INTERVIEW WITH DR. LARRY SEIFERT



Mark Joseph: Dr. Larry Seifert, please tell us about your profession and

what you do.

Larry Seifert: I'm honored to be a plastic and reconstructive

surgeon...that has a field of surgery to alter form to achieve the most

esthetically pleasing contours in various areas of the body.  And it also

deals with reconstruction, which has to do with altering function.  Mark,

you may be interested to know that one of the earliest definitions of

plastic surgery came from an Italian plastic surgeon named Tagliocozzi. And

he said in 1597 in Bologna, Italy that "the art of plastic surgery is to

restore those parts that nature has given and malfortune has taken away, to

delight the eye of the afflicted, and buoy the spirits."  And the term

plastic has nothing to do with plastic or silicone.  There really is a

Greek word from "plasticos" meaning to alter shape, to  form and function. 

The earliest operations were among the most ancient of all surgeries, some

of which began in the Orient, and a thousand, 1500 years before... B.C. 

Many crimes were punished by amputation of the nose, so there was a caste

of barber surgeons in India.  The particular name of Sushruta comes to

mind.  And he devised techniques to restore the nose by using flaps of skin

from the forehead, which were brought down over the nose like a visor or a

hood to make a new nose.  And this just did not come to the Occidental

medical world until the time Victoria was on the throne and India was a

British colony, and then medical doctors from Great Britain came there,

learned of this technique and wrote it up around the 1800's in the British

medical journals. Dr. Carp noted and described it. And we still use

modifications of that today.

MJ: So when did the practice begin in the United States?

LS: I think after... It really began to be very popular after World War II.

The society... The American Society of Plastic and Reconstructive Surgery

to which I belong is over 50 years old.  It was founded in the early

1940's.  The greatest stimulus to plastic surgery frequently comes after a

war.  And it did after World War II.  The earliest plastic surgeons went to

Europe to visit and study with doctors who were doing cosmetic surgery

there.

MJ:  What sort of background does a person in your position have to have?

LS: That's a very good question. I think one has to be a scientist.  You

have to be an anatomist to know the anatomy very thoroughly.  You have to

be a student of history to know the operations that have preceded you,

because the way of the ancients in our profession is to be respected, and

many things we thought we had invented have already been described.  And

one has to be a student of the arts, to be able to integrate the work so

that there is symmetry, harmony, beauty, and proportion, it looks natural,

and it does not look like it's been done.

MJ:  And your training... What type of training do you go through?

LS:  The plastic surgeon of today in the United States has to be trained at

a select residency program, having first accomplished or achieved four

years of general surgery. That's a long time.  And a very rigorous

training. Then they're selected into a plastic surgical residency for a

minimum of two years.  Frequently today with an additional fellowship of

six months to a year.  And various sub specialties, for example cranial,

facial surgery or micro vascular surgery, or aesthetic surgery.  And then

after about a year or two, they can take a very difficult and rigorous

exam, administered by the American Board of Plastic Surgery, which

determines their proficiency and competence.  And if they pass this exam,

then they can hold themselves to be a candidate... a member... a candidate

certified by the American Board of Plastic Surgery, and become admitted to

the American Society of Plastic and Reconstructive Surgery. That

organization is the largest recognized body of plastic surgeons committed

to excellence and proficiency in surgical skills in the world.  It has a

little over 4,000 members.

MJ:  What is your background, and what particularly interested you in this

field, as a young - younger man?

LS:  "Younger man."  Thank you. Doitashimashite. I like the artistic part

of it; the assemblage of things to fix the whole.  If I were to break this

pot, o.k. and it shattered into many small pieces, to be able to restore it

to put it back together, to make it new, is pleasing to me. I... and I like

art, and... so that all that together I see as kind of a universal... has

appeal to me, the restoration, the artistic to make it whole to touch the

lives of our patients and make it better.

MJ:  What are the most common procedures that you do, or that are done in

the United States?

LS: The most frequent operation is liposuction.  That's a technique to

remove unwanted areas of fat by suctioning it out via a very delicate,

slender surgical instrument like a small pipe.  And it's not for people who

are overweight, but for people who have genetic predispositions to

localized accumulations of fat in unwanted regions.

MJ: Doesn't it migrate back there after you've taken it out?

LS:  As much as we know about it, once the fat cell population is removed,

it doesn't come back. I think it's the number one operation in the United

States because we have such a passion for cheeseburgers and french fries

and cherry pie and ice cream and malts. Less so in the Orient where people

eat sensible meals like sushi and rice and vegetables.  However, I

understand with McDonald's opening up in Tokyo, that there might be a

burgeoning of new patients in the Orient for  liposuction.

MJ:  So that's the most common. What are some others, after that?

LS:  Operations dealing with rejuvenation.  To remove the manifestations of

facial aging. A face lift, which is basically a technique to tighten... to

remove the excess skin in the  face and neck and tighten up in a more

pleasing fashion. Eyelids... Rhinoplasty, to either enlarge the nose, or to

reduce its length and height to esthetically pleasing contours. Breast

augmentation, breast reduction, tummy tucks, those are the most common

operations that we do.

MJ: Are there any operations that you simply refuse to do, or do you ever

turn away customers?

LS:  I decline patients  I think for several reasons.  One, they may be

psychologically or emotionally unsuitable a candidate for surgery.  They

may have emotional problems. A woman just divorced,  lost a member of the

family, is not doing well - a man or a woman - and sees the surgery as an

immediate quick solution to the problem, where they are hoping to change

the conditions of life by changing themselves immediately, and have an

unrealistic perception.  People who are not in good general health

shouldn't... to be very careful when we do aesthetic surgery upon them. 

It's important to be sure that the motivation for the patient come from

within, and not be unduly influenced by those around them, in order to try

to fit in.  I think it's very important to pay attention when operating on

people from other lands and distant countries about... particularly when

they move here and may feel frightened or anxious about just fitting in,

and want to alter features of ethnicity, quickly, in order to be o.k. I

have frequently talked patients who have come to me for Oriental lids out

of the surgery because I believe that the Oriental eyelid is a thing of

mystery, serenity and beauty, and I have heart to heart talks to suggest to

wait a while before it's done, if at all, because I think that if they're

here for awhile they'll be accepted and assimilated and fit in, and I think

that before we introduce scars, or alter the appearance in the lid region

in the Oriental... and I worry about how they will feel about their

forefathers and their family and you know having in a way maybe renounced

their ethnicity by doing this.

MJ: Are there any other race specific procedures that you see?

LS:  There are patients from the Orient with a low nasal bridge who would

appreciate a very minimal and subtle alteration to make it more Occidental.

 And that's a very... there's a very fine line- hard to define, between a

subtle enhancement that still looks natural but is esthetically more

pleasing, and a drastic alteration that is immediately recognizable as not

being natural. I'd have to point out to Michael Jackson, where we all can

see that he's had very radical, you know, alterations of his appearance

over a period of time.  He may be happy with that, and I'm certainly not

being critical of the maneuvers, but I think that most of the patients that

I've seen from the Orient want a subtle enhancement, not a radical change

in the appearance of their nose.

MJ:  Now here's the big question, Dr. Seifert.  Would you ever have a

procedure done on yourself?

LS:  That is a big question.  I have. I've had my upper and lower eyelids

done.  And when I find the time I think I would like to have a facelift so

I look more youthful. Unfortunately I don't grow gracefully into age.

MJ: And what age would that be right now?

LS:  About the very age that Admiral Yamamoto was when he took the fleet

out of Tokyo harbor.

MJ: What types of procedures do you envision in the future that maybe we

don't have today the technology for?  Can you look in your crystal ball for

us?

LS:  I think that there is interest in being able to stimulate the growth

of cartilage cells and bone from tissue cultures so that we can restore

missing parts or alter parts by a bank of the person's own cartilage or

bone, and this would be interesting and exciting work in restoration of

fractures of the extremities.  There's some interest in being able to do

biogenetic work to influence undue fetal factors by improving embryo

genesis. And I'm certainly not an expert in this; I apologize if my

answer's a little clumsy.  In aesthetic surgery, my field, there is a

continual march toward a commitment of excellence; to improve the results,

to make them better, to be more bold, all the time.  And competition is

very difficult.  I think that the true plastic surgeon, the one I've

described with all this training, sees himself as the samurai, and he has a

mandate from heaven, you know, to fulfill his destiny and be the best he

can be.  And while you ask me that, I'd like to point out that in this

country, the United States, the problem is that there are many doctors who

do cosmetic surgery with no formal approved residency training and call

themselves cosmetic surgeons. Additionally, while the American Board of

Plastic Surgery is recognized by the AMA, through it's Board of Medical

Specialists... this is very confusing, an alphabet soup of names there are

many self designated boards, recognized only by their members.  It's as if

you, Mark, and four friends could call yourself the American Board of Tokyo

Plastic Surgeons, you know, and so you could then advertise, and patients

lured into your office by that, but it wouldn't mean the same. In my

organization, after completing all that training, and after being a

specialist for five years, one can then apply to the American Society of

Aesthetic Plastic Surgery, the highest organization in the United States in

terms of excellent results of pursuing the best ability we can be to be a

plastic surgeon, and it only has about 1100 members nationwide, in the

whole United States.

MJ:  What are people's reactions to you when they find out what your

occupation is?

LS:  Oh, that's a good question. I think first..They make their joke

frequently, because they're a little nervous about it, because, I think,

they feel self conscious about some part of themselves, and they hope I'm

not looking at it, to fix it, which I try not to do, but sometimes it's

involuntary, I just sort of see it.

MJ:  How many plastic surgeons are there in the United States, that are

certified?

LS:  By the American Board, a little over 4000.  And then of those, having

completed their training, and practiced for awhile, waiting five years,

about 1000 more have gone on, have been recognized by the American Society

of Aesthetic Plastic Surgeons, the largest organization of  surgeons

devoted to pursuing the highest level of aesthetic surgery in the world.

MJ:  You mentioned some of the most frequent procedures.  Can you give us a

price range, an idea of what those procedures run?

LS: I must say that, not to be evasive, but there are large ranges in

different areas of the United States, according to how expensive the

overhead is for the practice, and also the complexity of the procedure, but

for say, fat suctioning of the hips, it's about 2,000 dollars for the

surgical fee, then a fee for the anesthesiologist about 6 or 700, and a fee

for the operating room facility, maybe about 800 dollars, to 1200. And then

if there are additional sites for suctioning it increases the fee.  The fee

for a rhinoplasty, or surgery on the nose, can be anywhere from 3500 to

5500 and 6000 dollars, and that's because the operations become very

complex, if one does an open rhinoplasty, and put in additional cartilage

grafts, I'll show you the results of that, it alters the length of the

operation, its difficulty, its complexity, and therefore it raises the fee.

 Facelifts could be 4,500 to 8,000, depending on all the maneuvers, the

skill of the surgeon, how affluent his patients are, the reputation he's

developed.  Breast augmentation - I think the implants are now  1,000

dollars because of the many lawsuits that have gone on, and the surgery fee

is about, I think a range would be about 3,500 to 4,500 dollars.  The fee

for the surgeon the implants, 1,000 to 1,300 dollars, the use of the

operating room, about 1,000 dollars, the anesthesiologist about 8 or 900.

MJ:  In the past few years there's been a large controversy about silicone

breast implants - that there's a connection between that and connective

tissue disorders and other diseases.  What are your thoughts on that?

LS: Well first, I'm not an expert on connective tissue disease, but I have

acquainted myself with much of the literature.  Interestingly enough the

first reports linking any possible relationship between silicone and

connective tissue disease came from Japan where honored colleagues, workers

in the field there showed evidence of many patients, or history of many

patients who had developed diseases such as scleroderma, which is a very

serious disease, and other connective tissue diseases, and had injections

of silicone- paraffin, and in some cases silicone implants.  Now

unfortunately that was a problem because they were all linked together -

injections of silicone, injections of paraffin, which is a wax, it isn't

silicone at all, and use of some implants. Further, the silicone

injections- as I understand it, some of them were made in Japan with a

sakurai formula, different than Dow Corning's medical grade silicone. In

any event, there were several reports suggesting a linkage between silicone

and connective tissue disease.  And in fact the workers in Japan coined the

term "Human Adjunct Disease," implying that prolonged exposure to the

silicone molecule induced this disease state of a variety of symptoms -

weakness joint disease, skin changes affecting the esophagus, skeletal

system.  So, this became a major concern in the United States. I want to

emphasize, and highlight this statement, to say that there has been no

evidence of any cause and effect relationship in ongoing research done

here, in the last several years in large medical schools throughout the

United States of any cause and effect relationship, so that people in Japan

watching me now do not become unduly frightened or apprehensive.  There is

no real evidence whatsoever.  And I summarize it by saying larger studies

from the Mayo Clinic, which is a very large medical institution in the

Midwest, studies from the University of Michigan, studies from Johns

Hopkins - Baltimore  Hospital, University of Pittsburgh, and University of

California, San Diego have shown that there is no cause and effect

relationship between silicone and connective  diseases that can be

demonstrated.  And the research is ongoing.  The problem is that I think

that some people in this country with all respect are highly susceptible

and suggestive of catching the symptoms from one another without truly

getting sick.  It is my feeling that much of the information, all of the

information; too much information that people in the United States rely

upon comes from television.  So they're used to quick statements. You know,

five words to explain the origin of the world.  And these subjects are so

complex that the nuances, the subtleties, the intricacies of the language,

and all of the data, can not be brought to bear.  It's not of interest to

the viewer.  You only have ten seconds to make your case.

MJ: How are you affiliated with UCLA?

LS:  I'm honored to have my office here, next to UCLA.  And to be in this

building you have to be on the teaching faculty, so I'm an assistant

clinical professor of plastic surgery in the division of plastic surgery

here at UCLA.

MJ:  Why did you choose to have your practice here in Southern California,

as opposed to somewhere in the Midwest, or  the South, or some other

location?

LS:  I suppose because I grew up here.  I spent some time in the Midwest in

training, and one year in the Orient during the Vietnam conflict, but I've

always felt at home in California.

MJ:  Well, Dr. Seifert, here's the second big question. Would you allow

your wife, or daughter, or mother, or  a brother, or some other relative to

go under some of these procedures?

LS: I'm not married now, but I have been, and my wife and a few of my

girlfriends have had aesthetic surgery done, and so the answer's yes.

MJ:  Are you concerned about lawsuits?  America is a very litigious

society.

Dr: Of course.  There are, as I understand it,  more lawyers in Seattle,

than in the entire country of Japan.  The problem we have in the United

States, I think, is too much money rewarding the alleged victim.  And to

feel sorry for ourselves, and to look to blame somebody, and  get money

without earning it.  It's totally different than the Japanese culture, the

little I know about it, that I have an immense respect for.  And it's a

large problem in the United States that we produce fewer engineers, fewer

scientists, and far too many lawyers than we need.

LS: We've done some research on you, and we hear that you do a lot of

procedures on movie stars, actresses, musicians, actors.  Are you able to

tell us which ones you worked on and what you did?

Dr:  I think that I have a fundamental obligation to keep that private. 

I've never released that information to the media.  I don't think they

would want me to.

LS:  Is it fair to say that a good part of you practice are some of those

clients?

Dr:  I've been honored to see many people from the entertainment industry

over the years, and grateful for the opportunity to be their physician.

MJ: What are some dangers besides - obviously anesthesia is one danger -

what are some other dangers with these procedures...with the various

procedures that you do?

 LS:  Let me say that no operation is safe, in terms of the meaning of the

word - "free from risk and harm."  In that context, every operation has a

series of risks, or dangers , which the surgeon must be well acquainted

with and know how to take care of and manage so that he can keep his

patient out of harm's way.  And the surgeon has a fundamental ethical

obligation to share these risks and dangers with the patient so they can be

understood before the surgery is begun.  Happily, for most aesthetic

surgeries, the magnitude and severity of the risks are very small. For

example in anesthesia it is extremely rare that any misadventure occurs,

particularly if one goes to a good doctor board certified by the American

Board of Plastic Surgery a member of the Aesthetic Society, and the

operation is done in an approved, certified operating room with trained

personnel.  Very low chance of anything going wrong.

MJ:  Are there any specific dangers you can discuss for various procedures?

LS: If you wish, but you would have to narrow it down.  For breast

augmentation, the breast can get firm, or hard, the implant can rupture. 

Today we use primarily saline implants.  It has I think the inevitable

final outcome, of leaking at some point, because it's just a balloon

although very sturdy... So one would have to have a new inner tube or a new

implant put in, like the innertube of a bicycle before they...  Very

quickly they could be replaced.  Very quickly the deflated implant could be

replaced.

MJ:  We've talked primarily about cosmetic.  Do you also deal with burn

victims, or crash victims, and so on? Could you describe one of those

experiences?

LS:  Well, I spent a year in Vietnam, and there I ran a unit that took care

of many  Vietnamese children with cleft lips and pallets and congenital

deformities. Then in this country I was on the staff at USC before UCLA in

Children's Hospital, and I did congenital anomalies, and I set up and ran a

burn unit here, which later became the Michael Jackson Burn Unit in Los

Angeles, but I was the first chairman of it, so I've taken care of burn

victims there, and many many reconstructive procedures at a very famous

other  hospital in the city, Cedar Sinai Medical Center, to which many in

the motion picture industry which we talked about go for care.

LS: I think the single most important decision affecting the outcome of an

operation of aesthetic surgery is the selection of the surgeon by the

patient.  Be sure that your doctor is fully trained and he or she is

certified by the American Board of Plastic Surgery and a member of the

American Society of Plastic and Reconstructive Surgery, and further it

would be very nice to be a member of the American Society of Aesthetic

Plastic Surgery.

MJ: Dr. Seifert, thank you for joining us today.

LS: My honor