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MedicalIamA board-certified plastic surgeon AMA!

Jan 23rd 2018 by laradevganmd • 14 Questions • 34 Points

Judges and a property owner worked together to create a money making system off of incarcerated juveniles. I was one of those kids.

The juvenile judge worked closely with schools and police to have a zero tolerance system for juveniles.

The County run detention center was closed down due to the work of these judges and this property owner. A private detention center was built and the judges were offered kickbacks for sending kids there since the privately run detention center was paid for having the kids. (Through CYS or some form of the government, I'm not sure)

My first offense was when I was 14. My mom and I had gotten into an argument and I wanted to "run away". She stood in front of the door and I pushed her out of the way and left. Took a walk in the woods and came back home to find the police. She called them because I left. She just wanted help finding me, but they arrested me. Simple assault for pushing her. I was put away for 6 months. My mom called everyone she could and somehow managed to get me out.

My second and final juvenile offense was when I was 15. I was in school playing with some ketchup packets or something equally as childish. One of the cafeteria aids came over and began yelling at me. I was a cocky little teenager and I made up some story about my dad being someone important and told her she would lose her job. I ran my finger across my throat when I told her this. The rest of the day went by and I was called down to the office just before dismissal. My mom was there and a police officer came. They all went into the office and I assumed the school was trying to scare me... I was arrested and sent to the detention center. The judge told me I was charged with terroristic threats for threatening to kill the cafeteria aid. I was sent away for a little over two years.

There were no defense attorneys into he courtrooms. Only the judge and the children. We all knew he was very strict since he had visited our schools many times and talked to us about crimes and how he would have zero tolerance. I had no idea at the time that anything was wrong with the system. Every kid just thought it was normal. About a year after I was released the situation was exposed and investigated. The judges were arrested and the children were part of a class action lawsuit.

I spent a year and half of my high school years getting a very dulled down education consisting of multiplication tables and learning middle school level history. I was between 50 and 200 miles away from my family and because of this I went months without visits. I got a phone call once every few days if I was lucky. I was housed with kids who had gun charges, drug charges, and attempted murder charges. I was borderline abused by staff members. The class action settlement was about $20,000, which I don't know if that made up for everything.

Proof: https://imgur.com/gallery/Y35F4

EDIT: documentary is here - https://www.youtube.com/watch?v=vxpNynnYwC0

Ask me anything.

Edit: I chose to not use the word "victim" because I do not see myself as a victim. I did what I did. I may not have deserved what I got, but I initiated what happened. I don't want pity, or anything of the sort. Just getting the rest of this situation off my chest and answering questions anyone may have about what happened.

I took some steps to hide my identity, but with the story taking place in scuba small area and with personal details being put out, it's very easy to figure out. Who I am doesn't have to do with the story, but I don't care if anyone knows who I am or not.

The documentary has apparently been removed from Netflix but is still on YouTube.

Q:

Hello doctor! Big big fan of your content!

As a final year medical student hoping to pursue a similar path as you in the long run, I’m currently at a career crossroads whilst choosing speciality training programs and would really appreciate your advice- do u have any opinion on whether a route in dermatology (and further training dermatological surgery), or a traditional route in plastics and reconstructive surgery better prepare a doctor to work with facial plastics, injectables and the ever growing field of minimally invasive cosmetic surgery?

Is there a particular reason you chose plastics over derm (if you ever considered it), as I see that you enjoy a lot of minimally invasive procedures.

Any pros and cons regarding dermatology and plastics training is highly highly appreciated!!!

A:

Hi. I'm a breast cancer survivor currently in the process of my reconstruction (DCIS, bilateral mastectomy). I wanted to ask if you have had genetic testing?

It's very rare to have breast cancer so young and and as a male. It is possible to have a genetic condition even if cancer is not in your family history. For example, I am suspected to be the first in my family to have my genetic condition.

I would strongly suggest that you push for genetic testing. If you have a condition it could save your life to know what to look for.

Check out this site for more info. http://www.hereditarycancer.org/

Edit:. Spelling.


Q:

For fucks sake. $20K is a big fuck you. I'm sorry you had to deal with that.

Have you still been able to lead a successful life due to these bs charges on your record?

A:

Dermatology and plastic surgery are both amazing fields. I love plastic surgery because I like the intervention of surgical procedures. It's a long and difficult training, but if you love anatomy and surgery, it is unbeatable. Dermatology is also an interesting field!


Q:

I had genetic testing done after my mastectomy. The oncologist told me it came back with nothing.

A:

Yeah, I mean, I feel like $20k is a lot of money, but when I look back on it, I don't think it really made up for anything.

Everyone's juvenile records were all erased, however I met a kid in the detention center that I wound up hanging out with afterwards. We did get into adult trouble together about a year after I got out. Bumpy start to adulthood. Used most of my settlement to repay restitution and court costs for adult problems.

Since then I've turned my shit around. Own a business, father of two kids, ran for mayor, lost, do a lot of volunteer work, run lots of community events. Deep down, I think those places had both positive and negative effects on me.


Q:

Which of the two do you think better prepares for a career in cosmetic surgery/ minimally invasive procedures etc?

A:

What were you tested for? Make sure it was a full panel not just BRAC, and CHEK. (There are allot of genetic conditions out there that can increase your risk of cancer that aren't always in the panels. If you did Myraid you should be covered though.) Assuming it was a full panel I'm glad to hear you are clean.

Best of luck with your recovery. Fuck cancer.


Q:

I work closely with kids in mental health treatment centers that come off as being similar to detention centers.

What could staff have done to help your stay there?

I saw that there was a lot of abuse but were there staff members that helped you at all?

A:

I think the 3-dimensional anatomy of surgery is unbeatable, so I would vote for plastic and reconstructive surgery. The training is extremely rigorous, and you will always feel that you have the tools to help patients, even in complex situations.


Q:

I'm not entirely sure to be honest. Thank you for bringing it up though, I go back to the doctor Monday and I'll ask him again just to be sure we checked everything. Good luck with the reconstruction! Fuck cancer!

A:

I really liked a lot of the staff. Like anywhere, you have dicks and genuinely good people.

Some staff went out of their way to be personal with the kids. Share life experiences, get to know them, give advice, etc...

For clarification I was in four different places. With four drastically different methods to their systems. One was a very not strict bland type of detention center with cells where the kids wore provided sweatsuits and followed a schedule for the day. I remember nothing significant of the staff there.

Another was a very laid back place with more of a home atmosphere aside from the locked doors and fences. The staff there were generally nice and took the time to get to know the kids. This was also a VERY new facility when I went there. I was probably the 12th kid ever sent there.

One was an INSANELY nice place from the outside, with a pond, bicycles, riding paths, gym equipment, etc... Got there and found out it was all broken or no longer allowed. Lol. Most staff there were seasoned vets. Mostly irritable. Some were decent, but a majority of them had been doing it for so long and didn't care to get to know the kids anymore since the place held a few hundred and staff usually juggled around.

The last place was very strict. I got cocky about pushing in my chair silently one time and wound up being restrained on the floor for about three hours.

Shift change came and they literally switched out. I only struggled for about 10 minutes of it. They screamed in my face and I pretty much cried the whole time.

It's fucked up, but I feel like that last place kinda helped me a lot.

I wasn't cocky again after that. Lots of yes sir, no sir out of my mouth. After that, the place got investigated from kids being hurt.

One staff member in one of the lighter places would bring in his guitar and teach us. Another brought his xbox and played with us. I really liked when it felt more like a big brother or sister rather than a staff/inmate.


Q:

Have you ever had any plastic surgery?

A:

Thanks unfortunately I had an infection in one of my breasts near the AlloDerm so I had to have 2 extra surgeries and am about 4 months behind schedule. My surgeon is really happy with results now and we are thinking I will be done in March or April. I had lots of room between the tumor and my nipple so I was able to do nipple sparing.

It looks like you probably had your nipple removed. Are you planning on surgical reconstruction, 3D tattoo or just going nippleless? This is a big issue with the women I know that have reconstruction. I wonder what you are thinking as a man?


Q:

Fuck that judge.

What movie have you watched more times then any other ?

What did you eat when you got out the second time ? first meal out I guess I mean.

A:

No because I can't operate on myself lol. Just kidding. But I do use my own skin care line, and I've also (judiciously and consevatively) done botox and fillers, as well as microneedling, peels, and lasers.


Q:

Sorry about the complications. I'm debating on either nippleless or tattoo. I think i'm leaning more towards a tattoo though to try to cover the scar a bit.

A:

I've probably watched Talladega nights way too many times.

We stopped at McDonalds. Lol. It was about 8 months since I last had fast food.

I also met my now Stepdad on the ride home.


Q:

As a women do you encounter more negative comments about your home/career balance than you feel you would if you were an equally successful male surgeon married with 5 children? How do you handle it?

A:

Will you do any type of reconstruction?

I hope no one thinks I'm joking--I'm curious how a man feels about how a mastectomy has affected his body, and if you'll feel comfortable going shirtless. And good job to you for spreading awareness about this!


Q:

Follow-up : what did you order ? I have never had a quarter pounder from Mcdonalds, or a mcrib.

Mcdonalds make little baby jesus happy. Sitting there in his manger holding a happy meal.

A:

Definitely. The double standard is unfortunately alive and well.


Q:

Nah I don't plan on any reconstruction. I have recently started trying to lose weight (definitely needed) so hopefully it will kind of just even out. Fingers crossed!

A:

Hahaha. I don't remember what I ordered, but that's definitely how I like to imagine Jesus.


Q:

Hi Dr. Lara! You are a true inspiration for me. I am an IMG from Nepal, applying for a residency in the US soon. Since you have been through so many years of formal education, I was wondering if you could share a little about the study methods that worked for you? The timing of your study sessions, tips/tricks, management of all of this medical information into memorable chunks. Any personal methods you could share?

A:

First, I'm glad you caught it before it got any worst....

Being that males are not usually associated with breast cancer, what were some of the strangest reactions you have recieved after revealing that you were a young man fighting a rare form of breast cancer?

Again, I'm soooooo happy that you kicked chemo's ass!

Edit: Fuck you auto correct! Once again you make a fool of me. For all you folks who were able to decipher this gaggle fuck of not-so-good English words and look past the misspelling, congratulations.

And thank you for proving that reason will prevail!


Q:

Hi everyone,

I'm from the area(Luzerne County, which is near Scranton, PA. Yes, the Scranton from The Office)

A lot of people want the gist of the story, more answers, etc.

So here it is, from someone who has experienced first hand Luzerne County's "Culture Of Corruption".

First off, let's establish that the two judges who went to jail, Mark Ciavarella and Michael Conahan were gushed over by plenty of officials/staff on Luzerne county. Notice that the same papers blasting those who stood by and did nothing were also those who praised Conahan/Ciavarella for their "tough" sentencing style. I don't recall which off the top of my head, but one of the two won the Newspapers "Man Of The Year" award.

A property developer, Robert Mericle, had gotten a prison contract and in exchange for cash bribes, the judges would sentence the kids harshly for often nothing crimes. One girl received 3 months for a fake mocking facebook page of her principal.

The story on the books is that two judges went rogue and that was that. They were caught, got jail sentences, public condemning, and that was that.

But that's not where it actually ended, or even started.

To understand how corrupt this county is, you have to take a look at it in context.

Take Anthony Lupas. Anthony Lupus was a local attorney, and the chairman for his towns Democratic Party Board. His son, David Lupas, became the District Attorney(DA). The son is now a judge. What's wrong with this? Well, Anthony Lupus was a ponzi scheme artist. A pretty damn successful one, too, with over $6 million missing. Now, the sins of the fathers don't always transfer to the son, but they do when the son borrows $400,000 to run unopposed.

What you witnessed in Kids For Cash was not justice finally taking place, but rather a coup that took place for others to rise high.

The situation hasn't gotten better, it's actually gotten worse as the new criminals are actually competent compared to the two failures of human life that were Conahan and Ciavarella.

Proof that the uppers don't really care about what happened? The most exclusive and expensive private school in the areas sports field is the Robert Mericle sportsfield. This came up after Kids For Cash, and while you could argue it would be OK if he was just accused, he wasn't. He was convicted. Convicted. Anthony Lupas name is still up at our local Casino, take a look.

One of the worst areas is Dupont. Dupont was(is?) pretty much the Wild West. There were 3 cops in the area. One is in jail for being a drug addict, one is in jail for molesting children, and the DA who was elected following the outing of the criminals will no longer recognize the old Chief of Police as a cop.

By the way, the one who was molesting the children had his wife beg officer John Saranchuk for help. Saranchuk's response? Telling her that if she kept pushing, she'd be arrested. The drug dealer? Well, I can't say if Officer Saranchuk has a drug problem. I can say that when the FBI raided the Dupont police office, that a pretty large amount of cocaine was missing. After the drug user(or one of them) was gone.

The new police chief had to give up his gun because of a PFA filed against him.. This is "progress" in Luzerne County.

The current assistant DA is the reason many of the Kids For Cash cases went through.. So when you ask "But why didn't you do X? The answer is that a lot of the time the assistant DA would say "just let this go, you'll only make it worse by fighting." Hey give him credit, they would have made it worse.

These days the Luzerne County Courts are basically Kangaroo Courts. Go into court and observe. Play Bingo with any of the following:

Refusing to have certain parties go under oath.

Threats of contempt of court.

Refusal to even hear certain motions. Can't appeal something if it was never legally denied. Pretty clever, right?

A person involved in the Kids For Cash scandal but still somehow with a law license.

Rampant nepotism.

Rampant cronyism.

Now, Luzerne County is somewhat split. No one will say anything bad about the Kids For Cash victims, but you'll get the occasional "just some troublemakers who got to spend some extra time" in juvy. Others want to speak up but can't. Others speak out, and are punished for it.

There is a ton of stuff I won't go into here in depth, but feel free to look the stuff up if you're interested:

The fact the old court administrator was the brother-in-law of Conahan(meaning the guy who can decide where cases go was related to the guy who judged the cases.)

Gas Gate(In which thousands of dollars of gas was stolen, and seemingly disappeared)

Leo Glodzik, a corrupt businessman who had cars illegally towed. Poor people were essentially left to walk in the cold. Nicer cars were towed. Off duty cops were caught multiple times driving cars possessed in this way. The man was convicted, the cops were not.

The fact that one of the judges, the honorable Lesa Gelb, stole her firms client list when she went off on her own, and then had this squashed.

The pay-for-play DUI system, in which the mayor of Laflin(the town where both judges for Kids For Cash lived, as where Lupas lived, his son lives, and Sanguedolce live) wasn't charged for an obvious DUI.

I can answer other questions, assuming I don't get a knock on my door.

A:

For me, repeated exposure to the same materials over and over again helps me learn. I like to read, draw, summarize, and write things down. Learning medicine is like learning a new language-- there is a lot to learn-- but when you get it down, it really changes your brain and the organization of your thinking patterns. One method that helped me in med school was reading a chapter, then closing the book, and trying to summarize everything I learned on a blank piece of paper.


Q:

Thank you so much! A ton of people didn't believe me. They all thought it started somewhere else and just spread to the breast. I had to explain that it was just in my breast and nowhere else. Some people didn't know that men could even get it either. I told them that they definitely can it just is less common for men.

A:

So accurate. I've put my story out there before once or twice locally...

People here wouldn't believe the amount of "It was your own fault" or "It's not the judge's fault".

For some reason, the corruption is not only ignored but accepted locally.


Q:

Hello! What's your strangest experience on the job?

A:

It’s sad but people don’t know men have breasts period. Not breasts like boobs, but still.

I’m glad you recovered okay. Good luck with your future!

EDIT: I know about gynecomastia, a hormonal condition where men can develop breast tissue. I’m speaking generally, that its sad people don’t know men have breast tissue (hello nipples).

What’s more, it’s sad that people reacted to “I have breast cancer” with “yeah right, you’re a dude” rather than “oh, I didn’t know that could happen. Is there anything I can do to help?”

I know people aren’t bound to understand everything that isn’t common, but biology/sexuality/anatomy courses through school should make people at least aware enough to understand that the human body is anatomically female during development until the point where sexual differentiation occurs.


Q:

How did your first "conviction" happen? The one where you got sent away for six months - did you have a trial, did you plead guilty?

Did your mom try to get a lawyer when you were incarcerated for six months?

And what about your second offense? Same questions.

I understand there was a corrupt system (no defense attorneys? That is really messed up), but I'm familiar with the juvenile justice system where I live and you'd have gotten next to nothing for those offenses where I am.

A:

When I was in residency, I once took care of a patient who needed leech therapy to improve blood supply to surgical site on his face. We had to apply real live leeches to his nose. It's an established technique to help with venous drainage, and the patient did great, but it was definitely a surreal experience to see leeches in a non-swamp setting.


Q:

Thank you! You as well!

A:

There was no real trial. I stood there with my mom in front of the judge. No defense attorney. My mom cried. She said she wanted me to get help with my issues at home but didn't want me taken away. The judge didn't care and sent me away. My mom called lawyers and elected officials. Everyone she could for 6 months. One day out of the blue I was told to pack my things up because I was getting out.

The second time, it was basically the same. No defense attorney. Me and the judge. The juvenile court room was much different than any other court room. The judge and the other workers there all seemed like buddies. There was no feeling of fair justice. No telling your side. Just the judge putting you away. Scary to a kid, and even scarier to me as an adult knowing that it happened that way.


Q:

If you had to choose, would you prefer to work with a PA or an ARNP? And why? I think you're awesome

A:

I'm glad to hear that you're doing well and that you're sharing your story.

I had a similar scare a number of years back. I was an 18-20 year old guy and felt a lump. Thought nothing of it for a few years and finally got it checked out. Had to get 3 mammograms over a year. Finally turns out it's just female breast tissue. Apparently 1/5 men or so have this, it just never develops because of the lack of estrogen. But I'm so glad that you're raising awareness about this. Men check your man titties for lumps!

Also have to have a question so what's your favorite food?


Q:

$20k doesn't make up for your years lost, and that's obviously understandable. Have you ever thought about what would help the past injustice sting less? For example, an apology from the judge, or new laws to prevent this from happening again?

A:

I would love to work with either. It's more about the individual's personal qualities, knowledge base, and work ethic than his or her title (for me).


Q:

I'm glad that everything turned out fine! Pizza is definitely the most superior food in the world.

A:

Time helped a lot.

As I've said in other answers, the places weren't all bad. Aside from the obvious negative aspects, I did learn a few things and the experience did make me grow into the person I am today. Better or worse.

I don't want to hear from the judge, but I suppose an apology would help. I think I'd rather just let him know that I no longer blame him and explain what I was put through.


Q:

Hi! As an english major, what made you interested in plastic surgery and pursuing medicine? How did you spend your undergrad summers?

A:

First of all congratulations. Secondly how long did it take you to get through the initial brick wall of emotions that is "you have cancer"?


Q:

Sounds like you did something a little bad but not as bad as some kids in there...

Did you meet anyone who did less than you? I mean... what's the stupidest thing you heard that someone did to end up in the detention center?

A:

I love language and writing, but I also love science and art. I still love books, but I found myself gravitating toward a more hands-on field. I love the action and decisions of surgery. I like the feeling of being able to intervene in an important moment of someone's life.


Q:

Thank you! It took a while for the shock to go away. About a week after he told me I just broke down for a bit. I was really mad at myself for waiting as long as I did to actually go get it checked out. It took about 2 weeks before I finally accepted it and got a more positive outlook on the situation.

A:

I don't remember asking any other kids what they did until I was in the last place I was in. It was a really strict place with intense therapy groups and pretty bad physical punishment for the kids. (Staff broke a kids arm and gave another rug burn from head to toe for an escape attempt.)

In a Balanced And Restorative Justice group one day, we went around and said what we were there for. Kids were saying drugs, theft, robbery... The kid before me says he forgot his gun at someone's house so he went to go get it and brought his other gun, and when he got pulled over by the cops he forgot a third gun was under his seat so he was arrested for having two of his three guns on him.

I said "I told my teacher my dad would fire her..." Lol.


Q:

Hi! As an english major, what made you interested in plastic surgery and pursuing medicine? How did you spend your undergrad summers?

A:

Was there any kind of discomfort or change with the lump?

I'm a guy with what my physician says is a hardened lymph node in my pectoral muscle, I'm still trying to figure out if a second opinion is warranted. $$$$, America and all....

Thx!


Q:

What were their reactions to that?

A:

Thanks Reddit for all your great questions! Now it's time to go. Follow me on Instagram @nyplasticsurgeon, Snapchat at nyplasticsurg, or online at LaraDevganMD.com to learn more about my life and work, in and out of the operating room.


Q:

It go to where when I laid on my stomach it would hurt my chest cause of how big it was getting. But I had no other changes other than it growing.

A:

They didn't respect me. Lol. I don't know how else to word it.

I felt a need to prove myself I guess. Acted out a bit there at first.

The place was strict. Like insanely strict. I got cocky once when told to push my chair in more quietly. They restrained me for a few hours. On the floor with football linebacker sized men holding me down. I fought and cursed at them for 10-15 minutes. Gave up and cried for a while after. They had shift change and just swapped out the guys holding me. Screamed in my face about rules and respect etc.

After that the kids respected me and I respected the staff. Win/win I guess.

When I was leaving that place there were noticed put up not to hit or hurt the kids.

Staff sat there while we talked on the phone so we couldn't tell our family what it was like. Word got out after two kids tried to escape and staff broke one of their arms and gave them pretty bad rug burn while restraining them AFTER they were caught and brought back in.

Staff made us watch that time.


Q:

She is a celebrated doctor and you're asking her about her body shape?

A:

Did it hurt? Cancer I mean. Well, and chemo.


Q:

You should've said "Littering."

A:

Or maybe the question was "mentally fit"? ;) In that case I read lots of medical journals and listen to the NPR news brief on my Alexa when I'm getting ready in the morning!!!


Q:

The bone pain from the shot of Neulasta I had to get after chemo was the worst pain i've ever felt in my life. Other than that the nausea and tiredness was all the chemo did to me really.

A:

On the group w bench!


Q:

Hi, Dr. Devgan. Part of your success is to help your patients look natural. What do you do when someone has unrealistic expectations but they are steadfast in what they want?

A:

More men in the US are diagnosed with breast cancer each year than are diagnosed with penile cancer.

Did you meet with resistance from the medical community when seeking treatment?


Q:

Did you get into any fights inside?

Any time you genuinely feared for your safety? Did you get bullied or picked on?

Did the people inside split along racial lines like they do in prison?

A:

I find that the doctor-patient relationship tends to be self-selecting. Most of my patients seek me out because they want natural-looking results, so I am lucky to not encounter this issue often.

I do think beauty is very individualized and personalized. There is no one right breast size or lip look or nose style. I like to empower people to feel good and look good in their own ways, according to their own eyes. That said, if I feel that someone wants something that is not safe, not medically advisable, not in their best interest, or not something I am comfortable with, I will tell them I can't help them.


Q:

I wouldn't call it resistance but every doctor I talked to when I told them how long I had it the first question they asked was "why did you wait so long?". Other than that everyone has been wonderful every step of the way!

A:

I was bullied at times. Other times I was the bully. I got into a few fights.

In the place where fighting and bullying did occur, there wasn't much staff intervention and there were definitely groups and a sort of hierarchy.

There was some racial tension. At the one place, I was the only white kid and the only kid not from a big city with bad crimes, which felt a little intimidating, but after a while we all got along great.


Q:

Thank you Dr. Devgan for visiting Reddit! I follow your instagram and it inspires me everyday. So many questions!

  1. What was your path to medicine? I know you have an MPH so I am wondering if you knew in your first day of undergrad you wanted to become a doctor, or if you had other experiences along the way, and what those experiences were. Did you always want to do plastic surgery?

  2. Your artistic talent is evident in your practice. Do you have any creative hobbies or did this develop alongside your medical career?

  3. How did you fit the development of your skincare line into your practice? Did you collaborate with a cosmetic formulation team or create the formula yourself (or something in-between)?

  4. Work life balance. How do you do it? I mean this as a compliment—you have a large beautiful family! What advice do you have for aspiring women in medicine to balance their families and passion for medicine?

  5. Selfish question—can you provide insight of the roles of advanced practice providers and MDs in the aesthetics field? I am a PA student striving to go into aesthetics and know I won’t be doing surgery, but I would love to help patients achieve non surgical results and hopefully assist a talented doctor as yourself in surgery. What is the MD/care team relationship like in plastics?

Thanks so much!

A:

Do you by chance live near a military installation? There has been documentated cases of an increase in infant mortality and male breast cancer near military installations due to hazardous chemicals contaminating the local water supply.


Q:

What goes through your mind, at 15, when you realize you're going to jail for two years? Was anxiety, depression, suicidal thoughts a big factor? How did you adjust and calm the sudden impact of this?

A:
  1. I always loved medicine. When I started at Yale, I wanted to be a writer-- hence my English degree. I found myself wanting to spend my life doing more hands-on things, and I gravitated toward medicine very quickly. I did my MPH after my MD at Johns Hopkins-- it was part of a combined NIH T32 grant research fellowship program.

  2. Aww thanks. I love art and have a background in drawing, painting, sculpture, and photography.

  3. I've been working on my skin care line since I was 18!! It's been a passion project. My background dates back to biochem labs at Yale!

  4. I ask myself this question everyday!!! You just find a way to do what is important. If it matters to you enough, you do it.

  5. You can do so much as a PA. I think it's an amazing field where you can make such an impact. I know PAs who are very hands-on in aesthetics, who have huge followings and loyal patients. Good luck!


Q:

I live about 20 miles from a military base. That's pretty interesting do you have any links?

A:

Well, they don't tell you how long. In fact, you never know how long it will be. At any point. There was no "finish line".

The places had systems of treatment and let you out when you were ready.

It sucked at first. Then it still sucked but you got used to how things were. Then it still sucked, but you dealt with it and it became normal.


Q:

Hello!

What advice would you give people wanting to have plastic surgery either in general, or when going for their consultation?

Thanks!

A:

Have you given any serious thought about what kind of lies you will tell to brake the ice about that bad ass scar on your chest?

"I had a big enough heart to save 10 orphans and then some bby, wanna fuk?"

Seriously thought good luck, as a smoker this is one of my worst fears.


Q:

Do you have any power to also implicate the people that are responsible for "KARS 4 KIDS"? Specifically the people who created the advertising jingle.

A:

Have realistic expectations. Find a reputable, board-certified plastic surgeon. Write down your questions in advance. Spend some time researching the procedure, but don't fall down the rabbit hole of the dark recesses of the internet. Listen to your post-op instructions. Allow yourself time to recover. Understand that surgery is not magic-- you will have downtime, bruising, discomfort, etc-- but it should all be reasonable.

Best of luck


Q:

I haven't but I definitely need to!

A:

Working on going after them next.


Q:

Hi doc, I’m a 40 year old female with a wide face and square jaw. What would you suggest to make me look more attractive? I’ve tired masseter Botox with limited results and am afraid that Buccal fat removal will make me look old. People think I’m 10-15 years younger than I am!

A:

I see someone already talked about the genetic test, but I also want to say that if it's possible, you could ask your mom or your sisters to have a genetic test as well. Also remind them to have annual check!!!

You are such a strong man, buddy! Keep in mind, follow up is important! Also have a positive, healthy life~

Quick question: How's your feeling after chemo? Do you feel something changed, physically or mentally?

Wish you all the best!


Q:

My question is this, what do you think about the US prison system?

Edit: my fist comment was deleted, here's what it said. In the US private prison industry, the corporations have contracts with the government, the corporation gets a certain amount of money per prisoner, but if the government doesn't keep the prison full enough, usually like +90%, the corporation FINES the government millions.

That's a major part of why we have a small portion of the world's overall people, but 25% of the world's prisoners.

We are not free. This coutry sucks.

A:

If people think you're 10-15 years younger than you are, you are probably stunning the way you are! That is what we call a "luxury problem"


Q:

Thank you so much for the compliments! I did ask my mom and sisters to take the genetic test but they didn't seem concerned. It scares me but I can only ask them so many times. The only thing I've noticed is i'm a lot more scared of random things. If I cough too much I start thinking like "is this lung cancer?". Or if my throat hurts "is this cancer too?".

A:

As a juvenile, I was in places that generally focused on rehabilitation and therapy. They all varied in how they did it, with some more physical and some more emotional, but they still focused on fixing issues and making you a better person.

I did get into trouble as an adult and was very let down that it was literally just a time out with no steps towards corrections, despite being a "correctional facility".

I feel like jails and prisons should focus much more on the individual inmates and work to recover them.


Q:

any tips on staying focused and ignoring judgmental and negative people?

A:

Congrats!

My question: have you seen Archer?


Q:

Use their negative energy to inspire you to work harder and do better. You will ALWAYS have naysayers, no matter how senior or successful you become. It says more about them than you (namely jealously, envy, and insecurity).

A:

I have not seen it but I have heard good things!


Q:

Yay! I’m so excited for your AMA.

I have pretty severe under eye circles from thin skin and hollowing. Would you consider a blepharoplasty an appropriate treatment on a 28yo patient or would you suggest doing cheek and under eye filler?

A:

I have a lipoma in my chest and needed an ultra sound to get that confirmed. Unfortunately, my local hospital wouldn't do an ultrasound until I had a mammogram. I found the whole procedure to be very embarrassing and emasculating. How has dealing with breast cancer as a male affected you?


Q:

It depends so much on your anatomy and desired results. Many younger patients start with injectables, but I have done blepharoplasties on patients in their 20s-- usually if they have a strong genetic component to their periorbital aging.

A:

I was very embarrassed. It was one of the reasons I waited so long to do anything about it. I felt like I had nobody to relate to almost if that makes sense. The people working at the breast center I went to for my mammogram and ultrasound seemed shocked I was there. It was definitely just a weird experience overall.


Q:

Im currently a college student who has followed your work for quite some time now. I haven't had children but plan to in the future. I really want a breast lift, but am unsure if becoming pregnant and nursing after a lift would cause my breasts to sag back to where they are now. Any advice on the best time to have such a procedure?

A:

How does a mammogram work on a man? I was told that it flattens the breast tissue like a pancake. I’m genuinely confused at how that would even be possible to do on a man.


Q:

The best time for this procedure is a personal decision. Breast reduction/ lift will not change your ability to breastfeed, so that is not an issue. It is common to have weight changes/ tissue fluctuations after pregnancy and childbearing, though. Probably half of women do these surgeries before kids, and the other half wait til after kids.

A:

Being fat it made it easier to flatten it. I have no clue how they would do it to a man that had a flat chest.


Q:

hello dr.lara! I have facial hair, if I want to do laser sittings on my face will hair grow after 1 or 2 years? Is it good idea to take a laser on face? Will there any problems?

A:

First off, I love your shower curtain! Second, how are you coping with your body change? I know when women have a mastectomy they tend to have a hard time dealing with their breast(s) being removed. As a male do you think it affects you the same way? Are you considering doing anything to the site when this is all over like a tattoo or anything?


Q:

You need an in-person evaluation with a laser hair removal specialist to help you answer this question. Lasers do have risk of hyper or hypo-pigmentation. You will likely require 6-7 treatments. Hair does regrow at a finer caliber. Best of luck

A:

At first it was shocking to take my shirt off. I didn't really like seeing it. Now it's just kind of there and I think I want to get a tattoo to cover some or all of it up.


Q:

Do you play any kind of music during your conscious patients' procedures/appointments? Why or why not, and if you do, what kind of music do you like (or do you mainly use playlists)? I am very curious as you are obvious a patron of the arts and enjoy art immensely (and have wonderful pieces in your new office) so I'm wondering if that translates into your practice?

A:

Congrats on fighting it. So we have this false perception that as men we can’t get breast cancer. Did it sink in right away or did you kinda tell the doctor; but I’m a man this can’t be.?


Q:

I love classical music, and during office hours, I mostly play Spotify playlists related to Mozart, Bach, Vivaldi, and Beethoven (and Tschaikovsky during wintertime). In the operating room, I either listen to classical or to some alternative music playlists that my husband made me (U2, the Cure, the Police, and the Killers are some of my favorites)

A:

At first I kind of shut down. Everyone was telling me it was most likely a cyst or some other benign lump. I guess with so much assurance that it wasn't cancer I got my hopes up too high and it just crushed me to hear it. After a while though it got to the point where I just blame it on shit luck for it to happen.


Q:

Have you had plastic surgery done on yourself?

A:

Here's hoping it's all good news from here. I didn't have any questions at first but then I scrolled through your pictures and HOLY FUCK that scar is a lot bigger than I expected. How has it healed? How do you feel about it these days?


Q:

Popular question! What are you guys trying to tell me???

A:

It definitely was bigger than I expected as well. I am pretty much okay with it. I finally have a flat chest kind of now I just have to get the other half to flatten! It is weird though that sometimes I will think "damn my nipple itches" but it's not there so there's nothing to scratch!


Q:

Three questions~!

  1. I get botox for Migraines. However, I only allow my Neurologist to place it in the corrugator and procerus muscles and masseter and not in any areas of the Frontalis muscle. Even though she seems highly competent, I'm very nervous having a doctor that doesn't have a specialty in Aesthetics place Botox all over my face (and I need to be able to show expression for my job). My question is, do Neurologists receive training in the Aesthetics apesct of placing Botox in the face and how to place it exactly as to not make any aesthetic changes?

  2. One of my eyelids has always been hooded, but I guess recently due to age (32) my eyebrow has dropped more. I already know I need a Blepharoplasty, but my Dermatologist recently said she thinks I need a Brow lift instead. Is it crazy to get an endoscopic Brow Lift at 32?

  3. How much are racial differences in face structure and overall composition recognized in the Plastics world as a definite. For example, an Asian patient receiving a Blepharoplasty vs. a Caucasian? I'm half Asian and need a Blepharoplasty, and all my Asian friends are saying to make sure I go to a PS that has extensive experience with Asian eye structure.

Thanks!

A:

I feel like I wanna hug you right now. Good for you for getting over that. I am sure It has been a very difficult thing to go through. My question is: how did all this change the way you see life, the things we were previously complaining about and your relationship with people?


Q:
  1. Aesthetics are not a standard part of neurology training, but you could always ask your doctor this question in more detail.
  2. It truly depends on anatomy and genetics. It's not common to get a browlift but it's not absolutely unheard of.
  3. Anatomy fundamentals are similar, but experience is always beneficial.
A:

Honestly, I think it made me appreciate everything more. I spend more time with my family now instead of just staying home all the time. I feel like the relationship with people around me got awkward for a bit. Seeing people now, they avoid the topic of cancer altogether now. If I talk about how treatments were going I felt like the mood in the room just changed dramatically.


Q:

Have you watched nip tuck? What do you think of it?

A:

Your answer made me smile. I lost my dad to cancer and it really change the way I see my life (for example I never complained again about a silly boy problem or I did not pay attention to things that were not so important) and the people around me. I wish to nobody to go through what you went through, but it makes me smile seeing them getting something positive out of it. It shows a very strong person to be able to see something positive out of something so sad. I wish you the best! My love from Greece x


Q:

I've seen a few episodes ages ago, maybe in 2003 or 2004. It's... um... not my life, to say the least. Entertaining though!

A:

I am so sorry for your loss. Wishing you the best as well!


Q:

Could you please tell me if this attendant behavior was normal, at the followup visit after Mohs surgery for skin cancer?

The skin cancer surgery was done by a well-known, well-established plastic surgeon, and it went smoothly (aside from my walking into the operating room to find a portable stereo on the floor playing Carole King's "It's too late" at above-background-music volume, and delays getting the surgeon to return to finish up.)

But what seemed odd was the followup visit to remove stitches. After the surgeon had left the room, the female attendant (wearing no ID) picked up an IPad and took multiple photos of my face from various angles. I asked if this was normal practice after surgery for skin cancer and she assured me it was, although I don't recall it happening the previous time I'd had a skin cancer removed there.

Does this sound normal to you?

A:

Did you ever face difficulties just because of the simple fact you're a male with breast cancer? I figure a lot of people don't even know men can get breast cancer.


Q:

Medical photography is pretty typical in plastic surgery, but if you have any concerns, you should definitely voice them to the doctor/ practice.

A:

A lot of people thought I was lying when I told them. They would tell me that they always thought only women could get it.


Q:

what's you view on upper lip laser hair removal?

A:

hey man! best wishes and all the best for your recovery..

are you totally done with it? or are there further steps still needed?

how have people been towards you while you had the cancer? any specific incident you remember for it being way too nice or bad?

all the best again!


Q:

It's good if you are bothered by excess hair in this area, but lasers (and all interventions) should be done with caution

A:

Thank you! I go back to the oncologist this Monday. I don't know if anything else is going to be done or if it's over yet. Family and friends say "I love you" a lot now I've noticed. Also, people tend to try to avoid saying anything about it or talk about it at all. I think it makes them either uncomfortable or they don't want to make me uncomfortable.

I remember after my first dose of chemo I had to get a shot called Neulasta to increase my white blood cell count. I completely forgot to take medicine like they told me too because the shot causes bone pain. I woke up at 2 in the morning I couldn't move my head was killing me and my lower back felt like someone was stabbing me over and over. It would come in waves and it lasted about 3 or 4 hours. My husband got me my medicine and it thankfully dulled down. I never forgot my medicine again after that!


Q:

We're the same age! How did this change your life? Did you make any major changes in your life when you got diagnosed?

A:

I don't stay inside as often as I used to. I used to just stay home and play video games or watch TV or something like that. Now i'm going to see family and friends and going outside to actually exercise which is something I never would have done before. I don't want to die early so I'm really trying to improve my health


Q:

Just saying congrats, treatment sucks. What is your favorite colored stapler?

A:

Thank you it means a lot! Blue.


Q:

How do you feel about missing a nipple now?

And I hope this doesn't sound insensitive but do you know if having gynecomastia was a factor in this or no?

A:

The doctor never said gynecomastia was a factor in it. I think the biggest factor was probably my weight. It is weird because sometimes I'll feel like I need to itch that nipple but it's gone so I can't do anything about it lol.


Q:

Radiation oncologist resident here... don't you need adjuvant radiation? I'm from Canada, but typically it would happen before adjuvant chemo.,, just wondering if your doc ever mentioned radiation as an option and if so, why it wasn't done?

Edit: AFTER adjuvant chemo

A:

I finished my last dose of chemo on 1/11 and I go back to the doctor this Monday. Last time I saw the doctor he said we would discuss our next plan after all the chemotherapy was done. It's kind of a mystery right now for me.


Q:

Where was it exactly? I asked my doctor about it and he just said that having small breast tissue right under my nipple is normal.

A:

It was directly under my nipple and areola. Also, it was hard to the touch.


Q:

First of all congrats, secondly I don't mean to be a jerk, but I'm legitimately curious if you were overweight when you found the lump? I know that excess fat causes an increase in estrogen and estrogen can cause you to develop breast tissue so basically I'm curious if any of that might have been a factor. Again, congrats on finishing up chemo and I hope it's only good things from here.

A:

Thanks! Yea I was overweight when I found it. I read online that weight does play a factor into it but my doctor never told me it was a factor for mine. He did recommend I lose weight and I definitely am trying harder now than I ever have!


Q:

Thank you for being so open and I hope you get amazing news on Monday.

I have a friend that was recently diagnosed with cancer and would like to offer as much support as I can without being overbearing, intrusive, or inadvertently offensive. From the biopsy procedure to the last round of chemo, is there anything your friends or family did that was especially helpful or touching? On the other hand, was there any point where you really wish you had someone to talk to, a sudoku puzzle, etc.?

A:

My family made it clear they would support me no matter what. I think the biggest thing was when I wasn't feeling like eating from nausea my mom would make me some of my favorite food that she makes and bring it to me. It really made my day and it made eating easier.