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 to Meet the Doctor. My guest today is Dr. Elizabeth Kiwanuka and she's a, I'm not quite sure how to describe you because I tried to look at your training and figure it out, but it's a different path than I'm used to. So I'm gonna let you tell us how you describe yourself and we can start there. 

Dr. Kiwanuka (00:52):
Thank you. Thank you for having me. Yeah. My path is a little different. I finished medical school and then afterwards I spent a couple of years doing research in wound healing and tissue engineering, and that's how I get into plastic surgery. So I'm, I guess, a scar expert, I would call it. And that was a lot of fun. I did that up in Boston, one of the labs at, at Harvard. And then afterwards I enrolled in a residency program at Brown University. And what brought me to New York was my training at M S K. I did my microsurgery fellowship there before going into private practice. So it's been a lot of fun. 

Eva Sheie (01:26):
So you are a plastic surgeon?  

Dr. Kiwanuka (01:29):
Yes. Microsurgeon and reconstructive, as well as cosmetic. Yes. 

Eva Sheie (01:33):
But there's a part of this that we haven't mentioned yet, which is that you actually trained in Sweden before you came to the United States. 

Dr. Kiwanuka (01:39):
Yes. So I, I'm born in Russia, but I grew up in Sweden. So Sweden is, used to be my home. That's where my family is. And uh, my time in the US was supposed to be a one year adventure, but here I am, like 15 years later. 

Eva Sheie (01:52):
15 years.

Dr. Kiwanuka (01:52):
Yeah. 

Eva Sheie (01:53):
So how did you get stuck here? You're not stuck. 

Dr. Kiwanuka (01:55):
No, it, it, it was just wonderful. And my time in Boston was so rewarding. You would, in the hallway of the Brigham meet the, the doctors that wrote your textbooks. It was just so inspiring. And, uh, plastic surgery is a great field and there's so much innovation done here in the States. So it was just felt natural, staying. 

Eva Sheie (02:15):
Wound healing and, um, tissue. What did you 

Dr. Kiwanuka (02:18):
Tissue engineering. Mm-hmm. <affirmative>, it's a fancy word for scar and scar treatment and just understanding how uh, wounds heal, how scars heal, and how to optimize healing, uh, both after surgery or trauma or just understanding the natural processes. 

Eva Sheie (02:32):
And there's a lot happening in this field right now. 

Dr. Kiwanuka (02:34):
It's a very exciting field. Uh, wound healing is one of the most strictly regulated processes in our body because if a wound doesn't heal, we'll be in trouble. So our ancestors who had problems with that are not around anymore. So it's very tightly regulated. Sometimes it overshoots and that's when we have problems with keloids or hypertrophic scarring, which basically means scars that are thicker or problematic. But in other situations we have wounds that don't heal. So these are kind of the things we're trying to understand better. 'cause it is a problem that affects a lot of patients, both after surgery, but also, uh, with other conditions. 

Eva Sheie (03:09):
Do certain kinds of people struggle with wound healing more than others? 

Dr. Kiwanuka (03:13):
There are predisposing problems that can lead to wound healing issues. Um, anything like diabetes, things like that, or immunosuppression. Um, for the plastic surgery population, the biggest problem becomes the aesthetic of a scar if a scar doesn't heal the way we would like it to. And so there are a lot of development done there in terms of how to treat a scar after surgery in order to optimize the healing. 

Eva Sheie (03:37):
I think scars are also a little bit unpredictable. Are they not? 

Dr. Kiwanuka (03:40):
They are. Um, just to some extent they are, but there are also a lot of things you can do as a surgeon to try to optimize. Because basically as soon as you start the surgery, you're preparing for what the scar one day will become. It has to do with tissue handling, the type of technique you use, the type of sutures, and also how you dress the wound afterwards and what technique you're, you're using. So even though it is somewhat, it could be unpredictable, but there's still a lot you can do as a patient as well as a physician to try to optimize. 

Eva Sheie (04:09):
If you're a patient and you've gone through surgery and, and you are in that healing process and you think that something's starting to go wrong, what do you suggest that they do next? 

Dr. Kiwanuka (04:18):
Well definitely let your doctor know. 'cause there are a lot of, um, options in the early phase as well as later phase. But it's also important to know that even if a scar is healed, and let's remember, it takes a full year for a scar to mature and heal. But even when you're down the road, if, if you're not happy, there are plenty of options. It's just about having that conversation with your provider, making sure that your surgeon or or physician is comfortable with scar management, is knowledgeable and also excited. 

Eva Sheie (04:44):
Can you share a little bit with us about what those treatments look like if you're down the road? 

Dr. Kiwanuka (04:49):
Yes. Yeah. So everything from silicone-based treatment, silicone tape, silicone gel, that's one of the few things that's evidence-based. Also, a lot of physicians, me including like to tape, because then you kind of decrease the tension on the superficial layer of the skin. Sun avoidance is key. That way you avoid the scar getting darker. I think those would be the most important things. 

Eva Sheie (05:11):
Is silicone tape something that you have to get from a doctor? 

Dr. Kiwanuka (05:14):
No, not at all. They have, you can actually buy it on Amazon. 

Eva Sheie (05:17):
Oh.

Dr. Kiwanuka (05:17):
Yeah. They have medical grade silicone products that are great. 

Eva Sheie (05:20):
What else can you do with silicone tape? Is it the kind of thing we should have around the house? 

Dr. Kiwanuka (05:25):
I mean, yes and no. Usually around the house when you have an a scar or problem, it's traumatic, so you wouldn't wanna put tape on it. You want it to heal before you start taping. But of course, as soon as the scar or the wound is healed, that's when you start applying these products. So it's usually after the superficial layer of the skin has healed. So yes. But also with that said, you can just order it online on Amazon, I'm assuming, and then it'll be there in time for when your scar is ready. 

Eva Sheie (05:52):
Is that something that is normally recommended after surgery? 

Dr. Kiwanuka (05:56):
I would say it is. Yeah. 

Eva Sheie (05:59):
That's funny. I've never heard that before. Okay. That's very useful. Thank you. What does your practice look like these days? 

Dr. Kiwanuka (06:06):
So I have a body focused practice. I'm all about holistic plastic surgery because I want my patients to feel as good as they look. So I, I'm all about function. Uh, the motto of my practice is where form meets function, because I think that's as important for patients. So basically if someone comes to me and, and they say, I want liposuction, I'm not really interested in what procedure you want, I wanna talk about the goal. What are we trying to achieve? Are we trying to, I don't know, be able to do situps again, wear a bikini, wear a specific dress, like what is the bigger picture? Nobody comes to a plastic surgeon to have a procedure. They're thinking about the bigger picture. And I kind of need to know what that is before we figure out how to get there. And for most patients, that will include some muscle toning treatments to begin with. Then addressing the, the other layers and structures, um, depending on what their goals are. But I'm always thinking about the fitness, I'm thinking about the aesthetics of it, but then also longevity. We have to think about nutrition and also the postoperative care. So for my patients, we get to know each other and we know each other for a very long time because it's an ongoing relationship. It's not just about the surgery, it's even more important about the aftercare. 

Eva Sheie (07:16):
How long have you been doing things this way? 

Dr. Kiwanuka (07:19):
So it's fairly new. I call it functional aesthetics. And it was just honestly, after I had my own kid, I started thinking about, well, what would I wanna have done? And function was equally important or even more important than the way I looked. And to achieve that, I need to think about the muscle layer you have to restore and then you can start talking about skin or, and, and things like that. So I kind of build it from inside out. And that makes it fun. It makes great conversations and it really gives you happy patience because you're addressing so many aspects of their lives. And in one year down the road, my patients are able to feel great, they look great, they're happy. 

Eva Sheie (07:58):
So is this what you're becoming known for? 

Dr. Kiwanuka (08:01):
I would hope so. Functional aesthetics is really my baby. And I think that there's such a big restorative component of plastic surgery that that's overlooked. And I do feel that especially women postpartum, that's what they're looking for. They're trying to get back to being able to do a sit up to do the activities that they used to do or even just new things that motherhood provides. They wanna be able to keep up with their kids and, and feel strong and powerful. And again, um, I like to remind my patients that if a man has a hernia, the only way to fix a hernia surgery, and if you have rectus diastasis, which is widening of the muscles after childbirth, then it's a surgical issue that needs to be fixed surgically. And I think that when you accept that, you get treatment and then you continue and you live your best life. 

Eva Sheie (08:47):
It sounds very functional. 

Dr. Kiwanuka (08:49):
I mean, I love it. That's the way I, I, I see it, but I do think it's a slightly different way of seeing plastic surgery. People usually focus on the aesthetic aspect, which is great, but there's so much more that can be done. 

Eva Sheie (09:01):
I think you're onto something here, that functional piece. You know, a lot of us are frustrated with modern medicine because the functional is so ignored or looking for the root cause trying to solve a problem that's causing other problems instead of just throwing bandaids or prescriptions at things. 

Dr. Kiwanuka (09:21):
Absolutely. This is not in any way a quick fix. That's why I was mentioning my patients are with me for a long time. Before we book the procedure. We go through nutrition, we talk about a fitness, either we set them up with the fitness program preoperative, or we do muscle toning treatments such as M Sculpt to prepare the body and even for our patients that are really fit. This also helps with recovery. Like after surgery, if you have a strong core, your recovery is gonna be better. And these are all like beneficial things going into the procedure. 

Eva Sheie (09:50):
Are your patients mostly young moms or not so young moms? 

Dr. Kiwanuka (09:54):
Uh, women in general. Women, it's a, it's a female focused practice for sure. 

Eva Sheie (09:59):
I feel like, uh, a lot of us, and especially, I mean as I've gotten older, there's always a list of things that we wanna do and the order might change a little bit, but there's always like a, a plan in your mind and we're waiting for something to happen so that we can move forward with the plan. Sometimes that's having kids, but are there other things that you see women wait for and maybe wait too long for before they go to an aesthetic expert too, to really get help? 

Dr. Kiwanuka (10:31):
I, I think that's a really good point. And I think it has to do with not fully appreciating how much can be done. Even like preventative. So even before considering children, just going through procedures that allow you to, uh, prepare your core is going to be helpful for the rest of your life to see, I mean, we go to the gym and our, when we're younger, we build a strong body in order to be able to have an active life. And sometimes we can do it with exercise, but especially if you have specific concerns, it can be great talking to a doctor or I don't know, a trainer or someone who is knowledgeable about that, that can help in preparation. So you don't have to like, wait until there's an actual problem. You can start thinking about what it is your goals are and then work towards that. 

Eva Sheie (11:14):
You're making a lot of sense <laugh> and it certainly resonates. So you're doing this a little differently. You have long relationships. Is there anything that you wish your patients knew before they came to see you? 

Dr. Kiwanuka (11:31):
I think timing is kind of what you mentioned. I wish that many of them understood how like it's not a big deal. It's self-care and you don't have to wait until you've kind of reached some kind of dramatic event in your life. This is a part of self-care. In the same way as we go to the gym early, we make sure our cardio is strong. All of these things are just a part of taking care your body and depending on your life, your goals, this can be done at any time in life. Uh, so I just, I guess wish they would've had some of these conversations earlier. 

Eva Sheie (12:03):
I think a lot of times we wish we had started earlier too, and we don't know that there's plenty of things we can do. Yeah. Small things even, you know, and maybe we just don't think plastic surgeons are where you go for small things. 

Dr. Kiwanuka (12:18):
I can see why that would be the case, but I, I think that that's also gonna change over the years because plastic surgery is really changing. I think that the fact that we have more female providers really helps because many of of us have been kind of, it's easier sometimes to identify with the patients and kind of, it makes it personal and it makes it a lot of fun. I like to call us the Fit Femme Club. It's sorority of, of ladies and, and self-care. It's a lot of fun. We become friends. 

Eva Sheie (12:47):
Is there any part of your job that you really, really love that stands out over all the other parts? I have a guess what it is. 

Dr. Kiwanuka (12:56):
I mean, of course as a surgeon, I love to operate, but I've always loved teaching. And teaching means kind of spreading knowledge and educating your yourself, your colleagues. And I think that's true for patient care as well, because at the end of the day when I part with my patients, I want them to kind of be able to bring this knowledge with them so they can practice self-care. So I spend a lot of time talking to patients, being able to like, identify their goals, but also making sure that I give them the tools that they need to continue to be successful on their body journey. 

Eva Sheie (13:30):
Is there anything about women in New York that you think is unique to hear? 

Dr. Kiwanuka (13:34):
Oh, women in New York are great. They know what they want. They know how to find it. They're so accomplished and energetic. It, it's been so much fun working with the ladies of New York. It's a very demanding population, but that makes you as a surgeon better. Like, they know what they want and they're very compliant. They will listen to what the doctor ordered. A fun thing for me with New York is everybody, it's such an international city. So I have patients from all over the world. Me being raised in Sweden, I see a lot of Scandinavian patients, but, so I was born in Russia, so I, I speak Russian, so I, I see a lot of that as well. And I think that's what makes New York so unique. You get such a mix of cultures and patience and, and it's such a melting pot. 

Eva Sheie (14:18):
Do they expect you to be Swedish? Like actually Swedish when they come to see you? 

Dr. Kiwanuka (14:24):
I mean, yes, but you know what? I'm, I'm gonna say not anymore. It's such an international world we are living in. So people, they figure it out pretty quickly. 

Eva Sheie (14:32):
Mm-hmm. <affirmative>. Yeah, it doesn't take long. I was gonna make jokes about Sweden 'cause I'm Norwegian. 

Dr. Kiwanuka (14:39):
Oh. Okay. 

Eva Sheie (14:40):
I hear that Norway is much more beautiful than Sweden.

Dr. Kiwanuka (14:43):
So I have never been, I must admit.

Eva Sheie (14:45):
 <laugh> Never been in Norway. 

Dr. Kiwanuka (14:47):
No. So my sister is a hiker. I'm more of an indoors kind of gal. So since Noro is so beautiful, everybody goes there to hike and enjoy nature. But I haven't been, but I must go. 

Eva Sheie (14:59):
Eventually. Mm-hmm. <affirmative>. 

Dr. Kiwanuka (15:00):
Yeah. It's beautiful. Have you been? 

Eva Sheie (15:02):
I haven't.

Dr. Kiwanuka (15:03):
No. It's, it's beautiful. 

Eva Sheie (15:05):
Tell me more about your office and what it looks like and what it feels like there. 

Dr. Kiwanuka (15:09):
So I try to create calmness in, in the office. It's a space of, uh, relaxation and self-care. And when patients come into my office, especially if they've not had a procedure before, they tend to be nervous and they don't really know what to expect. And I really want this to be an experience of self-care and, and mindfulness versus just a doctor's visit. I want it to be something that you look forward to. Same way as you treat your, you get your nails done, you go to the hairdresser, this is a treat and I, and I want it to be a positive, um, experience. 

Eva Sheie (15:42):
Are there other people there who you might run into? If we were, if we were coming to see you in the office, who, who else is there? 

Dr. Kiwanuka (15:49):
Well, I have a fairly small office staff. We keep it very like intimate. It's front desk. Uh, we have two nurses working there and, and then a lot of our care also has to do with lymphatic massages. So there's that aspect as well. Um, people that are gonna be a part of, of the recovery aspect of, of the surgery. 

Eva Sheie (16:07):
Do you feel like people know that lymphatic massage is almost not optional? That it's part of the process? 

Dr. Kiwanuka (16:14):
Especially the past five years, lymphatic massages have really become like a thing. I know that in other countries, this has been like a part of plastic surgery, postoperative recovery for decades. But it took us like a lot in Colombia and Brazil where body Conting has, there are pioneers in it, whereas here it took a little longer. We had a different approach with using the garments, whereas the lymphatic massage is kind of the mechanical way of, of removing that extra fluid from the tissue. Some of my colleagues that perform these massages, they even advocate doing it before surgery to prepare the tissue and making sure that the procedure itself goes smoother. So it's really becoming a very important part of the postoperative recovery. Absolutely.

Eva Sheie (16:56):
And you have somebody full-time that does that? 

Dr. Kiwanuka (16:58):
Yes. 

Eva Sheie (16:59):
Yeah. That's really great. For your patients, did you ever do reconstructive work? 

Dr. Kiwanuka (17:05):
I did. So reconstruction, primarily after cancer, during my fellowship, we did a lot of breast reconstruction using a free tissue transfer, which means microsurgery. And that was very rewarding. And this was just around the time of C O V I D. So it was also challenging time for the patients. Um, they weren't able to get the, not all patients had their social support, so it was a very sense, even more sensitive time, uh, during their, uh, cancer recovery, 

Eva Sheie (17:34):
Their social support and also, I mean, they couldn't even bring anyone with them.

Dr. Kiwanuka (17:37):
Exactly. And this is a big procedure, so it was, it was tough, but it's very rewarding working with, um, the cancer population. Being able to give back 

Eva Sheie (17:47):
That lymphatic system is also really important with the reconstructive patient. 

Dr. Kiwanuka (17:52):
Absolutely. 

Eva Sheie (17:53):
In fact, I think for some of them they have to go for years because of the disruption to their lymph system. 

Dr. Kiwanuka (18:00):
So, exactly. And, and there are a lot of, um, breakthroughs in that field as well with, um, with surgeries that can be done to help like bypass these blockages or help patients that have both prevent and help patients that have problems after surgery. 'cause even though they're, they survive the cancer, they're still living with this debilitating situation, not being able to, for instance, use their arm or leg or whatever it can be or having to wrap it every day. So, um, but there's a lot of things being done. Mm-hmm. <affirmative>. 

Eva Sheie (18:30):
Yeah. I hope they can get more help going forward. Mm-hmm. <affirmative>, it's really challenging. Let's touch on the technology front a little bit. Mm-hmm. <affirmative>, there's so much innovation happening and it seems like you've always been in front of that and are paying attention to what's going on. Is there anything that you're excited about that's coming out right now? 

Dr. Kiwanuka (18:51):
Well, I'm very excited about, um, well it's been out for a little while, but both vaser and more specifically J plasma, um, non or minimally invasive ways to achieve skin tightening. So for patients that are not really ready to go through like a full tummy tuck or something more invasive for skin tightening, there are all these modalities now that can kind of get the job done. It's been really impressive. 

Eva Sheie (19:15):
So are you using those in combination with things like tummy tuck and liposuction? 

Dr. Kiwanuka (19:19):
Well, mostly for patients with liposuction Um, so for patients that are looking for some kind of skin tightening, that, that's a very efficient way to help with that after the liposuction procedure. And what's great about it is the effect continues for up to six months. So even though it looks great at once, it continues to just get better. 

Eva Sheie (19:40):
And because your patient is under, when this is all happening mm-hmm. <affirmative>, they don't know that it was even there. Right. It just, you just wake up and it's all done. 

Dr. Kiwanuka (19:49):
Yes. I mean, it doesn't add anything in terms of, to the length of the procedure. It's minimal. But most patients, I mean all patients, this is, they actively want it. Mm-hmm. <affirmative> and they are excited about that aspect because again, sometimes liposuction is, is just to address smaller parts of stubborn fat. And then the j plasm is for some patients, kind of the main goal of the surgery postpartum. If you have extra skin, then that can really help instead of doing a full-time tuck.

Eva Sheie (20:16):
I know that the next logical question is, can you have it all by itself? 

Dr. Kiwanuka (20:19):
Yeah, absolutely. But for most patients, it's a nice combination to do both at the same time. But absolutely you can have, um, just a skin tightening. 

Eva Sheie (20:28):
What can patients expect when they come to see you for the first time? 

Dr. Kiwanuka (20:32):
Well, kindness. I am really all about making the experience for the patient pleasant. I, I want my patients to be relaxed. I want them to feel that they can talk to me and, and so we can figure out what the body goal is. I, I want them to leave my office feeling happy. 

Eva Sheie (20:50):
If someone is interested in coming to see you, where should they learn about you online? 

Dr. Kiwanuka (20:55):
So they can visit my homepage, it's called Core Aesthetics, New York. There's also an Instagram with the same name or they can find me on RealSelf. 

Eva Sheie (21:04):
I'll make sure I put all those links in the show notes. 

Dr. Kiwanuka (21:06):
Thank you. I appreciate that. 

Eva Sheie (21:06):
So it's easy to find and it was a real pleasure getting to know you today. 

Dr. Kiwanuka (21:11):
Thank you very much. Thanks. 

Eva Sheie (21:18):
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.