You’re listening to the Confident Choice Podcast with me, Dr. Roberto Garcia, a double board-certified facial plastic and reconstructive surgeon. Honest conversations and expert advice about the decisions that make you feel your best.
Dr. Garcia:
So, welcome everybody to The Confident Choice. I’m your host, Dr. Roberto Garcia, and I’m honored to have my older brother here—the man I’ve learned so much from throughout my life. Not only as my best friend and confidant, but also as an incredible surgeon who has taught me a tremendous amount in my career. I’m very thankful for that.
We’ve really been enjoying this podcast—this is now our ninth episode. Last week we had Dr. Pasal on, which was a great conversation about surgical and non-surgical options.
One of the topics I’ve been wanting to cover is the importance of specialization. And when I thought about who needed to be part of that conversation, it had to be you—because you were truly one of the pioneers forging the path of facial plastic surgery in this community.
You were like… what’s his name—Meriwether… Lewis and Clark. That’s it. I apologize to my high school history teacher if you’re watching this—I got there eventually.
So, welcome. Tell us a little bit about when you started, what you found in your specialty, and for those who may not know, you’re double board-certified—first in ENT and then in facial plastic surgery. Why do people go into ENT versus general plastics? And also, give us some background on the history of our specialty and your personal journey.
Dr. Garcia’s Brother:
Thank you for having me.
My initial interest started in medical school, particularly during gross anatomy. Like you, I really enjoyed the anatomy of the head and neck. Everything felt precise—almost like the inside of a clock, where every component works in synchrony. It was fascinating.
As I moved into clinical clerkships—pediatrics, internal medicine, surgery—I developed a strong interest in surgery. I enjoyed solving problems and performing procedures. Over time, I explored different surgical subspecialties, and otolaryngology stood out because it brought me back to that head and neck focus.
Otolaryngology is a competitive residency. At the time I applied, there were about 270 spots nationwide with close to 1,000 applicants. Fellowship positions were even more limited—around 35.
Training in otolaryngology involves highly intricate work, especially in areas like ear surgery, which is microscope-driven. You develop extremely refined technical skills—fine motor control, precision, and the ability to operate in very small spaces. Those skills translate naturally into facial plastic surgery.
During residency, I was exposed to a significant amount of facial trauma and reconstructive work. That naturally led to an interest in cosmetic procedures, especially rhinoplasty. To specialize further, I pursued a fellowship—just like you did—where we refined those techniques and expanded into facial aging procedures.
The key point is this: over time, you narrow your focus. You don’t do everything—you concentrate on a specific set of procedures and repeat them consistently. That repetition leads to mastery.
Dr. Garcia:
And that’s something I feel strongly about. Surgeons who don’t specialize in the face but operate across the entire body—it can feel like a disservice to the complexity of facial surgery.
Brother:
I understand that perspective. I think it’s important to recognize that board certification represents a minimum standard. What differentiates specialists is the scope and focus of their practice.
For example, with rhinoplasty, repetition matters. Doing the procedure consistently allows you to refine your technique, reduce variability, and improve outcomes. It’s not about being more intelligent—it’s about doing the same work repeatedly and improving each time.
Dr. Garcia:
So, you started your practice in North Florida in 2001—right after 9/11. What did the landscape look like back then?
Brother:
At that time, most facial cosmetic procedures were performed by general plastic surgeons. Some ENT surgeons did facial plastics occasionally, but it wasn’t their primary focus.
When I started, I made a commitment to exclusively practice facial plastic and reconstructive surgery. That wasn’t easy financially, especially since people didn’t yet recognize facial plastic surgery as a distinct specialty.
But over time, that changed. Studies showed a major shift—from most procedures being done by general plastic surgeons in the early 1990s to the vast majority being performed by facial plastic surgeons by the early 2000s. That shift was driven by outcomes—better results and patient satisfaction.
Dr. Garcia:
Exactly. Patients aren’t being misled—they’re responding to results. That’s what drives referrals and builds practices.
Brother:
Right. And historically, facial plastic surgery has deep roots in otolaryngology. Early pioneers like Jacques Joseph and Harold Gillies had ENT backgrounds. Our specialty evolved naturally from that foundation.
The creation of our board helped formalize the field and establish credibility. From there, training programs expanded, and specialists became more prevalent.
Dr. Garcia:
And now patients actively seek out facial plastic surgeons.
Brother:
They do—and that’s something to be proud of. It reflects years of dedication and commitment to the specialty.
Dr. Garcia:
Before we wrap up, I want to touch on something we do at the end of each episode—lessons from our dad.
Our father passed away last June, and he was someone who constantly emphasized growth through failure. He believed that to succeed, you have to fail—many times—and learn from it.
I often tell patients that the surgeon I was early in my career is completely different from who I am today. Growth comes from recognizing mistakes, correcting them, and improving—not just professionally, but personally.
Brother:
One lesson from Dad that always stayed with me is: nobody owes you anything.
When I finished training and was ready to start my practice, he told me, “Now the work begins.” That mindset has stuck with me. You’re only as good as what you did yesterday. Nothing is guaranteed.
You have to stay humble, work hard every day, and never take anything for granted.
Dr. Garcia:
That’s exactly right.
It’s been an absolute honor having you here. This might be our best episode yet—sorry to everyone else, but it’s my brother.
Next week, we’ll be discussing revision surgery—when to intervene, how to approach it, and what patients should expect. And I’ll say this: any surgeon who claims they’ve never had to perform a revision is either not being honest or hasn’t done enough procedures.
Good decisions always come from good information.
We’ll see you next week.
Under the direction of visionary double board-certified facial plastic surgeon Dr. Roberto Garcia, Contoura Facial Plastic Surgery offers the latest surgical and non-surgical procedures in a relaxed and serene setting. Schedule a virtual or in-person consultation today to get the first glimpse of your future self.
230 A1A N, Ponte Vedra Beach, FL 32082