It has been 30 years since plastic surgeon Walter L. Erhardt, Jr, MD, FACS, first hung up his shingle, and he has never spent a dime on advertising. Instead, Dr E, as he is affectionately known to peers and patients alike, generates new business through word-of-mouth.
Over the years, he has become somewhat of a “family” plastic surgeon. “It is second-generation stuff at this point,” Erhardt says, “I’m doing augmentations on daughters of moms that I did augmentations on years ago, and facelifts on ladies I did augmentations on previously.”
It is nothing against advertising per se, but some of the methods used today to drum up business won’t bring in the type of patient he prefers. “I like the patients that can distinguish between value and cost, and the ones who are looking for the cheapest route are not the best patients,” he adds.
Erhardt speaks from experience, having watched the entire plastic surgery specialty evolve over the past 3 decades. When he first started practicing, most of the “newer” craniofacial and maxillofacial techniques that stemmed from World War II trauma care and breast reconstruction could only be done using tubed pedicle flaps. The aesthetic side of the specialty really hadn’t reached mainstream America and was mostly limited to the “rich and famous.”
“I don’t think there is a procedure that I do today that I do the same way I did when I was in my training,” Erhardt says from his office in Albany, Ga. And it’s the evolving, creative nature of the specialty that drew him to plastic surgery in the first place.
“I started out thinking I wanted general surgery, because I was swayed into medicine by my uncle, who was a general surgeon. But during training, I realized that I didn’t want to do cholecystectomies and hernia repairs over and over again,” he recalls.
All it took was one rotation in plastic surgery to convince him what he did want to do. “The procedures were interesting and sometimes bizarre, but always very creative,” he adds. “When I was in medical school, what could be accomplished aesthetically and with reconstruction was really pretty limited, and it took a great deal of creativity to obtain a good result.”
Erhardt received his bachelor’s degree in science from Roanoke College in Salem, Va, and his medical degree from the University Of Virginia School Of Medicine in Charlottesville. Then, he was off to Vanderbilt University in Nashville, Tenn, for his general surgery and plastic surgery residency.
Today, Erhardt’s practice is 75% aesthetic and 25% reconstructive, with the bulk of the reconstructive side being breast and facial reconstruction following skin cancer resection.
“My most common operation is breast augmentation and revision of breast augmentation that was done elsewhere, followed by breast reconstruction,” he says. “I never totally evolved into a 100% aesthetic practice. I’ve always had a foot in both the aesthetic and reconstructive arena.”
This diversification helped Erhardt’s practice stay afloat during the recession, when plastic surgery procedures were down on all counts. “When our aesthetic practice dropped off, the other didn’t, but we ended up working harder because the financial reimbursement for reconstructive procedures is less than what one gets from aesthetic procedures,” he says.
However, some of the reconstructive patients remain close to his heart.
In fact, he often runs into a former cleft lip patient. “He’s a big, tall, strapping young man, and his face looks great,” Erhardt notes. “I fixed his lip and palate, and every time I see him I feel like I made a difference.”
Many people are quick to equate plastic surgery with vanity, but it’s much more than that.
“When you hear a story about breast reconstruction, otoplasty, or cleft lip or palate, and someone says, ‘This really made a difference for me,’ you begin to understand the effect we can have on changing people’s lives for the better,” he says.
His dedication to improving the lives of his patients is one of the reasons that he still does all of his own injections.
“I see physician assistants who are very adept at sewing up lacerations and doing injections, but if you can’t name the muscles you are putting the stuff into, maybe you shouldn’t be doing it,” he says. “It involves more than just rote training.”
He also sees a fair share of patients who got injections at local medical spas. “These are a steady source of patients who had problems with Botox and fillers, and need them straightened out,” he says.
SEPARATING THE HOPE FROM THE HYPE
The growing number of noncore physicians who are performing cosmetic surgery procedures with little training has strengthened Erhardt’s commitment to educating consumers and colleagues. He has served as the editor of Plastic Surgery News, and currently sits on the advisory board for two online consumer plastic surgery resources—The Consumer Guide to Plastic Surgery and Breast Implants 4you.com—where he suggests topics and thoroughly reviews articles for medical accuracy.
Plastic and reconstructive surgery has grown exponentially in the past several years. With the advent of many new procedures and technologies, Erhardt remains conservative when it comes to embracing the new.
That’s not to say he is resistant to new and emerging products or procedures. Instead, he prefers to adopt a wait-and-see approach, and relies on the tried-and-true, evidence-based methods. He is one of the clinical investigators with Allergan/INAMED for the Style 410 highly cohesive silicone-filled breast implant clinical study, and is optimistic that these so-called “gummy bear” breast implants will become an option for women in the United States.
Erhardt admits that the specialty has also taken some hits from the media with highly publicized celebrity plastic surgery disasters, as well as the plastic surgery reality television craze.
“It has given plastic surgery more visibility, and that has been good in that people think about it more and certainly people are more aware of what can be done in cosmetic and reconstructive surgery,” he says. “The commercialism of medicine has not been good for plastic surgery.”
Even though the public’s thirst for knowledge about plastic surgery has been educated via the media, “Some of the education hasn’t been good,” Erhardt notes. “They may be more knowledgeable, but they don’t always have a realistic idea of what can and can’t be accomplished. Watching some of these shows makes a person think that miraculous transformations are possible, even probable, in short periods of time with little or no risk. Patients need to know the whole story.”
Denise Mann is a freelance health writer in New York. Her articles regularly appear in WebMD, health.com, cnn.com, Arthritis Today, American Profile, and special sections of The Wall Street Journal. She is also the editorial director for several plastic surgery portals, including The Consumer Guide to Plastic Surgery.