The Future Of Plastic Surgery Is Female

“I did the exact opposite of what everybody told me to do,” says Dr. Lisa Cassileth, an award-winning plastic surgeon and leader of Cassileth Plastic Surgery and Skin Care in Beverly Hills. For context, the practice — which was founded in 2003 — is now in the top 3% of all plastic surgery practices in the United States. Twelve years after launching her practice, she opened Bedford Breast Center next door, a best-in-class breast cancer treatment facility. While many of Dr. Cassileth’s male colleagues told her to avoid the swanky neighborhood synonymous with celebrities and plastic surgery — advice she equates to waving a red flag in front of a bull — she decided to build a women-run empire.

“I heard the same thing every single time: ‘Lisa, if you were my daughter, I would never recommend that you come to Beverly Hills. It’s so competitive and you’ll never make it here — it’s way too tough,’” recounts Dr. Cassileth. However, when she looked at the list of plastic surgeons in the area at the time, there wasn’t one woman to be found. The same could be said of Cedars-Sinai Medical Center where Dr. Cassileth would ultimately become the Division Chief of Plastic Surgery for two consecutive terms. From her perspective, being the only female plastic surgeon in town was already a win. “What everyone was really afraid of is that I would come to Beverly Hills and be the one person who could take their patients away,” she says.

Women Should Run The World — And Beverly Hills

Gender isn’t the only advantage that Dr. Cassileth and her team — which includes Dr. Kelly Killeen, Dr. H. Elise Min, and Dr. Heather Richardson — have over their male competition. They are among the most sought-after surgeons in the plastic surgery business, an industry in which female patients account for 92% of all cosmetic procedures in the U.S., reports the American Society of Plastic Surgeons.

Originally interested in architecture, Dr. Cassileth transitioned to pre-med after enjoying and excelling in biology and physics at the University of Pennsylvania. In lieu of constructing skyscrapers, she pieces together parts of the human body with unparalleled precision and is world-renowned for revising failed cosmetic and reconstructive surgeries. She says that solving problems other surgeons can’t is one of her favorite parts of the job. Dr. Cassileth also pioneered and perfected the Direct-to-Implant Breast Reconstruction technique, a procedure that helps mastectomy patients avoid multiple surgeries.

Surprisingly, assembling a predominantly female staff wasn’t by design. “The people I learned to love and trust just happened to be women,” says Dr. Cassileth. Dr. Killeen, a double board-certified plastic surgeon who completed her residency at Cedars-Sinai under Dr. Cassileth, joined the practice in 2015. A star on the 2020 season of Dr. 90210, she specializes in breast and body procedures, including implant removal and revision, as well as breast reduction and reconstruction.

Dr. Richardson, who helms the Bedford Breast Center alongside Dr. Leslie F. Memsic, initially crossed paths with Dr. Cassileth in the operating room when another surgeon dropped out. “Heather sings when she’s in the O.R., so I thought this person is either the worst human that ever existed or I love her,” says Dr. Cassileth. Needless to say, Dr. Richardson’s flawless work made that decision easy. Today, she specializes in nipple-sparing mastectomies, lumpectomies, and oncoplastic surgery. She also co-developed the Goldilocks Mastectomy, a procedure that removes cancerous tissue and reforms the breast using a patient’s healthy residual flesh.

Dr. Min, a board-certified plastic surgeon who did advanced fellowship training in microsurgery and breast reconstruction, was added to the roster in 2020. Most recently, the esteemed crew welcomed Dr. Omar Hussain, a facial rejuvenation surgeon, into their tight-knit female circle.

Female Surgeons Have Receipts

“Among many men, there is this idea that women are volatile, emotional, and we can’t handle stressful situations,” says Dr. Killeen, who believes the exact opposite to be true. Results from a recent study published in JAMA Surgery, a peer-reviewed medical journal, may underpin her personal opinion.

The report analyzed records from 1,320,108 patients who underwent 21 common procedures performed by 2937 surgeons in Ontario, Canada between 2007 and 2019. Overall, it showed that female surgeons had better postoperative results than their male counterparts in that patients were less likely to die, have major complications, or be readmitted to the hospital within 30 days of a procedure. The data also revealed that women were 15% more likely to experience a negative outcome if their surgeon was a man and had a 32% greater chance of death.

There were limitations to this study (it was observational and the researchers could not account for the influence of other hospital staff on a patient’s results), but it clearly supports the “diversification in the field of surgery,” says the study’s lead author, Dr. Christopher J.D. Wallis, a urologic oncologist at Mount Sinai Hospital and University Health Network and an assistant professor at the University of Toronto.

Communication skills may be a strength among female physicians. “My anecdotal experience suggests that female surgeons are particularly detail-oriented and both patients and their colleagues expect that they will take that additional time,” says the aforementioned study’s second author, Dr. Angela Jerath, a cardiac anesthesiologist at Sunnybrook Health Sciences Center in Toronto, Ontario, and an associated professor at the University of Toronto.

Another report published in JAMA Surgery found that medical visits with female physicians are, on average, 10% longer than those with male doctors. The study’s authors also note that women “engage in significantly more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk.”

In addition to making sure that a patient is physically well enough to have surgery, Dr. Killeen says that it is equally imperative to take into account a patient’s mental health. She points to a study in Plastic and Reconstructive Surgery that suggests psychological factors, such as poor body image, can adversely affect surgical results and recovery.

“I think our minds are incredibly powerful,” says Dr. Killeen, who says she commonly says no to prospective patients that she believes are seeking surgery to fix deeper problems, like a broken relationship. “Someone isn’t necessarily wrong if they want to do something that I don't agree with, but I'm probably not the right surgeon for you.”

Women Talk The Talk & Walk The Walk

Dr. Killeen also believes that sharing the same anatomy and being subject to similar societal pressures is a unique opportunity that allows female surgeons to empathize with patients of the same sex on an entirely different level. “I had a breast augmentation because I felt [subjected to] society’s beauty standards. I’ve had babies. I breastfed for three years straight,” she says of three personal experiences that help her connect with patients. “I don’t think there’s anything wrong with saying that I have a different relationship to boobs because I have them.”

Dr. Richardson agrees that female doctors have a unique perspective. “I don't necessarily think that having breasts makes you a better doctor to deal with breasts, but it’s certainly not a hindrance,” she says. “There are some things that we can understand a little bit more, especially in terms of a woman’s identity.” Dr. Richardson notes that breast cancer patients are too often told that they should feel lucky to be alive and aesthetics shouldn’t really matter. “Not only should you be alive but you should be proud of the way you look. [As doctors], we should do the best job we can to make you feel whole and feminine, whatever that means to you,” she adds.

For Plastic Surgery Trends, Bigger Isn’t Always Better

At the moment, practicality is paramount for many people. Dr. Cassileth has noticed that many of her patients (95% of which are female) are downsizing or removing their implants altogether. “No matter their [cup] size, women don’t want to think about supporting their boobs and hiding things,” she says. “It’s less about making men look at them and more about focusing on [the patient’s] own comfort and ease in their own body.”

Two other procedures that are rising in popularity within the practice: lipoabdominoplasty (which combines liposuction with a tummy tuck to target central fat) and fat grafts (i.e., transferring fat from one area of the body to another to add volume). Dr. Cassileth often uses fat grafts to supplement a breast augmentation and says that this surgical procedure is an especially good option for transgender females because of its ability to sculpt the body and create more natural-looking results. The “mega-butt,” however, is on its way out. “Overdoing a procedure is always a bad idea,” she says. “If you stick 1000 CCs of fat in each [cheek], over time, you’ll end up with a low, saggy butt covered in cellulite.”

Always Be Unapologetically Yourself

While the ideal sizes of bums and breasts seemingly fluctuate as fast as the stock market these days, a patient who is informed and unafraid to say what they want and expect from their healthcare provider usually comes out on top. “You are a consumer of what a [doctor] is selling and it is appropriate in this relationship to realize that you have the power — not them,” says Dr. Cassileth. “If you were having your kitchen remodeled or buying a dress, you wouldn’t have someone tell you what you’re supposed to want. Plastic surgery shouldn’t be any different.”

Regardless of gender, a doctor should always be board-certified by the American Board of Plastic Surgery in the right specialty, operate in an accredited surgery center, have admitting privileges at a hospital, and work in tandem with a board-certified anesthesiologist. They should also have plenty of before-and-after photos to share. “If a surgeon is promising something that you can’t see delivered anywhere, don’t go to that person,” adds Dr. Cassileth.

The ratio of male to female plastic surgeons in the U.S. may be five to one according to American Society of Plastic Surgeons, but 40% of current plastic surgery residents and more than half of medical students are female. “If you look at the numbers ten years from now, things are going to change a lot,” says Dr. Min. “These stats are a reflection of prior generations and are going to become relics of the past.” The rest of the Cassileth Plastic Surgery squad agrees that a wave of whip-smart women will soon flood the field. For now, they’re more happy to lead the charge by outperforming the opposite sex. “Here’s the crazy thing, it’s not even that hard,” says Dr. Cassileth. “Just do beautiful work and care about your results.”