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. Today on Meet the Doctor, my guest is George Bitar, who's a plastic surgeon in Fairfax, Virginia. Welcome, Dr. Bitar. 

Dr. Bitar (00:38):
Very nice to be here with you. 

Eva Sheie (00:40):
Tell us a little bit about yourself. 

Dr. Bitar (00:43):
I'm a board certified plastic surgeon in the Washington DC metropolitan area. I've had my practice for about, uh, 21 years now. And, uh, we have two adjacent offices, a Med Spa and the Surgery Center in the Med Spa. We have aestheticians, we have a PA injector, we have all latest in terms of machinery for nonsurgical rejuvenation and injectables. We have also our own skincare, Model Skin, that is exclusively from the Bitar Institute. And in the adjacent office our, uh, surgery center is where I spend most of my time, and this is basically our clinic and operating room. We have a board certified anesthesiologist who administers anesthesia. We have a, uh, very fine crew of nurses and we do all our surgeries on the premises. We have a nurse that we contract with that can recover the patients overnight. So basically it's a cosmetic surgery institute all under one roof with our own skincare line, our operating room, our Med spa, our, uh, aesthetic fellowship. And basically it's a fun place to work. I love my patients, I love my staff. And, uh, over the years we had different iterations, and now we have a, uh, beautiful office that is, uh, the Med Spa adjacent to the surgery center in one location. So it makes things very efficient, it makes the, what we provide for the patients very accessible. We have patients from all around the world who used to come in droves before covid. Things slowed down in covid and now they're coming back. So we're very excited about our post covid setup. 

Eva Sheie (02:39):
Is there a procedure in particular that they come to you for, from around the world? Is there something that you're known for? 

Dr. Bitar (02:45):
Yes, I do a lot of ethnic rhinoplasties and I have a lot of patients who come from the Middle East for, uh, rhinoplasties. Uh, I am originally from Lebanon, so I speak Arabic, French, and English. So, and I trained around the world. I've, I've, I've operated in all six continents. I've done an aesthetic fellowship with prominent plastic surgeons. So I've developed a, um, connections and patients from all around the world and Washington, DC because it's a metropolitan area, it attracts patients, uh, from around the world as well. So I do a lot of facial rejuvenation, facelifts, neck lifts, and ethnic rhinoplasties, which I'm known for in the Middle East because of social media and the patients that I've operated on for the last 20 years. And I also do transaxillary breast augmentations, so there's no scars on the breast. And people who have darker skin tend to like that because they have much less chance of keloid. And if it does, it's in the armpit as opposed to around the nipple or under the breast. 

Eva Sheie (03:50):
That makes a lot of sense. Sometimes that transaxillary approach is a little controversial, isn't it? 

Dr. Bitar (03:55):
It is controversial if somebody has not trained well how to do it. I trained with Dr. Eves, who wrote the book about transaxillary breast augmentation with endoscopic assistance, and I did a fellowship with the group of, uh, Dr. Eves, who later became the president of ASAPS. And I learned how to do it with an endoscope. But after you know how to dissect the pocket, I did not feel the need to have an endoscope. So I do it now without an endoscope. It's a very consistent operation that gives very nice results, very happy patients and quick recovery. 

Eva Sheie (04:29):
When there are complications with that particular procedure, what usually happens? Or is it, is it just rare? 

Dr. Bitar (04:36):
Well, I mean, as I tell my patients, there are three types of complications. The immediate, the intermediate, and the long term. The immediate would be something that happens in the operating room or right afterwards, such as, for example, a hematoma. And if I have a hematoma, I can open up the breast to do, you know, an incision around the nipple or under the breast. I'm, I'm happy to tell you I've never had a hematoma with this operation. And you know, as surgeons, you should never say never, but that's the truth in 20 years, because I inject the breast before I start operating with tumescent solution, so it cuts down on the bleeding, and when I create that pocket and put the implant in, the implant itself creates a tamponade. So I've not had any bleeding, but I'm, I do breast implants also from under the nipple under the breast. 

Dr. Bitar (05:24):
So if I have to, I can open up very easily. The intermediate complication is an infection that can happen, you know, two weeks to a month later. And I've had infections of sutures in the armpit, but I've never had a breast implant infection from that approach. I've had breast implant infections from, uh, inflammatory approach or around the areola. But this approach decreases the risk of infection. One of the reasons why I like it, because you're nowhere near the milk ducts where the bacteria sit, uh, you don't have to do too much dissection. And I do it with a Keller funnel, so I do it with a no-touch technique, and I tell my patients the time between the implants on the shelf till the time it's inside your breast is about one minute. So as a result, when you inject the breast with tumescent solution and you use a Keller funnel, it cuts down on the bleeding, cuts down on the risk of infection, which brings me to the long-term result. 

Dr. Bitar (06:18):
Long-term complications are mostly either unevenness of the breast or a capsular contracture. Capsular contractures are thought to be a result of either infections or subclinical infections or bleeding. When you inject the breast with tumescent solution, you cut down on the bleeding and you use a no-touch technique, and I changed my gloves three times and cleaned the area with Betadine. That decreases the risk of infections, it decreases the risks of hematomas and therefore decreases the risk of cap contractures a year later. So I think all my complication rates are, are very low and very acceptable, uh, definitely better than the national standards. I'm happy to say. 

Eva Sheie (07:02):
Is the tumescent a standard part of the transaxillary approach? 

Dr. Bitar (07:06):
No, it's not standard. I like to do it like that because I feel there's no reason not to do it. It cuts down on the bleeding. The only argument not to use tumescent is cuz people may think that it can distort their breast or make the breast bigger. So you don't know exactly what size implant to put. My argument when I've discussed that with my colleagues is the size of the implant should be determined in the pre-op visit, not on the operating room table. So when you determine the size of the implant after you tumescent that should not affect the decision on what size is put in the breast. 

Eva Sheie (07:46):
When you have patients come to you for this and then they're back for a post-op a couple weeks later, six weeks later, what kinds of things do they say to you? 

Dr. Bitar (07:55):
So we have a very nice and patient-friendly follow-up schedule. We see everybody the day after surgery. We see them a week after, we see them a month after, six month after, and the year after, I typically see the patients at the one month mark and at the one year mark and my pa who is excellent, sees them at the other times. And obviously if there's a problem, she, she, you know, lets me go in and see them with her. Um, but we try to give them multiple follow ups just so that they can be reassured that we just don't, don't do a surgery and then not follow up with them. And there are some things that are of concern to patients the first week and month, and then as time goes by become less of a concern. But we kind of nurse patients along, we give them a reassurances. If somebody has a lot of swelling or somebody is healing on one side or on the other, we say, you know, it takes about six months to a so you have to be patient. But the fact that we see them multiple times, I think is reassuring to the patients and they feel well taken care of after the surgery. And because I said it's a low risk, low complication operation, I think it yields very happy patients. 

Eva Sheie (09:12):
What other procedures do you like to do? 

Dr. Bitar (09:15):
I love doing rhinoplasties, and I think it's one of the most frustrating and one of the most rewarding surgeries that a plastic surgeon does. And I think that plastic surgeons are divided into two piles. The ones who hate doing rhinoplasties and the ones who love doing rhinoplasties. I think there is very few in between. I love doing rhinoplasties and because I trained around the world, I think one of the reasons why I did a fellowship, and I trained in Beverly Hills, in Rio de Janeiro, in Paris and London and uh, Johannesburg, South Africa and in Melbourne Australia is because cosmetic surgery is a special kind of medicine. It is the only type of medicine where the patient selects the doctor and the doctor selects the patient. In other words, if you are a doctor on call to the emergency room and somebody shows up to the emergency room, you cannot not see them. 

Dr. Bitar (10:12):
And vice versa. If you are a patient and your cardiologist tells you that this is the surgeon who's gonna be doing your heart surgery, you really have to go along with what your cardiologist recommends. But cosmetic surgeons are a unique breed in the sense that a patient picks the surgeon and if I don't feel comfortable operating on somebody, I don't operate on them. So basically about 20% of patients who come to me, I don't offer them surgery for one reason or another. So when I went to train around the world, basically one of the reasons why is because I felt that cosmetic surgery is one of the very few surgeries that your ethnic background and your cultural background affects what surgery you have. I'm a general surgeon before being a plastic surgeon. You know, I've done a general surgery residency, so I've done gallbladder removals, I've done liver transplants, I've done, uh, heart surgery, I've done brain surgery. 

Dr. Bitar (11:00):
You will remove a brain tumor on somebody from Africa the exact same way that you're gonna remove it from somebody from Italy. But when it comes to cosmetic surgery, norms play a role, cultures play a role, ethnicities play a role, and nowhere is that more evident than in rhinoplasties. I'm giving a talk next month in Dubai at the ICOPLAST conference on ethnic rhinoplasties and basically to compare and contrast different maneuvers or different techniques that we use based on the ethnicity of the nose. So for example, if somebody has an African nose with white nostrils and thick skin, they have to be handled very differently than somebody who is Norwegian with thin nostrils and thin skin. Somebody who has a big hump is gonna be managed differently than somebody has a deviated septum. Somebody who is in the Arab world, because there are a lot of women who wear the hijab and they cover their hairs and sometimes their, uh, you know, their mouth. 

Dr. Bitar (12:04):
Uh, so the nose not only is a central part of the face, but it becomes a iconic part of their beauty and their self-identity. So for all those reasons, and then some, the nose is a very gratifying operation when you get it right and the patient comes to me and says, doctor, you changed my life and you gave me the nose that I felt I was meant to be born with as opposed to the nose that I had. So that's one operation that I love to do. I get patients from all over the world that I do it on. There is a changing tide in rhinoplasty right now with preservation rhinoplasties surfacing with the peso rhinoplasty and ultrasound rhinoplasties. And I think that makes a lot of sense to adapt the technique to the nose, not the other way, not the other way around. So as a surgeon, it's my responsibility to learn all the techniques and then decide what technique fits what patients. 

Dr. Bitar (13:03):
So we are lucky that we are now at a time that is very exciting for rhinoplasties. There's a lot more precision that we can afford our patients by offering them ultrasound rhinoplasties, which means basically we cut the bone with a oscillating saw as opposed to a hammer and chisel. So it decreases the trauma, it decreases the swelling and increases the precision of how the bones are cut in the nose. Secondly, preservation rhinoplasty, which basically is a new philosophy, if you will, it's not a technique, but a philosophy that says, you know, if you can maintain as much of the nasal structure as, as nature has, you know, given the patient, then the swelling is less, the healing is less, and the results are more predictable. So we went from in the seventies to doing extreme rhinoplasty with those people with ski slope deformities and, and everything was like done to an extreme to in the last 20 years, we have been more conservative. But now I think preservation rhinoplasty as opposed to the structural rhinoplasty, which is what the traditional rhinoplasty is called, is adding more tools in the box of a surgeon to be able to offer a patient something that is less traumatic, less painful, quicker recovery. That also gives them a very natural result. 

Eva Sheie (14:29):
Do you also see a lot of revision rhinoplasty? 

Dr. Bitar (14:33):
I would say about 70% of my practice, uh, or 70% of my rhinoplasty practice is revision rhinoplasty. Now, I think that that has to be stated with a grain of salt. I, I think number one, a lot of people are having rhinoplasties and rhinoplasties 10, 20 years later can the cartilage can warp the bones, can, you know, change configuration, can get thinner, can, can get broken afterwards with trauma, they can just shift because of a previous fracture that was done that was not a good fracture. And with time the nasal bones have shifted or the scar tissue has made them shift. So those are technical issues, but I think that with the advent of Instagram and with the advent of, uh, Snapchat and different filters that people use, I feel that also the patient's expectation of a rhinoplasty is becoming except nothing less than perfection. 

Dr. Bitar (15:39):
So what I've noticed, and I've talked to other rhinoplasty surgeons, I think what we have noticed collectively is the nose that was okay and patient would be happy with 20 years ago that was not perfect, but was a good looking nose. Now all of a sudden is not acceptable, you know, because people compare their nose to those Instagram models that use filters on their nose or are born with a naturalized nose. I'm not gonna say every nose, every nose needs a filter. But the point is that women or men who have their rhinoplasties right now are expecting perfection from the surgery. And you know, I tell my patients, you know, you're never gonna have a perfectly symmetrical nose and it's never gonna be perfect. I think I'm gonna be giving you a nice improvement to your nose, but you have to compare it to what your nose looked like before the surgery. 

Dr. Bitar (16:27):
You cannot compare it to a digital imagery of a perfect nose. And I think a big part of that whole experience is being honest with our patients and sitting down with them before the surgery and explaining to them what can be done and what cannot be done. I spend a lot of time explaining to them the surgery. I have a, uh, digital image of a nose on the screen. I tell them exactly what I'm gonna do. So if I'm doing an open rhinoplasty or a closed rhinoplasty, if I'm shaving down the hump, if I'm breaking the bones, if I am fixing the tip, I draw it on that image so they know exactly what surgery they're getting. Secondly, I show them a lot of before and after pictures of my patients who typically would've had nose similar to what the patient was looking for. And I tell them, look, you know, none of these results are perfect. 

Dr. Bitar (17:16):
If you're gonna stare at those re after results, you're gonna find a problem or an asymmetry with every single nose you look at. And if you're looking for perfection, then you should not choose me as your surgeon. But if you like the work that I'm showing you here, I'll be happy to do something similar to you. But the catch is that you have to wait a year to judge because all the pictures that I show on my board are a year out. And that's the problem with digital imagery is digital imagery almost implies that the patient's gonna have a perfect nose immediately after the surgery is done. And that's not the case. 

Eva Sheie (17:50):
What are the tools that you like to use in particular for showing the software platforms? 

Dr. Bitar (17:57):
So I think that people learn in different ways, and I feel as a surgeon, I try to impart the knowledge both to my fellows when I'm training fellows and residents and to my patients in different media or in different ways. So that if somebody is a visual learner, you know, they can benefit. If somebody learns by statistics and by reason they can learn. If somebody learns by touchy feely and looking at their own nose in a mirror, I can show them that. So I try to not just take one approach because not everybody learns in one approach. Some people need to know all the details about how I do a rhinoplasty, you know, and, and are very, very detail oriented. You know, I'm, I'm married to a, a woman who is a PhD electrical engineer who is very detail oriented, so I'm used to it with my own wife. 

Dr. Bitar (18:54):
So if somebody comes and, and asks, you know, 50 questions, I'm okay answering them. So number one is go over the surgery in detail what I would do for them. And the level of detail I think depends on the person. You know, somebody who is a nurse who has been a nurse of a plastic surgeon who does rhinoplasty, I'm gonna be way more detailed with her, for example, than, you know, a 17 year old girl who you know is in high school and wants to get her nose between high school and college. Secondly, I show them a lot of my own before and after pictures on Touch md. So we have a Touch MD screen in every room that we do, uh, consults in, mainly in our main consult room, but in all also the exam rooms. And I go over noses that I think are similar to that person's nose in terms of ethnicity, in terms of shape, in terms of problems. 

Dr. Bitar (19:52):
And thirdly, I draw on a diagram exactly what I'm gonna do for their nose. And then I hold a mirror and I start pressing on their nose and say, that's the hum that I'm going to be shaving. Those are the nostrils that we're gonna be bringing inwards. That's the tip that I'm gonna elevate it. And I give them two mirrors. I'm like, okay, how much do, would you like me to elevate the tip? Or how much would you like me to bring the tip down? So I think that my approach in the consultation is very hands-on and very get the patient involved early on so that they will not come back to me a year later and say, well, I had no idea that you're gonna break my bones, or I had no idea that, you know, it's gonna take a year for me to see the final result. 

Dr. Bitar (20:35):
Or I had no idea that I'm gonna have splints inside my nose. I mean, I'm very graphic and I'm very detailed when I am talking to the patients about the surgery. And if I feel that there's a, between us, I, I just don't offer them surgery. I say, you know, maybe your expectations are more or you know better than I can achieve with your nose. So I would recommend that you go to somebody else, especially with secondary or tertiary rhinoplasties, then you have to really, really detail oriented because patients who've had their nose done once and they're not happy, they come with the attitude that burned me once, shame on you, burned me twice, shame on me. So now they feel that it's up to them to do their homework, to be very careful about who they choose, to make sure that they know what exact is gonna be, what exactly is gonna be done. And, and I think that's their right and I'm very happy to operate on a patient who is well informed, who wants to be involved in their own care because I'd rather find out before I operate on them what their expectations are and what they're willing to accept versus after I operate on them. 

Eva Sheie (21:49):
As I listen to you talk about especially your approach to rhinoplasty, you sound to me like you're very pragmatic and candid with your patients, but also extremely dedicated to furthering, uh, where we're going, not just with rhinoplasty, but with everything else that you're doing. And you mentioned to me earlier that you are teaching here at the Miami meeting about sutures suspension neck lifts. 

Dr. Bitar (22:15):
So that is one of my, uh, signature operations. I love doing it. It's basically a, as I'm gonna be discussing tomorrow, is sort of like a middle of the road neck lift because now we are faced with a huge spectrum of procedures that you can do for the neck. It can range from doing Kybella injectables, Botox, liposuction, cool sculpt, skin excision, what other things do we do for the next? So we do a lot of, uh, lasering, you know, um, NeckTite, you know, radio frequency. So we do a lot of things on the minimally invasive edge of the spectrum. Now there is a big trend in doing deep neck lifts. And what a deep neck lift is, is basically doing first liposuction if you need it, doing skin resection, if the patient warrants it, doing a muscle tightening of some sort, removing part of the digastric muscles, which I think is a little extreme. Removing part or all of the submandibular gland, which I think is also a little bit on the extreme and removing the deep fat in the neck. 

Dr. Bitar (23:36):
So the argument for doing deep plane facelifts is that you get a very chiseled neck and you get rid of the fullness around the mandibular border. My problem with that is it almost is too chiseled when I see people who come to me with a deep neck lift, you know, especially ones who've had their, all the things that I discussed, submandibular gland removed, the digastric muscles removed, the deep fat, you know, excessively or aggressively removed. You know, in my opinion they look sometimes like bobblehead <laugh>, you know, it looks like that neck does not belong to that head. And I feel that sometimes plastic surgeons are so gung ho about doing such a perfect neckline that they forget about the overall picture. And so now we have patients who are coming back and asking for fat to be reinjected into their neck. Well, it's difficult to do that. 

Dr. Bitar (24:37):
So why am I saying that? Because I discussed the, the low end of the spectrum. I discussed the high end of the spectrum. The suture suspension neck lift is in the middle of that spectrum. So what a suture suspension neck lift does is I explain to my patients is it tackles all three layers, the skin, the muscle, and the fat. So first what I do is I liposuction the fat if I need to. Not every neck needs a liposuction, but the first thing I do is I do liposuctioning. Secondly is I cut the skin, but where my neck lift differs is I cut the skin behind the ear so there's no scars in front of the ear and therefore you don't have to worry about the stigma of having had a neck lift that in most people will look like a facelift with a scar. Thirdly, I open up the neck from the anterior portion and behind the ear I tighten the muscles in the midline of the neck. 

Dr. Bitar (25:32):
And then I put two stitches in the midline of the neck at the level of the hyoid bone or the adam's apple that are connected to the muscle in the middle of the neck and connected to each other. So those two sutures that are permanent sutures, they're nylon sutures. One of them goes to the left behind the ear area and one of them goes behind their right behind the ear area and they, because they interlock in the middle of the neck when those are tightened and sutures behind the ear, it creates an artificial sling that basically suspends the neck on it. That does two things. Number one, it creates a very nice cervicomental angle or a very nice angle between the jaw and the neck and a very well-defined angle. And number two, it, it's a permanent procedure. So that will not change with time because the muscles have been sutured together. 

Dr. Bitar (26:27):
They have been suspended on this neck lift on his suture, and that suture is tied to the, uh, bone behind the ears. Now the reason why I say it's the middle of the road is because the submandibular gland is not removed, the digastric muscles are not removed. There is some fat that I remove from the deep fat of the middle part of the neck. So from that standpoint, it may be similar to a deep plain neck lift, but from the other standpoint, it's not. And I don't have to cut and lift and suture the platysma muscle. I put that suture suspension to kind of curtail the platysma muscle and shape it up. And it's about an hour, an hour and a half procedure. I do it under local anesthesia or under general anesthesia, depending on whether the patient wants local or in general. And I think it has stood the test of time. 

Dr. Bitar (27:16):
I think one criticism of this operation is people feel like when your sutures are tight, if they're tight too much, people have like a choking sensation. Well that's a valid criticism if somebody is not knowing how to tighten the suture because it has to be done just right. If you do it too much, the patient will have a choking sensation. If you do too little tightening, then you don't have the result that, that you want. So, you know, fortunately or unfortunately tightening the suture to the right amount comes with experience after having done thousands of these. When I'm teaching the fellows, I think they first cringe when they see me tightening the suture, but then they get the idea that if you do it properly, it's fine. You know, over the years I've had to remove that suture on only three patients, three or four maybe. So it's not a big deal. I mean, the first week or two they complain about it, but then as the swelling settles down, they're perfect, they, uh, happy and they kind of, you know, completely forget about it. 

Eva Sheie (28:13):
You're such a detailed and thorough teacher. I can visualize all of this even though I'm not a doctor and I, I really appreciate that about the way that you explain things 

Dr. Bitar (28:22):
And Well, I try in my, in my, uh, consults and I tell my patient <inaudible>, I tell my fellow, I try to do my consults like I'm doing it to an eighth grader. And now I have a fifth grader and an eighth grader. So it, it hits home. You know, I have a son and a daughter who are in, uh, eighth grade and fifth grade, and I feel like if I explain the surgery in a way that my 13 year old son can understand it or my 11 year old daughter, then I think we're okay. I feel that if you start going over very technical aspects and some doctors do that maybe inadvertently, but it comes across as wanting to show off that you know, your anatomy or you know your techniques, whereas the patient has no clue what you're talking about. I don't think that serves anybody's purpose. 

Eva Sheie (29:15):
Do you use Touch MD for all of your consults and show everybody? 

Dr. Bitar (29:19):
Yeah, I mean, whatever surgery they come for, I show them there before and after and I draw on it and show them what I mean. Actually, no, if, if I'm doing body work as opposed to rhinoplasties, I draw on their bodies. So if I'm doing a tummy tuck, I draw exactly where my skin excision is gonna be. I draw where their muscles are and how I'm gonna pull the muscles together. I draw where the belly button is and where the new belly button is going to be coming from, from the skin above that gets pulled down and I draw on them where I'm gonna be liposuctioning. So they end up leaving my office with magic markers on them or we give them alcohol to remove them, but a lot of them want to go home shower and just, you know, where their scars are gonna be. 

Dr. Bitar (30:01):
And I think, you know, it may be a little inconvenient when you first do it, but I think it's a great tool in explaining to people where those scars are gonna be, whether I'm doing it for breast lifts, for arm lifts, for tummy tucks or for thigh lifts, I draw on everybody and if somebody tells me, I don't want you to draw on me, I say, then I will not operate on you. If they cannot stand the idea of having a pencil draw on them, how are they gonna accept the fact they're gonna have a permanent scar there? 

Eva Sheie (30:30):
Makes sense. So I'm curious what you do with yourself when you're not working. Sounds like you travel and you teach a lot.

Dr. Bitar (30:38):
I do, but I feel that I was a late bloomer. I, I married late in life and I had kids late, so I feel like I want to spend as much time with my wife and my kids as I humanly can. And you know, I think work is work, but I like to think that I, I work to live not the other way around. I do do spend a lot of time on my career, but I also love to spend time with my kids. I play squash and I got them into it. And I'm happy to say that my two kids now are national competitors in squash. So every other weekend we have a place to travel to Philadelphia, Houston, San Francisco. We're all over the map. Uh, most of the time it's my wife who's, you know, going with them because because of my work I cannot go as frequent as I'd like, but I, I like going as much as I can. 

Eva Sheie (31:31):
Do you take them on your travels sometimes? 

Dr. Bitar (31:33):
Not for medical purposes, no. And I go on their travels, I go on their, they have enough squash tournaments that I don't need to add to their schedule. I just need to go with them on their, and those are fun because squash is basically a higher form of racquetball. It's played in a court with two people in that court with a ball that doesn't bounce that well and a longer racquet than racquetball. So it's a, it's a more tedious and more effort demanding sport than racquetball. But the point is that it's not that well known. So the people who play squash in the country, after you start competing, they start knowing each other. So when we go on these competitions in different, uh, parts of the country, my kids now have formed a network of friends all around the country that they start, you know, running back into them over and over, kinda like plastic surgeons coming to meetings. 

Dr. Bitar (32:22):
You know, we're like not that many around the country, so we start knowing each other and that's kind of like, that's really fun. Similar in squash, you know, we also have, uh, I place chess with my son. I, I love playing chess and I like playing chess with him. I paint with my daughter. I like to paint also and she has a pension, art and painting. So, uh, we do a lot of family trips and family, uh, fun things. I'm, I'm lucky to have my extended family also in the Washington DC area. I immigrated from Lebanon when I was 16 and I ended up in the DC area. My wife immigrated after she finished college in Lebanon. But we both are of Lebanese heritage, but now we have a very nice extended family in the DC area. So on the weekends we spend with the cousins, with the family. 

Dr. Bitar (33:08):
So I, I, I feel like we have a well-balanced life between work between the kids, between family and and social affairs that have to do with either our personal affairs or related to the practice. Cuz the practice before covid with a lot of charity events, a lot of, uh, sponsoring tournaments or 5K runs and now these things are coming back after Covid and, and then that's a, a fun part of the practice. It creates a nice link to the community and we feel like we're not just operating on people, but we are contributing to the community. 

Eva Sheie (33:44):
That's wonderful. If someone, uh, is listening today, they would like to find out more about you or reach out, how should they find you? 

Dr. Bitar (33:52):
So we are on Instagram at the Bitar Institute and I think we try to keep our Instagram educational somewhat fun, but I feel that we try to keep it educational and factual and because we've been doing it for years, you know, you can go and find any surgery you want if you scroll down on the Instagram or you look at the stories cuz they've all been saved. So that's one area where people come to us a lot from, we also have an Instagram for our Med Spa. So it's called at the Bitar Med Spa. So the Instagram for the office is at the Bitar Institute and the Instagram for the Med Spa is at the Bitar Med Spa. Then we have a very elaborate website, which is Bitar institute.com, b i t a r institute.com. They can always call the office and ask for a consultation with me or with one of other providers. 

Dr. Bitar (34:49):
Our nurse, uh, we have a, uh, two PAs in the practice, a medical pa and an aesthetic pa who does injectables and, uh, lasers. We have our aestheticians who can guide our patients for our nonsurgical or skincare treatments. And I think those are, and there's a lot on, on online. I've written a lot of articles and chapters and books. They can be found on our website or they can do their Google search. We have a lot of people who come to us from Google reviews and real self reviews and Yelp reviews. So I feel that the practice is pretty transparent. I think we've been around for 20 years, so there has been enough documentation, whether it's from our end or just from third parties online. I feel patients will be able to, to find enough information. 

Eva Sheie (35:44):
You're really in the sweet spot for sure. It's all there. Thank you so much for sharing yourself with us today. 

Dr. Bitar (35:51):
Well, thank you for having me, <laugh>. 

Eva Sheie (35:56):
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