Goesel Anson, MD, FACS, and Terry Higgins, MD, manage pain with traditional herbs and supplements

The Las Vegas aesthetic plastic surgery practice of Goesel Anson, MD, FACS, and Terry Higgins, MD, is noted for many things, but among the most intriguing is its de-emphasis on pharmaceuticals in the management of postoperative pain. In place of conventional drugs, Anson and Higgins allow some patients to choose herbal medicines, along with a regimen of nutritional supplements that they begin prior to surgery.

The two surgeons find that in certain cases, the use of drug alternatives contributes to speedy and comfortable postsurgical recovery. Alas, the evidence that demonstrates efficacy is almost entirely anecdotal. But the paucity of hard science doesn’t discourage many of the patients who are considering the alternative route from taking it.

“They find it a healthier, more natural way to go,” says Anson, the founding partner.

Greater Satisfaction

Beyond helping reduce the need for drugs after surgery, another reason Anson and Higgins prescribe nutritional supplements before surgery is to counter the ill effects of unhealthy diets, so that patients are physiologically at their best when the day of surgery arrives.

“I’ve seen studies showing that as many as 30% of patients are malnourished prior to surgery,” says Higgins. “Our experience pretty much bears that out: We often encounter patients who don’t eat correctly. So, before we operate, we like to bring them up to speed, so to speak, by putting them on nutritional supplements.”

More importantly, taking supplements—combined with exercise and healthy eating—gives patients a stronger sense of participation in the surgical process, which, in turn, contributes to their being more psychologically prepared for the operation and for the recovery that follows it.

“We want our patients to have an ownership stake in all this, an active role,” Higgins explains. “Empowerment is what we’re talking about, and patients love it.”

According to Anson, patient empowerment changes the entire dynamic of the process, from beginning to end, and results in a higher level of patient satisfaction. “The greater their satisfaction from their experience with us, the more likely they are to refer family and friends,” she says.

And refer they do, in numbers so substantial that Anson and Higgins today rank among the busiest of Las Vegas aesthetic plastic surgeons.

Uncommon Situation

Anson started the practice in 1997. Higgins joined it 7 years later as a full-fledged partner, and it now goes by the name Anson and Higgins Plastic Surgery Associates. They’ve divided their cases into those pertaining to the face (that’s Anson’s specialty) and those related to the remainder of the body. (Higgins’s forte is body contouring and breasts.)

The Anson–Higgins pairing is something of a rarity in the Las Vegas market. Indeed, by Anson’s tally, theirs is virtually the only group aesthetic surgery practice in the city—all other plastic surgeons are either solo practitioners or employees of medical spas, she says.

An advantage of the partnership is that it leads to a case volume sufficient to pay for state-of-the-art equipment and thus allow the physicians to offer most every type of aesthetic service. In addition to surgical procedures, they also provide injection therapies and laser work; the most recent innovation they have adopted is intense pulsed-light treatment, a four- to six-visit service that combats pigmentation changes, broken blood vessels, and fine wrinkling caused by sun damage.

Anson and Higgins practice in leased space in a two-story, freestanding building. They perform all their procedures in an on-site accredited surgery center that consists of two fully equipped operating and recovery rooms.

However, even at approximately 6,000 square feet, the surgery center and offices are too small for Anson’s and Higgins’ needs. That’s why they’re preparing to move to a larger building. The new place—which should be up and running in less than 1 year—will likewise feature a comprehensive in-house surgery center. The most important difference is that Anson and Higgins will be co-owners of the new building. Their tenants are scheduled to include an otolaryngology group, an orthopedic surgery team, a radiology practice, and a family-medicine provider.

The planned new offices will carry forward—and even improve upon—the warm and welcoming ambiance found in the existing suite.

“In our current location, we’ve tried to create an elegant yet comfortable atmosphere,” says Anson. “We’ve decorated in lavender, purple, warm gray, and silver. And we have many nice pieces of artwork on the walls—some are prints, some originals. My favorite piece is an oil painting of a mermaid. I procured a lot of these pieces at art fairs and some galleries, but also from my travels—everywhere from Tennessee to Turkey.”

Office manager Karol Capezio suggests that the good feelings produced by the office also are a reflection of the quality of the people who staff the place.

“Our office runs with true professionals,” Capezio says. “This is a team of individuals who are just like family. Patients respond very favorably to that.”

A ‘Wrinkle Factory’

Las Vegas is a vibrant market for plastic surgery because of its large, affluent—and growing—population. In the last 25 years, the city has gone from 350,000 residents to 1.8 million, with as many as 6,000 households currently being added per month. Together with the millions of tourists each year attracted by the casinos and big-name entertainers, there are enough people in the desert hot spot to form a quite crowded metropolis.

That Las Vegas is sunny and hot most of the year also helps the plastic surgery market. For one thing, appearance-minded people aren’t able to hide flab, sags, and paunches beneath layers of clothing, as they might in locales where cooler weather is the norm, so they’re more prone to seek out medical solutions for those problems. Moreover, the arid, sunbaked conditions promote premature aging of the skin—yet another problem widely understood by local consumers as best addressed with the help of aesthetic plastic surgeons.

Regardless of the type of help sought, the patients who turn to Anson and Higgins are atypically young.

“My average facelift patient is in the early 50s,” Anson reveals.

But that’s OK, because she believes that patients enjoy better results over a lifetime by having a number of small, maintenance-oriented procedures performed from an early age—say, their 20s and 30s—as opposed to waiting until they reach their 60s, when nothing less than major work will suffice.

In addition to seeing younger patients, the practice also serves an unusually large number of males. Higgins says that roughly 25% of his liposuction cases are men.

“Most of the men are in good physical shape to begin with and are clearly taking care of themselves,” he says, “but they want to complete that with a more youthful appearance.”

The health-consciousness of those men is equaled—surpassed, even, in many instances—by the practice’s female patients. This is what prompted Anson and Higgins to offer alternatives to pain-relieving medications.

“We noticed lots of patients coming in who were already taking supplements on their own, so we decided we had better educate ourselves on this phenomenon as fully as possible in order to be able to inform our patients as to which supplements and which herbal medicines they could continue or needed to discontinue in the days before and after surgery,” says Anson.

Other alternatives for postoperatively dealing with pain and swelling were soon added to the practice’s armamentarium. Ultrasound treatment for facelift patients is but one example; a computer-driven massage system as a way to more quickly diminish postoperative bruising and swelling in liposuction patients is another.

Low-Key, but Highly Visible

Anson and Higgins have not made herbal medicines and nutritional supplements a selling point to be touted in their marketing. This is perhaps not surprising, because formal advertising doesn’t play much of a role in the practice’s growth strategy.

“Our outreach is very low-key; we spend very little money on it,” says Higgins. “We prefer to let satisfied patients promote us in their interactions with friends and relatives. The vast majority of patients we see have come to us as a result of this kind of referral, patients who really liked the work we did and want to tell the world about it.”

Despite the minimalist approach to marketing, the practice nonetheless sees its name popping up quite a bit in the news and on television. Anson, for instance, has been featured on programs aired over cable televisions’s Discovery Health and The Learning Channel, as well as on the BBC in the United Kingdom.

Her Web site, www.ansonmd.com, has a page brimming with links to consumer and business magazines in which she was profiled or served as a story source. Earlier this year, her face graced the cover of Las Vegas Life magazine for an article about the city’s top physicians.

“I didn’t solicit any of that coverage,” she insists. “It was the result of my having a prominent practice and a good reputation.”

A good reputation is worth its weight in gold. Is Anson worried about hers possibly losing some of its luster because she offers patients the option to use alternative approaches to postoperatively managing pain and swelling? The answer is no.

“Oh, sure, we cause a few raised eyebrows here and there among colleagues,” Anson acknowledges. But then again, approving nods from other practitioners isn’t what fuels practice growth—it’s approving nods from satisfied patients. On that front, Anson and Higgins clearly hold the advantage. From the looks of things, it’s an advantage they aren’t likely to lose any time soon. PSP

Rich Smith is a contributing writer for Plastic Surgery Products.

An Unexpected Match

Chicago-born and -bred Goesel Anson, MD, FACS, a 1983 graduate of the University of Illinois School of Medicine, originally planned to become a surgical oncologist.

During her general surgery residency at the University of Illinois and Cook County Hospital in Chicago, which she com­pleted in 1990, Anson spent 2 years en­gaged in surgical oncology research sup­ported by the National Cancer Institute.

Along the way, however, she became increasingly discontented with certain aspects of oncologic surgery.

“I loved the magnitude and complexity of the surgeries, but I hated the aesthetic results,” she says. “I eventually decided I needed to be on the reconstructive side of the process. That meant changing my training focus entirely.”

She did so by entering the plastic and reconstructive surgery training program at New York University in 1990, which included experience at New York University Hospital, Bellevue Hospital, and Manhattan Eye, Ear, and Throat Hospital. Anson then completed a fellowship in microsurgery at New York University.

In 1993, she joined the teaching faculty at the University of New Mexico in Albuquerque as an assistant professor. Early on, she was assigned the responsibility of helping her department develop an aesthetic plastic surgery practice. That effort came to a halt 11¼2 years later when Anson became part of a multispecialty practice separate from but affiliated with the university.

Anson says she decided to devote herself wholly to aesthetic private practice to get out from under the thumb of miserly insurance companies and to fulfill her desire to become a top-ranked expert in aesthetic work. With those twin goals in mind, she opened her Las Vegas office in 1997.

Anson and her neurosurgeon husband chose to establish their respective practices in America’s glittering capital of fun because they mutually agreed it was a great place to live and work.

Says Anson, “We had grown to love the Southwest from our time in New Mexico, but Albuquerque was too small a market for us.” Las Vegas, on the other hand, was an explosively growing market where opportunity abounded. “It’s a much more sophisticated city than people give it credit for.”

Just ask Terry Higgins, MD. He should know, because Las Vegas is his hometown. Like Anson, Higgins also started out aiming for one medical speciality only to ultimately choose another. His initial plan was to follow in the footsteps of his father—a locally well-regarded orthopedic surgeon—and become a bone-joint-and-muscle specialist.

He started off in that direction by obtaining his MD degree from the University of Texas Medical School in Houston in 1998. However, he altered his course after discovering the thrill of plastic surgery during a routine rotation in that discipline.

“Free-flap reconstructions struck me as being a lot more interesting than resetting bones,” he says.

Higgins then set his sights on becoming a purely reconstruction-oriented plastic surgeon. Accordingly, he undertook general surgery and plastic surgery training at the Michigan State Uni­versity College of Human Medicine, East Lan-sing, completing the former in 2001 and the latter in 2003.

When all was said and done, though, Higgins discovered that aesthetic plastic surgery better suited his personality. After Michigan State, he was fellowship-trained in aesthetic surgery at the Cleveland Clinic. Higgins then returned to Las Vegas—along with his wife, daughter, and three sons.

Upon his homecoming in 2004, friends and colleagues mentioned Anson as someone with whom he ought to become acquainted. Perhaps she could offer him a position as an associate, they suggested. So he sent her a letter of introduction and sought a meeting.

His timing couldn’t have been better. Anson—whose practice had grown so busy that she could no longer comfortably handle the case volume by herself—was preparing to initiate a search for a partner. However, she didn’t have a man in mind.

“I was thinking I’d invite a woman to join my practice—and then Dr Higgins came along,” Anson says. The two immediately hit it off. “Dr Higgins shares many of my views and surgical philosophies; we also hold the same set of values when it comes to family and lifestyle. It didn’t take me long to realize we would make a terrific team.”