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 is 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 today is Gary Alter and he's a double board certified plastic surgeon and urologist based in Beverly Hills and New York, and I'm so glad to have you, Dr. Alter.

Dr. Alter (00:43):
Well, it's great to be here, Eva.

Eva Sheie (00:45):
Now you're pretty unique. You're kind of a unicorn. How many double board certified plastic surgery and plastic surgeon urologists are there actually?

Dr. Alter (00:55):
Well, I was the second ever. After me, I know of at least four others and then kind of lost track, I would assume under 10. However, I don't know any of the other ones that do exactly what I do. So generally when they go from urology to plastics, they just end up doing the usual plastic surgery, surgical procedures, whereas I went a little bit of a direction. Yeah.

Eva Sheie (01:26):
Was there something that made you think I got to do both? I just can't choose.

Dr. Alter (01:32):
Yeah. What happened was I was a urologist and I was in practice for 10 years and I was doing the spectrum of urology, and I realized while I was practicing that I couldn't do this the rest of my life. There were technological innovations that were eliminating surgery from urology. So urology became a much less broad surgical spectrum. In addition, I saw a lot of issues in urology that were not being covered because urologists didn't know how to treat the issues and the plastic surgeons didn't have the knowledge or the interest to treat 'em. So I figured that if I went from urology to plastic, I could develop some new techniques, broaden in my surgical skills, increased my creativity, and have a better career.

Eva Sheie (02:27):
So you were already 10 years into your career as a practicing urologist. Not a lot of people say, I'm going to go back to school some more after that long. Is that what you actually did?

Dr. Alter (02:38):
Yes. It took a good psychiatrist to realize I wasn't crazy. It's pretty unusual for somebody to practice for 10 years and then to totally change their specialty. But in reality, what I did is I didn't totally change the specialty. What I did is I took the points of urology that were of interest to me and I was able to expand on 'em and I was able to be more creative. So I decided that in order for me to be happy, I could not see me doing urology for the rest of my life that I needed to make a change. And I had many friends who were plastic surgeons and all of them were very happy because one thing about plastic surgery is that there are many different subspecialties and you really can create the kind of practice you want depending upon your interest. So I decided to pursue plastic surgery. It was a very difficult transition, not just physically, geographically, but it was difficult at that age to make a change and to kind of move and to really subordinate myself into a student type of position again, where you were in your own practice making your own decisions, and then subsequently you have to subordinate yourself to people who oftentimes were younger than me. So it was a psychological, geographical, financial transition that was very difficult.

Eva Sheie (04:16):
We'll start with the easy one. What was the geographical shift?

Dr. Alter (04:20):
Well, I had to apply to programs. So very few programs wanted a little bit older doctor who's a urologist. They like younger people that they can mold. So they were somewhat,

Eva Sheie (04:33):
Yeah, they were like, who's this guy? What is this guy trying to do?

Dr. Alter (04:37):
One guy looked at me, one professor at university, he looked at my background and he said, well, let's see here. You're a urologist. Your practice in Beverly Hills, you've got a good practice. You want to be a plastic surgeon. It looks like a croc to me. So you have to get over the skepticism that you're, you really actually want to do it, and you have to let these people know that you're really going to do it and going to make the change and that you're really dedicated to making the change. I had to let them understand what my vision was and what my vision was, obviously to be a plastic surgeon to do regular plastic surgical procedures, but my vision also was to create some new techniques and try to add something that no one else has added.

Eva Sheie (05:29):
And so who responded to what you were trying to do and said, yes, we want to help you do this?

Dr. Alter (05:35):
Yes, I applied to many programs. I got blanks from a lot, but I was fortunate enough to get into the Plastic Surgery training program at the Mayo Clinic in Rochester, Minnesota, which is a really good program and it was a good match for me. So I left Los Angeles and moved to Rochester, Minnesota for a couple of years and got my plastic surgical training there.

Eva Sheie (06:02):
And also deep appreciation for California.

Dr. Alter (06:05):
Well, it was really an uprooting of my life. And then after I finished that two years at the Mayo Clinic, I actually did a further training in Norfolk, Virginia at Eastern Virginia Graduate Medical School to get more further training in genital reconstruction. So it was a two and a half year process just to get the training. During the two years at the Mayo Clinic, I also spent six months in Scottsdale where they sent the residents to get some trauma training. So it was interesting. It was a great experience. I was single so I could kind of move around, but it wasn't easy, but it was worth it.

Eva Sheie (06:50):
So your colleagues at that time that you were training with, are you still connected to those people?

Dr. Alter (06:57):
Yes, I am. I am to some of 'em, sure.

Eva Sheie (07:01):
I imagine that that sort of relentlessness that it took you to be there in the first place was probably pretty inspiring to the others.

Dr. Alter (07:10):
Well, they had their own difficulties. For example, I trained with a couple of former general surgeons that had families and that were in practice as general surgeons, and they realized that that wasn't the way they wanted to practice for the rest of their lives. So they uprooted their families and moved to Minnesota and started over again. There were a couple of good friends of mine that did that. There were obviously others that were just going along the usual transition of you don't take a year off, you just kind of follow it through. But my story's a little different in that I was in a specialty where prior to me applying, it was not an accepted pathway into getting credentialed to be allowed to be a plastic surgery residence. So I had to ask for a special exemption in order to even apply, and I was initially refused and I appealed that and talked the Plastic Surgical Credentials Committee, which is a powerful group of plastic surgeons in academia that I could do it and that I could bring something to the table.

Eva Sheie (08:21):
Has this sort of unwillingness to take no for an answer, always been part of your personality?

Dr. Alter (08:27):
I don't know. I was a pretty obedient child, but there were other issues that I had to undergo also, but I could give motivational speeches because there were other roadblocks too that I had to overcome in order to achieve what I wanted to achieve. And you have a vision in your mind and then you take the first step. You don't really know if that's where you're going to go and you don't really know if that's the right channel, but you take the path and then once you get going down the path, you have to make a decision to quit or just to keep going and just see where it leads. And then you hit the point of critical mass where you say, well, I guess I'm going to just do it and fight the obstacles. I mean, at that time, I actually had a very potentially career ending wrist injury while I was applying and I was going to need wrist surgery, but I applied with the hope and that my wrist surgery will be successful and I'll be able to physically be able to operate. So there were a lot of other trials, but you just have a positive attitude and you believe that everything's going to work out, and if you work hard enough, you'll get there. If you quit, then you always have regrets. So I didn't want to have regrets.

Eva Sheie (09:54):
You're only one side of this coin. The other side is that there's a specific person or set of people in your mind that you're working towards being able to help?

Dr. Alter (10:03):
Well, yeah, I saw some potential problems. As a urologist, there's genital issues that were never addressed because nobody had the skills or the overview. Because what I, basically, I have the anatomical knowledge of a urologist with the skills of a plastic surgeon to know what you can get away with transferring tissues and with the creativity of a plastic surgeon, because there's no question plastic surgery is the most creative specialty in my mind. So as a plastic surgeon who knew the genital anatomy and not being afraid of it and know that there are some issues that need to be addressed, it opened up a whole new area for me to explore. And fortunately, I did achieve my vision and I was able to really make some significant contributions.

Eva Sheie (11:02):
What was that first kind of big milestone in that path from once you were out and actually practicing as a plastic surgeon? What were you working toward?

Dr. Alter (11:13):
Well, the hard part is if you're gone for two and a half, three years and you run into somebody in the town, the practice as a urologist three years is nothing, right? So they go, Hey, Gary, what's new? And I go, well, I'm a plastic surgeon. They go, no, you're not. There's no way. I go, yeah, I've got more training than most of the guys out there. Yes, I'm a plastic surgeon. I do breast augmentations and facelifts and all that other stuff, but I do a lot of genital surgery. And so it was very difficult to build a practice when I got done because people pigeonhole you. You've been branded, you're a urologist. And it actually took me 10 years at least for people to think of you, me in this town LA as something other than a urologist. In fact, even every once in a while they'll say, well, I did a breast aug. And they go, well, you don't do that. Just

Eva Sheie (12:06):
Not allowed. You're not allowed to do that.

Dr. Alter (12:08):
Right. I do this other surgery too. So people have their conception of what you are, and it's hard to break that impression. So I was fortunate when I got into practice that there was a very good reconstructive urologist at UCLA who was a close friend of mine, and he would've some very difficult genital reconstructive cases, and I would help him. We would do 'em together. So our skills together were able to do some very difficult cases and really help some people that otherwise might not have been able to be helped. And then I was, when I did my fellowship in Virginia, I got a very good background in genital anatomy and genital surgery. So those skills I added to, and it was a slow process. I do a lot of female genital aesthetic surgery, and I always had this idea that women were being kind of mutilated by some of the surgeries for labial reductions, et cetera.

(13:18)
And I came up with a new technique that's actually used all around the world now. I lecture and teach all over the world, and that is a major contribution. And then that derived into other female genital aesthetic procedures that I've created with the clitoral hood. And I got my own technique for doing clitoris reductions on women who have large clitoris from hormone malfunctions or from bodybuilding where they take testosterone or women who are older that take testosterone for sexual gratification. So I've developed technique for that. And then I see all these women that have mutilated, and it's really true mutilated by some surgeons that are very callous with the way they do labiaplasty. So half of my practice is reconstructing women who have had previous labiaplasty, and I've developed some techniques and some flaps to reconstruct them, which is very rewarding because when they come to me, they're totally devastated and I'm able to get most of 'em back to normal where they can continue with their lives.

(14:31)
So it's been very rewarding. I've had a great career. It's not over yet. I'm actually now I'm starting to videotape a lot of my more esoteric procedures so that my skills aren't lost when I'm through with it and I'm putting together a textbook, which will take a few years to do. And it's been a great run. I've also been very fortunate because of my unique skills. I was on the show DR 9 0 2 1 0 for five years. That certainly increased awareness for the procedures that I'm able to treat. So that raised public awareness. And then I actually did one episode with my friends who are the stars botched, and they just replayed it. And I'm getting all these phone calls from patients and friends that happened to just see this replay of a show I did maybe four or five years ago. So the entertainment aspect was fun.

(15:30)
I can't say I really enjoy the entertainment filming and everything, but it certainly helped to get the word across that there are ways to help people and that there are procedures that can be helped. So it was a great to increase public awareness and public education. If it were not for the internet, I would probably never have had a practice because the procedures that I do are hush hush and people don't talk about it. And I was probably one of the first people in the mid nineties to have patients send digital photos to me for valuation and to do phone consults. So now it's real popular to do that. But I was doing it since the mid nineties when these cameras were terrible, and I had to fight my way through bad photography to come up with diagnostic plans. So it's been a good run.

Eva Sheie (16:25):
Just the idea that it was challenging to even take a photo. You couldn't take a photo like that and have it developed at the store. They wouldn't do it.

Dr. Alter (16:34):
Correct.

Eva Sheie (16:34):
So when you're the only one in America, that means people pretty much have to fly to see you, and there's no other way.

Dr. Alter (16:43):
So the internet really opened up the world for men and women who are very self-conscious about their genitalia, and it opened the way for them to seek help education, because I only get so many doctor referrals. Most of my patients are self-referred.

Eva Sheie (17:01):
I'm sure you go to New York. How often are you over there?

Dr. Alter (17:07):
Yeah, I do. I go to New York for a week every quarter. So I'm there every three months or so, and I do surgeries there, see patients. I don't do the most extensive surgeries in New York, but I do labiaplasty, labia revisions, et cetera. But I don't do any real body aesthetic surgeries. I do that back in Los Angeles.

Eva Sheie (17:30):
What are people finding you for most often now?

Dr. Alter (17:34):
Well, like every plastic surgeon's practice, things tend to get conned in. And what they find me for the women they find me for labiaplasty, clitoral hood reductions, reconstructions of failed or botched labiaplasties. That's half my practice. Clitoris enlargement. For men, hidden or buried penis, circumcision revisions, penile curvature, various genital plastic problems that most doctors are not really comfortable doing.

Eva Sheie (18:12):
It seems like this would be the most terrifying and stressful thing to go through is to go through it once and then have it not work, not work out, or to be damaged by somebody and then have to figure out how to get that fixed. So I think we probably all have a ton of empathy for someone who's going through that. And you're certainly not alone there. So can you speak a little bit to the team that you have around you and how they support people going through that and what that looks like for someone reaching out to talk to your office?

Dr. Alter (18:42):
Well, obviously someone who's been botched and in general, that's a woman that's had a labiaplasty, they are reassured by looking at photos. I have on my websites on reconstructions, they're reassured because I have publications in the mainstream plastic surgery literature. They'll call my office. I do phone consults. I have a couple of very good employees who will certainly talk to the woman if necessary. The woman can talk to a former patient or two of mine. These women are so often so desperate and so destroyed that they are so skeptical, but they'll come to me because they know my history, whereas they may not have done their research prior on the first operation. They sure do their research when they come to see me. So it's just a matter of reassuring the woman, and I'm pretty good at that. I show 'em exactly what I'm going to do.

(19:53)
There's no surprises. I show 'em the surgical technique. I'll show 'em photos of the surgery prior. And they're generally, they're skeptical, but they're calmed down. It's hard. Like you said, it's very hard. You've gotten beaten up by a doctor that you trusted. So how do you trust another doctor? I tell this to all people who go to doctors, listen, most doctors are great, but you got to really do your research and you got to get second opinions, and you got to know what's going to be done to you. Don't just go in with blind faith. Even if the doctor's a great doctor, typically the woman that comes in with a botched labiaplasty plus said, well, I went to my OB GYN, and he delivered my kids and I really trusted him, et cetera, et cetera. Well, that's great. He's a great OB, GYN, but his interest is not in labiaplasty, and his skill is not in it. So just because someone says yes, I can do it, doesn't mean they'll do it well.

Eva Sheie (21:00):
What would you advise that we look for in that circumstance? Obviously with board certification as the table stakes?

Dr. Alter (21:09):
Well, who does labiaplasty? Plastic surgeons, gynecologists? Few urologists? You want to look at before and after photos. You want to look at the technique they're using to do the surgery, you have to look at a lot of photos and you really should go on the internet and read about what the different techniques are, and you want to make sure the photos are good photos. When I look at some other doctor's websites that promote it, their photos look like they're taken from 10 yards away, so you can't see anything, right? So you want to see photos that are taken close up so you can really evaluate what your result is. Board certification's important. There's differences between what a plastic surgeon can do and what a gynecologist can do. Different training, different techniques. Just do your homework and make sure you're happy with the choice before you do it.

Eva Sheie (22:06):
I liked your advice about multiple consultations. Well, that's not exactly what you said, but I think a lot of times that we feel a little guilty. We took this doctor's time, we should probably say yes. There is no reason to feel guilty about having multiple consults ever.

Dr. Alter (22:26):
And fortunately, like I said, the internet is available. Internet has good information, but it has misleading information also. So what do you believe? It's almost like watching a newspaper now. You don't know what to believe, right? It's the same as the internet.

Eva Sheie (22:41):
Good analogy.

Dr. Alter (22:42):
So you really have to dig, but you have to know you are making a decision that really can affect your life forever. So it's your life, not the doctors. So do your homework and make sure you really don't just rush into something or say, oh, by the way, can you do this? Oh, sure I can. And then the next thing you know,

Eva Sheie (23:06):
Can you and should, you are not the same thing.

Dr. Alter (23:09):
Right.

Eva Sheie (23:09):
Right. Well, you're in LA. Most of the media we see comes out of Los Angeles. Do they still call you up to be an expert on TV for stuff? Does that happen?

Dr. Alter (23:21):
Every once in a while, the doctor shows there's not as many anymore. There was a big rash of 'em in the early two thousands, like DR 9 0 2 1 0.

Eva Sheie (23:32):
Extreme Makeover was

Dr. Alter (23:34):
Extreme Makeover.

Eva Sheie (23:36):
Did you do that one?

Dr. Alter (23:37):
A few others. No, I didn't do that. So there were a lot at that time and they kind of burned out. So I would be on more. I was told by the producers of Botched, they'd have me on more shows, but they can't show anything. And they're very visual TV's visual. So when you can't show anything, the producers kind of hesitate. Even if the story's a great story, they hesitate to do the story. Now, when I was on Dr 9 0 2 1 0, I did a lot of labiaplasty, et cetera on that show. And what they did is they did diagrams because the stories are really the important thing. It's not so much seeing the surgery. You can show that with diagrams and illustrations. It's really how these procedures affect somebody positively or negatively. And so the answer is, yeah, I get called every once in a while to be an expert on something on tv, but not as much as I used to.

Eva Sheie (24:41):
How often do you see a patient who you actually can't help? Does that ever happen?

Dr. Alter (24:47):
Uncommonly. Okay. That really is tough for me. I try to figure out some way to help them. I can make almost everyone better, but there's a small number where I can't do anything. It's really pretty uncommon. It's difficult for me to refuse that kind of a patient because as a doctor, you want to help somebody. And when you haven't been able to figure out a way to help them, I mean, that's one of the reasons why I went to plastic surgery from urology, because there's all these issues that nobody ever approached with all these people that are suffering, and there was no one that was dealing with those issues. So if I have to turn somebody away because I can't figure out a way to help you, it's difficult. So then my mind starts to work. How can I figure out something for this person?

Eva Sheie (25:45):
You seem like you've always been a problem solver. This is what you do, obviously, because you wouldn't have ended up here if you weren't. Was there something when you were a kid or growing up that maybe gave us a clue that that's where you were headed?

Dr. Alter (26:03):
No. I always wanted to be a doctor, but no, there was no, like, somebody turned the light bulb on moment.

Eva Sheie (26:11):
No, just kept putting one foot in front of the other.

Dr. Alter (26:13):
I just, I did well in school.

Eva Sheie (26:16):
Where'd you grow up?

Dr. Alter (26:17):
Well, I was born in Chicago, but I grew up in San Jose, Silicon Valley and didn't move to LA until medical school. And then I left and came back and I left and I came back. I'm very fortunate that my parents were always the kind of people that said, you can do anything you want to do. And when my parents were 35 with three kids, they started all over from Chicago to San Jose. So they were used to people. They weren't the kind of people that say, well, you've made your bed live with it for the rest of your life. So their attitude to me was, yeah, you're young enough, you can make a change and just do it. Unfortunately, a lot of people aren't like that, and therefore they live their lives somewhat unhappy because they have regrets. And I figured I had to make the change because I didn't want to have regrets.

Eva Sheie (27:15):
Is there anything that you like to do outside of work in the limited amount of time you have to not be at work?

Dr. Alter (27:21):
Well, I mean, I play golf. I travel a lot, see my friends, nothing profound. I do a lot of traveling. I'm a big history buff.

Eva Sheie (27:32):
Where's the last place that you traveled to?

Dr. Alter (27:36):
Last place was Greece. I spoke at an international meeting in Athens, and actually my brother met me there. And what we did is we went on a historical archeological tour through the mainland, and we went to Sparta and Macedonia, Thermophiles and Corinth and all these historical places that you hear about. So we went and spent about a week and a half doing that. So I did a lot of historical reading prior to going so that I'd get the most out of it that I could. But when I go on a trip, I don't like to just sit there on a beach and sweat. I like to get something intellectual out of it too.

Eva Sheie (28:22):
And where's your next trip?

Dr. Alter (28:24):
I don't know. I mean, I have to go work in New York in a couple of weeks, but I haven't got any major trips scheduled right now.

Eva Sheie (28:32):
Well, New York is always fun. Even if you go all the time.

Dr. Alter (28:36):
I'm working too hard. It's not fun.

Eva Sheie (28:39):
If someone's listening and they want to find out more about you, where can they find you on the web and on Instagram?

Dr. Alter (28:46):
Well, my main website is alter md.com. That's AL T as in Tom, ER M as in Mary, D as in dog.com, alter md.com. And as I said, I have, my main office is in Beverly Hills and I have a secondary office in Manhattan in New York City.

Eva Sheie (29:03):
And on Instagram, not much.

Dr. Alter (29:07):
I don't do them there, but Dr. Gary Alter is my Instagram.

Eva Sheie (29:12):
I'll make sure I put those both in the show notes so they're easy to find. And I'm so glad that you had time to join us today. It was really, really a treat to get to know you better.

Dr. Alter (29:20):
Oh, it was fun. I enjoyed it.

Eva Sheie (29:25):
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 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.