Going for the Natural Look
An important part of Edwin A. Cortez, MD, FACS’s medical philosophy is to be personally involved in every procedure.
“Since the early days of my practice, patients have expected hands-on treatment by me personally, with the help of my RN assistants,” says the veteran Kansas City-based facial plastic surgeon. “I personally perform all injectables, peels, laser treatments, and surgical procedures. And this personal hands-on treatment has been one of the main reasons that my practice has grown yearly since its inception,” he adds.
Some physicians don’t take the time to see each and every patient who walks through the door of their practice—for consultations, procedures, or even routine skin care treatments. However, Cortez credits much of his practice’s success due to this approach. His attention to patients and, especially, a strong reputation for seeing each one of them, has helped him thrive in the Kansas City area for more than a quarter century.
“I personally evaluate each patient for their skin care needs and perform their monthly peels,” Cortez says. “This gives us brief contact time that allows them to query me about other procedures. We have found this process most helpful in teaching patients about new procedures, and we believe they subsequently schedule other procedures and surgery for me to perform. The personal touch of the physician is very important to the development and growth of an aesthetic practice.”
Cortez is something of an authority on running a successful practice, with “best plastic surgeon” nominations in local magazines over the past several years. In addition, Cortez was chosen as one of the Best Doctors in America 2009 to 2010.
“I have the reputation of being the doctor to go to if you want to look natural after aesthetic surgery,” he says. “I do not like anything that looks operated on. When people come to me a lot of the reason they do is because they say they saw one of their friends, one of my patients, and they didn’t look like they had any work done and looked great. They can’t figure it out. Why did they look so good? I think that’s the biggest compliment you can pay to an aesthetic surgeon.
“My patients don’t look pulled, they don’t look abnormal, their eyebrows are never too high, their necks are never too tight, and they are never pulled in the wrong direction,” he adds with a smile.
Cortez’s practice is limited to cosmetic surgery of the face, head, and neck, with a subspecialty in the treatment of the aging face. He says a large part of his practice, which is 75% female, concerns patients who come back to him for what he calls preventative maintenance: fillers, injectables, office peels, and a variety of skin care treatments.
“We do a lot of things in between facelifts or forehead lifts that help maintain people. I want to maintain the patient I’ve operated on to look as good as they can for as long as they can,” he says. In addition, he advises his patients to start their skin care and other rejuvenation-related treatments earlier in life. “An ounce of prevention is worth a pound of treatment,” he says.
IT’S ALL SKIN DEEP
|Cortez, with the help of staff member Denise Winters, RN, marks a patient prior to surgery.|
In treating people for premature aging, Cortez looks for signs of skin cancer because the things that cause premature aging are the same things that cause skin cancer—mainly, photodamage.
“The main component of the aging process is the result of photodamage and smoking,” Cortez says. “Photodamage causes the elastic and collagen fibers to break down. The face tends to become more lax with more lines and wrinkles. The cigarette smoking causes textural changes in the skin.”
Unlike practitioners who have high-tech gadgets and machines to see deep under the skin for underlying cell damage, Cortez prefers to use visual inspection, palpation, and physical exams to look for what he refers to as “obvious visible signs of photodamage.” The best way to diagnose his patients is to examine the lines, depth of lines, brown spots, red spots, pre-skin cancers, skin cancers, and their skin laxity, he adds.
“Sometimes in patients I’m looking for dyschromias, which are brownish discolorations of the skin. In these cases, I use a Woods lamp, which tells me whether the pigmentation is superficial, moderate or deep. Determining the level of pigmentation guides you in your therapeutic regimen,” Cortez says.
In addition to as much face time as possible for the patient, Cortez also interacts a lot with his patients’ primary care physicians regarding diet and exercise, as well as the patients’ use of sunscreen.
|Cortez at his practice in the Kansas City area, using fillers to augment a patient’s lower face.|
When dealing with aesthetic patients with skin care issues, Cortez encourages them to have their thyroid checked annually and “total and free testosterone run, as well as vitamin D levels,” he says, “Low vitamin D can affect the metabolism of glucose and other hormones, such as testosterone.”
In addition, he educates patients about a process of aging that he believes they can avoid, called sarcopenia. “Sarcopenia is the replacement of muscle with fat,” Cortez says. “We encourage all of our patients to do cardio and, more importantly, resistance training. If you do resistance training and you retain your muscle mass, then you don’t get the sarcopenia, and it dramatically reduces the aging process,” he claims.
Cortez has a few terms to describe his approach to treatment—a holistic approach and an “all-encompassing approach,” as he puts it. This covers the surgical facelifts, eyelid lifts, forehead lifts, chin augmentations, jaw augmentations, and skin resurfacing that he performs…to the other, less invasive procedures and strong focus on prevention.
He credits much of what he learned about facial plastic surgery to E. Gaylon McCollough, MD, FACS, who was profiled in PSP in December 2009. Cortez completed his facial plastic surgery fellowship with McCollough at the McCollough Institute for Appearance & Health in Gulf Shores, Ala. McCollough is his “main mentor; a unique individual, willing to share anything he can with his fellows.”
In addition to learning aesthetic techniques from McCollough, Cortez sat in on consultations. It was here that he learned the business side of the practice of cosmetic surgery.
BUILDING BY WORD OF MOUTH
|Cortez and his office manager, Carolyn Rideout, review a patient’s chart.|
Currently, 99% of Cortez’ surgeries are performed in the Accreditation Association for Ambulatory Health Care-certified surgical center in his office. He says he was one of the first physicians in the Kansas City area to create an accredited facility—that was 16 years ago. He did it primarily for safety reasons, because “having this control cuts down on the risk of infection,” he notes.
When Cortez started his practice 27 years ago, he decided to have only registered nurses as assistants. Besides the staff, which is all medical-trained, Cortez credits his wife, Susan, who he refers to as, “the overall director of everything,” for helping with his overall practice—from the interior design of the office to the products that are used to the Web site that Cortez is just now, in 2010, creating. “My wife was a designer of jeans for Lee Jeans; she has a great eye for aesthetics,” he proudly states.
Throughout the Internet age and the dot-com boom, Cortez has resisted the urge to create a Web site. His approach to business has been to shun all things advertising, including Yellow Pages ads, although he does have a listing in the local White Pages.
Instead of embracing the almost universally approved practice of putting one’s practice on the Internet, Cortez focused on growing his business via word of mouth.
He says he’s only now developing a Web site due to patient demand. They were asking him to publish a Web site in order to be easily kept up to date on the latest products and procedures/treatments offered.
Cortez is hoping to unveil the new Web site, which will be educational in nature, sometime this year.
Amy Di Leo is a contributing writer for PSP. She can be reached at firstname.lastname@example.org.