Ali Totonchi, MD - Plastic Surgeon in Cleveland, Ohio

Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest this afternoon is Dr. Ali Totonchi and he's a plastic surgeon in the Cleveland, Ohio area. Welcome to the podcast.

Dr. Totonchi (00:41):
Thank you.

Eva Sheie (00:43):
So you're in a pretty remarkable place and I know from talking to your colleague, Dr. Guyuron, that you do a lot of really special work there and I'm interested to hear sort of from your perspective what that looks like on any given day or just in general, what is it like to work in the practice that you're in?

Dr. Totonchi (01:05):
Thank you very much. I have a kind of unique practice. I work in a hospital setting and I also work in a private practice with lots of patients over here too. In private practice, my focus is mostly cosmetic surgery. I do lots of facial cosmetics, I do rhinoplasty, facelift, eyelid surgeries and some body surgery, breast and abdomen. In hospital, I am medical director for the Craniofacial Deformity Clinic. We usually work with the kids who have complex deformities like cleft lip, hand palate and help them with their deformities.

Eva Sheie (01:51):
Do they come from Ohio or are they coming from all over the country or all over the world?

Dr. Totonchi (01:55):
I get patients from all over the country, sometimes out of country as well. I have been fortunate enough to work with Dr. Guyuron for a long time. He's the one who discovered migraine surgery. I'm currently president of Migraine Surgery Society and in this part of my practice I get patients from everywhere basically.

Eva Sheie (02:18):
And these are often people who are really struggling to just have normal lives?

Dr. Totonchi (02:24):
That is correct. These are the patients who have tried everything. By everything I mean really. Medications, injections, Botox, nervous stimulators, everything. And they have no help. They literally disabled. They do stay at home. They can't do any social life and migraine surgery is a kind of hope for them. And to get to back to normal life.

Eva Sheie (02:53):
How often are you able to resolve their issues with surgery?

Dr. Totonchi (02:57):
Surgery Actually, if they're a good candidate, there's a good success rate. Like 80% of the patients they respond to surgery, that meaning at least they have 50% reduction in intensity and severity of the headache.

Eva Sheie (03:13):
Is it easy to figure out if you're a candidate, if you're just listening and I've been wondering since I learned about this surgery a few months ago, if the people who successfully are treated with Botox for migraines are the same people who are usually successful with the surgery?

Dr. Totonchi (03:29):
That is correct. The people who have very distinct trigger point, in my opinion, that is the first clue of success. If patient comes in, points into the location of the pain, literally with one finger and at that location is at the anatomy or just the path of this nerve that we know of, and usually these patients are great candidates for surgery.

Eva Sheie (03:57):
So it's a nerve specifically, it's not?

Dr. Totonchi (04:00):
It's specifically nerve in all of the trigger points except one area which is the nose, in the nose because nose can cause lots of headache too. We call it rhino headache. Those patients get headache because there's a contact point in the nose, usually septum touching the turbinates and with the weather changes and swelling of the mucosa, this contact point gets worse and people get headache. There's no nerve by name over there, but there's a rich nervous plexus or lots of nerves come together. At the end of it, they get irritated and cause headache.

Eva Sheie (04:40):
It seems like that location is a good candidate for maybe you and Dr. Guyuron naming it something special.

Dr. Totonchi (04:46):
Could be. We call it rhinogenic headache. So actually I have a presentation coming up literally this week as a part of American Society of Plastic Surgery and Migraine Surgery Society Symposium, which I'm talking about justice topic and we pulled lots of articles, few of my slides about what to call this. Actually, it was interesting that you asked that question.

Eva Sheie (05:11):
We should have a contest.

Dr. Totonchi (05:13):
Yeah,

Eva Sheie (05:15):
I don't think I'd want to be named after that nerve since it causes so many people so much trouble. But there's probably lots of conditions in the world that are terrible that are named after doctors aren't there? The discoverer of something?

Dr. Totonchi (05:29):
Yes, you're right.

Eva Sheie (05:32):
When someone is successfully treated, I'm curious what kind of things they say to you when they return?

Dr. Totonchi (05:38):
Literally the first impression is that when I walk into the room postoperatively, I see a different person. You don't see that depressed. The eyes are looking down, those are all gone. The eyes are open, they're looking at you, they're smiling and you can say that this is a different person that you're talking to.

Eva Sheie (06:02):
They even probably look more beautiful because they're not miserable anymore.

Dr. Totonchi (06:06):
Yeah, they are beautiful even before surgery, but again, they need help.

Eva Sheie (06:13):
It's really must be very rewarding for you.

Dr. Totonchi (06:16):
It is the most rewarding part of my practice.

Eva Sheie (06:19):
So is it important to you that other surgeons learn that this exists and that it's possible that many more people could be helped by what you're teaching them?

Dr. Totonchi (06:28):
Exactly. I mean that's why we have the Migraine Surgery Society and one of our initiatives to work with the Headache Society, basically American Headache Society, international Headache Society, and there are some work underway that we are working with them. There are lots of bright headache doctors that are cooperating with us to get this distributed, get the word out there.

Eva Sheie (06:53):
Is there anyone who doesn't believe you? Is there pushback against what you're doing from any part of the medical community?

Dr. Totonchi (06:59):
There was a lot of pushback in the beginning, and I give lots of credit to Dr. Guyuron because in the beginning he was single-handed, he was going against the floor basically, and now there are lots of people that are on board, even from headache society still. There are lots of pushback. Insurance companies are not accepting this as a standard treatment. But again, there are lots of people on board and I'm guessing that in the next few years it's going to be more and more.

Eva Sheie (07:31):
I hope we're helping you with that too.

Dr. Totonchi (07:33):
Thank you.

Eva Sheie (07:35):
So let's kind of go back way back to how you ended up here. Where did you come from and how did you meet Dr. Guyuron?

Dr. Totonchi (07:43):
Actually I am related to Dr. Guyuron. He's my uncle, so it's a family business for us.

Eva Sheie (07:52):
So you've known him since you were born.

Dr. Totonchi (07:54):
Maybe a few years after. <laugh> He knows me since I was born, but I didn't know him when I was born.

Eva Sheie (08:03):
And did he have any influence over you deciding to become a doctor in the first place?

Dr. Totonchi (08:08):
Of course, yes. I mean I have few. My brother is a doctor, my cousin is a doctor and my uncle is a doctor, so there are multiple, a few doctors in the family.

Eva Sheie (08:22):
Where did you grow up?

Dr. Totonchi (08:24):
I grew up in Iran actually. I'm originally from there and I moved here after doing my medical education and a couple years of residency over there. I came here to Case Western University, did research and in reconstructive medicine and then started my residency here. I did general surgery, first plastic surgery, then I did fellowship in cranial facial surgery and cosmetic surgery.

Eva Sheie (08:53):
Did you ever have an opportunity leave Ohio or have you just been there the whole time?

Dr. Totonchi (08:57):
I travel a lot. I go to lots of conferences. I present nationally and internationally in different subjects, but I have always lived here.

Eva Sheie (09:08):
Even during all that training, you just stayed in?

Dr. Totonchi (09:10):
That is correct.

Eva Sheie (09:12):
Yeah. That's unusual.

Dr. Totonchi (09:13):
Yes, it is unusual, but I have a big family in Ohio, northeast Ohio. So doing well.

Eva Sheie (09:21):
So let's switch and talk about aesthetics a little bit. How does this experience that you've had working so closely inside the nose and the face influence the way that you think about those things? From the aesthetic point of view?

Dr. Totonchi (09:38):
I mean they go hand in hand. Even if reconstructive surgery, if you don't think about aesthetics, I don't think you're doing patient's favor, doing a good service for them. So everything knows if it doesn't function very well, patients are not happy or you haven't done a good job at the same time, as best as it needs to function, it needs to look good as well. So that goes for everything. Face is the same, body work is the same. You can't just focus on the aesthetics without function of it.

Eva Sheie (10:13):
You also take care of a lot of kids. I saw that in your background, are you still doing work with kids?

Dr. Totonchi (10:18):
That is correct. I run a clinic which deals with the kids with the facial deformities.

Eva Sheie (10:26):
I have so many questions about this. What does taking care of kids look like that's different from adults?

Dr. Totonchi (10:33):
I mean the kids, you need to be their advocate. Literally as a physician, you need to think about questions that they might ask from you 20 years from now. You really need to be in a different state of mind when you're dealing with the kids because they don't know anything about what you're doing. You explain everything to mother, their father or their guardian, but again, the kid is not the one who's making the decision, so you need to put yourself in the shoes of that patient 20 years from now, am I going to be able to look in their eye 20 years from now and make sure that I have done the best I could do for them? Because again, there's no informed consent with the patient. It is just their guardian.

Eva Sheie (11:24):
Do you find that parents usually make the right decisions or do they have trouble sometimes?

Dr. Totonchi (11:30):
I try to help them to make the right decision. That's part of the process. I mean, if the decision is not right as a physician, my job is to coach them and steer them in the right direction. There's sometimes we are not on the same page, but again, there needs to be discussion. Sometimes there are very complex situations that we need to sit down and talk about it and make sure that it's clear to everybody.

Eva Sheie (11:58):
Do those situations sometimes require speed or urgency or do you usually have the luxury of time?

Dr. Totonchi (12:06):
It depends on the situation and most of the craniofacial deformities are congenital. You don't have to make a decision right away. You can have discussions for days and weeks, but if there's a more urgent situation like working in the hospital, if trauma is coming in, you need to make a decision in literally if you minutes or few hours, you don't have that much time to discuss the situation.

Eva Sheie (12:34):
I'm curious about the people around you. I think a big part of the role you're in, especially in the hospital, but I'm sure in both places is the team around you and I'm curious who those people are and how they work with you.

Dr. Totonchi (12:52):
I mean, medicine in general, specifically surgery, you need to have a dedicated team that work with you. They believe in your work, you believe in their work, and it needs to be in a harmony. For example, if I'm in the operating room, if I'm doing facelift for now, for example, that's the surgery that do lots of them. There's so much of an exchange between you and your team in the operating room. So you get the instrument, turn the instrument back on. There's a maybe few hundred exchange of instrument doing one surgery. It needs to be in harmony between you and your team. Otherwise you're going to get tired or people are going to notice that the or there's something wrong. I've been fortunate enough that I've been working with the same OR team for the last 10 years. Literally they work with me in my private practice and hospital practice.

(13:52):
It's the same team that I've worked with and that for me is one of the most important aspects of the or that is something that the operating room in the private practice knows and the hospital administrations know about it. So fortunately they have played along with me on this, so that's important. That goes everywhere in the office. Our office manager, she's sitting with me right now. She's great. She, we handle the issues together. We are in a good communication and it needs to be all along with everybody. I mean, if you don't have a good team, then you can't do anything by yourself.

Eva Sheie (14:35):
How do you see the team, the great benefit of having that kind of team benefit your patients in the long run?

Dr. Totonchi (14:43):
Again, it's a teamwork. Everything is a teamwork, so you can't be available for every single thing with the intensity of the stuff that you do and with the amount of stuff you do, you can't be doing everything, so you need to have a team that you trust them, they trust you so you can deliver the best care for the patients. Otherwise, if I'm having to do everything myself, then I'm not going to be available to lots of other patients.

Eva Sheie (15:17):
What about your team at home? Who's there?

Dr. Totonchi (15:21):
I have two children. My son is 13 years old. He's in middle school. My daughter is in a college second grade, and my wife is a pediatrician, so we both share the care of kids, both of us. So she works in a hospital as a pediatrician. She works with the autism kids, which is, I don't know how she does it. It's very difficult, but she does and she enjoys it. And again, I also take care of the kids at work too, so that part of our work we share.

Eva Sheie (15:54):
Did you meet her at work?

Dr. Totonchi (15:56):
Yes.

Eva Sheie (15:58):
Is there a story?

Dr. Totonchi (16:00):
I mean, not a story, but we used to work together overseas. Actually I was orthopedic resident back then and she was my medical student and literally the part that got us together, it was hard work. She liked the fact that I used to hard work in the hospital setting. At least that's how she saw it, and I liked the fact that she was very hard worker. She used to stay after hours and take care of the patients.

Eva Sheie (16:31):
That's a very important quality. But you have to go back and tell me how you ended up not being an ortho. If you were an ortho resident, how did you get away from that?

Dr. Totonchi (16:41):
I can't say I didn't like orthopedics. I did actually, I enjoyed being orthopedic resident, but when I came here again, I was working in an environment in a research background that was combination like a literally shared area between orthopedics and plastic surgery. We were working on the bone regeneration, which was the project combined between the orthopedics and plastic surgery, and that's when I got introduced to plastic surgery and I really loved it. Plastic surgery has artistic area that you see in plastic surgery more than orthopedics. That is the part that I really got attracted and just followed that path.

Eva Sheie (17:30):
I feel like Dr. Guyuron said something similar. He said he switched because he couldn't talk. I think they were neuro patients. Is that right? Does that sound right? He said he liked it, but the patients couldn't talk to him and he really wanted to have conversations with them. So he changed.

Dr. Totonchi (17:47):
That is correct, yes. That research has a neuro part into it as well, I should say.

Eva Sheie (17:54):
So you work hard, your wife works hard, and I hope your kids work hard too because it's important. What kinds of things do you like to do when you're not working?

Dr. Totonchi (18:05):
I love going to my son's practices. He's a basketball player in middle of school. I like teasing him, playing with him. I play golf and I like traveling. I try to get the family together. My daughter is also busy in the university, so traveling something that I love a lot.

Eva Sheie (18:31):
Did she stay in Cleveland or did she go far away somewhere?

Dr. Totonchi (18:34):
She's in Ohio, but not in Cleveland.

Eva Sheie (18:37):
You can get there in the car though.

Dr. Totonchi (18:39):
That is correct.

Eva Sheie (18:40):
Yeah. That's good. That's not too far, but not too close.

Dr. Totonchi (18:44):
That is correct.

Eva Sheie (18:46):
Yeah. How do you think the staff around you would describe you?

Dr. Totonchi (18:52):
How do staff around me describe me? Suzanne, what do you think?

Eva Sheie (18:58):
I just asked her if you were laid back and she said, oh yes.

Dr. Totonchi (19:02):
She said, you're very focused, but you're also lots of fun.

Eva Sheie (19:07):
That seems accurate. Can you tell me, I know this is an audio podcast, but behind you there are three shelves and there are a series of figurines on the shelves that look very interesting and I need to ask you about those.

Dr. Totonchi (19:21):
I will bring one of them actually. And this is what we like doing Dr. Guyuron and myself. So this is a nasal analysis. That's how we plan the surgery, not that's how we plan much better than this. But I sent to my friends when they asked me what you do, this is what I do.

Eva Sheie (19:44):
Draw noses.

Dr. Totonchi (19:45):
Yeah.

Eva Sheie (19:46):
And is that figure supposed to be you?

Dr. Totonchi (19:48):
No, not really.

Eva Sheie (19:50):
Oh, it's just a doctor.

Dr. Totonchi (19:51):
That's just a general doctor.

Eva Sheie (19:54):
Kind of looks like you.

Dr. Totonchi (19:56):
I have a friend in the hospital who is a plastic surgeon, but he does lots of hand surgery. His fellowship was in a hand surgery. He's my colleague over there and he runs a multidisciplinary clinic for amputation patients, amputee clinic. And I send this to him and I said, this is you. And the other one is me.

Eva Sheie (20:21):
<laugh> In one hand is a butcher knife and the other hand is a leg. And then now we understand your sense of humor a little better too. Well, it's been delightful getting to know you a little bit, and I know we're probably, we're in the kind of final planning stages of launching a podcast for the practice, which is very exciting and I'm sure that we're going to have you back on to talk about things in more detail, including rhinoplasty and migraine surgery. So I'm very much looking forward to that.

Dr. Totonchi (20:51):
That'd be great.

Eva Sheie (20:53):
If someone's interested in reaching out to you directly, how should they do that? Are you on Instagram? Should they go to the website? What does that look like?

Dr. Totonchi (21:01):
Yeah, I have an Instagram page and we also have a website. My website is dr totonchi.com and Instagram is to Totonchi Plastic Surgery. So our office number is 4 4 0 4 6 1 7 9 9 9.

Eva Sheie (21:23):
I will make sure we put those links in the show notes so they're easy to find. Thank you so much Dr. Totonchi, it's very nice to meet you.

Dr. Totonchi (21:32):
Thanks for your time. I appreciate it. Have a good day.

Eva Sheie (21:37):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s.io.