actorartathleteauthorbizcrimecrosspostcustomerservicedirectoredufoodgaminghealthjournalistmedicalmilmodpostmunimusicnewsworthynonprofitotherphilpolretailscispecialisedspecializedtechtourismtravelunique

MedicalI am a Los Angeles based plastic surgeon. I have done everything from gender reassignments & testicular enlargement, to operating on A-list celebrities & government officials. AMA.

Sep 22nd 2016 by LawtonTangMD • 32 Questions • 71 Points

I've been in practice for a decade, with offices all over Los Angeles such as Pasadena, Beverly Hills, Irvine. Most of my practice consists of typical procedures such as breast augmentation, face/body lifts, liposuction and things like that but living in Los Angeles, almost every day someone walks in with an atypical request and I've met all walks of life.

My newest endeavor is a non-surgical weight loss program where patients see an average weight loss of 25 pounds in 4 weeks, and even up to 80lbs. Afterward, I lift up the skin with a full body lift. NSFW Example: http://imgur.com/Mk7mYBz

I'm also trained in reconstructive surgery, so if your legs fall off after a motorcycle accident, I reattach it.

My Proof: http://imgur.com/SreOXFw

Q:

Do patients go through any counseling/evaluation when they come in for major cosmetic procedures?

A:

Generally counseling is not needed, however, procedures such as gender reassignment require 6-12mo of psychiatric evaluation before we'd consider doing a procedure.


Q:

I thought it was two years... that's what I heard...

A:

It depends on different insurance policies and protocols, but usually it's closer to 1 year.


Q:

The "full body lift" before and after looks nothing less than miraculous, so much so that I think the average person would be highly skeptical. How is such a thing done without any obvious scaring?

A:

Thanks, I'll take that as a compliment! However, there is actually a lot of scarring any time you cut into the body- the trick is to minimalize it. An experienced plastic surgeon will carefully place the scars in the normal folds of the body so that they are difficult to see. For example, alot of surgeons leave scars behind the ear when they do a facelift.... I utilize a technique where the scars are hidden inside of the inner ear so that you don't see anything overtly. Another factor to consider is that everyone also heals differently, some heal better than others. Plastic surgeons also suture up wounds with a different technique than other surgeons, increasing chances of minimum scarring. If you ever need stitches, make sure to ask for a "plastics suture".


Q:

Well I'm completely amazed at the transformation, that's truly amazing work. That must be very gratifying to know you've helped someone on that kind of level.

A:

By the way, I get asked all the time if this really is the same person. This particular patient did not want to do her legs, so if you look closely, you'll see her upper thighs are the same.


Q:

Have you ever operated on government officials for the purpose of giving them anonymity/a new life? (In my head I'm thinking, like, secret service guys getting their faces rearranged for crafty purposes 😛)

A:

I'm trying to decide if my nonanswering of this question is an answer in itself.


Q:

I get the implication.

Hypothetically, if you DID ever have to perform that sort of task, would you find it interesting? Do you think it'd be difficult to do?

A:

I think it is more difficult to try to get natural, realistic results. Changing your look entirely is not difficult, just requires many procedures.


Q:

The shadow in the after picture shows a rounder belly than the picture seems to depict?

A:

Crap. Time to fire my photoshop specialist.

Just kidding- if you look at the shadow in the back of her (behind the buttocks), you'll see that it also goes considerably further back. My guess would be that there was something else between the wall and the light but behind the photographer... or even the photographers arm. Good thing we have photos of our patients in different angles :)


Q:

Who was your favorite patient? Obviously I'm not expecting you to name them, but what were they like? What surgery did they get? And what's the weirded request you've gotten in regards to surgery?

A:

Actually my favorite patients are really just plain ordinary people who are thankful for the work I do for them. I have a few patients who are eternally grateful for the work they had done because it brought some normalcy back to their life and it feels good knowing I helped them.

I have a lot of celebrity patients but the problem with celebrities or anyone high profile is that they require special treatment (my surgery center has a secret backdoor entrance where no paparazzi can access) yet I can't use their photos for advertising, and they generally don't ever admit they had plastic surgery done, let alone give credit. I had a very famous actress come in for some minor work and then later do a magazine interview on how she'd never get plastic surgery.


Q:

For a rhinoseptoplasty, how difficult is it to perform a osteotomy correctly and get the nose straight? How often does it work correctly?

A:

The process of osteotomy is not difficult, what is difficult is positioning and applying the right amount of magnitude and direction to obtain an adequate break so the internal results will reflect the external results. Majority of times it works well, but it depends on the level of experienced hands.


Q:

Thanks. Does an open vs. closed procedure make much of a difference in terms of just straightening the septum, straightening the nose and reducing turbinates?

A:

It depends on the level of deviation and correction needed.


Q:

In case nobody has asked this yet: thoughts on the head transplant procedure being discussed in the news?

A:

The real question: Is this a head transplant, or a body transplant?


Q:

What are some more unusual requests you've gotten?

A:

The scrotum/testicular enlargement is pretty unusual, but I've also had patients who wanted to look like a reptile or an alien- they request to have reptilian skin, implants in odd places, and a sliced tongue, or a large bulbous head and excessively large eyes to "look like they're from another planet".


Q:

When you say testicular enlargment, do you mean just making small balls average sized? or someone wanting some Randy Marsh nonsense happening in his bag of beans?

A:

I've had both but usually it is to make small balls into regular balls.


Q:

Um, asking for a friend, but just how small are small balls compared to regular balls? Is there that much variation?

A:

That's a subjective question for you and your significant other to decide. And yes, all parts of the human body are subject to variation!


Q:

Do you mind explaining how that procedure works? Do you just line them with a filler or something? Or inject them with something like expandable foam insulation that you buy at your hardware store?

A:

Testicular enlargement or replacement is usually done with a silicone implant. However, when people say they want a testicular enlargement what they really want is a scrotal enlargement which gives the perception of larger testicles. Assuming that all anatomy is normal and there are no elements of scar contracture, and the tissue is of its normal elasticity, you can mobilize the dorsal perineal raphe/frenulum and do a VY advancement flap moving all tissue anteriorly. In other words, I cut a little bit here and there to loosen things and let them drop.


Q:

When something like that happens do you refuse to perform the surgery to "make them look like they're from another planet" or do you accept their requests?

A:

I've never made any lizards or aliens and I'd hope that my career doesn't lead me down that path ;)


Q:

Any instance(s) that you couldn't keep a straight face?'

A:

When I was the chief resident in general surgery residency, I was asked to go the emergency room to evaluate someone with severe abdominal pain and possible free air in her abdomen. I evaluated the woman in front of her husband and asked her her past medical history and she denied any, so I furthered followed up with a KUB xray and saw that she had possibly perforated something in her abdomen. When I was reading the xray, it confirmed my suspicions of her having free air in the abdomen so we needed to take her for emergent exploration in the operating room. When we put a scope into her, looked around and saw some blood. Also realized her uterus was missing- it had been surgically removed in the past and she had a blunted vaginal wall where her uterus used to be attached to her vagina. I realized that the blind end of her vagina was torn open so I repaired it. The next day, I went to the patients room when she was recovering to tell her what was going in front of her significant other, when suddenly, she tells her husband to hide behind some curtains. She whispered to me that her REAL husband was right around the corner about the enter the room and that the first man I met was actually her boyfriend and then she finally admitted to me that she was playing with some large foreign objects in her vagina prior to coming in which led to the rupture of her vagina in the first place and I was left needing to somehow explain how all of this happened to her real husband when he suddenly walked in, while her boyfriend was hiding a few feet away behind the curtain.

More recently, I had a patient who called me and told me she was taking her antibiotics every day but it seemed like her incision on the breast from doing a breast augmentation was infected and looking worse. I asked her how many times she was taking her antibiotics, and she said 4 times a day, as directed. I asked her if she's taking it after meals and is it irritating her stomach. Then she said "Why would my stomach irritate me? I'm crushing up the antibiotics and spreading it on my breasts."


Q:

Have you ever amputated something? Whats the deepest cut you've ever made?

A:

I was trained as a general surgeon before becoming a plastic surgeon so I've amputated a lot of things, unfortunately. I've done complete amputations which involved the skin, subcutaneous tissue, fat, muscle, bone and cartilage.


Q:

Have you ever messed up? What haplened?

A:

Of course I have- I am human. Mistakes are a part of learning, that is why they have medical school, residency, and fellowship training. Error is a process towards learning and perfecting your skill set.


Q:

Ok, how much do people in the profession make on average? What about the top end? Thanks.

A:

Anywhere from $250,000 to millions... I would say an average of $400,000 but also geographical location is a huge factor. A plastic surgeon in New York or Florida is going to be busier than one in Kentucky... but the doctor in Kentucky might have a bigger house than the one in New York (or California) because the cost of living is so high. It's a long road to becoming a plastic surgeon and I wouldn't recommend anyone going down this path for the sole purpose of making money. The real money is made when you can make money without exchanging your own physical labor.


Q:

Which of the surgeries you perform do you like to do most? What are the people you work with like/how is the work environment?

The woman who underwent a full body lift looks amazing! Great work :)

Edit: spelling..

A:

Great question. I enjoy elements of all of my operations because each operation offers different specific nuances which are challenging and allows me to add to my own creative spin to it. There are also different challenges in plastic surgery every day because you have so many different patients that want different things done. I enjoy the problem-solving aspects of operating itself- using surgical conflict resolution to fix peoples problems. Even down to the little things like removing moles- because I like making it seem like the mole was never there. I like operating on children, because it changes their lives, and they are very happy and thankful. I like being able to help someone change something that has bothered them their entire life, and boost their self esteem and image. I like fixing things that people thought were broken and never to be used again, like putting limbs back on. I just like being a surgeon, I guess!

As for the work environment, there are enough strong personalities involved to make for an entertaining TV show.

And, thank you!


Q:

Biggest penis enlargement you've done?

A:

A radial forearm free flap- you take the skin from their arm and move it to their penis and I can make it as big as they want it- easily 10inches in length.


Q:

Aww you can't leave it as that, how about some examples please?

A:

I turn away patients when there are psychosocial factors involved and unrealistic expectations. For example, I try to identify if they've had any recent traumatic stressors in their life such as a death, divorce etc, and I usually tell them to wait until after the grieving period is over.


Q:

How did you determine that this job was for you? What made you want to pursue this?

A:

Life is about balancing your long term dreams and aspirations and managing it with your short term realities. Deciding on a career path is a very personal affair which intrinsicly forces one to look deep down inside starting with determining what you want to accomplish in life. However, just because you determine and want to pursue a career in something, does not make it rightfully so.

Since plastic surgery is such a highly competitive field, picking plastic surgery is also about having plastic surgery pick you. To achieve this goal you have to achieve certain parameters in life by standardized testing as well as traditional hard work. Out of all of the fields in medicine, it is the most dynamic in regards to taking care of the human condition- this is why I decided on this path. Passion, persistance, planning, and prayer goes a long way to staying the course.


Q:

What was it like performing your first operations, I'd imagine it was pretty nerve wracking? Does it feel more routine now?

A:

My first rotation in med school was OB/GYN so I did a C-section. My first plastic surgery was a breast augmentation. I was too engrossed in the operation to feel anything except excitement and a rush of adrenaline because we have to study and read about doing things for so long, and it's awesome to finally get to the point where you actually get to perform.

Yes, I operate almost every day for the last 10+ years so it's definitely routine.


Q:

Have you had any patients that have backed out at the last minute?

A:

Yes, only about 2 in my entire career. Most of the time I cancel surgeries because they have other issues which would not lend itself to undergoing a successful procedure.


Q:

What educational path did you take to become a surgeon? I'm looking into going into trauma surgery and like to know how a professional got to where they were. Thanks!

A:

4 years of medical school, 6 years of general surgery residency, 3 years of plastic surgery residency, then I also did two fellowships which took another 3 years.


Q:

What did you major in before medical school? I'm currently going to school for a major in Biology and a minor in Chemistry. Would that be sufficient?

A:

I started off in mechanical engineering then went into biology and chemistry so I would say you are on the right track. Keep your grades up and do well on the mcat.


Q:

After an enlargement, does the penis operate the same way( flaccid and erect) or does it stay in a constant state?

A:

It depends upon the process that in which you do the enlargement- is it minimally invasive or a complete reconstruction?


Q:

Have you made a gynecomastia surgery? If so, is the surgery very complicated and are there any dangers on doing it?

A:

I have performed this procedure at the breast and body symposium on a live open forum in front of 200 plastic surgeons in New Mexico & Texas, so I have a bit of experience with gynecomastia.

There are 4 grades of gynecomastia- the fourth one being the most severe. Predominately, the most important factor is identifying the root cause then determining the level of severity. The first two grades can be treated with ultrasonic liposuction. The latter two, treated with ultrasonic liposuction as well as a surgical lift and excision of excess tissue. There are risks involved any time you have surgery. The most common risks are infection, bleeding, hematoma, seroma, asymmetry, permanent scarring, irregularities in healing and dehiscence of the wound.

I would not consider gynecomastia a difficult operation compared with other procedures and the risks are also relatively low.


Q:

What is the most exciting thing about to happen in the next 10 years in plastic surgery? I mean what emerging surgery or procedure should we be looking forward too

A:

Plastic surgeons are leading the frontier in regenerative medicine and stem cell research, notably University of Pittsburgh.


Q:

How realistic was Nip/Tuck?

A:

Nip/Tuck has elements of reality however, most of it is dramatized for Hollywood.