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. Lawrence Bass. He's a plastic surgeon in New York City. Welcome Dr. Bass.

Dr. Bass (00:40):
Thank you. I'm delighted to be here.

Eva Sheie (00:43):
Now you are not new to podcasting, so let's start there. Tell us about yourself and tell us about your podcast.

Dr. Bass (00:51):
I'm a plastic surgeon in New York City on Park Avenue, and I started the podcast called Park Avenue Plastic Surgery Class in the middle of the pandemic. You know, I really stopped going to medical meetings. I wasn't at the hospital as much teaching the residents. Uh, all, all of my interaction for learning and teaching was curtailed. And through the podcast, it gave me a new avenue to reach out to patients and share some of my knowledge and experience.

Eva Sheie (01:25):
Do people come in and say that they've listened?

Dr. Bass (01:28):
I do get that. And the other thing that happens on a daily basis is one of my long-term patients who will be in for a visit will ask me a question and at least once a day, if not several times a day, the answer is, we've done a podcast on that, and they can get 15 or 30 minutes of answer to their question instead of three minutes as part of the medical encounter.

Eva Sheie (02:00):
That's, I think, extremely valuable and a major addition to a good patient experience. And I, it makes me very happy to hear that that's what's happening and that you're able to use. Has it improved your own quality of life on a daily basis? Uh, you know, do you feel like it's okay to say, go listen to my podcast instead of answering?

Dr. Bass (02:21):
I, I think one of the virtues for me is I realize that a patient can go and listen to, and if they don't get something, rather than feel like, oh, I don't want to keep the doctor and I need to rush on with my day, they can play that part over and over. They can go back and listen to it next week until they're sure they really understand.

Eva Sheie (02:45):
Has anyone ever said to you that they were so glad they could do that?

Dr. Bass (02:49):
I, I have had patients say it really gave them a level of insight into a subject again, you know, because it is like a class, it's intended to be instructive as well as entertaining. So they've really been able to get a deep dive instead of just superficial information. And a lot of people absorb things better listening to it than they do...You can hand people a brochure, but it's hard to read dense technical language or even company promotional language in a, in a brochure and really get an in depth understanding. And we kind of play dual pathways in the podcast where there's some more technical questions and there are definitely lay people questions that my co-host asks. So exactly like what most patients are wondering about.

Eva Sheie (03:47):
I've learned a lot actually from listening to your podcast, including, I think one of the most important realizations I had as a, you know, as somebody who's been thinking about from a marketing standpoint, all the plastic surgery and nonsurgical procedures for 20 years, it didn't occur to me that the way we approach facial rejuvenation had changed so much until I listened to you take me through it in such great long detail. And that is something that has completely changed my own thinking. And I tell people often that they need to listen to your particular episode about facial aging, so I know exactly what you mean and what it turns into on the other end. And I believe in podcasting and I'm happy that you do too.

Dr. Bass (04:35):
You know, I think part of that episode and a number of the episodes, because I'm not a beginner and, and I've spent 25 plus years in practice plus all those years training, I've seen the history of how a lot of this has developed. And so in a sense, I'm teasing it backwards because patients who are just coming to the point where they're thinking of consuming plastic surgery and a lot of the doctors who didn't live through the history, it's all squashed down in and monolithic. And by teasing back out some of that development and the different aspects and the different stages of what needs to be done is critically important to getting as close to a home run out of whatever you decide to do as possible.

Eva Sheie (05:27):
Now, I also know from listening to you that you love technology.

Dr. Bass (05:31):
That's true.

Eva Sheie (05:34):
What are some of your favorites right now?

Dr. Bass (05:37):
You know, there are so many devices out there, and it's really, again, about matching what the patient's needs are with, with what's happening on the technological side. So I think there are some great fractional resurfacing options that are being increasingly mated with things like P R P, platelet-rich plasma and being mated with exosomes. We talked about stem cells a couple of times on the podcast, and from a regulatory point of view, that's just not possible yet in the United States, but some of what's happening with exosomes brings us pretty close. It amplifies what's been done in the past with microneedling and with P R P to give a more sustained effect or push to the skin to rejuvenate. So I think fractional resurfacing channeling, in other words, opening the skin so that either P R P or exosomes can get in under the skin or other skin medicines is a big area of application for skin quality.

Eva Sheie (06:56):
Is there, uh, an easy definition for exosomes for anyone who hasn't heard about this yet?

Dr. Bass (07:01):
It's the body's way of micro encapsulating growth factors and signals to cells to make new collagen, to make new blood vessels, things like that, to ramp up their metabolism. So it's like taking a sustained release tablet instead of just taking a tablet. The effect is going to be more amplified over a much longer period of time.

Eva Sheie (07:28):
Is it something that you, it's not a product, it's something that's extracted from us.

Dr. Bass (07:34):
It's usually extracted from cell culture. So these are available as commercial products for topical use in the US. We're not currently at a stage in the US as I understand it, where they're available for injections. So that would still leave you drawing blood and processing platelet-rich plasma.

Eva Sheie (07:58):
Is this something that you do every day?

Dr. Bass (08:00):
It's something that we are increasingly involved in in the practice, and I, I think for a lot of patients that are looking for a big reboot on skin quality, uh, they haven't been keeping up with it. And this is a common event during the pandemic that a lot of people were distracted with other issues, and they're now trying to get back to, uh, a little bit of appearance restoration. And sometimes that's surgery and sometimes that's Botox and fillers. But skin quality treatments, having a biological or regenerative component to it, not just an energy component, I, I think is really state of the art for 2023.

Eva Sheie (08:47):
So it sounds like it can actually correct skin.

Dr. Bass (08:51):
Yes. And so after microneedling or channeling, picking which medication you're applying, um, like tranexamic acid, if there's a hyperpigmentation problem that's going to affect what you fix. So you still need the provider to be the expert, pick the correct medications, monitor the progress, and adjust the treatments accordingly. But it, it just gives you a much bigger handle on being able to rework the skin without doing a big recovery based treatment.

Eva Sheie (09:32):
Sounds really exciting. Is there other technology that you're particularly interested in right now?

Dr. Bass (09:40):
I've written about four book chapters on body skin smoothing, and whoever's editing the book will call me up and say, you know, Dr. Bass we're buddies. You do me a favor and write a chapter on body skin smoothing. And I usually tell 'em, you're gonna get about half a chapter because we're gonna tell you why it's such a hard problem to fix. But I think some of the energy based devices that are being used now have really begun to not magically make our skin 20 again, but, but make a significant improvement in skin smoothness in terms of creppiness, in terms of cellulite. And the, the problem has always been, you know, these are big heavy body parts. It's not your face, which is small and light and it's a large area. And so it's very hard to apply a treatment over a large area. Especially a lot of treatments that have been tried for this in the past were really designed for the face and the economics don't work doing it on a large body area.

(10:48)
If you are firing disposable lines on body areas that were designed to do a face area, the economics of that treatment just don't work unless you're independently wealthy. So, uh, some of the newer microwave and radio frequency devices really have had an, the impact on being able to more reliably get an improvement. And, you know, I would tell patients in the old days, a lot of these things were a lot of work and you get about a base hit in terms of results. And I would say we're not getting a home run, but we're definitely getting a double or a triple and with a lot less work and expense.

Eva Sheie (11:35):
You often, uh, bring in other experts to talk to you about these things on your podcast and sometimes have very lively debates. Can you think of any guests you've had on in particular that were really enthusiastic to participate in?

Dr. Bass (11:51):
It's hard to single a particular guest because they've all been great. They're all handpicked by me as people who I know are real thinkers and not promoters. We don't like to be promotional on the podcast and sell a product. We're trying to teach people how to think about consuming their plastic surgery services. But Jason Bloom is a very enthusiastic fellow. He's extremely knowledgeable. He has his opinions, but he's open-minded enough to recognize the potential validity of other opinions. And so that allows us to beat issues back and forth without hurting each other's feelings, uh, in a way hopefully that's educational for the listeners.

Eva Sheie (12:38):
Now here, we're at the Aesthetic Society meeting in Miami today, and on Sunday I notice that you're on the program with two giants of laser, Dr. Posner and Dr. De Bernardo. Is there anything that the three of you are planning to cover that might be controversial or exciting on a Sunday morning?

Dr. Bass (12:59):
Well, the title of the, the course that we give every year at this meeting is Hot Devices and Plastic Surgery. So we're trying to show which technologies are new, not not just a new and improved version of something that's been out for a long time, but things that really take a, a new approach or allow us to do something we were unable to do before. And so things like, uh, like Sciton HALO, which allows you to combine ablative and non-ablative resurfacing in a single application, rather than making multiple passes with multiple devices or, uh, the Sciton BBL options that allow you to apply BBL either for pigment or hair removal by rolling over the skin instead of taking a stamping approach. This makes it a, a quicker, easier treatment for the patient and for whichever staff member is applying it and gets superior coverage without skip areas.

(14:03)
So things like that are some of the things we're talking about so the surgeons can understand what the differences are between a lot of similar seeming devices, which ones have really put in the innovation in there. Ellicor is another one, and we're going to try to parse through. This is a tissue removal device that takes out little punches of tissue to reduce the amount of lax skin. And we're going to try to sort through is that really a wrinkle improver or is it really a skin laxity reducer? Because that's not a hundred percent clear yet.

Eva Sheie (14:46):
Super curious about that Ellicor. But I would like to go back to, cause what we're really trying to also do here is, is allow people to get to know you. So you've been in practice for how many years?

Dr. Bass (15:01):
For a little over 25 years.

Eva Sheie (15:05):
So take us back to the beginning and let us in on those earlier years and how you ended up where you are now.

Dr. Bass (15:14):
When I started in plastic surgery, which was the early 1990s, there were eight or so aesthetic plastic surgery procedures, eyelid plasty, brow lift, facelift rhinoplasty, breast lift, breast augmentation, and tummy tuck. I had previously done a lot of work in lasers that were not in plastic surgery during my earlier surgical training, but by the mid 1990s, lasers were starting to be a mainstay in aesthetic plastic surgery and cutaneous therapy treating various skin conditions, most of them cosmetic. And so finally there was a laser application in my field instead of related to tissue coagulation of tumors or, or tissue joining or things like that. So that's, that's how I got my technology start in plastic surgery. And what happened in the ensuing 20 years is that instead of aesthetic treatment being predominantly surgical, it's become predominantly non-surgical and small treatments and small procedures. People by preventing skin aging, by maintaining their skin, can substantially delay the need for surgical intervention in many, you know, sooner or later, I, I tell my patients between now and the time we're a hundred, we're, we're gonna be a candidate for everything in the book, but we can delay that substantially with good care, with nonsurgical means.

(17:07)
And so it's very important as an aesthetic provider to bring the right treatment to patients at the right time to address the needs of patients at all stages of aging, rather than just be there when everything collapses as as the rescue team.

Eva Sheie (17:27):
Mm-hmm. <affirmative>. So if I can bring you back around, you were talking about using lasers really early. If you can tell us where you were training that you were using lasers. Is that when that happened, was during training?

Dr. Bass (17:43):
Well, not so much during training. I mean, during my general surgery training, I was doing research with lasers and other energy-based devices, but again, not for plastic surgery or aesthetic uses. And there really wasn't much of any use except for a few very unusual conditions in plastic surgery at the time that I trained. But shortly after I finished training, laser resurfacing started to be used. So this was originally the ultra pulse and then the silk touch lasers, and those were CO2 resurfacing lasers and that focused on treating wrinkles. And if you think about it, it's great to have a facelift. If you have a big bag of hanging skin or a turkey waddle under your chin, it's a really great thing to have a facelift or a neck lift and get rid of that. But if you're still covered with lipstick, bleed lines and wrinkles furrowing your cheeks, you still don't project youthful appearance.

(18:49)
So chasing wrinkles is a critical other half of the facial rejuvenation question. So I, I saw that right away and got very involved in that cuz I understood how the lasers worked. Uh, but there was a lot to learn about how to manage the care of those patients, particularly with those original very aggressive laser peels. Then erbium resurfacing became available that was originally billed as a light laser, but the reality is erbium, which is almost exclusively what I do at this point when I'm doing an ablative resurfacing, one that vaporizes the skin. erbium really has a huge range. So you can do an extremely light peel just to take off a little surface texture or pigment where you can do something even more aggressive than what CO2 resurfacing does or anywhere in between. So it's very scalable and that great ability gives you the flexibility to bring what each patient needs. You know, the 40 year old with a few early crows feet or lipstick bleed lines is different from the 75 year old who lived in Florida for 50 years. And I grew up in the pre sunscreen era. So, you know, if you grew up in the sunny area and you're my age, uh, you know, you got sunburned so many times when you were young, you, you can't even count, uh, because there was no way to protect yourself. And part of life was outdoors in a sunny environment.

Eva Sheie (20:29):
It almost sounds like, it sounds like the beginning of a joke. Like I'm so old there wasn't even sunscreen. So was there something in your early life, like before you went to medical school that maybe signaled that you were already gonna be really interested in technology and how stuff works and, and putting all these pieces together?

Dr. Bass (20:52):
Well, from the time I was a very small child, I mean that, that was, that was the, the space era and the, the science of space travel was a big thing for little boys when I was growing up and I was always interested in science in general. Uh, in college I did research in x-ray crystalography and that was actually using a physics technique to solve the chemical structure of a molecule three-dimensionally to determine a biological function, usually an antibiotic or anti-tumor function. So it kind of strung all of those sciences together. But crystallography is spatial and three-dimensional. And in some ways that was a harbinger of what sparked my interest in plastic surgery because plastic surgery is more like sculpture than it is like painting. It is spacial and three-dimensional and that's critical. Being able to think spatially is critical, I think, to having the aesthetic eye that's needed for plastic surgery.

Eva Sheie (22:11):
Was there anyone you can remember at this time in your life who really nurtured that or pushed you in that direction?

Dr. Bass (22:18):
In my first year of medical school, that was actually when I first began to consider possibly going into plastic surgery. And the reason was because one of our instructors in the anatomy course was a plastic surgeon named Bard Cosman, who had become quite ill, was no longer able to practice, but he was on faculty at Columbia University where I went to medical school and he wanted to do something. So he was helping to teach anatomy and he taught me a great deal about head and neck anatomy. His advocation was sculpture. And so that and his appreciation for shape and for the anatomy and head and neck was what sparked the first thoughts in my head of going into plastic surgery, which is ultimately where I landed up

Eva Sheie (23:14):
Away from your office, which is on Park Avenue. And you've been there for quite a long time, right?

Dr. Bass (23:20):
Yes. Since 1999.

Eva Sheie (23:23):
You've seen New York change a lot, I'm sure. What kinds of things do you like to do away from work?

Dr. Bass (23:31):
Well, I have a broad range of interests. I, and I think I grew up in an era where children were encouraged to have hobbies and children are more screen driven nowadays. It's, it's different. But I am a private pilot. I own a single engine aircraft. I'm a scuba diver. I love to ski. I raise orchids. These are just a few of the things that I do in my spare time, such as it is.

Eva Sheie (24:04):
Just a few, but all different seasons I think so.

Dr. Bass (24:09):
So I can spread them out <laugh>.

Eva Sheie (24:11):
That's right. If someone's listening to this podcast and wants to hear your podcast or potentially reach out and get more information about seeing you as a patient, where should they go?

Dr. Bass (24:25):
Well, the Park Avenue Plastic Surgery Podcast is available on all the major platforms and they can go to Apple, Spotify or whatever their favorite platform is and search the podcast and stream any of the episodes, all of the descriptions of the episodes offer the contact information. If you want to email a question, we can try to cover it in a future podcast episode.

Eva Sheie (24:55):
And your website for the practice.

Dr. Bass (24:58):
So our practice, yeah, that, that one. I know the podcast, uh, one, I don't know off the top of my head, but you can see us either at drbass.net or bass plastic surgery.net.

Eva Sheie (25:13):
Thank you so much Dr. Bass. It's a privilege to hear your stories in person.

Dr. Bass (25:18):
A pleasure to join you today, Eva. Thank you.

Eva Sheie (25:23):
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 Th Axis, t h e a x i s.io.