast, “Plastic Surgery Unplugged with Dr. Raghu Athré,” to share our knowledge and give you a peek at the industry behind the scenes. 

Listen to our first episode on YouTube, Apple Podcasts, Spotify, Podbean, or Google Podcasts. 

➢ Listen on Apple Podcasts:

https://podcasts.apple.com/us/podcast/plastic-surgery-unplugged/id1557751111

➢ Listen on Spotify:

https://open.spotify.com/show/2cKofy7a1TRdTAZKLuaKTA?si=3nihs11qRQGNcwwySgAKoA

➢ Listen on Google Podcasts:

https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkLnBvZGJlYW4uY29tL3BsYXN0aWNzdXJnZXJ5dW5wbHVnZ2VkL2ZlZWQueG1s

➢ Listen on Podbean:

https://plasticsurgeryunplugged.podbean.com/

➢ Watch the video podcast on our YouTube channel:

https://www.youtube.com/c/AthreFacialPlastics

Don’t forget to subscribe and share with friends and family. Here’s episode 1: “All Things Rhinoplasty: A Conversation With Rhinoplasty Expert, Dr. William Silver.” Thanks for listening!

[Audio transcription via Rev.com:]

“All Things Rhinoplasty: A Conversation With Rhinoplasty Expert, Dr. William Silver”

Speaker 1:

You are listening to Plastic Surgery Unplugged with Dr. Raghu Athré.

Dr. Raghu Athré:

Hello, everyone. This is Dr. Raghu Athré, with Athré Facial Plastics in Houston, Texas, host of “Plastic Surgery Unplugged.” On today’s episode, I sat down with one of my plastic surgery mentors and dear friend, Dr. William Silver from Atlanta, Georgia, and we discussed all things rhinoplasty, a little bit of history, as well as to say, a little bit of how I do it, type of thing. 

Dr. Silver is considered one of the nation’s most innovative and forward-thinking facial plastic surgeons, and I’d like to introduce him as one of the forefathers of modern rhinoplasty here in the United States.

Dr. Raghu Athré:

He really is a true pioneer in his field, he taught me what it means to be a doctor, he taught me what it means to be a rhinoplasty surgeon, taught me a lot of rhinoplastic techniques. So he’s all-in-one Renaissance guy who’s taught me a little bit of everything, all the way from doctoring to the technical cutting and sewing in the surgery room. 

One of his cool traits, I think, is his unique ability to get to know and deeply understand his patients, as well as his never ending desire to learn new things, new techniques. So without further ado, let’s get on to our conversation with Dr. William silver. Alright, ready to get started?

Dr. William Silver:

I’m ready to go [crosstalk 00:01:43]

Dr. Raghu Athré:

For the benefit of the listening public, that once we put this thing out there, so just for an introduction sake, so this is the first podcast, we’re trying something new. And so most of my patients are probably going to be the ones that are seeing this first before the general population, and so almost all of them know something about you. So now they’ll actually get to put a face to all the stories.

Dr. William Silver:

Well, let’s hope it’s a fun afternoon.

Dr. Raghu Athré:

Yeah. All right. So one of the things, I think I had started off, I made a list of questions. So we’re going to talk a little bit about rhinoplasty, so I think I’ve gone to the right space here. So tell me, I’ve read a lot about the history of rhinoplasty while I was doing fellowship with you there, you told me a lot about it. So just for the sake of everybody out here, in your own words, tell me about the history of rhinoplasty.

Dr. William Silver:

Well, in the history of rhinoplasty, obviously it’s one of the early plastic surgery procedures that was adopted for a cosmetic procedure. Obviously during the World Wars, when they were many facial accidents and things like that, you had teams of people that put together broken faces and so forth. But the original modern rhinoplasty began back with a gentleman named Dr. Jacques Joseph. 

And interestingly enough, he was known as an orthopaedic surgeon, and he began to see patients who wanted to see about having their noses changed, actually the large nose was an ethic quality that in the days in Europe at that time, and they didn’t want to be identified with certain ethnic changes.

Dr. William Silver:

And Dr. Joseph decided that he would see about making some changes and he did this, and he did it on a young fellow, and it made such a big hit that it became a very sought after procedure. The interesting part about it, a little different than what we do today, he began to do the surgery and began to show other physicians how to do it but not completely. He would actually have them sit around in a large room and they would look at the procedure from an amphitheater and-

Dr. Raghu Athré:

We’ve seen those in shows and TV shows, the kind of theater seating.

Dr. William Silver:

Right. And then he would go ahead and he would operate, but he would cover his instruments. So the patients, I mean, the surgeons who were trying to learn the procedure really couldn’t see the actual procedure. 

Interestingly enough, there was a doctor from the United States by the name of Forman, and Forman was a real good organizer of outlining ways to take exams or to teach. He was not necessarily a surgeon, but he could outline these and he was known to be able to teach foreign graduates how to pass the foreign graduate example.

Dr. William Silver:

He traveled to Europe and came across this doctor, Jacques Joseph, and lo and behold, he actually went up there, took the course or the seminar, and was able to sneak up into the operating room and actually look at the instruments that had been covered. And he copied all of those, brought them back to the United States, and at that time, since he really didn’t know exactly how to do the surgery, he went and spoke to several different groups of surgeons.

Dr. William Silver:

Part of the group was the general plastic surgeons, the oral maxillofacial surgeons and otolaryngologist. Well, interestingly enough, the old otolaryngologists, since they were used to working in and around the nose from multiple infections and things like that, were the ones that actually gravitated to this particular procedure. 

And interestingly enough, those instruments were reduplicated in New York, and I had the good fortune of having an uncle who worked with Dr. Forman, who his name was Dr. Abe Silver, he was my father’s brother, and they began to perform this rhinoplastic surgery in New York. And he would travel around, Dr. Silver, he would-

Dr. Raghu Athré:

So ballpark, what time period are we talking about?

Dr. William Silver:

This was probably in the late forties when he would travel around, he’d go to Chicago, he would have doctors in Chicago that would have the patients there. He would line them up and would operate on them, they would take care of the post-ops and he would come back to New York. 

And then, it just so happened, because of his brother, my father was a practicing a dentist in Atlanta, my dad would be able to get patients for him, and he would come down to Atlanta and we would line up the patients, and he had trained at Emory in Atlanta, so he had a Georgia license, so they allowed him to actually operate here in Atlanta. And I had the good fortune of having a hobby of taking photographs.

Dr. William Silver:

So he actually hired me to take the photographs of his patients preoperatively, before he came down to Atlanta and operate on them. So this way he could study the photographs and he knew pretty well the procedure he was going to do on the patients when he saw them, and then I would take the photographs many months later in the post-ops to send up to my uncle. And it was at that point that ironically speaking, I realized the excitement, the happiness that these people had from having their noses corrected to a more pleasant appearance, as a child, I was only 14, 15 years old, I said, hey, that’s what I’m going to do.

Dr. Raghu Athré:

Yeah.

Dr. William Silver:

And I was very fortunate that because of that interest, I went ahead and went on into the study of medicine, eventually into otolaryngology and had the opportunity of working with my uncle, Dr. AG Silver, and became somewhat of an apprentice while I was in my residency in New York at NYU and Mount Sinai. 

And then after serving in the army, came back to Atlanta and pretty much started my practice doing somewhat general otolaryngology, but because of my severe enjoyment or excitement in rhinoplastic surgery, having been around it for so many years, I really began to focus just on that.

Dr. William Silver:

And actually my practice now is primarily rhinoplastic surgery, but that’s a general overview of how I got involved. 

And the interesting part about rhinoplastic surgery is one of the few true plastic surgery procedures of the face that you can actually develop, you can create, whereas such things as a blepharoplasty or a facelift, you’re really restricted into the structures that you’re going to be able to manipulate, where in a rhinoplastic procedure, the beautiful part is, you can create, you could mold, you can adjust, you can add, you can take away.

Dr. William Silver:

And to me, that’s the excitement. And when you see the excitement that a patient has after having had this drastic change, and you can see the changes fairly quickly, even though it takes possibly a year for the full healing to take place, all the feeling comes back, but within the matter of a week or so after the surgery, or even the day you take the dressings off, which is usually about a week after the surgery, you can see pretty much what it’s going to be like. And even better, when you are in the operating room before any swelling comes about, you have the opportunity to see your work right in front of you.

Dr. Raghu Athré:

Right.

Dr. William Silver:

So to me, rhinoplastic surgery is such an exciting field. And I think, of all the surgical procedures I do on the face, it is the most rewarding for me and for my patients. And as I said, in my practice now, it’s all either rhinoplasty or revision rhinoplasty. Now, I’ve given you an easy overview there, of how rhinoplasty developed, how it came to this country and so forth. 

But it is an incredibly disciplined procedure that has to be learned, and learned, and learned. And we have certain techniques that we use that allow me to evaluate every part of the procedure before, during, and after the procedure. And what that is, is I take exact size photographs that I can duplicate, and I actually draw out on these photographs what changes I want to make.

Dr. William Silver:

Now, of course, I’ve done all of this in conjunction with my consultation with the patient. So not only do I have the opportunity of listening to them to make sure we’re all on the same wavelength, I go over with them, today, using computer imaging, but I still make these drawings. 

And I draw out and not only do I take the drawings, but I go step, by step, by step, by step each procedure, each step of the procedure that I plan to do in the operating room.And I take those pictures of the drawings with me, and they are actually right next to me or right behind me in the operating theater.

Dr. Raghu Athré:

Right.

Dr. William Silver:

Then I go through step by step and do all of this, and make sure I double check on my list and to make sure that I don’t overlook something. And when you’re doing a large number of procedures, sometimes I don’t care how good your memory is, you don’t want to depend on just your memory, so that helps out a great deal. 

So when I finish, I compare the pictures, compare my notes, and I could see pretty well what is there, then when I take the dressings off, we examine it and know that everything looks like it’s in place.

Dr. William Silver:

And then I wait six months or so, take my post-op pictures and ironically speaking, before I actually finish, leaving the operating room, I’ve taken a pen and pencil and drawn out on a special diagram, the actual steps of the procedure that I did. 

So then in six months later, when the patient comes in and I’ll take the post-op photographs, and I compare one to the other, the pre-op and the post-op, I’ll look at my drawings, I know exactly what I did.

Dr. William Silver:

And then I can look and see, well, what I did, how did it turn out on that procedure? Because healing is not something that you can control every aspect, sometimes healing can make a difference. So I can look at it, I know exactly what I did. And then it gives me the opportunity of knowing what I did there and how it looks six months later. And I know what that does for me, it allows me to have a one-year experience, 30 times, 30 years experience, but it gives me at least 30 years of experience, not one year experience, 30 times, but 30 years of experience, because I can look at every procedure and I treat each one as an individual procedure because each one is an art within itself.

Dr. William Silver:

So that’s a little bit about rhinoplasty from my point of view. And I love to teach it, you and I have had a lot of fun working together and exploring ideas. And the good part about it is it’s a type of procedure, when you do the appropriate evaluation, you can share it with other people just like you and I did, and that helps the patient, it helps the surgeon, it helps the student, and it gives the best opportunity to create a feeling of accomplishment when it’s all over.

Dr. Raghu Athré:

Right. So I’m going to add, I’ve been listening. So you actually answered about the first four questions that I had without me asking them, so I’m going to add a few little things to what you said. 

So to people listening to this that may not know completely, so I trained with Dr. Silver for close to almost 15 years ago, now it’s 14 years. So been a little bit, everything he was talking about basically is the way that I still do it, in terms of drawing pictures and doing it, so much so, first of all, I want to show the people. I don’t know if people can see this, I keep this on my desk. This is a silver osteotome.

Dr. Raghu Athré:

So I always keep it on my desk to remind me where I came from. And so he was talking about making these diagrams, which is what I call the blueprint. So I’ve actually went ahead and went to a guy in Brazil and made this little device, which is called a projectometer. And it’s got these little tines that go on the nose. So when we do our photograph and get our blueprint, I draw the one-to-one and say, hey, I need to take down whatever, three millimeters or two millimeters, whatever it may be and so I can actually measure three millimeters in the operating room and when I’ve done it, measure it, make sure that it was exactly three millimeters,

Dr. William Silver:

Put it on your face so I can see it.

Dr. Raghu Athré:

So it actually goes like this. So this portion sits on the forehead, there’s a little mouthpiece that sits on the upper maxilla and they have these moveable tines, and these tines actually have a little spike that goes in there and then each spike has a ruler measurement of the number of millimeters. So you can measure at different points what the projection is from the base plane.

Dr. William Silver:

That’s beautiful. That’s beautiful.

Dr. Raghu Athré:

Yeah. I’ll tell you where to get one if you want one. There’s one guy who’s sitting during COVID making these things. 

I think you mentioned something, when you’re talking to your patients, one of the things that I love about rhinoplasty and how I explain it to patients is, I feel like Santa Claus, and I have this big bag instead of gifts, I have tricks. And the bag of tricks that I have is the combined experience of my experiences plus your experiences, plus your uncle’s experiences, and I’m sure the next guy after me will take all of that plus mine.

Dr. Raghu Athré:

And so when you’re in the OR you make this detailed blueprint before you get there. And then once you get there, sometimes you get a few, what I call bombs, that you didn’t quite expect. And that’s where the bag of tricks really help because you end up looking there and you scratch your head for a moment and you go, okay, what am I going to do here? What’s the, you have certain tenets and principles that you know, but then sometimes each and every rhinoplasty, even on twins, I tell patients, is different. So you could have identical twins and they don’t get the exact same rhinoplasty, which is the thing that I find the most challenging about rhinoplasty, that it is so customized and specific to the patient.

Dr. Raghu Athré:

And I think that when, and I’m not making you feel old, but by the time I get to where you are, I think I’ll still be a student. That’s the one thing I’ve always said that I admired about you and I hope that I pick up that trait, is that you never stop learning. 

So even when I call you today and I say, hey, I have this idea, you still go in there and you go, well, that sounds pretty good, send me a video, send me whatever, see what it looks like. And I think that that’s the greatest thing about rhinoplasty, is that I don’t think we’ll ever be the hundred percent masters of it.

Dr. Raghu Athré:

You can be technically perfect and still, there is this little nebulous spot in there when you’ve seen the image in the OR, you go, this is perfect. We never walk out of the OR without a perfect result. And then there’s this six-month time period where we just have to wait, pray, and hope the stars align, and it’s as anxious, I guess, for both of us, that it is for the patient. Maybe more so, and that’s the magic of rhinoplasty in my [crosstalk 00:19:58]

Dr. William Silver:

I think you bring out an excellent point that every patient who is going to undergo a rhinoplasty must understand, that healing is a major important factor in the end result. And the healing factor is not something that my every little cell is controlled by the surgeon.

Dr. Raghu Athré:

Correct.

Dr. William Silver:

The patient has to have a realistic expectation because you are changing tissues and you’re depending on the body and nature itself to bring these together just exactly right. And sometimes it doesn’t, which means there are times when sometimes you have to do a little revision, and you always want a patient to understand that because there is a risk regardless of how the intent the surgeon is, those are factors that have to be considered when you’re talking to a real patient.

Dr. Raghu Athré:

Absolutely.

Dr. William Silver:

And if you have a good rapport with the patient and they in turn have the confidence in you, it’s very easy to share those details. And if you can’t, then you may want to let the patient think a little bit longer, but your approach is so wise in your short time that it’s really good to hear that you always explain those kinds of things to your patients.

Dr. Raghu Athré:

Right. Now, one of the things I think I really wanted to chit chat with you about, so let’s say we both of us have the opportunity right now to talk to Jane Doe on the street. And Jane Doe is probably searching for rhinoplasty surgery, you can only imagine in today’s world, it really is confusing for a patient. 

If you do a Google search, you’re bombarded with information and everyone says I’m the best. And so what should Jane Doe really be looking for? There’s a billion different blogs, but coming straight from the horse’s mouth, someone who’s done it and it’s almost you’re probably what I’m going to say, rhinoplasty royalty, right? It’s almost in this very father son apprentice type of system, if you could talk to Jane Doe, what would you tell her?

Dr. William Silver:

Well, I think there’s several things that a patient must have in seeking out someone to perform a rhinoplasty on themselves or on their daughter or-

Dr. Raghu Athré:

Anybody, a family member.

Dr. William Silver:

The point being is, number one, they need to be able to be upfront and open with the doctor with a free exchange. That means you cannot go in there with the idea that you’re frightened, you want to make sure that you feel comfortable talking to the surgeon. Number two, the surgeon, number one, must listen carefully to the patient. It’s not to impose the surgeon’s wish, it’s to make sure that the surgeon understands the patient’s [crosstalk 00:23:21]

Dr. Raghu Athré:

Absolutely.

Dr. William Silver:

And then the last part, the next part is to make sure what the patient wants, the doctor wants. Number two, that what the patient wants and the doctor wants fits the patient, and number three, that physically it can be done. 

So those four things, patient has to be able to talk openly to the doctor, patient has to be able to express what they want, it has to agree with what the doctor agrees with as well, and the doctor has to say he or she understands what can be done physically. And then after that’s there, then it’s very important that you’re able to sit there and explain to the patient how it’s to be done and what the expectations are being upfront and openly.

Dr. William Silver:

And to be able to pick the doctor to go through the Google search, today it’s done very easily because anybody can put anything they want. But one of the best things to do is to be able to find out from the doctor, is this a procedure that he does often many times, and the doctor obviously needs to be honest with her, if the patient really desires, and some patients will come and ask, how many do you do? 

I think it’s a good thing to tell the patient how often and how many you have done and do, and let them know what your training is. Now, rhinoplasty happens to be a very cross area of surgeons. For instance, you have a general plastic surgeons who perform body work and do a liposuction over the body and the implants and everything else.

Dr. William Silver:

And then you have the facial plastic surgeon, who is trained primarily from the neck up. And the background normally comes in where they’ve done the multiple internal and external procedures on the nose. So I think it’s important that the patients understand the difference between a rhinoplastic facial plastic surgeon, and a general plastic surgeon who performs rhinoplasty. And I think that that’s a very key part in having a patient look up a surgeon to perform a rhinoplasty. 

When you do a rhinoplasty, you have to understand there’s two factors, there’s the outside, and there’s the inside. And your own layer of illogic or ear, nose and throat, trained facial plastic surgeon, has the experience in both sides.

Dr. Raghu Athré:

Absolutely.

Dr. William Silver:

[crosstalk 00:26:07] nose not only to look good, what you want it to function very well.

Dr. Raghu Athré:

Right. So there’s some-

Dr. William Silver:

I think those are some of the points that I want to tell a patient when they were picking a surgeon, how to go about skipping the Google part, but finding out the history and the training specifically of the individual surgeon.

Dr. Raghu Athré:

So, a couple of caveats that I’d like to add, so when patients ask about this, one of the ways that I try to explain it to them is, let’s say your car really needs some major work done on the engine, you have a choice. You can go to the guy at Jiffy Lube who does oil changes to do the engine work, or you can go to a guy who specializes and says, Hey, I do engine work and that’s it.

Dr. Raghu Athré:

And so the guy who probably does nothing but engine work, from an experience standpoint, from how many times he’s done it, it’s just not even a comparison. I think I was looking at data and this wasn’t just for rhinoplasty, this was for other, for many other surgical procedures. And they found that the number one factor to minimize complications with a surgical procedure is simply, how often does the surgeon do that specific procedure? And it makes perfect sense. It’s just common sense-

Dr. William Silver:

I agree.

Dr. Raghu Athré:

But sometimes we forget about that. And so, I think that that’s a very important aspect. So for everyone listening, both Dr. Silver and I are both facial plastic surgeons, and we had very similar training in terms of how we went about getting to where we do, and both of us, our practices are primarily rhinoplasty. We do other stuff, he doesn’t do that much other stuff anymore, I still do, but probably 80% of my practice is still rhinoplasty. 

So one thing that’s coming up a lot about, and I know that you and I shared the same opinion on this, so there’s a lot of buzz, I’d like to say buzz, about the liquid rhinoplasty coming up. I probably get at least four or five people call a day saying, hey, can’t you just stick a little something in my nose.

Dr. Raghu Athré:

So my usual things that I normally say are A, your nose is extremely special, we know that where it is, the blood supply, the tissue layers and all these various things are extremely sensitive. And you don’t just willy nilly stick something in there because it does have ramifications. There’ve been cases of people going blind, there’s cases of scar tissue and if down the road, you really do want a rhinoplasty, it’s going to make that job five or 10 times more difficult. It’s actually a revision rhinoplasty at that time. 

So what’s your take on the liquid rhinoplasty?

Dr. William Silver:

Well, I think that it is a situation that patients misunderstand that when a liquid coats, I use the word liquid rhinoplasty really is, they feel that you can do the same thing by injecting some of these cosmetic fillers that you can performing a surgical rhinoplasty, which is the real negative part of what happens when you see advertising on a procedure like that. This liquid rhinoplasty that people do mention is done in a very special type of deformity that number one, is temporary and number two, only gives an impression of a change.

Dr. Raghu Athré:

Correct.

Dr. William Silver:

It’s a change, but it’s not the overall picture. When you change, as you mentioned, this device that you talked about measurement projection, which is how far the nose sticks out or the length of the nose with how short it is, or the width of the nose and so forth. All of those things are things that have to be considered when you’re doing a surgical rhinoplasty. During a filler, you’re really experiencing a very small dimension and it is something that I do feel, just from what I’ve seen, is more of an advertising ploy than a real procedure. 

And I think patients have to be very careful because number one, the fillers are very expensive, they last very short period of time and the satisfaction is just not there. And I think the patients just need to be really educated as to what it really is.

Dr. Raghu Athré:

Yeah, I agree. I think that fillers do have a role, I do sometimes use fillers, for example, if I’ve done an extremely complicated revision rhinoplasty, and a patient has a very minimal deformity, which is almost imperceptible, but can be shadowed with a tad bit of filler, I think that’s a great use of a filler.

Dr. William Silver:

But that’s different than a rhinoplasty.

Dr. Raghu Athré:

Exactly. [crosstalk 00:31:29] I agree.

Dr. William Silver:

…Thing there, that’s where the finesse around a plastic surgeon can come in, when the choice of a specific filler to take care of a very minute little defect that can make the patient very happy, that’s a total different ball game, you’re not using a whole-

Dr. Raghu Athré:

Absolutely agree. And I think that it’s a conversation I have with my patient and I say, listen, I believe that doing a small amount of filler may help with this and the risk-benefit ratio is in your benefit because I really don’t want to open everything up again, because I don’t think that the risk-benefit ratio to doing that is in your favor. So I think that these little, that’s why I say fillers, I think have a role in these little things. I’m not saying it’s off the table completely, but I do believe that it’s not a rhinoplasty.

Dr. William Silver:

Correct. That’s the key. That’s the key.

Dr. Raghu Athré:

So now, I’m going to ask you another question here, and I’m going to put you on the spot a little bit. So many patients, I think there’s a lot of, in my experience, I find that patients have the greatest fear factor of going in for a rhinoplasty. And it makes sense. It’s right in the middle of your face, everybody knows somebody who’s had a bad rhinoplasty, there’s a lot of press about bad rhinoplasties, we’ve seen even public figures with bad rhinoplasties. 

So, how do you alleviate some of that anxiety for the patient when they are so anxious about that?

Dr. William Silver:

The key of any rhinoplastic procedure is the openness, honesty of the doctor to the patient. And the patient must understand that we are performing an operation, and you’re not guaranteeing a perfect result. But in this situation, I actually tell the patients openly that if I personally perform a hundred rhinoplasties, there are approximately two of those that I may have to do some revision. Now, one of the things that I do is, if I have to do a revision for the way it healed from the perspective of what my expectations were and the patient’s expectations.

Dr. William Silver:

And I feel after waiting the appropriate period of time, which is usually about nine months to a year, if I feel that there’s something that can be done, I will do this at no charge of surgical charge to the patient. That’s my way of giving the patient a little bit of understanding that I want to follow them completely. And it doesn’t mean that I’ve never had a patient that I’ve had to not do some revision on, but they need to have an understanding that that is a possibility.

Dr. Raghu Athré:

I think the adage is, if ever there’s a surgeon that says I’ve never done a revision, especially rhinoplasty surgeon, I think the response really should be they’ve either not done enough or they’re lying, one or the other. One of the big stalwarts in our field, Gairon, I think wrote an article and he puts out there, it is impossible to have a 0% revision rate regardless of who you are. And here’s the guy who’s written all these articles and textbook chapters and such, and he says, it’s just not possible.

Dr. William Silver:

Well, I think the other factor that you have to consider is that just because the end result is not exactly what you want, or you have to do some revision, doesn’t mean the surgery was done badly.

Dr. Raghu Athré:

Correct.

Dr. William Silver:

Sometimes healing is a, not sometimes, but healing is a very important factor when one wants to consider the end result, but in a very skilled surgeon, the number of complications or the number of times you would have to revise goes down. It goes to zero.

Dr. Raghu Athré:

Correct.

Dr. William Silver:

And I think to give the patient the confidence to know that you’ve done enough to know that you would not do the procedure, if you didn’t feel pretty close within about 90% or better, that you’re going to accomplish almost all of your goals, but [inaudible 00:36:30] almost only because you want to be upfront with the patient just to make sure they’re not walking into something that has not been explained carefully to them.

Dr. Raghu Athré:

Correct.

Dr. William Silver:

And I think if you do that, the patient will feel better but keep in mind, any patients, including a doctor undergoing a procedure needs to have a certain amount of anxiety.

Dr. Raghu Athré:

Absolutely.

Dr. William Silver:

Because you can’t walk in there with the idea that, hey, I’m going to go in there and I’m going to buy a haircut and don’t work, it didn’t work out, I let it grow back. It is a procedure and you want to make sure that it’s not a permit for a surgery, it’s a request for surgery When the patient signs that information.

Dr. Raghu Athré:

So one of the things, I sometimes have patients who ask me, am I willing to give them a valium or something, pre-operatively, okay? And they call the night before and they say, I’m very anxious, I can’t go to sleep. And I sell them, give them the valium, I don’t believe in it. And one of the things I tell them is, I’m a surgeon, I go to the operating room almost every day and the night before I have to have surgery on myself, I have anxiety, even when I’ve a patient, I am anxious.

Dr. Raghu Athré:

I had surgery on my hand and the moment I woke up, the first thing I wanted to do is move my fingers, just to see if they still worked. So I think it’s a normal human feeling and it keeps us healthy, keeps us real, keeps us alive. And I don’t want to shut it down pharmacologically. I think it’s part of that process that we need to go through to understand this entire journey as we’re going through that journey.

Dr. William Silver:

Yeah. And I think the doctor needs to understand that and explain that to the patient that they should be anxious and that’s not abnormal.

Dr. Raghu Athré:

Right.

Dr. William Silver:

And when the doctor is going to do the surgery, it’s important that the patient understands the doctor is prepared for that patient’s reaction and things will be done at the time of the surgery to minimize, not to remove, but to minimize that anxiety.

Dr. Raghu Athré:

Right. Well, I think we beat rhinoplasty down-

Dr. William Silver:

[inaudible 00:39:11]

Dr. Raghu Athré:

…Over the last hour, but I had a lot of fun.

Dr. William Silver:

I’ll tell you, I think that it’s interesting I’m saying this, an idea that you seem to come up with incredibly often, which is a pleasure for me to see your clear thinking, and you’re always coming up with new ideas and new thoughts and this is something that may be very helpful to a patient to watch, listen to, and bring up questions about. 

And I hope that you and I will get a chance to talk again, to share different views, maybe specific to patient concerns, maybe not do them so long, do little short vignettes.

Dr. William Silver:

I think it’s a great little thing to have because now you and I can talk openly and patients can then listen in as though you’re talking to two experts talking to each other, getting ideas that, at the most part, helps the patients. And I really thank you for your free enthusiasm, for your clear thinking and all the wonderful things that you do, and obviously I’m sure it’s transferred to your patients as well.

Dr. Raghu Athré:

Well, thank you Dr. Silver. It really means a lot to me. And the thing is, I really learned to be a doctor with you, I’d already done residency, and you how to operate, you know how to throw suture and you know how to do stuff, but that’s not being a doctor, okay? 

Being a doctor is a lot more than just cutting and sewing, it really is how you talk to people, how you understand them, you understand their fears or what they’re going through, and trying to figure all of this out and still stay objective, being the best clinician, being the best person to execute a surgical plan, but putting all of this together. And before I came to Atlanta, I think I’m going to give myself an F-

Dr. William Silver:

I don’t think you can ever do that.

Dr. Raghu Athré:

No, I’m serious. I’m being very blunt. Yeah, I had a diploma on the wall and I could have started practice, but I really learned how to be a doctor, and it’s something I aspire to every day. As I said at the beginning of this, I really do hope that when I’m in my eighties, that I will still have the patience, the excitement, the motivation that you do to still make it new every day, and learn something new and take it to be better and better and better and better and better because there’s the thing, if you’re not growing, you’re dying, right? And it really is important because I see so many young surgeons and there’s this like, oh, I got done with school, I know everything. And now with a few loss of hair and a little gray hair, you chuckle a little bit and you let it go and you just let them do their gig.

Dr. William Silver:

Well, I’ll end this with a statement remark I’d heard many years ago, and it applies very much to you. And that is that the meaning of life is to find your gift, purpose of life is to give it away. And I think you’ve done one great job.

Dr. Raghu Athré:

Well, thank you.

Dr. William Silver:

Hat off to you.

Dr. Raghu Athré:

Well, thank you Dr. Silver, I really appreciate that. You made my day. Thank you.

Dr. William Silver:

[inaudible 00:43:00]

Dr. Raghu Athré:

So I really do think that’s a great idea. I think what we should do is set up, I’m going to try and see if I can set up another little chat like this, and what I’m going to do is, I’m going to see if I can get maybe a patient picture or something like that. I’ll send you the pictures upfront so you can take a look at it. We can both do our little surgical game plan action, like how we still do it and we can set up a little 20-minute, just like how we used to do it with what’s the surgical game plan and what we’re looking for.

Dr. William Silver:

Fun. I look forward to it.

Dr. Raghu Athré:

All right, let’s do it. I’ll see if I can find… I’ll just probably pick the next rhinoplasty I’m doing, set it up, we’ll send you the pictures and let’s do it.

Dr. William Silver:

You got it.

Dr. Raghu Athré:

All right. Till next time.