In this episode, Dr. Roberto Garcia discusses how the facial plastic surgery consultation has evolved. Rather than beginning with a predetermined procedure, today’s consultation is about understanding a patient’s concerns, anatomy, goals and expectations, then developing an individualized path toward a realistic result. He also discusses facial balance, AI and 3D imaging, and the importance of asking the right questions before surgery.
Dr. Roberto Garcia: 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.
All right, everybody. Welcome to Season 2, Episode 4 of The Confident Choice. I'm your host, Dr. Roberto Garcia. I'm a facial plastic surgeon in the best part of Florida, I think - Ponte Vedra Beach. It's so fun. We're like a little island. We don't get hit with hurricanes. Wait - did I say that in the middle of hurricane season?
Speaking of hurricanes, the Miami Hurricanes are opening tonight against Stanford. You guys are actually going to get this podcast in about three or four weeks because we're backlogged, but I'm still going to talk about Labor Day weekend because it's one of my favorite weekends. It's the end of summer.
I'm going to be beaching it, getting into my shortest of shorts, getting out there and getting some suntan - the Euro cut, whatever. Sorry, guys. I know you're puking right now, but that's fine.
The Hurricanes are traveling to Palo Alto, wherever Stanford is, and taking on Stanford tonight at 7:00 p.m. So, all of you who want to see the future national champions, tune in. You'll see an amazing football team - only the best that money and NIL dollars can buy, by the way.
Their quarterback is making $6.5 million as a collegiate athlete. What do you think the incentive is for these kids to go to the NFL anymore?
My second thing I want to talk about is my team, the Florida Gators. I'm sorry for all of you Georgia and FSU fans. They're hosting FAU tomorrow under a new regime. They have a great offensive line, they're young and aggressive, and they have a core of receivers. We'll see what happens.
As a note, my wife went to the University of Miami for undergrad and grad school, and my son goes there. So currently I am what they call a financial Hurricane. My oldest daughter, who went to the University of Florida, was easy on Dad's pocketbook. God has a sense of humor, and I feel like he's living it out with me now with my son, Rocco, who's actually a very studious, very focused pre-med student.
So, roughly 13 and a half years from now, Rocco will be doing Season 42 of The Confident Choice, talking about how AI is now doing facelifts.
Amelia, our producer, is in the house. She's on her iPad taking notes. She also wants to be a doctor. You better be a doctor, Amelia. We need smart women like you.
Okay, let's get to the nuts and bolts of this podcast. Enough of the fun. I know it's Friday. I'm kind of laid-back with a collar, no tie. Amy apparently doesn't like me to wear ties on the podcast.
My youngest child is also rushing at the University of South Florida. Good luck to my youngest daughter, Eva. If you're listening, I love you, baby. You're going to do great.
So, what I wanted to talk about today on a serious note - and we touched on this in Season 1 - is the consultation mindset that someone needs to go through when they decide to seek a consultation.
Dr. Roberto Garcia: Back in the day, consultations were the moment where patients actually learned, from moment one, what the process was like. They had very little information beforehand. I'm old enough to have lived in a world where the internet existed, but it wasn't nearly as rich with information as it is now.
Today, our patients come in very well informed. They have information about procedures they think they want, and they've often narrowed things down to one or two surgeons. In my practice, many have pretty much narrowed it down to me by the time they get here.
That's good, because now the decision we really need to come to is: What's the right procedure? What's the right timing? And are you going to achieve the result you're seeking with whatever we might recommend?
The mindset has changed. The consultation is really centered around finding the right path. Surgery is game day. Everything we're doing up until that point is preparing for game day. We know the goal; now we need to find the best way to achieve it.
I always recommend that patients come with as many questions as they have about the process. What is unique to my practice that may be different from another facial plastic surgery practice doing a similar procedure? We have our own style and a very methodical, detailed and disciplined way of managing patient care.
Nowadays, patients may also come in with morphed pictures of themselves. We see this especially with rhinoplasty patients. They'll come in with a photograph showing a beautiful nose on their face.
With the advent of AI, some of those images can actually be useful as a starting point for discussion. Before AI, traditional morphing programs simply manipulated a photograph. Newer technology can create much more sophisticated visualizations.
Here in our office, we also use three-dimensional analysis. We take several angled photographs of a patient, create a 3D model and then I can shape the nose on the computer screen to fit that particular face.
None of my rhinoplasties are ever exactly the same because every face is different. That's where our specialty has really advanced: recognizing that the appropriate nose, jawline or appearance around the eyes is individual to that patient.
In the old days, surgeons sometimes had a recognizable 'nasal style' or 'jawline style.' Today, the goal isn't to create the same look on every patient. Every time I go into surgery, I'm creating something different - and that's probably why it's so much fun.
Dr. Roberto Garcia: Every face that comes to see me is different, so the result has to be unique to that face. We always talk about facial balance. The idea is that whatever we're doing should fit that person's face.
It's not that one procedure should stand out so that someone walks into a room and people immediately say, 'Oh, that person had her nose done,' or 'That person had her eyes done.' When it's properly done, the person should simply look aesthetically balanced and natural.
I encourage patients to bring photographs and ask, 'Is this something realistic?' Sometimes the answer is yes, and sometimes I have to tell a patient, 'This isn't realistic.' Anatomy matters.
For example, someone with a very heavy neck may show me an image with an extremely defined neck and jawline. Their anatomy may simply not allow that exact result. That's why I often go back to: What did you look like in your 20s?
A patient may come in and say, 'I saw two or three other surgeons and they said I needed a chin implant.' I'll ask what their chin looked like when they were younger. If they thought their chin was fine in their 20s, we need to look at what has changed over the last 30 years rather than automatically assuming the solution is an implant.
Many times, it's the angle of the aging neck. You lose the angularity - what we call the cervicomental angle - and the chin begins to look relatively recessed. We've seen this hundreds of times in before-and-after photographs. You tighten the neck and suddenly the chin appears more defined again because you've corrected the changes caused by aging.
That's what we're explaining during these consultations. It's great that patients have information, but we need to digest that information and get down to the reason they're seeing these changes.
The mindset has shifted from, 'This person needs a facelift,' or, 'This person needs a rhinoplasty,' to, 'This person wants this result. How do we get him or her there?'
The last patient I saw this morning may have needed a neck lift to reach a certain result. That doesn't mean the next patient needs a neck lift to reach a similar goal. That person may need something entirely different.
That's where the science and the art come together. What do we need to do to reach the desired end result? Two people may be traveling to the same destination, but they don't necessarily take the same route.
Dr. Roberto Garcia: I often have patients who say, 'I went to see someone else and they told me I need this, this, this and this.'
I say, 'Okay, hold on a second. What are your major concerns? Let's rank them.'
If the number one concern is the neck, let's talk about how we're going to correct the issues you're seeing in your neck. What's number two? Maybe it's around the eyes. You may not need three different procedures to rejuvenate the eyes. You may be able to accomplish what you're looking for by doing one thing.
It's a minimalist approach with a maximal result. In other words, the goal is to achieve the best result while doing only what is actually necessary.
The consultation has also changed from being a lecture from one person to the patient into a conversation. It's back and forth. I want to learn from you why you have these concerns.
Sometimes I may tell you that you don't need to place as much importance on one concern and that we should focus on something else. The appropriate approach may be less invasive, less obtrusive and, many times, less expensive.
One of the final things I want to talk about regarding the consultation process is: What questions need to be answered by the time the consultation comes to a close?
Hopefully, by the end of the consultation, you have a different level of comfort. I see patients who have gone somewhere else with one concern and were told about 10 different things they 'needed' to do. If something doesn't bother the patient, it doesn't bother the patient.
The questions you really need answered are:
Is the plan we've created going to achieve the result I'm after?
According to the surgeon, is the result I want realistic and achievable?
Do I feel confident that this surgeon is giving me an honest approach?
And do I feel confident that this surgeon and the team are going to take care of me properly throughout the process?
Of course, there's also the financial side, which is personal.
Once those questions are answered, the most important issue isn't simply the cost. It's whether you feel your goals can be achieved in a realistic, reasonable manner.
Dr. Roberto Garcia: Don't overthink the consultation. Don't feel like you need to walk in with a three-ring binder full of photographs, questions and concerns, or have family members from across the country on speakerphone.
And don't feel like every question has to be answered within that one hour.
A lot of patients leave and later think, 'Oh my gosh, I have a few more questions.' They may do a little more research and then call our patient coordinator, one of our nurses or our office manager. We may simply say, 'Come back in. Let's go over it again.'
Sometimes they'll bring a husband or another family member who has questions about anesthesia or another part of the process.
The most important thing is that you walk out with a level of comfort that your desired result can be approached in a reasonable and realistic manner.
Dr. Roberto Garcia: I want to close with an interesting 'dad thing' I was thinking about the other day.
One of these podcasts, I'm going to tell my dad's story of how he came from Cuba. Every time I tell someone the story, people say it needs to be a movie.
My grandfather on my mother's side was a very successful businessman in Cuba. When he came to the United States around 1964, he had been the mayor of a small town in Cuba. He had originally been a cigarette salesman.
He was this slender, tall guy who never smiled. I remember asking him when I was a kid, 'Why don't you smile?' He said, 'Because I don't want flies getting in my mouth.'
He wore a suit until the day he died, almost 85 years old. He'd get up in his condo, put on a suit jacket and tie, and the only time he'd loosen that tie was when he took a nap in the middle of the day.
He loved America. He was very proud of this country.
My dad learned something from him, and then he taught it to me: 'Learn quietly, teach loudly.'
When I was in training, believe it or not, I was the quietest person in the operating room. I just wanted to learn.
My grandfather would always say, 'The reason God gives you two ears and one mouth is so that you listen twice as much as you speak.'
So when young people come to shadow me, I tell them: Just listen. You'll learn more when you're listening. Don't try to speak over your mentor or predict what they're going to say. They have years of information and experience ahead of you. Absorb it.
The only way you're going to absorb and learn enough that one day you can 'teach loudly' - and I don't mean loud in decibels, I mean loudly in the amount you can share - is by learning from the people who walked the earth before you, so that you can climb upon their shoulders and speak with a louder microphone.
If you're beginning a job, starting a career path or moving in a different direction, remember: learn quietly, teach loudly.
That concludes Season 2, Episode 4 of The Confident Choice.
Next week we're going to be talking about rhinoplasty, one of my favorite subjects, and the things you should consider when making that decision. It's a major decision. Your nose sits in the middle of your face, so it's important to understand why you want to make a change and what the right choices are.
I'm your host, Dr. Roberto Garcia. Have a wonderful weekend, everybody.
And as a final note, Amelia has reminded me: good decisions come from good information.
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