Botox and Burpees
Botox and Burpees
S04E86 Revolutionizing Plastic Surgery: AI, Mentorship, and Sustaining a Career with Dr. Edward Lee
What if the future of plastic surgery could be revolutionized by artificial intelligence and robotic suturing? Join us as we sit down with Dr. Edward Lee, the division chief of plastic surgery at Rutgers, New Jersey Medical School, to explore this exciting possibility. Dr. Lee shares his journey from private practice to academia, detailing his innovative work in microsurgery and targeted muscle re-innervation for amputee patients. Learn about his pioneering efforts in developing cutting-edge clinics and his visionary outlook on the future of plastic surgery.
Curious about the evolution of surgical training and mentorship? Dr. Lee's reflections on the shift from traditional techniques to advanced methods in breast reconstruction and orthopedic oncology provide a rich narrative on how surgical education has transformed. Delve into the importance of both formal and informal mentorship as Dr. Lee recounts invaluable lessons from his mentors. Discover how personal connections and structured learning opportunities shape a medical career in profound ways.
Struggling with burnout in the medical field? Dr. Lee's insights on managing burnout and maintaining a productive mindset are invaluable. He emphasizes self-awareness and the support of friends and family as critical mechanisms for overcoming professional fatigue. This episode also highlights the importance of teamwork in the operating room, the role of music in creating a conducive atmosphere, and Dr. Lee's ongoing goals to enhance research and patient outcomes. Whether you're a medical professional or simply intrigued by the intricacies of plastic surgery, this episode offers a treasure trove of wisdom and practical advice.
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As you listen to my next guest, dr Edward Lee, plastic surgeon, it may only take you a minute before you recognize him as a big thinker. He is the rarest of plastic surgery animals, someone who started his career in private practice and then found his way back into academia at a large medical center. He climbed to the top of the mountain as division chief of plastic surgery at Rutgers, new Jersey, medical School and residency program director. But this particular big thinker is not a passive ivory tower brahmin, even though he did go to Yale and Georgetown, two elite organizations. Dr Lee is a doer, a dynamic mover and shaker, training future plastic surgeons in the field of microsurgery, managing multiple teams of surgeons and clinics, working on big ideas such as re-innervating muscle in amputee patients and, as you will hear, even speculating about future advances such as artificial intelligence in plastic surgery, coupled with technological advances such as robotic suturing. Dr Lee is a leader in our specialty who is simultaneously hoping to dramatically widen the scope of plastic surgery, as well as render much of what we do as antiquated, which is both wonderful and scary at the same time. His approach is practical, down to earth, and he is a master at seeing situations from both the ground level as well as the 10,000 foot level. Dr Lee approaches challenges with inclusivity, finding ways to lead his division, community and those around him without leaving anyone out. It was fascinating to cover so many different topics about surgery and life with Ed and I know you will find him as thought-provoking as I did speaking with him. Thank you very much.
Speaker 1:All right, welcome to another episode of Botox and Burpees, the surgical series. And I have with me my very special guest, dr Edward Lee. And Dr Edward Lee I've known him for a long time is the residency training program director of plastic surgery at Rutgers, new Jersey Medical School. He's an associate professor of surgery and Dr Lee grew up in North Brunswick, so he's a New Jersey guy and he attended the Lawrenceville School for high school. Dr Lee graduated from Yale University with a double major in philosophy and molecular biochemistry and biophysics, and then you completed your MD from Georgetown University School of Medicine. You did your plastic surgery residency at University of Pittsburgh and you have been at New Jersey Medical School for how many years now?
Speaker 2:It's been quite a while. So I actually started out in private practice for three years. Okay, so I was based in Englewood Cliffs, family was around there and then you know I actually really enjoyed the academic side of things. So I attended the Grand Rounds and enjoyed teaching and Mark Granik, who was the division chief there and is still there, asked me if I wanted to take a job. So I took a part-time job at the VA hospital. Asked me if I wanted to take a job, so I took a part-time job at the VA hospital, really enjoyed my time there and then ended up moving on to join the university full-time in 2018.
Speaker 2:So I've actually only been full-time at the university for about six years now, so it's been great I've taken over the role as the residency program director. I started that back in 2011 or 2012. And then division chief over at Rutgers, New Jersey Medical School. Their residency, their program, their division.
Speaker 1:What are you guys?
Speaker 2:at this point we're division within the Department of Surgery.
Speaker 1:So that's a lot of hats. You're a busy man, Dr Lee.
Speaker 2:Yeah, it's a few too many hats really, but no, I mean, I've got great partners right. So Mark Granik is still there. Ramazi Datiashvili, who you probably remember from your time at NJMS, is still there and the two of them are phenomenal partners as well, as you know, leaders in thought in terms of what they do.
Speaker 2:And so Mark's interest in wound care technology is phenomenal. He's constantly running different clinical trials and so he's very involved with the students in the residence as well. And then Ramazi is one of the world's leaders in replant, whether it's digital replants or major limb replantation. So it's great to have those two. And then we've hired a couple of new people. So we have got a guy, ashley Ignachuk, who is a well-trained hand surgeon. He's Canadian, so of course you know he's a nice guy, but he runs a very interesting clinic we put together as a team.
Speaker 2:We put together something called the Targeted Muscle Re-Innervation Clinic. So it's a new procedure that people were doing to try to reduce phantom limb pain after major limb amputation, so below knee, above knee and then upper extremity amputation. So we have a specific clinic where we partnered with the Hanger Clinic, a prosthetics company, in order to better serve these patients Right. So we track them from the time of their amputation, whether it's traumatic, oncologic or vascular and then we will do TMR or RPNI at the time of their amputation and then track them as they go through, and we've seen some very good results for them. So it's a multidisciplinary clinic. We have a physiatrist, we have our prosthetist and rehab people there as well, so it's a great clinic that he runs. And then we've recently hired Stephen Ovadia, who's a gender affirmation specialist as well as craniofacial specialist, so that'll be a great source of experience for the residents and service to the community. And then in April we actually have Alex Wong coming on board.
Speaker 2:I don't know if you know Alex, but he's a microsurgery director at USC and then City of Hope and also has a translational science lab that's NIH funded, oh wow.
Speaker 1:So what is your clinical focus, Ed? What do you focus on surgically?
Speaker 2:You know, my focus really is on traumatic and oncological reconstruction. So I would say most of my practice comes from either the orthopedic oncology or surgical oncology world and then the orthopedic trauma or general trauma surgery world. You know they've tried to. I guess people have created a bucket for it of complex reconstruction is the term that they're using for it, and I kind of wonder. Like there were two when I was was training there were two surgeons. One had a practice that we considered kind of elite reconstruction and the other one had a practice that we kind of considered bottom of the barrel reconstruction. But honestly, both of them were doing the same procedures. It was just slightly different groups of patients and I think that I cover the full spectrum of both of those you know. So it's going from wound debridements to deep flaps for breast reconstruction or, you know, really nice like orthopedic, planned out orthopedic oncology procedures where we're doing free flaps for, you know, muscle re-innervation and reconstruction as well as soft tissue coverage over the megaprostheses that they'll use.
Speaker 1:How much is your practice micro?
Speaker 2:I would say probably about 20% of my practice is micro. I really like doing it but honestly we kind of move away from it. It so a lot of our traumatic reconstruction uh, because dr granik is such, has such a focus on wound care technology. We do use a lot of wound care tech, uh, whether it's the advanced wound care products like um, solera, somagen, uh, integra things are things that sort of downgrade the intensity of surgery that's needed. So, going from requiring a free flap to here's a product, put it on the wound, vac it for a week or two and suddenly you have a granulation bed where you didn't think you would have one.
Speaker 1:So you mentioned how you had mentors or people who you trained with, who did fancy pantsy, reconstruction and then more of the blue collar stuff. What other kind of memorable training experiences or stories do you remember from when you trained that might have been formative or really sort of put you on the path to where you are?
Speaker 2:today. You know, I think they're all formative. I mean, that was part of training, right? I mean it was. You know, when I started the 80-hour work week, I hadn't quite caught on yet and most of us, honestly, as trainees, didn't believe in the 80 hour work week. We felt that it was better to spend more time in order to see more. So we were happy to ignore the 80 hour work week and keep going.
Speaker 2:But I think, you know, honestly, the training has gotten better. We've moved away from it, and part of it is that we, as educators, we've developed opportunities to learn rather than waiting for opportunities to come along. So it used to be you're just in the hospital so long you'll see every type of case throughout your residency. But since you're not going to stay in the hospital that long now, now we have to create an opportunity for you to learn about it, whether it's through simulation, um, additional didactic time, uh, you know, courses that you'll go to in order to see it, mission trips that uh residents will go on in order to see more of the cleft lip, palate or other congenital issues. So I think the education has gotten better and so the experience has gotten better Now, formative experiences, like I said and you've been there it was kind of like war, right.
Speaker 2:You're like in boot camps for five, six years, and so all of them are formative experiences. What really stands out? There's so many cases that are just mind-boggling and a little bit crazy. You know, I think really some of the formative experiences were not in the hospital though, right, it's like when an attending who you admire takes you aside and says, hey, let's go grab lunch.
Speaker 1:Or hey, you know why don't you?
Speaker 2:come over to dinner. Tonight I'm having some other people over for dinner and so.
Speaker 2:I remember one of my attendings did that for me, you know, invited me out. There were a couple of other attendings there with him in different specialties and you know it. It was a. He was very much into wine, so it was a wine tasting dinner and the first thing I thought was oh my god, that's a lot of bottles of wine for. Very well, you know, by the time you're like a PGY5 or 6 res, like you haven't really had anything to drink for years because you're in the hospital so much, and especially as you're doing more microsurgery. Yeah, I don't know about you, but for me if I drink and then I try to do micro, it's just a little bit off and I don't like that feeling little bit off and I don't like that feeling. It's probably similar to you for other surgeries or, or you know, a hardcore, um hardcore workout right, like you don't want to go in a little bit hung over, like that would be awful.
Speaker 1:Did they finish all the bottles that night? Uh?
Speaker 2:they did. I stopped after a little bit cause I I couldn't hang with them.
Speaker 1:Yeah, those, uh, those attendings back then. Yeah, that was old school being able to do that. So what kind of mentor? Do you remember anyone in particular that was really special to you during that time?
Speaker 2:Yeah, I mean there were a number of people and they were mentors in different ways so you know, there was a guy, joe Losey.
Speaker 2:Oh yeah, he is our residency program director and he's a craniofacial surgeon and still is. He's one of the most meticulous guys you know and so like, dedicated to his patients, to his students, to his residents and to his craft and he's always improving it. But you know, I strive to be more and more like him, but I know I never will be um and but then the guy who actually probably had the most impact on me was a guy named jimra savage. He's the guy that you'll never hear about because he rarely publishes, but is was by far the best plastic surgeon I've ever worked with. You know, the guy's kind of like the A-team. You remember the slogan for the A-team? It's like if you have a problem, bad enough, if there's nobody to help, call who do you call? You call Jim Rizabic. They also call him the pizza man because he always delivers.
Speaker 2:But you know, this is one of the guys who was oral maxillofacial surgery trained, then general surgery trained, then plastic surgery and microsurgery trained, and it was one of those things where his attitude and his ability to train residents was phenomenal. And one of his attitudes really was how do I? His quote was I asked him why does he stay and train us? Because he would sleep on the couch for hours while we're operating, till the wee hours of the morning, and then, if there's's any issues, he'd come in and fix whatever it is. But no matter what it was, he could fix it, and we knew he could finish way faster without us.
Speaker 2:And you're kind of like, well, why are you doing this? And he said his argument. One, you should train everybody. So no matter who it is, if they're, if they're slow, if they're bad, it's your job to make them better. And two, he was like he was like one day I'm gonna be old or I'm gonna get injured and I'm gonna look up and and if I know that you were a bad surgeon and I hadn't trained you, that's gonna fall on me. It's like. So you know you want your friends to, when they go to see a plastic surgeon, to know that they're good and the only way that you know that they're good is if you've helped train them and make them better.
Speaker 2:Wow, that's awesome.
Speaker 1:Oh my God, yeah, I mean that resonates with me on a couple levels. One is that selfless dedication that that I've encountered as well in mentors, the fact that he would let you operate, and then, uh, the fact that, uh, he would let you operate and then be able to fix anything that wasn't right. And then also the multi, the triple threat, the OMS, general surgery, plastics, micro. I mean I knew a couple of those guys and they were in training until they were almost 40. And yet they were the best surgeons I had ever seen in my life, like the ones who had gone through all that training. I don't know what it was about them, but crazy, crazy, impressive.
Speaker 1:So. And the fact that he wasn't like a flashy academic, like big shot guy, like they were in the trenches teaching, like I feel like the best clinical specialists are the ones that I have seen not be like up on podiums, you know, like presenting, doing all that kind of stuff, like these were the guys that were really busy clinically and like a lot of the unsung heroes of residency programs I feel like are guys just like your mentor for sure, like that means a lot. So, um, so, tell me, uh, in your journey to becoming where you are. Give me a one method or way that you became better as a surgeon. Uh, for yourself.
Speaker 2:Um, you know, I I saw this question and I kind of ignored it, Because it's one of those things that's a little bit hard to answer, right, yeah?
Speaker 1:it is hard.
Speaker 2:I think, more than a method, it's sort of a mindset, right? And it's one of these mindsets of always being humble, always being curious, right, how do you get better at something? You have to accept that you're not good at it, or, if you are good at it, that you're not the best and there's a better way to do it, and to be curious to say, hey, well, how is someone else doing it and how can I do that better? And so I think it's more of that mindset than any particular technique. You know, all of us read books in all sorts of different aspects of the world.
Speaker 2:We're not focused just on medicine or plastic surgery. Right, you'll read, you know something from what's his name? Adam Grant. Or you know the guy who wrote Blink. Like, these are great books and how do you apply that then to medicine? And you know, like it's that, I think, that mindset to say how can I be better? More than any particular technique. You take that concept, you focus it on what it is that you're doing and then try to, I guess, adjust it or make sure that it is safe. Whatever it is that you're doing, that it's safe for your patients. You're not going to wholesale change exactly what you're doing. You want to do it in a measured capacity that you're able to then sort of see what the results are or what the change is.
Speaker 1:Have you done something where you saw something and said you know what, I think I can make this better, and you played around with it and figured out something that made that operation a better operation, for example, for yourself, for myself? I mean you know because we always say in our hands, so you know.
Speaker 2:Yeah, I mean, I think we're constantly playing around with it a little bit, you know. So, even something as simple as you know I don't want to say simple as common as a breast augmentation, you know how are you choosing where to put your incision for an inframammary fold? You know there are a number of papers about how to do it right. There's the IE method, there's I-5, and they're all slightly different measurements, and so you keep playing with it until you're like well, this one kind of matches what I do and how I would do it, and so you know even something like that yeah, that's worked out, and same for and then. So I guess, what have I?
Speaker 1:changed.
Speaker 2:Yeah, so how do you?
Speaker 1:do your breast augmentation incision planning then.
Speaker 2:Honestly, I let the residents choose no, no. We go through. We go through all of the different steps for it, I see, and the different methods, and then usually we end up choosing sort of along the high five plan.
Speaker 1:Okay, got it.
Speaker 2:Yeah, so it's nothing where I would like them to read what other people have done, analyze their data and then compare it to their own methods, and so oftentimes I'll have them mark the patients. We talk about it ahead of time. They get to see the patients ahead of time in the operating room. We're doing the operations together.
Speaker 2:And then if they are not in post-op clinic, then I'll send them pictures from post-op clinic so that way that they can see sort of what the results are and how it matches what they thought it would be.
Speaker 1:That's awesome. What is one of your favorite surgical procedures that you really still enjoy doing at this time?
Speaker 2:You know I got to say I'm probably a little bit burnt out at this point. No, honestly I I like operating um and I enjoy like it. Historically I really loved microsurgery. I loved seeing the anatomy come apart and then I loved seeing the anatomy go back together again. I felt like it was one of those great expressions of a plastic surgeon where you're actually taking one body part, molding it and making it a different body part, whether it's a deep flap, a free fibula that you're then making a jaw out of, or a free fibula that you're taking to reconstruct a femur or humerus with
Speaker 2:osteomyelitis.
Speaker 2:Like it's pretty neat, um, and very few people get to do that sort of thing.
Speaker 2:Yeah, um, at this point, I think what I actually enjoy doing more is kind of seeing some of these technologies and how things are a little bit different. Uh, so one of the things we're playing around with now is there's a I think it's lyophilized placental tissue and sort of what growth factors does that sort of bring to the field or cause the field to secrete that will improve wound healing? And it's one of those things like you kind of don't believe it at first, like you see the papers and you're like and just another thing, that somebody to use it, like you know, like the paper was clearly paid for by the company, but then you, you, you trial it and you're like, actually my patient's wound does look better. So then what's going on with it? So that's where having a guy like Alex Wong coming in who has a research lab who can then start playing around with you know, sort of breaking it down to what are the processes that are going on, is incredibly valuable. Yeah.
Speaker 1:No, we definitely see a lot of potions and things in plastic surgery. Someone always has something new, but if you find something that actually works, that's invaluable for sure. I've talked to a bunch of surgeons and surgeons our generation I think a little bit of burnout is really really common and it's kind of funny because ostensibly we're at the peak of our surgical skill, knowledge, experience. We have years and years and years under our belt. We're still very physically on point. So why do you think so many of us are a little burnt out and how do we combat that at this point when supposedly we should be at our I don't know most productive or at the peak of where we are surgically? Maybe I don't know.
Speaker 2:Yeah, I don't know, yeah, I don't know. It's something that we talk about a lot, particularly in academic medicine, because there is burnout and obviously we worry about our residents burning out and the training for it. Sometimes, when I think about my own like how I feel tired, my dad's voice pops into my head and basically he's just telling me I'm lazy and keep going.
Speaker 2:Yes, I hear that all the time, and so then I wonder how much burnout was there in previous generations? Because nobody really measured it and they just sort of kept going and work through it. It's kind of like when you're working out, right right, you're in a crossfit workout, you feel that burn, do you say, yeah, I gotta stop this. Or is there a level where you say, okay, I can maintain this.
Speaker 2:Or you know you're gonna bonk and you're you know you're you're gonna use up all of your glycogen stores and then you can't yeah, you can't finish the workout and so I think being able to measure when is the stress leading to greater productivity or greater growth, versus when is that stress going to harm you? And I think that's the question. So are you really burnt out or are you a little bit tired because you are growing and growing is hard?
Speaker 1:That's true. That's a really good point. I think previous generations it was survival. If they didn't do what they had to do, they would basically have nothing, like their family wouldn't eat and like it'd be a real problem. So I think we have the luxury, a little bit, of being able to look at ourselves and say, wow, you know, am I like you said? Am I, is this real? Is this something where I'm changing or is this something where I really it's affecting me in some, some negative way? But you're right, I think it's tough and how do you feel like you manage it better, like what is your way of sort of identifying it and then sort of managing it?
Speaker 2:yeah, I, I kind of rely on friends to tell me that one of my friends says as I walk around the hospital, he can see me hunching over more and more. He'll tell me when I seem to be hunched over more and it looks like you need some time off. But I think that's a joke, but it's not. How do we? And I think one of the ways we know is our interactions with others, your interactions with family, interactions with others, right, like your interactions with family. And and I think that's one of those areas where burnout, uh, is most destructive, because if you're not enjoying the work that you're doing and then you come home and you're upset, but you're even more tired now and then you're kind of, you have no reserve for the people that you love the most your family, friends then unfortunately they do suffer with it.
Speaker 2:And I think that's where trying to identify burnout, trying to deal with it, is the most beneficial, not necessarily for our careers or for development as a surgeon, but for development as a human being. And so how do I deal with it? You know, when I'm feeling burnt out, I think I do try to carve out more time for myself. Then you know whether it's a morning workout or taking a weekend off to go away somewhere just to have some peace and quiet, turn the phone off, avoid, you know, whatever social media or other things that you're supposed to be reading or doing, and then, really, this you know how to again, I don't want to blame my parents, but you know because we should have out we should have outgrown our parents conditioning by by now, but it's hard not to hear their voices, right, yeah, yeah and uh.
Speaker 2:You know. One of the things, though, was always that you can always do more, you can always study more, you can work harder, um, but you know the that, I think, leads to burnout. It can push you to do better, but that can also lead to burnout. So the idea of self-acceptance hey, what I did was great, I can do better, but right now I can't and to accept what it is that you've done, who you are at that moment in time and just sort of being present in that moment in time, I don't want to get too like new world new age um you know, but, uh, you know that sort of uh Buddhist thought of just being present, uh and accepting everything as it is, uh, I think is very valuable yeah that is Um.
Speaker 1:So when you're in the operating room I know you work a lot with residents. That's such a huge focus for you Do you have any rituals or any sort of things that you do in the operating room which are always the same or very similar every time you do something in the operating room?
Speaker 2:I mean the most consistent is going to be when you do something in the operating room, I mean the most consistent is going to be when you do your microcircular anastomosis.
Speaker 2:I see you know you want to have the same setup. You want to have your hands positioned properly, your body positioned properly, you want the field to be totally dry so that there's no bleeding, or if there's anything oozing, it's controlled through a suction drain. You just want it to look like a picture textbook of what an anastomosis should look like and then get started so that it's exactly the same. I think for me. I do a lot of different cases, so my practice is very broad, and so I don't think I do things. I don't think I enforce or am as rigid sometimes, and so I'm willing to go with the flow. We often have a different team in the OR for each case because of whatever union contracting or what have you. We often have a different scrub, a different circulator, different anesthetist from the morning case to the afternoon case, and so some of those routines are hard to maintain. But within yourself, like for me, I always think about doing the operation. They do the operation three times in your head before you actually start, right. So you do the operation in your head. When you see the patient You're like okay, this is what I'm going to do, but you're not as detailed about it. Um, and then do the operation the night before and then do the operation as you're scrubbing it. So this way you're reviewing the process of it and I think this, this is something that I try to impress to the residents.
Speaker 2:Um, you know, it used to be that we would have to sit there and read a textbook, and you have.
Speaker 2:You have to imagine the anatomy, right, because it's hard to find a great picture of some of the anatomy. You would look back at the anatomy textbooks and then try to find cross-cut sections of where things are, because oftentimes it's easy to see the longitudinal and latitudinal orientation of anatomy as it's drawn out in a net or textbook, but then there's like depth to it and like kind of coming around a muscle or around the bone, and the only way you can really think about that is through your imagination. Right, there were now I feel like video is great, and all of my residents, honestly, they probably YouTube more of their study than anything else. But most of the videos, when you look at them, they lay out the anatomy for you. But it's laid out for you so well because they've chosen a great video and a great example of what it is that they're doing, that you're not using your brain to think about. Okay, well, as I'm cutting or moving through this layer of tissue, what is it that I expect to see before I see?
Speaker 2:so like, let's say you're, you're looking for a perforator coming out for a deep flap, you know, as you dissect there. Or even like as you're lifting the pec muscle to do a sub-pec aug, right, what will that look like as I'm getting closer to those internal mammary perforators that I don't want to ding because they'll bleed like stink and then you're in a lot of trouble? Or what will it look like as I'm coming across the uh insertion or origin of the pack, because there's always, like that, one vessel that bleeds, like sort of the central aspect of it, like what is that going to look like before I hit it?
Speaker 2:so that way I know to grab it with, you know an insulated debakey or something, or or slow down so that I can cauterize it nicely before I come through it, I think that's so true.
Speaker 1:I remember as residents looking at Netter or Mathis in the high and trying to figure out, but, like you said, the approach will change your perspective on finding that particular muscle or that dissection or that plane that you're looking for. It does take a lot of imagination to do that and I think we never had the benefit of YouTube so we never were able to see any videos like that. The pre-vis, I think, is something that I hear a lot of surgeons talk about. Pre -visualization of the surgery. I'd love that. Times three aspect of it and, uh, I never thought of it that way and and I probably that's a I might actually start thinking of it that way. That's a really, really good tip. Three times is, uh is a really good way of sort of approaching the pre-visualization of surgery. Um, that's amazing, that's pretty cool stuff. Um, what do you listen to in the OR then when you're doing all of these different types of cases?
Speaker 2:yeah, I gotta say I let the residents choose the music. You know I work with so many different residents. I like to hear what they're listening to. Often times, honestly, they have better taste in music than I do.
Speaker 1:What do they play? Do you, what do they? What do they play that you happen to like, like? What is it that they might?
Speaker 2:choose. Not like like just yesterday or was it two days ago, yeah, they were listening to some vibey lounge music. But if it was like, perfect for the case that I was, but but I would never have chosen that I'd probably choose something like classical, classic rock. I do listen to a lot of, like pop music, um, but it's nice to hear what they're doing and, honestly, when I'm operating, um, I actually am not listening to the music at all. Um, it's kind of like for me, uh, you know, when I used, when, when I was in college, uh, I like to go to like a cafe to study, I like to have background noise as I'm doing things, but I, what the what the noise is doesn't necessarily matter, and so, honestly, like, if it's an intense case, I won't even know what's playing or not playing. It can be on repeat a thousand times and I won't recognize that until that intense portion is over, and that intense portion may be hours, so I don't really notice it.
Speaker 2:And if any of my college friends watch this. They will laugh because they'll say I never studied in college.
Speaker 1:Yes, I think the smartest people I knew in college never seemed to study ever. So you are one of those guys for sure, I'm sure. So, as part of your team, either in the OR or out of the OR, who's really important in terms of your success as a surgeon, who is integral to what you do?
Speaker 2:Um, I mean, honestly, everybody is like you know, it's uh, it's such a team sport now. I think surgery used to. Surgery used to be more of a um, a captain running the ship and being in charge of everyone and controlling everybody around them.
Speaker 2:But I think medicine as a whole has moved so much more to a team sport and so, like in the aesthetic world, things may be a little bit different, because you're coming in, you have a very consistent team, your patients are a little more consistent, the operations are more consistent, but a number of my patients are very sick patients, and so I'm often operating with another surgeon and we're doing two or three different.
Speaker 2:There may be two or three different surgeons involved in the case doing different portions of the case, and so and our anesthesiologist is incredibly important obviously you know the people who are in the room with you circulators, scrub techs are all very important. And then you know the people who are in the room with you circulators, scrub techs are all very important. And then you know the medical team who's taking care of the patient, whether it's me, my residents, my PA they're all incredibly valuable. So I don't think there's one person that I would point out as being particularly valuable to my, to sort of the success of the operation, but I really think it is everybody. I do think it is important that there is somebody who is sort of calling the shots and running everything.
Speaker 2:You know there is a guy who is that guy from SEAL Team 6? Jocko Willink. Yes, I mean, he wrote that book. It was like an extreme ownership Right and the idea that you have to take ownership and understand and really be in charge of every part of what's going on. You can ask people to do stuff, but you got to know exactly what they're doing, and I think that is very much appropriate for the operating room. But it's still a team. It's not an individual doing everything. Every team member really needs to be invested and they all have to buy into that investment in the care of the patient.
Speaker 1:You're now division chief, you're a program director, you've sort of achieved the pinnacle of what most plastic surgeons would aspire to. So what are your future goals now, at this point of your life, now that you've achieved these achievements, at this point?
Speaker 2:It's funny that you say that. I told you I'm a little bit burned out, so every now and then I do buy a lottery ticket.
Speaker 2:I get it, but I think that there's lots of little goals. So there's lots of things to improve on. And maybe this is something that you were talking about with how do you become a better surgeon. It's the same sort of thing and you know it'll be one of those things I write out. This is what I'd like to do in five years or 10 years, but there's lots of little things that I want to improve. So, like I, like I said, we just hired Alex Wong, who's a good friend of mine, who's coming to Rutgers, so that's phenomenal because he brings a research component to it. But then we've got to add more right, it would be great, like I work in Newark, right, and we have a number of underserved patients. We have a large minority component. It's a majority minority community there. So why do we not have more patient reported outcome measures that are focusing on the outcomes for reconstructive surgery for minority patients? Because that is a large area of research and a way that we can become better. We know that outcomes are worse for minorities in many ways, but how do we make that better? So I think teasing out some of that would be exciting.
Speaker 2:You know, the other exciting thing to me really is AI. I mean, what a fascinating technology, and how are we going to utilize it in health care? You know, the hardest part is that you know, with health care you worry about hurting anyone. Right, like even something as simple as if you use an AI technology to like decide whether or not to get an X-ray for a patient. There's a judgment call that's being made by a computer, and will it be right, everybody using an EMR to start using decision support software, which is slightly different than an AI program? Right, it's, the decision support software has, like, an algorithm built in. But it would not surprise me if they quickly moved to an AI technology that can then scan or read through the latest literature in order to update what it's suggesting as an appropriate study for a patient.
Speaker 2:But when we look at AI, we also know that AI has what they call hallucinations right when, for some reason, it will go off the deep end for an unknown reason, for an unknown question, and so like, governance of the AI is important.
Speaker 2:So how do we know what data it was looking at, how it made its decision and how it produced that outcome is something that people are still are spending a lot of time and a lot of energy working on. But I think that would be fascinating, like wouldn't it be great if you had a chatbot slash AI that could do the intake for your patients and then convert all of that to ICD-10 and CPT coding, all of that to ICD-10 and CPT coding? Or you know, for the case of aesthetics, the different options for operations and say, okay, well, you know you can do X, y or Z and that's going to be, this is the gold. You know the gold package, the silver package and the bronze package and why they're better or worse, and then generate a picture outcome of what each might look like right.
Speaker 2:So for like facial rejuvenation yeah you can get the facelift with that grafting or you can have a chemical peel. The chemical peel improves your skin a little bit, but it's not going to tighten much more than X, y or Z but be able to generate those different outcome pictures for the patient.
Speaker 1:That's crazy. That is, both those possibilities are science fiction within the realm of reality very soon, like the fact that our EMR could actually help us with charting, billing, coding, like I know people are chomping at the bit for that, like yesterday. Like, yeah, with emr, uh, for aesthetic medicine to be able to say, scan a person's body and then say, here are the 20 different treatments you could opt for and this is what it might look like and here you go, would be amazing. Uh, I think it does sound like something that I might have even seen in a movie like 15 or 20 years ago. So that's that's. I had not actually thought about that for aesthetic medicine, but that would totally be within the realm of possibility within the next couple of years, I would imagine. So that's crazy.
Speaker 2:Yeah, I think it would be cool. You know, you get so many patients who come in and they're like, oh, I just want liposuction, and you're looking at them and you're going that is not going to fix this problem, that's right.
Speaker 1:You're right.
Speaker 2:But to be able to have a generative AI. You take a picture and you say, okay, liposuction will do this, liposuction plus abdominoplasty will do this, right. Or abdominoplasty followed by liposuction would look like this, right. And you know, because the problem is that oftentimes you're trying to tell a story to the patient and even if you show them other patients' photos, they'll look at it and be like, no, no, I'm different, right, but you're looking at it and they're like no, no, this is the problem that will happen.
Speaker 1:That's right, that's amazing, so okay. So if you have little goals and some other bigger program and institutional and society goals, how long do you envision yourself operating being a surgeon doing what you do at this point?
Speaker 2:It depends on if my lottery numbers hit.
Speaker 1:Those lotto numbers better hit, I guess pretty soon.
Speaker 2:No, I mean honestly, I'm actually in a pretty good place. I say I'm a little bit burnt out, but it's not bad. It's more along the lines of I think this is a steady state that I could do for a long time, but I'm not sure. Right, right, right. You know, as you're going particularly like I hate. I hate the erg, the rowing machine.
Speaker 1:Yeah, the concept.
Speaker 2:I rode in college and you know it was like the bane of my existence. Being out on the water is fine, being in the tank was fine, but the hurricane. There's something about it, and I think part of it is that as you're going, you're listening to that hum and that wine and you see your split times and you're like, ah, this feels pretty good.
Speaker 1:You go a minute in, five minutes in and then you're like, oh no, oh no, no, this pace was too much we recently did a 2k row for time at our in our gym, and that was one of the worst experiences anyone has ever had. Like we always say, the best pr you will have will be the first time you do a 2k row for time, because the next time you don't want to go. You don't want to go to that place to uh uh, cause it just hurts so much.
Speaker 1:So I I understand, but like you're ostensibly at the peak of your surgical powers, you have all the experience in the world at this point, Do you see yourself operating like this for another five years, another 10 years? Like is that something we know? Surgeons who will operate until they physically cannot operate anymore?
Speaker 1:And then we also know surgeons who will operate until they physically cannot operate anymore. And then we also know surgeons who will say listen, this is enough, I don't want to sit here for eight or 10 hours doing this case anymore, and they pivot. So what sort of is your perspective with that?
Speaker 2:You know my perspective with it is it's a little bit different, I guess, than most people, so one I think the medical licensing process that we go through in the US is it tries to be protective, but it is not. It is not progressive at all. The fact that you go from, oh, you were a medical student to now you finished one year of residency and you can, falls under that um and. But we all know that there are residents and there are colleagues who you're like you know you probably shouldn't do that procedure, that's.
Speaker 2:It's a little more complicated and I think, we, we all come up with that on our own right. Like you look at things, and like I will not do a cleft lip or palate I didn't do a fellowship in it. Could I do one and could I do a nice job of it, maybe. But like there are people who are so much better at it, why wouldn't I send it to them? Um, and so like I think that the medical licensing is to all or none right, like why don't we have something that says well, you can be a great lumps and bumps surgeon. Well, how did you do lumps and bumps? You know you can do? Uh, you know some other graded complexity?
Speaker 2:um you know, instead of saying, oh yeah, you have a medical license, you can do. Uh, you know, like these bbls that are being done down in florida, there's like that one county that has like the highest mortality rate, right, and it's like a outlier in the nation, like that, that's kind of ridiculous, all right. Same thing, I think, for the wind down of the career, right. Like at some point, I think everybody, like most plastic surgeons I know a lot of people were doing free flaps- right and then at some point they say you know what I, I don't really want to do that anymore.
Speaker 2:okay, well, you can voluntarily opt to not do that. Or should there be like a decreased sort of uh, licensing almost that goes with it. And so like I think, over time the number of procedures that you do and the complexity of the almost that goes with it, and so I think over time the number of procedures that you do and the complexity of the procedures that you do slowly decreases. So I could see myself not wanting to do free flaps after about 10 years, because that will put me at around 60. Or if I find that there are other people in my practice who are doing it way better than I am, great, go see them.
Speaker 2:And like I think that goes along with that sort of humility or being humble about who you are and accepting who you are, so yeah, so I could see that sort of winding down. But then the other part of it to me is we should be inventing technologies to make surgery easier. So one of the jokes right now is, uh, going around the or is button surgery right? So have you ever used the versaget?
Speaker 1:yeah, yeah, yeah yeah, yeah, it's the uh instrument that has the uh, high pressure water, that's. That is almost like a scalpel. You could use it as a scalpel.
Speaker 2:It will basically plane the tissues using a high-pressure water jet, so it takes out the technical component of retracting on the tissue, creating traction and counter-traction. In order to use a knife or a scissor to cut through the tissue, right, you just kind of rub over it, you press the button with your foot and rub over it, but then there's a lot of bleeding right. So then how do you stop the bleeding? Well, you have to like dry and pat and use your bovie is more.
Speaker 2:But or you can use the aqua mantis, which is uh, it's a uh radio frequency, uh, irrigating bipolar. Yeah. So basically, instead of having to wipe away the blood, it just irrigates the blood away for you and the bipolar. It just runs between the tips, so you just run it over the tissues, so you versaged it and then you bipolar it and look, well, lo and behold, it's all debrided and it's all cauterized that's pretty cool why do we not have more button surgery?
Speaker 2:it gets rid of the technical aspect of surgery. So like, for instance, when you're when you're watching or looking at robotic surgery right, it's pretty amazing what they're doing with robotic surgery, but why is there not a button to push, like when you have things kind of lined up, let's say, for a microvascular anastomosis and they want to put a stitch, why can we not line it up?
Speaker 1:point on the screen put the needle here.
Speaker 2:Put the needle here put the needle here and you push a button and it's a segmental portion of the operation that the robot then commits to on its own and goes, puts in a stitch, ties it right, that makes sense.
Speaker 1:Like if you could 3D image it, put the dots where you want, the sutures, and then hit, go. Then it's like a sewing machine. It just like does the knots and, you know, does the like the three stitches you want or whatever number you want. Like that sounds feasible to me. I don't know, has that been invented yet?
Speaker 2:I don't know, I haven't heard about it, but I'm sure it's coming. I mean, there's a bunch of robotic companies and those robots are not cheap, so, um, and the other thing is, you know, like, looking at very task specific robots, right like to me, the fact that we still suture skin in the same way that the ancient egyptians, it's a little bit crazy. We have better materials.
Speaker 1:It's very crazy. I think about that every time I'm suturing, like an abdominoplasty or something where there's like a million inches of skin to sew, I'm like, yes, we got to do something better for this.
Speaker 2:Yeah, and we came up with the stapler right, the skin stapler Right, and then there's the subcutaneous stapler, the Inzorb, but honestly it's not that great. So even a task-specific robot to do that, if you can set it up so that it does it nicely, it would be incredibly valuable, right? Then you take the art of plastic surgery in terms of skin closure and you've now mechanized it to a robot so that it then democratizes it so that everybody can use it. So your er doc, when they have to show up a laceration, they're like oh, bring over the robot.
Speaker 2:They numb it up, set it up for the robot. The robot goes ahead and closes it. They get a plastic surgery closure for the cost of the robot.
Speaker 1:You're technologicalizing our specialty out of business. Basically, that would be your goal in the future, which is a great goal. Honestly, I would love for plastic surgeons to take their intellect and ability and apply it to the next level of things to do for sure.
Speaker 2:Yeah, I think taking some of that technical I don't want to take the technical skill away from it, but being able to, uh, uh, what's it called? Mechanize it, I think it's valuable, like when you look at so. So, for instance, if you look at, like, thoracic surgery, right, um, the ravage stapler, it didn't decrease the amount of thoracic surgery being done. If anything, it increased what everybody was doing and the complexity of what they were doing, because now suddenly, well, this part where we were so worried about it leaking, so worried about bleeding.
Speaker 2:That's all passé. I no longer have to focus on how I'm doing that, how I'm doing doing that. We can focus on why and improve what else is going on with it. The fact that we don't have anything great to improve scars still right like we have.
Speaker 2:There's a lot of stuff on the market for scar care, but nothing is really proven to to make that much better. Instead of spending our time learning to suture, we could be learning about all of the different growth factors and methods to try to improve that scar healing and wound healing.
Speaker 1:Good goals. I like that. So you do train a lot of residents. You do work with a lot of medical students and other people who are learning. What do you tell them when they look at you or they're like you? Know what? I want to be like you someday, dr Lee. I want to do what you do. I want to be in the situation that you're in. What kind of advice do you give for for your young students?
Speaker 2:um, you know, one of the things I tell them is that, uh, you know, oftentimes the students are coming in earlier and earlier, right, so they? They used to come in somewhere during third year then? Second year, then first year and now we even get a bunch of college students who are eager and excited about plastic surgery and you know my advice to them is to go after everything with 110% energy.
Speaker 2:Be passionate about what it is that you're doing, and so if your interest is plastic surgery, that's fantastic. Do it 110%. But always have an open mind, because you may see something that suddenly captivates you and you're then very passionate about that or excited about that, and that's okay. You're young, you're early on.
Speaker 2:Even when you're later in your career. If there's something that's that captivating, give it some time to percolate in the back of your mind. But if you want to go after that instead, do it. And it's not that you wasted the time that you were excited about plastic surgery and going after it. Whatever you learn during that period is translatable right If it's a different field of medicine. The way that you learn to study, the way you learn to think about a problem and then try to answer that problem those are all valuable skills, you know. That's my advice to them. Usually, you know the applications process for residency really is getting more and more challenging. I mean, it's like an arms race.
Speaker 1:How much harder is it now than it was back in the day, when we were playing A lot harder, really.
Speaker 2:Basically, anytime you set a standard or a goal and you have a number of high achieving, high energy individuals, they will find ways to exceed that goal and keep building on it. And so you keep setting the bar higher and higher. Uh, but is it at the detriment of the, their development, of other aspects of their life? It's similar to if you're working so hard at your job and then you come home kind of burnt out with less to give to your family. Is that a cool thing.
Speaker 1:I don't know.
Speaker 2:I think there's a lot of people in education who are really focusing on that question and trying to answer that question. I think a lot of it comes down to who you are as a person and just trying to build up the person that you are, not necessarily the plastic surgeon that you are. You know, it's a lot of how do I put it? Just I don't want to say your moral compass, it's more just like your, your baseline, your baseline sort of thoughts, and you know how do you, how do you approach life, right?
Speaker 1:So that's true. Wow Well, ed, approach life right. So that's true. Wow well, ed, you have done amazing things over the past. I don't know, was it 10, 15 years that you've been at rutgers? You've, you've taken it to the next level. You've, you've put your stamp on it.
Speaker 1:It's been uh, and I can see how much you've accomplished there. I I see the residents coming out, I see how successful you are and how the program has been, and I am I am in awe, because for you to um, to be able to do that uh shows a lot of skillsets, not just as a surgeon, as an administrator, as a team builder, as someone as an educator, like. I think a lot of people would look at you, um, who have started or are starting in surgery and look at your life as a blueprint and be like this is a pretty good way to achieve some amazing success. So I really hope that anyone who listens to this or watches this sort of takes a look and listens to what you have done and said and you know, sort of take that advice and your experiences to heart, because that I think it means a lot. I think there aren't that many people that can do that and it's just super impressive.
Speaker 2:Well, thanks, sam. I really appreciate you taking the time to talk with me and inviting me to be part of your show. I think it's phenomenal to see what you do. You know, I mean looking.
Speaker 1:Oh, you mean finding successful people and talking to them and see what they do.
Speaker 2:Like, yes, well, what is it? What is it? It's humility, it's curiosity, it's those two things. It's curiosity, it's those two things. And you know the. And part of that humility is you taking on a new venture, like we were joking about technology and difficulties with technology, and you know you're podcasting. When. When did you start? Five years ago, six years ago? Yeah, to take on that challenge. I, I think, is admirable. And you know the whole CrossFit journey. I mean, honestly, I wish I looked like you.
Speaker 1:Thank you very much.
Speaker 2:I went to a CrossFit class, probably four years ago after my first class class. Probably what? Four years ago after my first class? Uh, it was the, it was what, what is it? Emom every minute. On the minute it was rowing burpees and then moving on to like sit-ups and then pull-ups or thrusters or something, and I got in my car to drive home and I felt like I had had a stroke. I pulled over after about a minute of driving and laid down in the back of my car and fell asleep for about half an hour.
Speaker 1:If you ever decide to try it again, I would be happy to do something that would be more appropriate. That would be a horrible workout for anyone. That sounds like they really put you through the ringer, there's no doubt.
Speaker 2:But it was fun, it was fun and. I really should get back to it, but my goodness, well, I understand.
Speaker 1:Thank you so much, Ed, and I hope to see you soon, and. I really appreciate you taking the time today. All right, take care, Seth. Thank you.