Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person, because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. I'm Eva Sheie, and today my guest is Dr. Michael Stein. He's a double board certified plastic surgeon with a practice in Manhattan on the Upper East Side, but he's originally from Canada. Dr. Stein, welcome to the show. Will you just tell us a little bit about yourself?

Dr. Stein (00:52):
Yeah, thank you so much for having me, Eva. Yeah, so I'm a double board certified surgeon. I trained in Canada and I came to New York for my fellowship at Manhattan Eye and Ear and fell in love with it and stayed and set up my private practice here.

Eva Sheie (01:08):
Now, Manhattan Eye and Ear is kind of a special place, isn't it?

Dr. Stein (01:12):
It's the ambulatory surgery center affiliated with Lennox Hill Hospital. And so you basically have literally hundreds of plastic surgeons that have private practices in the Upper East Side, and they're all affiliated with this one institution, and many of them do surgeries in Manhattan Eye and Ear. So when you do a fellowship there, you basically have access to operate with and learn from the best of the best in New York. And there are literally hundreds of them.

Eva Sheie (01:42):
So it's more than just plastic surgeons and facial plastic surgeons. There's everybody there. Right?

Dr. Stein (01:48):
Right, right. It's a multidisciplinary hospital. They do a lot of surgery there, but from a fellowship perspective, you're working with the plastic surgeons.

Eva Sheie (01:57):
Okay. So your, your fellowship concluded and how did you decide you're gonna go out on your own?

Dr. Stein (02:05):
I basically have a mixed aesthetic and reconstructive practice, but from an aesthetic point of view, I did my fellowship from basically concentrating on complex breast surgery, aesthetic and reconstructive breast surgery. And I wanted to tailor an aesthetic practice to this. Most of my patients are breast patients and they're split basically 50/50 between ones that come in for breast surgery, we call primary breast surgery, where they've never had surgery before or multiple one or many breast surgeries in the past, and they have a problem that needs correcting. And so I kind of designed my practice around that.

Eva Sheie (02:45):
And was there an aspect of your training that included breast reconstruction?

Dr. Stein (02:50):
Totally, yeah. I really think that to fully understand the complexities of breast, you need to learn equally the aesthetic side of things and the reconstructive side of things. So the reconstruction is basically deformities or cancer. And when you're doing cancer reconstruction, you're dealing with a patient that has undergone a mastectomy and you're rebuilding a breast mound either with prosthetic materials like an implant or the patient's own materials, which is basically what we call autologous reconstruction or flap reconstruction. Basically as a transplant, taking your tissue from your abdomen or your thighs and transplanting it to your chest. And doing a lot of reconstructive breast surgery, you get this understanding of the anatomy that makes you a better aesthetic surgeon. So aesthetic and reconstructive surgery is not mutually exclusive. It's not like you're a reconstructive breast surgeon or an aesthetic breast surgeon. And I get that a lot from patients.

(03:55)
They're like, which one are you? And you know, first before everything, we're doctors first and plastic surgeons second. So whether you're doing aesthetic or reconstructive breast surgery, you're basically accompanying a patient on a longitudinal journey. And you know, I always say to my patients, once a patient, always a patient, you are with them forever. And it's particularly rewarding, um, when you are there for their breast cancer diagnosis and this volatile, very anxiety provoking time. And then you do surgery with them and then you see them long, generally after, and you see their confidence and strength kind of be restored, but it's not really different in aesthetic surgery. Aesthetic is, is the exact same thing. You know, there's a very anxiety provoking time of taking that leap to do the aesthetic procedure. There's a downtime after surgery, not just from a recovery point of view, but from a psychological point of view. You know, what did I do? I don't feel great. Uh, did I make the right decision? And then there's that upturn that, you know, exponential rise in confidence and wellbeing. That's really rewarding for plastics. It's what we do. It's why we do what we do.

Eva Sheie (05:14):
I have those feelings when I was looking at your Instagram, I watched quite a few of your videos and I sort of wondered to myself, why would anyone do this to themselves?

Dr. Stein (05:24):
Mm-hmm. <affirmative>

Eva Sheie (05:24):
This is voluntary. But then you look at the results and you, and you understand. But I think we often miss on social media what happens between the day of surgery and the day that you go, that was worth it.

Dr. Stein (05:39):
Totally. It's a journey. And you flip through before and afters on Instagram and you see an after picture that's taken six months after when the swelling's down and the scars have matured and the patient's smiling. If it's a facial procedure, it's really a long journey and people need to go into it with a realistic understanding of what that journey's gonna be. And it's great speaking with the surgeon at length before surgery and really getting that chronology of events. And I usually tell my patients after surgery, there's a real, like a mood downturn in that you don't feel good. And you know, a lot of 'em feel, they feel anxiety, they feel depressed. And then there's that euphoric stage that follows where they're like, oh, I did this. I actually look great. The swelling's going down. I'm looking better and better every day. And there's a light at the end of the tunnel.

(06:42)
And it's not really just about the surgery, it's about the incremental lifestyle changes that are inspired by the surgery. Right? Like you're inducing a physical change in someone to create a psychological benefit. And it's not just the result, it's not the result that comes on the operating room table. It's a patient's confidence soaring. It's a patient starting to diet and exercise. And you know, the secret that many people don't talk about is that result you see at six months or a year in the before and after picture. That's not all me, that's 70% me, maybe even 60%. It's 30 or 40%. The patient being inspired to really take care of their body and just live a healthy lifestyle, be the best version of their themselves.

Eva Sheie (07:41):
How do you think your relationship with your patients impacts the other 30% or 40% that you're talking about there?

Dr. Stein (07:50):
Relationship is everything. You know, you have this longitudinal bond with a patient, you know, you need to be there for them. Every patient gets my cell phone number. We've, this is modern medicine. We were taught to create barriers. And you know, while obviously professionalism is paramount, having a patient have access to you all the time is extremely important in elite of eating. Their anxiety, in being able to ask questions whenever you are worried about something and you know, it's not like you just get your result and it's like, see you later. I know every one of my patients and I'm gonna continue following them for years. The most rewarding thing is having a patient two, three years out outta surgery, send you a picture, come visit you and just, you know, stay in contact with them.

Eva Sheie (08:43):
Has giving out your cell phone number ever backfired on you?

Dr. Stein (08:47):
Yes. <laugh> um, <laugh>, when you do enough cases, things are bound to happen, but I wouldn't give it up. I am gonna keep doing it because it's so meaningful for patients to have a good, strong relationship with you. It's, I think, unacceptable to not have access to your surgeon post-operatively. They, you know, we're doctors first, we're plastic surgeon second. We, you're, I'm taking care of you. You're my patient forever. And if you have worries, that's part of the surgery. You know, that it's not just the technical execution of the result. It's being there for you longitudinally after surgery when you need me. And yeah, you know, some people have messaged me at odd times, but you know, it's necessary. You need to be there for them.

Eva Sheie (09:44):
How do you think New Yorkers are different from patients maybe in other parts of the country?

Dr. Stein (09:51):
New Yorkers are busy and they don't want a disruption in their busy schedule. So they're really focused on recovery. And that is basically, it's really led to an explosion in minimally invasive and non-invasive modalities that have less of a recovery. And I do these procedures equally, maybe a little bit less than surgery, but I've found in the last couple years that people are coming to me first and foremost asking for procedures that are non-surgical because they're worried about time away from work. New Yorkers are obsessed with work, as am I, but not all these patients are candidates. You know, if you have a classic example is you have, you know, a female executive that comes into my office and wants lipo, but they've had three kids and they have rectus diastasis, which is separation of the abdominal muscles after pregnancy, and they have excess skin. You just can't, you can't deliver a result that's gonna give you a 30% benefit. You know, I can't knowingly give them what they want when I'm not gonna hit that home run. If you have excess skin, you have rectus diastasis, you need a tummy tuck. And I mean, more and more patients are striving for that minimal recovery, go back to work the next day procedure. Yeah, it's difficult. You always have to tailor the procedure to what they need, and you have to be honest with them.

Eva Sheie (11:32):
Are there any minimally invasive technologies that you're particularly excited about right now?

Dr. Stein (11:39):
In the last couple years, radio frequency has really taken off, you know, all these modalities, without going to specific about the brands, they do the same thing. They heat the tissue and there's controlled damage to tissue that stimulates tightening via collagen regeneration. So radio frequency devices, basically, if you think of the anatomy of, let's say the abdomen, you have skin, you have fat, and the interspersed in the fat is this connective tissue called fibro sectoral network. And you heat the tissues to contract the fibro sectoral network and induce collagen regeneration to make it tighter and healthier. And so there's been this treatment gap where some patients need for sure need a tummy tuck. Some patients have great skin quality and are good candidates for lipo, but there's this middle ground of patients that have a little bit of skin laxity, not enough for a tummy tuck, but liposuction alone won't make them completely satisfied. And so this treatment gap has been filled by a variety of different technological advances that tighten the tissue at the same time as liposuction. So I think that's the thing that's been most exciting, at least for me and my practice.

Eva Sheie (13:00):
Do you ever look at those results and go, wow, that really worked?

Dr. Stein (13:05):
Uh, yeah, <laugh>? Yeah.

Eva Sheie (13:08):
I, I'm speaking to my own age because I've seen all the ones that don't <laugh>. So when one does, I'm like, look at that <laugh>.

Dr. Stein (13:16):
Oh, totally. I mean, we live in an era of social media and there's, there's just a ton of information out there. I think the most important thing to realize is when there's so many different treatment options, there's no one good treatment option. You know, if there's one technology that was the best, everyone would be using it. But you see a plethora of new devices every year and modification of devices. I think they all have some literature to support their use and there's been some good results with a lot of them, but there's not one that's really dominated the market.

Eva Sheie (13:54):
Along with RF, what other trends do you think are really having a big impact on patients?

Dr. Stein (14:01):
Trends are dangerous. I don't even like to talk, talk about trends, because for the most part, you wanna wait and you wanna see when there's a new technology, there's, there's always new technologies, there's always hot trends, and there's this notion that you have to kind of jump on the bandwagon. And whatever's hot on Instagram or people are promoting, that's, that's what works. I mean, I think the modern age of plastic surgery is patients are well-informed and there's so much misinformation that they kind of have to swim through the misinformation to find the facts. And, you know, patients are smart. I think they're learning how, what the dangers of social media and, and there's so much information that that is popping up on their phone that is not really backed by evidence. So I think there's not one particular trend that I have really jumped on. I kind of wait, I wait for the evidence and I do what's right for the patient.

Eva Sheie (15:08):
You're such a practical Canadian.

Dr. Stein (15:12):
We tend to be practical, yes.

Eva Sheie (15:15):
<laugh>. There has to be a counterbalance, I think, to the misinformation. And I wonder, it sounds like you think about it too. My approach is podcasting because I think the more we can get doctors' voices out there telling the truth, the better. And then we can take the podcast and turn it into other things. So there's like a, a truth behind the social media that's important.

Dr. Stein (15:41):
Totally.

Eva Sheie (15:41):
And I, I wonder if you've thought about this and come up with your own approach to trying to battle it. It's, it's probably a losing battle at this point, but maybe, maybe not.

Dr. Stein (15:52):
I mean, you can't control the misinformation. There are many benefits to social media. You know, the information that we once had to find in journals are at our fingertips at times. I think the most important thing, I mean from the consumer's perspective, from the patient perspective, is you take pieces of information and then you double, triple check it with a professional, a board certified plastic surgeon, you ask to see the evidence and not evidence as in before and after pictures, but evidence as in articles from journals that the plastic surgeon can show you. And you ask a lot of questions. You have to ask a ton of questions. You can't just take the information as it is as facts. 'cause you don't know what facts are these days. So I think it's this multi-pronged approach. You start with what's on your cell phone and you question it with the professional, and you read and you read and you read and take it all together and have a well-informed decision.

Eva Sheie (16:59):
What would you do if you read and read and read and then you, your surgeon completely disagreed with you when you were pretty sure that you'd figured out what was actually true.

Dr. Stein (17:10):
See, multiple surgeons, that's important too. Get a second and third opinion. Speak to people, uh, like friends that had that procedure. Speak to different surgeons, read patient testimonials online. There's so much information out there and you, your job as a patient is to investigate. You're like Sherlock Holmes. You really need to investigate all the different modalities we have and make an educated decision by yourself.

Eva Sheie (17:42):
It looked like you went on a vacation last week to Italy, is that right?

Dr. Stein (17:47):
I was in Italy. Yeah.

Eva Sheie (17:49):
Yes.

Dr. Stein (17:49):
So why, uh, you saw on Instagram.

Eva Sheie (17:52):
I was imagining like when you get on an airplane, doctor sign and, and a stranger sits down next to you. How does that inevitable conversation go? Like, what do you do? What do you do? Do you tell 'em, I'm a surgeon? Do you tell 'em I'm a doctor? How do you, how do you do that?

Dr. Stein (18:11):
I always say I'm a doctor first, and the next question is what kind of doctor. But I'm, I said this twice already, that we're a doctors first. We can't forget that. And being a doctor before being a plastic surgeon, like, you know, 17 years of training to become a board certified plastic surgeon. We have a lot of training, but we're first trained as doctors. And you have to, you have to be proud of that. And being proud of that means doing what's safest for the patient and practicing evidence-based medicine. And that just means making your decisions for your patient based on literature, what has been proven to be, uh, effective and safe. And secondarily, you're a cosmetic artist. But the first most important thing is saying, I'm a doctor. 'cause that's what I'm most proud about.

Eva Sheie (19:13):
I tend to notice patterns in things. And I have heard from more than one person this year that plastic surgeons sometimes almost become the first doctor you talk to, especially if you're coming in for Botox regularly or you're, you're doing things that require multiple appointments. And those relationships are built into the aesthetic experience. And so it sort of just starts happening, combined with how challenging it is to actually get through the regular medicine system right now. And so I think people lean on their plastic surgeons to be their doctors much more now than we ever did in the past, because

Dr. Stein (19:52):
Totally.

Eva Sheie (19:53):
It's so hard.

Dr. Stein (19:54):
Totally agree with that.

Eva Sheie (19:55):
Yeah. So you've seen that?

Dr. Stein (19:56):
Totally. And in, you know, in my aesthetic practice, many of the questions I'm getting post-operatively from patients have nothing to do with scar burden or the shape of their hips. It, they're me real medical questions like constipation or nausea or feeling depressed after surgery. So you need to be well versed in everything to be a good plastic surgeon, not just delivering a beautiful result.

Eva Sheie (20:25):
Because if you've done a lot, maybe you're better at it than someone who hasn't done any then that's in the data too.

Dr. Stein (20:31):
Totally. I mean, look, in New York City, there are hundreds and hundreds of plastic surgeons and it's, I can imagine it's daunting for a patient. Like, you know, I'm on Park Avenue, you walk out on Park Avenue every block there's a plastic surgeon's office. So how do you pick which one? I mean, first, the, the easy stuff is that they're board certified by the American Board of Plastic Surgery, that they, you know, they went through the training that you should do as a plastic surgeon, that they have an accredited operating room if you're getting surgery in their office by quad ASF, or any sort of regulatory board that your anesthesia is delivered by a board certified anesthesiologist. These are the easy things, the harder things is two, one, you need evidence that the plastic surgeon does good work. And how do you determine that?

(21:23)
Well, you should be able to look through a gallery, an extensive gallery of all their before and after pictures. And those before and after pictures for your procedure of choice should show the result on different body types, skin tones, age ranges. And you should be able to read through reviews of patients that had surgery from that surgeon, your surgery. And you can do that on Google. But, you know, I think the second thing that's important is the rapport you have with your, with your surgeon, right? You guys are a team. You know, you're gonna, you're embarking on this longitudinal relationship together and you need to like each other, you need to trust each other, and you need to have a mutual understanding of your surgery. And you need to know that your surgeon's gonna be there for you. This goes back to what we talked about at the beginning of the podcast.

(22:21)
You need to know that the person's gonna be there for you pre-operatively to answer all of your questions and make you excited about surgery rather than nervous and postoperatively, you're gonna be able to reach him or her always.

Eva Sheie (22:32):
Mm-hmm. <affirmative>

Dr. Stein (22:33):
They're there for you and they're not going anywhere.

Eva Sheie (22:36):
Right.

Dr. Stein (22:37):
And if you have a problem with your implants in five, 10 years, you're calling your surgeon. You're not, you know, and your surgeon's gonna be like, okay, this is what's going on. Or, you know, issues with your, you gained weight and you have more excess skin after a tummy tuck five years later. Your surgeon needs to be there for you. You know, once a patient, always a patient. That's really important. So, yeah, I don't know if it's, maybe it's the number of procedures as you alluded to, but I really think you need to, you know, the modern plastic surgery is having a well-informed patient and that's really asking the right questions.

Eva Sheie (23:16):
I used to think quantity was the most important thing. And I still think it's important, but one time

Dr. Stein (23:21):
Definitely.

Eva Sheie (23:21):
I met a surgeon who bought a practice of a, someone who was retiring, and that surgeon had a special stitch that he did in the upper corner of every breast implant. And the stitch that he was doing was causing his implants to deflate prematurely. So if you said, well, he's done thousands and thousands, but didn't know that 90% of them had deflated, you would just think he was a great surgeon. And really he was like setting all of his patients up to fail <laugh>. So after that, I stopped using quantity as my only measure.

Dr. Stein (24:00):
Look, I mean, quantity is important because when you're, you know, let's take breast surgery as an example 'cause I do a lot of that. You get, you know, as a resident, you read a ton about the anatomy and the different techniques and you kind of get bogged down in measurements and algorithms and what, okay, this, this patient's measurement is this, so they need a nipple graft rather than a lift. There's all these different things you memorize for exams, but when you do enough breast surgery, you realize, you know, every patient has different skin quality. And while you can use those to guide you, it really is experience in knowing, okay, this is what this patient needs. I need to over-tighten the lower pole of the breast to this amount because they have stretchy skin and they're gonna stretch out a little bit. So that's where quantity comes in. You have the experience, you've done enough that you know how the tissue's gonna react.

Eva Sheie (25:03):
A lot of that comes from reconstructive experience too, I would think.

Dr. Stein (25:07):
Totally. Yeah. Yeah. Viewing any part of the body from an anatomical perspective, from different viewpoints just makes you a better surgeon. Right? So it's not mutually exclusive. Being a great reconstructive surgeon makes you a great aesthetic surgeon. And vice versa, you know, when you're doing a cancer reconstruction, your goal is not to make a breast mound and just make and, and put tissue on the chest. It's to make a gorgeous, natural appearing breast.

Eva Sheie (25:40):
I feel like we have a pretty good handle on your work, and I would like to know more about what you like to do away from work.

Dr. Stein (25:47):
Mm-hmmm <affirmative>, I think exercise is just essential to mental and physical health. <laugh> and I, I love biking, so I, I rode bike all the time. I was road biking in Italy. You must have seen some of those pictures in the Amalfi coast. But you know, I run and I rode bike almost every day. I'm training for the New York Marathon. So I was running this morning and, you know, every day before work, you know, you wake up at five, you exercise and you start your day. And I feel the days that I don't exercise, you know, something's off. You know, like it really, it has this calming effect on me. So what do I do on my free time? I like to exercise a lot and social engagements, you know, having a strong friend base and, and a strong family is really essential.

Eva Sheie (26:38):
You have a running buddy?

Dr. Stein (26:40):
Yeah, I do.

Eva Sheie (26:41):
Or a group?

Dr. Stein (26:41):
A couple. Yeah. Yeah. And it's good to run with someone 'cause they kind of push you if you're slowing down or you're speeding up. Yeah.

Eva Sheie (26:50):
So if anyone's listening and they wanna learn more about you, where should they go look?

Dr. Stein (26:55):
Um, my website, Dr. Michael J Stein.com or my Instagram, which is Michael Stein. Dr. Michael Stein. And we'll provide the link below.

Eva Sheie (27:05):
I will, I'll put it in the show notes. Thank you.

Dr. Stein (27:08):
I appreciate that. But really, thank you so much for having me, Eva. It's wonderful showing the human side to plastic surgery.

Eva Sheie (27:17):
My pleasure, truly.

(27:22)
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, 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.