Rodger Wade Pielet, MD, and Michael A. Epstein, MD, perform surgery in tandem

Among the obese, gastric bypass surgery has emerged as the preferred approach to shedding massive girth. That, of course, has been good for plastic surgeons, who are called upon to deal with the unsightly rolls of loose skin that dramatic weight loss leaves behind.

Sadly, though, many men and women arrange to undergo the stomach-stapling procedure unaware that they will require extensive body contouring down the road. Consequently, they’re often caught financially unprepared to go forward with plastic surgery.

Cognizant of the monetary hardship this unpleasant surprise introduces, Chicago plastic surgeons Michael A. Epstein, MD, and Rodger Wade Pielet, MD, have taken steps to lighten the load. Specifically, they perform head-to-toe surgery as a team, in a single session, and in a semi-outpatient setting. As a result, the job is done in a little more than half the time with a significant cost reduction.

“Having two surgeons in the operating room (OR) allows us to complete these surgeries in less than 6 hours, which makes them appropriate for our AAAASF-accredited in-office surgery room,” says Pielet.  (AAAASF is the American Association for Accreditation of Ambulatory Surgery Facilities Inc) “Also, we keep the patients in a nearby overnight facility and under the care of a nursing staff, thereby eliminating the expense of hospital inpatient services.”

Epstein adds that they operate side-by-side in other cases as well, particularly in those involving several procedures that a patient wants performed inall at once. As with full-body contouring, single-session, multiple procedures ordinarily take considerable time to complete by a physician working alone.

“Lengthy surgeries are physically exhausting, and that was certainly a consideration when Dr Pielet and I decided to start doing them together,” Epstein explains. “It’s safer for the patient, too, because the shorter time they spend on the operating table means they’re not under anesthesia nearly as long as they’d need to be otherwise.

“And, there’s a benefit for the practice itself—a shorter operation frees up our time so that we can see more patients.”

The duo doesn’t always operate in tandem. That usually occurs only 1 day per week—Friday—which is reserved for the most complex or comprehensive procedures. On other days, they work solo.

Epstein and Pielet practice under the name Aesthetic Plastic Surgery Associates. They maintain two offices: one in downtown Chicago, and the other about 30 miles northwest in stylish suburban Northbrook, Ill. The Northbrook office—the larger of the two at 3,600 square feet—houses the in-office surgery room. The site also houses the practice’s medical spa, which is almost always busy. Epstein is based at Northbrook and Pielet downtown; one day per week, they trade places.

Aesthetic Plastic Surgery Associates is a high-profile practice for facial rejuvenation that involves volume-restoration techniques. The offices also are well-known for endoscopic cheek and forehead lifts, abdominoplasties, breast reductions, and more.

Younger Patients

Pielet and Epstein are keen on endoscopic procedures because they contribute to reduced downtime for patients. “People are having these procedures done at much younger ages,” says Pielet. “They tend to have careers and families and they can’t afford to be away for a significant length of time after a surgery. So it’s far easier to attract these patients into your practice if you can offer less-invasive procedures from which they can recover in a hurry, especially if the procedures deliver a very nice, natural result.”

Younger patients con­stitute an ever-larger demographic for Pielet and Epstein. That’s be­cause “they’re deciding to not wait until they’re old and need major work,” says Pielet. “Instead, they’re coming in at younger ages for preventive maintenance along the way.”

By any measure, Aesthetic Plastic Surgery Associates is a successful practice. Epstein and Pielet attribute that to several factors. One is that consumers see them as problem solvers, not just surgeons.

“We have different training backgrounds, but our mentors held a common philosophy about plastic surgery and they taught us, above all, how to think,” says Pielet.

The two are successful also because they get along well with each other. “We’re friends. We’re comfortable together. We’re well-matched,” says Epstein.

Media Savvy

Beyond their talents with a scalpel, Pielet and Epstein are much in demand because of their knowledgeable use of mass-media communications.

“These days, to be in the top tier of plastic surgery practices in a major metropolitan market, you need to use publicity, the In­ternet, and other forms of outreach,” Epstein contends. “It has to be part of your business plan.”

Braving traffic to drive to the television studio and spend an hour or two in the “green room” while waiting for a measly 5 minutes on camera may not seem like the most productive use of a surgeon’s time. But, as far as Epstein and Pielet are concerned, it’s worth it.

Says Pielet, “We look at each interview, whether on the air or in print, as an opportunity. For starters, it’s a way to acquaint people with our personalities as surgeons and the personality of our practice. This is different from, but no less important than, letting the world know about our Board certifications, accredited facilities, or subspecialties. It’s also a way to educate consumers about plastic surgery in general and to present the message that you don’t want to go to just anyone who offers aesthetic services, but only to an MD who is Board-certified in plastic surgery and who has the requisite experience.”

Their first big publicity coup came about by happenstance: being in the right place at the right time, as Epstein puts it.

“We periodically provide our services on a pro bono basis,” he begins. “A while back, we worked on a teenager who had been shot in the face during a drive-by gang incident. The shooting was a terrible thing that received a lot of coverage in our local press, which also reported that we were donating our services to try to help put the teen’s life back together. Suddenly, the media were very interested in us. The next thing we knew, we were being invited to appear on ‘The Oprah Winfrey Show,’ and from there it snowballed.”

Since then, the media seemingly never stopped calling—even after interest in the gunshot-victim story waned. For example, early last year, the local NBC television station’s news department hit upon the concept of having Pielet and Epstein critique the various “reality” programs on plastic surgery and makeovers that were then breaking into the networks’ and cable channels’ prime-time schedules .

Viewers responded favorably to the physicians in that role, so much so that the station subsequently used Epstein and Pielet in a recurring feature: The two surgeons, along with other local providers of beauty and fashion services, participated in radical makeovers of two Chicagoans whose week-to-week progress was charted by television cameras.

“We got on board with this, thinking it would make a nice little story,” says Pielet. “Instead, it turned into something huge. It was so successful that the station wants to do it again this year.”

Challenges Ahead

Before becoming formal practice partners in 2001, Pielet and Epstein simply shared office space. They began that arrangement in 1999. Prior to that, Pielet ran an academically based practice in conjunction with the University of Chicago, his employer from the time he completed residency training there in 1993. While in academic practice, Pielet handled a large number of reconstructive surgery cases. Today, opportunities to provide this type of surgery have been few and far between. Pielet hasn’t lost his love for this field, however, so he’s exploring the possibility of spending a day at the university’s hospital once or twice per month to assist with facial trauma cases.

“Nothing’s firm at this stage,” he insists.

Meanwhile, he and Epstein are weighing the possibility of adding a physician to their practice who has a somewhat different set of skills to help them broaden the scope of their services. They’re not sure whether he or she would be one who’s focused purely on reconstructive surgery,  or a physician whose forte is nonsurgical procedures. Whatever they decide, Pielet is reasonably sure that the two offices they have now will remain sufficient to handle the growth of the practice during the next 3–5 years.

“Despite all the challenges we face as a practice—not the least of which is the state’s recent moves to tax plastic surgery services—I’m very pleased with the way things are going for us,” he says. “We have a practice that’s growing; we have a practice that’s constantly evolving in a positive direction. For us, these are very exciting times, whether we’re working alone in our respective locations or together in the OR.”  

Rich Smith is a freelance writer for Plastic Surgery Products.

How They Got Started

Acareer in medicine was perhaps inevitable for Michael A. Epstein, MD. His parents began pushing him in that direction practically from the time he was a tot. But that was fine with him.

“Many of my father’s friends were physicians, and I was always intrigued by their work in their various specialties,” he says.

As a premed student at the University of Michigan, Ann Arbor, Epstein thought that he might become a family physician. But during medical school at Wayne State University in Detroit, he realized that his interest was firmly in surgery. In 1985, he moved to Chicago to begin a general surgery residency at Michael Reese Hospital, and there his interests moved toward plastic surgery.

“I realized I didn’t want to spend my days removing sick organs,” he says. “I saw plastic surgery as a specialty in which I could utilize creative skills in conjunction with surgical skills to change the way a person looked, and in so doing help that individual feel better about himself or herself.”

In 1990, the Michigan-bred Epstein returned to his home state for plastic surgery training at Detroit Medical Center. Two years later, upon completing that residency, he was back in Chicago as an associate in the practice of a well-established plastic surgeon. Epstein soon decided to open an office of his own. He remained a solo practitioner until 2001, when he and Rodger Wade Pielet, MD, formally joined forces.

“We felt that by becoming partners, we could take our work to a higher level and grow at a much faster rate,” says Epstein. “We also saw partnering as a way to help reduce our individual overhead by sharing certain expenses.”

Like Epstein, Pielet expressed an interest in becoming a physician at a tender age. But while he was growing up in Aurora, Ill, about 45 miles west of Chicago, Pielet’s parents thought that he might become an engineer, based on his love (first expressed when he was around 5 years old) of disassembling major household appliances to gain an understanding of how they worked.

“I could have found all that out by reading books, but I’m the type of person who enjoys learning by doing,” he says, noting that as a youth, he got the same pleasure from assembling as dismantling.

Acting on a Whim

By the time he entered college, Pielet was solidly on track for a career in medicine. However, he knew that whatever specialty he ultimately chose would have to be one in which he could make use of his hands to satisfy his yearning to build. Plastic surgery seemed a likely possibility. In the summer following his second year of medical school at Tulane University in New Orleans, Pielet contacted the plastic surgery department at Northwestern University in Chicago on a whim and asked if he could come up for a look around. The 1-day visit somehow stretched until the end of the the summer, and Pielet returned to New Orleans convinced that this was the specialty for him. The following summer, he returned to Chicago to observe more plastic surgery, this time at the University of Chicago.

“They had a lot of reconstructive work going on that just left me in awe,” he remembers.

In 1987, the University of Chicago offered Pielet, then in his first year of general surgery residency at Tulane, an invitation to fill an opening that had suddenly come up in the plastic surgery program. Hesitating not a moment, Pielet arranged to catch the next flight to Chicago. It was there, at the university, that he and Epstein became acquainted. After completing residency, they went separate ways, but stayed in touch.

In 1993, Pielet joined the staff at the University of Chicago. He participated in full-time academic practice there for the next 5 years, at which time he took his first steps toward developing his own private practice—one with a cosmetic component.

A Setback—And a Solution

Then, in 1999, came devastating news: Pielet learned that he had lymphoma.

“I was able to continue working only during the first 4 months of chemotherapy,” he says. With Pielet out of commission for the remainder of his treatment, his up-and-coming practice fell by the wayside.

Pielet went on to win his battle against lymphoma, but when he was ready to resume private practice, he had no office to use as a base. That’s when Epstein offered to make room in a satellite site he operated in downtown Chicago.

Not long after accepting Epstein’s invitation, Pielet’s reconstituted practice was thriving. The two later explored ways of sharing various administrative functions, such as marketing. However, as they attempted to hash out the details, it became evident that a vastly easier way of going about it would be simply to merge their practices.

“This made enormous sense,” says Pielet. “We each had a lot we could bring to the table in terms of expertise, energy, and ideas.”

The rest, as the saying goes, is history.