Peter B. Fodor, MD, FACS, pioneers minimally invasive procedures

The next big thing in plastic surgery technology could very well be nonsurgical body sculpting, in which ultrasound waves aimed at precise depths gently disrupt subcutaneous fat cells so that they can be eliminated through the process of absorption. It’s about as minimally invasive as procedures get, and that’s why Peter B. Fodor, MD, FACS, is thrilled to head the clinical advisory committee assembled by the technology’s developer in advance of the pending start of domestic clinical trials.

Fodor, a solo practitioner whose office—Century Aesthetics in Los Angeles—enjoys an international reputation for excellence in lipoplasty and many other cosmetic procedures, confesses a fondness for minimally invasive work.

“Minimally invasive procedures these days are capable of delivering good, natural-looking results with a short, dramatically less painful recovery while leaving behind hardly any telltale signs of what was done,” says Fodor, 2004-2005 president of the American Society for Aesthetic Plastic Surgery (ASAPS) and a past president of the Lipoplasty Society of North America.

Technology Central

Nonsurgical body sculpting won’t be the first product Fodor (his name rhymes with “adore”) has helped prove and bring to market.

“When ultrasound-assisted lipoplasty arrived,” he recalls, “the five plastic surgery societies then in existence came together to assemble a task force to evaluate it. I served as the chairman, but later stepped down to become a clinical investigator. This gave my practice access to the technology well before FDA approval was granted. I performed approximately 100 ultrasound-assisted lipoplasty procedures as part of that investigative process.”

(However, as Fodor reported in a published article on this original study, he was able to ascertain that ultrasound-assisted lipoplasty in its early iteration carried more downside than upside. The cost of the equipment, the length of the practitioner learning curve, and the increased number of patient complications outweighed the benefits, he remembers. Even so, he felt it could eventually emerge a winner if ultrasound technology were appreciably improved, which did in fact happen.)

Five years after concluding his evaluation of ultrasound-assisted lipoplasty, Fodor was instrumental in developing another liposuction technology—VASER (vibration amplification of sound at energy resonance). He also pioneered a lipoplasty wetting-solution-infusion technique called Super Wet that drastically reduced blood loss in aspirate to less than 1% and, consequently, helped make lipoplasty a far safer procedure. On the heels of all this, Fodor was recruited to aid in the refinement of power-assisted lipoplasty (PAL).

“I performed the initial studies on PAL, which resulted in a seminal, peer-reviewed medical journal article,” says Fodor, author of a career total of 49 of those types of published papers, writer of seven books and, for 14 years, the co-editor of the internationally distributed journal Aesthetic Plastic Surgery. “Today, the estimates are that between 45% and 50% of the lipoplasty performed in the United States employs PAL.”

Meanwhile, Fodor’s successes with variant approaches to lipoplasty inspired him to explore ways of creating minimally invasive versions of other familiar procedures. The fruits of those efforts led to his participation with Newport Beach, Calif, plastic surgeon Nicanor G. Isse, MD, in the development of endoscopic facelifts. (In 1995, Fodor and Isse authored a textbook titled Endoscopically Assisted Aesthetic Surgery.) One of Fodor’s first such endoscopic procedures was a minimally invasive forehead lift.

“The traditional forehead lift involves an incision across the head from one ear to the other; by contrast, with the endoscopic version, you simply make a slit incision less than 1 inch in length behind the hairline, through which the endoscopic instrument is introduced,” he explains.

Comprehensive Approach

Above and beyond his enthusiasm for minimally invasive procedures, Fodor is an avid proponent of the comprehensive approach to plastic surgery, which takes into account patient lifestyle before and after surgery as part of the planning.

“With the comprehensive approach, you don’t function as a surgical technician,” he says. “You function at a much higher level than that. In the comprehensive approach, you are involved in preparing the patient well in advance of surgery and, later, in helping them take better care of themselves—including showing them, for example, how to correctly apply makeup or how exercise programs and proper diet combine to help produce the best results with liposuction.”

A Hungarian national who grew up in Communist-controlled Rumania before fleeing to the United States in the early 1960s, Fodor’s career choice of plastic surgery reflected in part his desire to be something more than a technician of medical services, as many other types of physicians so often end up being.

“I didn’t want to just write prescriptions all day,” he says. “I wanted, first of all, to be in a field where I could use my hands—surgery. But not just the kind of surgery where most of what you do is remove things. I wanted to be involved in surgery where there would be opportunities to create and make improvements in the patient.”

Fodor says he was attracted to medicine because of a fascination with how the complicated machine of body and mind works. “I also had a strong desire to help people—and, for me, I recognized that would be best accomplished as a plastic surgeon.”

Fodor began his medical instruction in Rumania. Soon after arriving in the United States (and barely able to speak a word of English), he enrolled at the University of Wisconsin’s medical school in Madison, completing that program in 1966 at the top of his class (having by then attained a superb command of the English language). He interned at Parkland Memorial Hospital in Dallas, then began general surgery residency at Columbia Presbyterian Medical Center in New York City. His training at that level was interrupted for 2 years when he volunteered to serve in the US Air Force.

In 1974, Fodor began his plastic surgery residency at Columbia University’s teaching site, St. Luke-Roosevelt Hospital, also located in New York City. He finished it in 1976 as the chief resident; simultaneously, he also completed a fellowship in hand surgery.

Out of residency, he became the associate director of the resident teaching service at St. Luke-Roosevelt Hospital, while at the same time operating a solo private practice in New York City. Ten years later, Columbia University offered him the opportunity to run the residency program, but Fodor declined it since accepting the position would have meant a full-time commitment—something he wasn’t keen about making.

“I’ve been in academia throughout my career,” he says, “but never on a full-time basis because to have done so would have limited my ability to participate in national societies and other nonteaching activities, including private practice.”

In 1992, Fodor relocated to Los Angeles. The University of California at Los Angeles subsequently invited him to take a clinical teaching position in its medical school; in that it was a part-time post, he happily accepted. In 1997, he was appointed chief of plastic surgery at Century City Hospital, a facility that has temporarily closed for renovation.

A recently initiated renovation of his own has enlarged Fodor’s Century Aesthetics by 40% to nearly 7,000 square feet. The office’s contemporary minimalist décor strategy, combined with soothing color choices (plus the playful use of marble in the reception area and chromed art deco light fixtures elsewhere), gives it a clean look that signals comfort, caring and cutting-edge capability. Fodor makes a point of keeping a tidy desk in the room where he holds his initial meetings with patients; his theory is that a desk free of clutter tells patients they’re dealing with a plastic surgeon who is meticulous about his work, highly organized in his thinking, and generally well-disciplined in his practice.

Making Patients Happy

A large share of the office belongs to Fodor’s medical spa, Century Cosmetics, which serves as an excellent mechanism for achieving greater satisfaction among patients.

“Our medi-spa’s technicians work with patients before surgery to get their skin in optimal condition,” he says. “In so doing, we can have surgeries and postoperative healing periods that go much better. Also, very soon after surgery, our aestheticians demonstrate for the patients how to apply special camouflaging makeup to help conceal some of the bruising. We also perform microdermabrasion.”

Additionally, Fodor offers an endermologie service through Century Cosmetics. (Endermologie is a computer-driven massage system that contributes to quicker diminishment of postoperative bruising and swelling in liposuction patients.)

Because his practice is so busy, Fodor plans soon to take on an associate, a plastic surgeon currently in academic practice. This arrangement would position Century Aesthetics to once again handle reconstructive work. (In days long since past, Fodor performed reconstructive plastic surgeries, but later he had to refer most such cases elsewhere as demand for cosmetic services burgeoned and took up the bulk of his available clinic time.)

Meanwhile, in the last few years, Fodor has noticed a trend in which more and more of his cosmetic cases involve the correction of work originally performed by other plastic surgeons. That so many redo requests end up with Fodor is a testament to his skill, since obtaining a good result with these types of cases is typically the most difficult to achieve. Thus, Fodor foresees that a focus of his practice in the years ahead will be remedial procedures.

“With the redo patient, it’s vitally important—yet very difficult—to bring expectations into alignment with reality,” he says. “But the good news is that, once expectations are managed appropriately, the vast majority of these patients come away happy.”

Making all of his patients happy is what Fodor does best. But thanks to the remarkable new technologies at his disposal, achieving satisfaction should be easier than ever for him.

“It’s about being cutting-edge, and remaining there,” he says.

Rich Smith is a contributing writer for Plastic Surgery Products.

A Year in Perspective

Peter B. Fodor, MD, began his term as president of the American Society for Aesthetic Plastic Surgery (ASAPS) last May with a desire to accomplish several noble ambitions.

“The most important things I wanted to achieve were, first, a redoubling of our efforts as an organization to help further improve patient safety and, second, to educate the media about how ASAPS members are different from other providers of aesthetic surgery,” he says, looking back. “I think a lot of progress was made toward fulfilling both those objectives.”

Fodor’s interest in pursuing such goals arose to a certain degree from his deepening concern over the mischief caused by the recent onslaught of television “reality” programs about or involving plastic surgery procedures.

“Those shows distort the public’s understanding of what plastic surgery can and cannot safely accomplish,” he laments. “They call it ‘reality TV,’ but all it does is promote unreality with regard to patient expectations. Patients will come in now to talk about their eyelids, but then they’ll ask if a tummy tuck can be thrown in while we’re at it. That happens because these shows have in a very cavalier way depicted procedure after procedure on the same patient in the same single sitting. They make it look like having plastic surgery is no different from a trip to the hair salon. The unspoken message a lot of younger viewers pick up from these shows is that they don’t have to take care of themselves, they don’t have to exercise anymore, and they don’t have to eat right; they can just go to a plastic surgeon and get all this work done, and everything will be fine.

“The public’s appreciation and understanding of the specialty of plastic surgery has been adversely changed by this, and now we have a very hard time keeping patient expectations at reasonable levels.”

Comfort Zone

Within the confines of his own Los Angeles practice, Fodor has sought to address the challenge of overwrought expectations in a variety of different ways. One of his methods is to not show patients computer-generated images of how they might look after a procedure. Instead, they’re presented with actual before-and-after photos of past cases involving procedures similar to what the prospective patient seeks.

“I have entire carousels of slides, organized by procedure,” he says. “I have the patient sit down, and then we show the pictures.”

Importantly, Fodor doesn’t present images of only the most dramatically achieved changes—seen in abundance are pictures of individuals whose improvements are impressive primarily for their subtlety.

Sometimes, though, it’s necessary to turn away patients whose stratospheric expectations defy gravity no matter what, Fodor indicates.

“I’m a lot more comfortable operating on someone with a big deformity whose expectation is simply to achieve a more natural look than I am operating on someone who has a minor deformity but blames it as the cause of her failing in school, doing poorly in every job interview she’s ever had, and the reason her marriage is in trouble,” he says.

Another problematic patient is the one who arrives for a consultation not knowing what she actually wants. Fodor recognizes he’s dealing with such a person when she brings in magazine photos of celebrity noses, for example, and tells him she’d like to have a nose exactly like the ones shown—except for the fact that all of the noses in the photos are dissimilar.

“The chances are very high that this patient is not going to be satisfied with the result,” asserts Fodor. “The patient convinces me he or she knows what she wants if the noses pictured are fairly close in appearance.”

Fodor hopes to shape patient expectations before they ever walk in through his door by putting together a consumer-oriented book about plastic surgery. The tome, to be titled At Your Best, will serve as a comprehensive guide to aesthetic plastic surgery, will be written by a number of cosmetic plastic surgeons, and will be edited by Fodor.

“There will be at least 40 doctors participating,” says Fodor, who makes clear that work on the book won’t start until after his term as president of ASAPS ends so as to absolutely ensure the propriety of the endeavor. “I’m very excited about this project. I think its impact on public awareness of plastic surgery will be considerable. It will go a long way toward correcting the misconceptions about cosmetic plastic surgery.” —RS