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So You Think You Want to Be A Plastic Surgeon?

So you work hard for your first 12 years in school and you graduate from high school at the top of your class. You may be able to get into a great college if you have high SAT scores as well and stellar extracurricular activities or achievements. The next 4 years you will be away from home looking to function entirely for yourself. If you are able to get through all of the premedical requirements with good grades and are able to do well in all of your other classes you may be able to get into medical school (though it may take more than one time applying). Now in medical school you must endure 4 years of additional instruction in medical knowledge and practice with studying around the clock for most to obtain decent grades. If you make it through medical school at the top of your medical school class and score in the top 1 to 5% on the Medical Board Exams with several publications to boot, you may be able to secure a spot in an Integrated Plastic Surgery Program (with only 70 positions in the country). You have a better chance of winning the lottery, all things considered.

Assuming you get into the plastic surgery residency, you then have at least six, if not seven or more, years of residency during which time you will subjected to constant putdowns, sleep deprivation, little time for exercise or relationships, and the stress of functioning optimally to take care of your many responsibilities of patient care and didactic learning as well as more exams and more research publications. When you finally graduate from the plastic surgery residency you have to make a decision on whether or not to pursue a fellowship in cosmetic surgery to make you more competitive. Assuming you can even get a spot at one of the more competitive plastic surgery fellowships, you will experience another year of call, long hours, presentations, paper writing and publishing. As you are finishing up your plastic surgery fellowship, you will have to take your written boards, and you will have to determine where you were going to work.

Some graduates prefer to stay in academia or join a group practice close to where they worked or grew up, because these are safer choices with guaranteed income. However if you want to practice cosmetic plastic surgery in a large, competitive metropolitan center, you may have to move 2000 miles across country, find a job, and focus on getting enough cases to be able to take your oral boards to become board certified. You better have a lot of determination and perseverance when everyone tells you that this is impossible or that there is no work or that many plastic surgeons have had to close their doors due to poor business.

You will hear it from every single person you meet that it can’t be done. So you sign on at a local hospital or hospitals to take call for facial and hand trauma to get enough reconstructive cases to qualify for your boards. The rest of your time is devoted to largely cosmetic surgery as you try to build your practice and reputation. You will also need a website and an internet presence. To get all of this done you will need hundreds of hours of dedication to the materials on your website, and you will need to gather hundreds of before and after photos to have a realistic chance of success. Somewhere in the midst of all of this you must gather all of your cases to take the oral boards, study the material, and pass the oral board exams that occur over a several day period.

During this period of time you will be determining your true skill set as an individual as you are on your own without anyone to hold your hand. Many will balk in this environment, but the most talented and driven will thrive. You also have to determine whether your personality fits a solo cosmetic practice in which you are solely responsible for the staffing, the marketing including website and internet presence, all of the patient surgical outcomes and postoperative care, and the reputation of the practice.

You also have to determine if you need to build your own surgery center because of the need to have flexibility in your schedule. Then the real fun begins in the sense that if you’re in a large metropolitan city like Los Angeles you will be competing with thousands of other surgeons for the few patients who want to have surgery. You will have to distinguish yourself in one form or fashion from those individuals. Many do this through marketing and spend a fortune only to fail. A few will do this through word-of-mouth or internet presence.

If you are one of the few who operates on several hundred patients a year, you have developed your practice and have a large patient base. However, this is just the beginning. You have to perform hundreds or thousands of surgical procedures a year that will satisfy even the most nit-picky, contrary individuals on the face of the planet. Many of the patients will be happy but the few that are not will be the bane of your existence. There will be threats of lawsuits or posting of bad false reviews. If you choose to communicate with your patients, they will call weekends and holidays at any and all hours of the day and night. You will get hundreds of emails a day if you choose to answer them. You are working 18 hours a day and completing all of your tasks perfectly, and still they will complain.

No matter how fit you are, you will be tired after a 16 hour day of surgery, knowing there are still plenty of emails to answer before bed. It is certainly nothing like the magical Hollywood lifestyle as presented in movies and on TV. Laughably, some of the least busy plastic surgeons attempt to maintain that kind of image. The real workhorses and masters of plastic surgery are the ones performing all of the most difficult surgeries that others would not attempt.

To learn more about Dr. Kenneth Hughes, Harvard-trained, board-certified plastic surgeon in Los Angeles, please visit

To see before and after photos of Dr. Kenneth Hughes, please visit

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