There was no doubt about it. Dr. Raz clearly had my attention from the very beginning. And for me, someone who prides themselves on the ability to multi-task in today’s day and age, that is somewhat of a feat. As the interview progressed, however, and Dr. Raz began to discuss his research, that perhaps my ‘multi-tasking’ is not as efficient as I believe it to be. In fact, attention – and what happens to our attention when under particular circumstances – can be quite fickle at times. And with cell phones and texting and Facebook and Twitter – well, this has become an even larger issue. One in which, perhaps, could be treated with Hypnosis, a practice of which Dr. Raz is well versed. But wait – can Hypnosis, or manipulating your thought process, really cure a Twitter addiction? Or the desire to constantly change your Facebook status while you should be focusing on a class lecture? Because wow; if so, maybe I should be the first to sign up.
So Dr. Raz, here I am. Go for it. Read my mind. Now tell me, what do you think?
Tell me where you’re from, how you came here and how long you’ve been here.
I’m from Israel originally. I moved from Israel to the US to do a post-doc and since that time I stayed in North America. I was an Assistant Professor at Cornell and did my post-doc at Cornell Medical School. Then I moved to Columbia University, where I worked as an Assistant Prof. In 2007, I crossed over the border and moved to McGill to become the Canada Research Chair and give Cognitive Neuroscience some attention here at McGill.
Can I ask what you did in Israel? Were you in the Army?
Well I’m Israeli born and raised. So I did the Army and did some of my education there as well. In the Army, I was in Research & Development for the Airforce, which is a special kind of group of people who are doing more covert sort of research things that is sometimes helpful for military applications.
I’m sure you’ve seen a lot of interesting things…
So I know you have a few areas of research. Can you tell me about some of them?
The first and foremost area I’m interested in is attention and what people pay attention to. More importantly atypical attention – forms of attention that don’t represent the mainstream. So for example, what happens to our attention when we’re sleep-deprived, what happens to our attention when we are in an altered state of consciousness, like when we meditate or when we’re under hypnosis; things of that nature. And as it turns out, attention is a very important and powerful capacity that we have to block out information – or sensation or perceptions – and to modulate, regulate and even govern our emotional state. Most people think about attention through the analogy of a zoom lens of a camera – but that’s a very simplistic and unhelpful analogy. Good attentional skills are not just about following a lecture. Good attentional skills are actually somebody who is robust emotionally.
This translates into a person who, when something bad happens, can still pay attention to the good; can pay persevere in the face of adversity; and people who can actually invest their energy in something despite possible distractions. And “distraction” is almost inescapable. We get emails and text messages and pages – and so in our high-speed world, interruption is the name of the game.
So paying attention has basically become the “abnormal.”Because of these multiple interruptions, having a strong ability to pay attention and to stay on task is crucial to functioning well. Most people think that in order to hypnotize a person, or to meditate, that you have to be in a very quiet room, and you need to be lying down on a leather sofa, and somebody with a beard and a pipe needs to speak to you. But the truth of the matter is, the people who I am working with are people that can pay attention on the metro because they live in their heads.
So to clarify what you mean. You mean paying attention?
Yes, paying attention. And paying attention is also an internal thing. For example, you can pay attention to your body and things that are happening in your body. And that is something that is learned. You can teach people how to do that; it’s a skill that actually uses your physiology. And we know quite a bit about the physiology of attention. And we see that with neurotransmitters and other chemicals in the brain we can train people how to pay more attention. It turns out that these people have the ability to modulate, regulate and influence their cognition, their emotions, and their actions.
So it’s almost a therapeutic effect –
Completely. For example, I can demonstrate, and this is demonstrated in the literature quite well, that athletes should probably invest quite a bit in attention training. Because with attention training you can boost, bolster and improve performance in a way that very little physical training would allow. Physical training will take you a certain distance but then there’s the element of attention that could make it even better. Of course an athlete cannot only compete with attention training alone, but it’s an important facet. So that’s one aspect of my research.
Another aspect of my research has to do with placebo effects. Placebo effects and placebo responses are huge in our society. So much so that some people claim that most of what we do is placebo. Some people claim psychotherapy is a placebo, some people claim taking Vitamin C when you’re sick is a placebo, and some people think that anti-depressants, for minor-moderate Depression, are a placebo. All sorts of claims are out there! But the fact of the matter is, placebos are very strong and they work on people in a big way, despite the fact that many people consider them to be nothing. But symbolic thinking and the power of suggestion make a huge impact on people; and as a result, physiology can change based on something that they think is happening.
So to switch the thinking so things can change physiologically.
Right. And that brings us back to what I was saying about attention, because when people pay attention and when they think – sometimes physiology can change just because you’re paying attention to something. So let me give you an example to help clarify things. Let’s say that somebody goes to the Doctor and by some huge error, the Doctor says to them, “Your X-ray shows that you have cancer and you really don’t have much time to live.” But say a week later, the doctor realizes there was a big mistake and they have to call this person to apologize. Well if you interview these people – the ones who thought they had cancer – they will tell you that they were actually having trouble breathing –
You mean, upon their “death sentence”…
Yes. They were really feeling that they were dying! Because these are very strong suggestions to make to a person. Now usually when we take about placebos we think, “Oh, you’re going to give me a candy.” But there are situations where we really are very susceptible to certain suggestions, particularly if they’re made in a serious way and if we think that they’re genuine.
Placebos are interesting because it’s a top-down process. It has nothing to do with what’s actually going on in your body in a bottom-up fashion. It has to do with what your brain is thinking is happening, which can then change your physiology in a top-down fashion. And that is something that medicine knows very little about. This is something that usually comes from Psychology or Behavioral Science. So for example, we can create a situation where people would come in to a pub and get – what they think – is an alcoholic drink.
When in reality they really have no alcohol in them…
Right, they’re actually virgin drinks, no alcohol whatsoever. But you’ll see that some people are going to act tipsy after two or three drinks – some people will have slurred speech, will have a hard time walking in a straight line. Some might even vomit! Even though their blood alcohol level will not change. But, because they are so convinced after drinking a certain amount that they should feel drunk, their body will start to act as such.
So this is a good example of how powerful placebos can be. And it also is a good demonstration of the power again of symbolic thinking and cultural influence. In Chinese or Japanese culture, for example, the number four is considered synonymous with death and ill-fate. So people in China and Japan will try not to travel on the fourth of the month because they think weird things will happen. They won’t wear jerseys or shirts that have a four on the back; they’ll try to change an appointment on the fourth if they can. They will actually go out of their way to avoid the ‘fours’. Sometimes, we will do retrospective studies and see if more accidents or deaths do actually take place to people of Chinese heritage, just because they’re expecting it and they know it I going to be a bad day. And as it turns out, there’s at least one study done and several others in the making, that you can actually demonstrate statistically that these things are, or at least appear to be, significant. People from Chinese backgrounds do have more heart-related deaths than people who are not from Chinese background.
On the fourth.
On the fourth. So it’s interesting to look at these sorts of things and the explanation of them. And it is all based on one’s thinking – if you are in a hospital’s ICU and you realize that tomorrow is the fourth of the month, these people might think that tomorrow is their final day of living. And that kind of thinking really influences your immune system – and you could actually lose it. Just because of these cultural signals.
Well then, that also links with the attention. The power of the thought.
Yes, as well as the power of the placebo. It’s actually both things.
Another trajectory of some of the research I do is what we call “attention training.” And that is just a set of programs that we’ve developed and other scientists have and we basically take children and we teach them how to pay attention. We train their attentional system, almost treating the attention like a muscle. We basically train children – or give them attentional challenges – just as you would in any other subject. And we can demonstrate, that with attention training, weird things happen. You can get an increase in IQ scores, better ability to contain your emotions and to pay attention. These are really important observations because most people who are researching attention are trying to understand conflict resolution and monitoring conflict. But I’m actually taking it in a slightly different direction, where I will manipulate the attention. Like with Hypnosis, for example. I take individuals and hypnotize them and under hypnosis I then suggest certain things to them. And see how these particular suggestions affect or influence them. And I can see what changes occur in their brain as they listen and as they follow.
What type of behaviours do you try and have an affect on? Do you do weight loss or more social-type behaviours?
Most of the things that I try to do are usually geared towards trying to see if I can take an automatic process and de-automize it. I’ll give you an example. We have certain behaviours that we all engage in that we consider to be automatic. If I put words in front of you, you’ll read them. It happens effortlessly. If I put the word “RED” in front of you, you get all sorts of things that are associated with Red. If, however, I ask you to read the word “YELLOW” but the colour of the word is different than the one written, then there is a conflict going on because you’re trying to read the word but you see the different colour and it’s not clear what you should respond. It’s difficult not to have them interfere with one another. So what I can do is override these conflicts that are going on inside the brain by suggesting to people that what they see is actually in a foreign language. If I tell people that this is in a foreign language, they basically stop reading because now they are processing the information very differently. They are modulating the way they look at the world as a result of their paying (or not paying) attention. And that then creates a completely different way of seeing yourself in the world. You can make people hot, when the room is not hot, you can make people hungry or thirsty. All these things have physiological affects. Basically what I’m saying is that with words you can actually override the physiology -in a top-down fashion – as opposed to bottom-up.
Right. So “top-down”, as in starting with the mind.
Yes. This has tremendous implications for pain regulation and pain control. Here at the Jewish General Hospital, for example, we use hypnosis as an adjunct for chemotherapy and other cancer treatments because we find it makes the treatments more tolerable. That is one approach…
Another approach to take that is slightly more scientific for your purposes is to see what is the limit to which you can actually influence individuals. There are certain things obviously that we cannot do. If I told you “don’t blink for the next two hours”; you can’t do that. As a matter of fact, as soon as I told you not to blink –
Very interesting. So my next question. Magic and Science. Link? Relationship?
My interest in magic is – sometimes it’s actually difficult for me to say if my interest in magic came as a function of interest or attention or the other way around – I actually think it was the other way around because when I started out I was a young boy and I was attracted to the idea of vanishing things and making them come back. And rabbis and pigeons and all these things. But I think I had this epiphany as I was beginning to read books into it, that most magicians are quite regular people. I remember that even as a young boy the father of one of my friends was a magician and I remember going to his house and I was not very impressed with him as a person – and I remember that he would do all these magic tricks. And I would like all the tricks but I wasn’t impressed with him as a person. I didn’t like his personality. And that sort of created in me this idea that you can be a good migician but you’re not nexcessarily a good person. And I thought initially that the magician is this person with powers.
That was a big moment for you!
It was a big moment. I think I was six. But the important bit for me was that magic was an introduction to a laboratory of behavioural science. Because you can learn a lot about what people think.
Well that’s the “power of thinking.” It’s all magic.
Magic is a complicated art because it incorporates theatrics with science with some psychology. There’s a lot going on with magic; choreography and timing and dexterity at some points. And very quickly, I found that I’m more interested in a branch of magic that is called “Mentalism”, that is more psychological tricks.
Like reading your mind or I’ll guess the card that you’re thinking about. I’ll tell you your date of birth and I’ll tell you all sorts of things that are supposed to be very personal and you think to yourself, “how do you know these sorts of things?” And you learn how gullible people can be.
Can you do that? You can do that right now? Or do I have to be in a lab and be in the right environment.
Sure. Anyone can do those things. Maybe we’ll do them later.
The idea is that magic is really a very interesting way of looking at what people really are interested in. Because sometimes they don’t listen to what you say they just sort of think that you said it, or they just sort of make up that you said it. And I was always fascinated by that.
Now there was a period of time where it was popular for magicians to do hypnosis shows. Hypnosis was under the rubric of magic. And one thing that I noticed from the get-go was that magicians would know nothing about hypnosis. I would ask them questions, even as a teenager, about how does this work and how did you learn it. And they would just roll their eyes.
So you were really interested in it…
Yes, and I can see that the answers that I was getting were very shallow and superficial and the whole level of inquiry wasn’t even there. I remember clearly, for example, a particular kind of chemical magic that I was privy to – a magician performed a type of timing response, where something would change colour – and I asked some very basic questions, and I was as young as 12 or 13, I asked “can you tell me how this is working?” And he said, “You don’t need to worry about that. You don’t need to worry about how this is working. Mix these materials and this is what you’re going to get.” And that always bothered me. You do things in sort of a blind, sort of a dumb fashion and it just happens and it’s not sort of clear to you how this happened. And I started, in addition to magic, I started interviewing people and magicians about what they do, how they do it, and I sort of learned that there’s more to magic than just the performance. There’s a whole science to it. I started getting more and more interested in the science of magic and the science of illusions and things like that. And I think I still have it to this day, to some extent.
It sounds like you developed critical thinking at a young age. And I now hear that you have developed this course on critical thinking. I know that there’s been a lot of talk about how students don’t think critically these days. What are your thoughts on that?
I think that people don’t critically think, not just students. I think that our education system doesn’t teach us to think critically. I think that just like attention training, you need to get critical thinking training. I think that somebody needs to be there to show you what are the appropriate questions to ask when claims are being made and I think that people need to learn a little bit about the logic of proofs and what is considered to be acceptable evidence and what is considered not to be acceptable evidence and all these things, they’re not trivial.
And what is your course called?
It’s called Critical Thinking: Biases and Illusions. It’s part of McGill given through the Psychology department. It gives examples and scenarios, and shows what is considered to be fantastic and what is considered to be less fantastic and how can you go about asking questions. The most important part is to explain to students that each situation is different. And even though you always have to improvise and go about things in a slightly different way, depending on the situation, there is always some kind of a governing principle. The class has no pre-requisites – except for the pre-requisite that is “life.” You need to have a pulse and you need to have two neurons that are connected to one another. And if you have that, then you’re ok.
That should be in your description of the course. I think that would be an attention-grabber.
Recently I had the pleasure of sitting down with one of Montreal’s finest plastic surgeons, Dr. Arie Benchetrit. In our conversation it became evident why Dr. Benchetrit is truly one of the best in this field – after twenty years of practice he is still intrigued by cosmetic surgery. I have to admit, aside from what I have seen on the medical drama shows I watch every week, I am not too well versed in the world of Plastics. And yet, after about an hour of sitting down and getting to know Dr. Benchetrit I felt I had more of an idea of what it takes to not only be a plastic surgeon, but what it takes to succeed as one. So move over Grey’s Anatomy’s “McSteamy”, because you have nothing on Dr. Benchetrit.
Here, Dr. Benchetrit helps us demystify some of the glamour that accompanies cosmetic surgery, as well as discussing the art of plastic surgery, the Hollywood craze, where he believes the specialty is heading in the future, and of course, his most favourite procedures.
Where are you from? Tell us a little bit about your background.
I was born in Morocco, and moved to Canada when I was four and grew up in Laval. I went to Vanier Cegep, then I went to McGill undergrad for 1 year, then to University of Montreal for Medical School. And then I did my General Surgery at McGill and Plastic Surgery residency at McGill….
It’s a long residency, isn’t it?
Yes, seven years. One of the longest!
Did you always know you wanted to be a doctor?
No. I was very young. I actually finished high school when I was 14…I was a bit precocious…and of course at 14 you have no idea what you want to do. In those days you basically went into Health Science, Pure and Applied Science or Law. Those were pretty much the three choices. So Health Science seemed the most obvious to me, for no particular reason, and then once you’re in Health Science you keep going and in Cegep I finished Health Sciences and then I applied to a Bachelor’s in Anatomy at McGill, and then during that year I decided if I’m going to do Science I might as well go into Medicine – it seemed like a good way to use my science background and so I applied to Medicine…and the rest is history….
…is History. And you liked it all the way through?
I’ve always liked the science of medicine. I’ve always been interested in the functioning of the human body, the interaction of the body with the environment and drugs and things like that. I’ve always been fascinated by that. The actual practice of medicine within Quebec is a lot different than you imagine it to be, especially when you’re a student – there are a lot of restrictions and a lot of rules and a lot of regulations that don’t exist elsewhere. All that being said, I have no regrets. To me it was a very good choice; a very good way to marry an interest in science with a practical way to use that science knowledge. And then veering into Plastic Surgery, it’s also allowed me to add a creative element, which I didn’t even know it was there when I was 14. My family’s a family of artists – my father’s an artist, my sister’s an artist. That’s my sister’s, that’s my dad’s – (Dr. Benchetrit points to two paintings displayed on the wall of his office) – so we have a lot of artists in the family, and so I never get a chance to express my art on paper, on canvas; and so this is in a sense a way…
It is! It is one of the medical specialties that is very artistic.
That’s correct. And so you need an artistic eye, you need a good sense of symmetry, of judgment, and so that helps. All of those interests make for a nice confluence and so it was a good career choice for me.
Do you ever do – art? Or no, you leave that to them?
I’ve dabbled but not really. It’s not a passion for them like it is for my family.
Is there a difference between Plastic Surgery and Cosmetic Surgery?
Yes, it gets confusing semantics especially for the public and a lot of doctors, unfortunately, play on that confusion to mesmerize the public, but uh, plastic surgery is a surgical specialty recognized by the Royal College of Surgeons of Canada and recognized by the American Board of Medical Specialties so it is a specialty onto itself. Within Plastic Surgery there’s basically two branches – there’s reconstructive surgery and there’s cosmetic or aesthetic surgery. So aesthetic surgery per se is not a specialty, aesthetic surgery could be practiced by any doctor, it doesn’t have to be a plastic surgeon – it just means, doing surgery for the purposes of aesthetics. However, while many doctors, including GPs, offer aesthetic surgery to the public, only plastic surgeons have the training to perform all of the various aesthetic procedures. Therefore, there is an ongoing debate about whether non plastic surgeons should be allowed to perform aesthetic surgery which, in Quebec, they presently are legally able to do. To be a certified plastic surgeon you have to be trained, have done a residency, and have been certified either in Canada or in the US or elsewhere as a Plastic Surgeon. Once you become a Plastic Surgeon you can have a mixed practice, which is the case for most, where you can have some reconstructive and some cosmetic, and some plastic surgeons choose to do mostly cosmetic or mostly reconstructive – you really have the chance to skew your practice according to your own interest.
And what type of practice do you have – are you a mélange of both?
Well when I started my practice 20 years ago it was all reconstructive because my main interests was surgery of the hand, that’s what led me to Plastic Surgery.
So you would do accident victims?
Accident victims, patients with congenital deformities in the hand, arthritic patients, peripheral neuropathies like Carpal Tunnel Syndrome, there’s a lot of surgeries for the hand and I really enjoyed it. It’s a very meticulous, very precise surgery and that was really in my nature, I’m a very meticulous and detailed person, so for the first five years of my practice I did almost all reconstructive surgery but the realities of community plastic surgery in Quebec hit after a few years, where a community practice is very different than an academic practice – I was trained in a university and to me, Plastic Surgery meant all kinds of big complex cases – replants, microsurgery – but you just don’t see those cases in the community, so after seeing the same small variety of cases basically over and over and over again it became clear that as long as I stayed in the community that would be the nature of my practice forever. And so I started to gradually incorporate some cosmetic surgery into my practice and then as it turned out I was good at it and developed a large patient through word of mouth referrals, and it grew and grew until now – it’s about 90% of my practice.
Ok, so there’s a lot of demand for cosmetic surgery within the community practice.
Um no. I would say that most community plastic surgeons do mostly reconstructive. In fact, if you look at most plastic surgeons here in Qc the majority of it is reconstructive, cosmetic is actually a small portion, but I would say 90% of the cosmetic surgery is done by 20% of the plastic surgeons, so it’s a fairly small pool and we do the bulk of it, I guess. Because we tend to specialize in it; and, of course, Plastic Surgery is based on word-of-mouth referrals and so as you tend to specialize in it you get better at it, you do more, and that’s how you build a practice.
But you said 90% of your practice now is Cosmetic. Well that’s transformed –
It’s changed completely.
…over the past twenty years.
Exactly, it went from fully reconstructive to nearly fully cosmetic.
Do you miss the reconstructive?
I still do some, I still do skin cancer, I still do some hand surgery, I still do some facial fractures, you know I’m affiliated with Lakeshore Hospital, I take call there. So obviously anything that comes into the Emergency Room that is plastic surgery related I will see. So I still enjoy it, but again, it’s the same limitations. In terms of elective reconstructive surgery in the community, it’s not a very varied pool of cases and so I’m glad I made the choices I made.
So plastics is pretty much, I think, the “sexy specialty” to have – although I’m sure Grey’s Anatomy is completely unrealistic…do you watch it?
No, I never really watch Nip/Tuck, I never watch Grey’s Anatomy, I never usually watch TV, but I try to stay away from medical shows because I have enough medicine during the day.
Right. Do you find it to be like the public views it? Because it does have that “sexy specialty” connotation or it’s built around that this McSteamy type of thing. Has it changed – I mean your practice has changed over the past 20 years – do you find that it’s changed? The public is very focused on looks…
Well I think the public has always been focused on their appearance. I mean cave men and women used animal blood to paint their faces and apply primitive make-up and so I think it’s just part of the make-up of the human being, is to try to appear our best – to look our best – obviously what looks good changes with each generation and the standards for beauty, for fashion change dramatically. But the desire for humans to look their best has not really changed. The difference is now we have procedures, technology, chemical procedures Dr. Joe, that make the achievement of a better more youthful appearance easier and safer than its used to be – and that’s been the main change in cosmetic ‘medicine’, I would call it, (rather than plastic surgery), cosmetic ‘medicine’ most of the procedures we do now to enhance somebody’s appearance are non-surgical, whereas 25 years ago really surgery was the only way to go.
Right. You now don’t need to go ‘under the knife.’
Absolutely not, in fact according to the American Society of Aesthetic Plastic Surgery statistics cosmetic surgical procedures in the last 14 years have pretty much doubled where as the non-surgical procedures have gone up almost 800%. So there’s been a huge shift towards the non-surgical/non-invasive procedures.
So that’s what I was going to ask you, because I was looking at your website – so explain the difference between the surgical and the non-surgical. I mean one obviously means you’re under anesthesia and ‘under the knife’ but what type is rhinoplasty – and what is that?
Well surgery means that somebody is using a scalpel on you basically, surgery involves a scalpel. It could be a small incision, it could be a large incision but it involves a scalpel, it involves a cut of some sort. And more and more surgical procedures and plastic surgery involves shorter and shorter scars, I mean, liposuction now has scars that are 3mm long. Some of the eyelid procedures we do are called ‘scarless’ because the scars themselves are hidden so the scars have gotten shorter but it’s still surgery, it’s still an invasive procedure; you’re going through the skin, you’re going through the body’s barriers. And that’s what defines it as ‘surgery.’ Non-surgical involves no scalpel. The most common non-surgical procedure that everybody knows are Botox injections, filler injections for lip augmentations or for wrinkles, the lasers are very popular – whether it’s laser hair removal –
That’s considered also cosmetic?
Oh sure. Wanting to be ‘hairless’ is again to enhance your appearance, especially if you’re very hairy…Lasers for wrinkles, what we call resurfacing lasers, we now have machines like the Ultra Shape that can dissolve fat non-invasively with using ultrasound –
That’s using only ultrasound?
Yes, only ultrasound. And again, non-invasively, as in it doesn’t break the skin.
There are machines that can tighten the skin non-invasively like Thermage, which is a radio frequency device, we also use ultrasound on the face for skin tightening. So there’s a whole slew of technological advancements that have made it easier to, again, non-invasively improve somebody’s appearance. And as well the pharma companies have been busy putting out products – injectable products – that we can use for the same purpose.
So would you say that, because of the pharma companies, and the use of all these non-invasive procedures the public is more aware?
I would say that yes, with all these procedures the public is more aware, certainly it’s much less of a taboo, much less of a restricted topic than it was 30 years ago, where if you had a facelift or a nose job you sort of kept it to yourself and your family and nobody really talked about it, well now it’s in every magazine it’s in every talk show like you said, some of the most popular drama shows are about cosmetic surgery it’s definitely all over the internet, it’s very easy to find information – in fact, you’re pretty much bombarded with it so I think it’s a much more open issue or open subject, and so I think more people talk about it more. Not always positively but at least people talk about it more.
I was reading about the Ultra Shape procedure. How does that work? I’m curious to know how that works! How much does something like that cost?
Basically the machine is an Israeli machine, developed by an Israeli plastic surgeon and engineer. By the way, Israel is the source of almost all cosmetic lasers and most of it comes from military technology. With all the military experience they have there, they’ve used a lot of it to develop a lot of the machines we now use to look better – it’s sort of a paradox. In any case, this machine was developed in Israel about 8 or 9 years ago and it’s been used in Europe for about 7 or 8 years, and it’s been available in Canada since 2007, and it basically generates focused ultrasound – waves that are focused like if you would focus the sun’s beams with a magnifying glass when you’re trying burn a hole through a paper, so the machine basically focuses the ultrasound down to a fine beam and sends these waves into the fat at the surface of the body and the ultrasound basically blows up the fat cells, the adipocytes, at a fixed level – 1.5 cm below the surface of the skin, that’s where they’re focused. So there’s no heat involved with this machine so it doesn’t hurt, it’s just cavitation makes the fat cells vibrate so fast that they “pop” and you do a whole area it pops a lot of cells. The fat then gets transported by your bloodstream and your lymphatics to the liver and it’s metabolized like any other fat you would eat.
That is amazing!
Yes, what’s really great about it is fat cells don’t reproduce, they don’t come back , they’re destroyed for good. And so for most patients, results are long-term or permanent. It’s a great invention for patients who are surgery averse. Because there is a large segment of the population that – no matter how much they want to look better – will never ever agree to have any kind of surgery even liposuction, which is a fairly minimal surgery. So for patients waiting on the sideline for something non-surgical to come out, we’ve had a lot of patients asking for that.
But what about if you have an unhealthy lifestyle? You can still generate Adipose tissue, right?
No you won’t generate new cells but the current cells that you do have can get larger. It’s not a weight-loss procedure, we’re not doing it to take 10-20 pounds off of someone, what we’re doing is re-contouring an area, most people have areas of “stubborn fat” – areas of fat that just won’t go away – whether it’s the love handles, the thighs, or the tummy – and that fat often resists diet and exercise, it’s also gender specific and race specific, so for those kind of areas that’s usually what we go to with liposuctions – we can do this now with Ultra Shape. It’s not as aggressive as liposuction, predictable or thorough. But it’s what we call the “muffin top” procedure, it will basically flatten that muffin top. We’ve treated over 300 patients with it, I’ve published our data and presented it at conferences all over the world – Europe, Asia – so far the data shows that an average person will lose 4. 5 centimetres in circumference, about 2 inches, after 3 treatments in the area that was treated. Significant enough for most patients to go down at least one pant size.
How much does the 3 treatments cost?
It varies depending on the size of the areas we treat. But, on average, about $1,000 per treatment.
What are some procedures you like doing most? Do you have a favourite?
I love doing rhinoplastys [nose reconstruction]. To me that is true art, because you are literally sculpting right on somebody’s face. And if you’re someone like me who wants to see the results right away there’s nothing better – because you see what you’re doing as you’re doing it. There’s no waiting to see the result. It is very delicate, very precise surgery. You have to be very meticulous, and that’s my personality. I also really enjoy other facial surgeries as well – eyelid lifts, brow lifts, neck lifts – all of those are similar. They’re all meticulous and deliberate type of surgeries.
Has anyone asked for a surgery that was really novel to you – a ‘can you do this’ type of procedure?
There are very few things that aren’t available. I don’t do every kind of surgery. I don’t do pec implants or calf implants, for example, which some surgeons do – especially in California – I don’t do penis elongation. So there’s things I don’t do that I do get requests for. But I don’t think I’ve ever been asked about a surgery that simply doesn’t exist.
What are some of the criteria to have certain surgeries done?
People talk about cosmetic surgery as if it’s a certain ‘fashion’ or ‘fad’ but it is medicine. The same criteria apply to this type of surgery like other surgeries. You are still dealing with the health of a human being. The first thing you look at is their health status. Obviously we’re not going to do elective surgery on somebody who’s very ill. So the first thing I do is look attheir health survey that we have them fill out. Are they on any medication, their history – diabetes – any conditions that could affect the outcome. There is also a bit of a psychological screening that goes on during the consultation. We want to make sure the patient is doing the surgery for the right reasons, that they don’t just look at the benefits but understand the risks and possible complications, the consequences of the surgery. Part of the consultation is to understand that we don’t perform ‘magic’ here we are performing surgery, and there are consequences. So I haven’t left my medical training behind, it’s part and parcel of what I do.
People talk about cosmetic surgery as if it’s not a big deal these days, it’s easy to forget that it is ‘medical’ surgery.
That’s right, there is anaesthesia involved. You can have complications from this surgery, even death. The advantage that we do have in cosmetic surgery is that we are mainly dealing with healthy patients. We’re lucky that we’re dealing with the healthiest segment of our population. But just the same, we have to be careful with how we’re operating.
Have you refused doing a surgery because someone is motivated for the wrong reasons?
Absolutely. I’ve refused people for wrong motivations, unrealistic expectations, people who I feel are unfit for surgery or I think the risk level is too high – they may be fit for some type of surgeries but not cosmetic surgery.
What are your most popular surgeries?
In my practice I would say tummy tucks, breast augmentation.
Is breast augmentation and breast enlargement different?
No, breast augmentation is just another way of saying breast implants. Augmentation is you’re making them bigger. Breast augmentation, enhancements, enlargements is just the same thing. To confuse you further you can do a breast augmentation and a breast lift at the same time, where you lift and make them bigger. Younger patients usually come in for augmentation, and older patients usually for the breast lift with or without augmentation.
And on women, obviously.
Well I haven’t done many breast augmentations on men, but I have done a couple on men wanting trans-gender surgery in the process of becoming women. I don’t see many trans- gender patients – that’s another niche of cosmetic surgery – there are some surgeons who specialize in that and they see the bulk of the cross-gender population. I see a few, but I don’t do the genital surgery – that’s a very complex specialized surgery.
And that is done here in Montreal?
Oh yes, in fact Montreal is one of the world centers for trans-gender surgery. There’s a surgeon here who’s known throughout the world for that.
So some of the Hollywood stories – Heidi Montag, from The Hills – in 2007 she had a breast augmentation, rinoplasty, Botox injections. She had 10 plastic surgeries in one day – browlifts, ear pinnings, chin reduction, a second rinoplasty, a second breast augmentation. And she says she almost died from too much Demerol, but she says it was worth it. A year later, in In Style magazine, she said, ‘it’s not what I signed up for; I should have been way more informed. Doctors should have really walk through all aspects of it, not just the glamorous side.’ She then goes on to say how it has ruined all aspects of her career and personal life, and how she wishes she could ‘jump into a time machine and take it all back.’
Do you think Hollywood and Heidi has glamorized plastic surgery, and put so much focus on the aesthetic…idolizing perfection?
I think Hollywood has made cosmetic/ plastic surgery look like a drive-through procedure. They’ve done it with cop shows, war movies, and they’ve done it in the last few years with cosmetic surgery. Shows like Extreme Makeover, which basically took patients who were down on their looks and did everything to them – surgery, hair make-up, whatever – and then by the end of the show, within the hour, the patient went from the Ugly duckling to the beautiful swan. It reinforced the notion that plastic surgery is somehow magical. That you can walk in the office and walk out a few hours later as a different person. What they don’t show you is that the surgeries take a long time, that there’s a healing process, there’s risks and there’s scars. So they swept all that aside and just show you the final product.
When that show was on I used to get emails from patients all the time saying ‘will you just take me on as a project, I’ve been unhappy my whole life. ‘Then shows like Nip/Tuck, it just falsely glamorizes the world of plastic surgery.
And then there’s Heidi Montag, and people talking about it. It’s taking cosmetic surgery and removing it from the realm of medicine and I think that is wrong. It is still a medical procedure. It’s a double-edged sword, it popularized surgeries but on the other hand, it made our lives (plastic surgeons) a little bit difficult because we had to manage expectations a lot more. You don’t get your surgery one day and then go to a gala the next. There’s recovery time. You have to manage expectations. Although now with the Internet, I have to say people are a little bit more informed and realistic. So the pendulum is swinging back a little bit, but you’ll still get the Heidi Montag’s and the Michael Jacksons’s, what I call the caricature of plastic surgery, not the real thing.
So what are some things that we could be looking for [on the market] to use where we’re not spending $1,000 on cosmetic surgeries?
The easiest and probably the least expensive is to buy a good bottle of SPF 60 and slather it on. Even in the Winter, because you’re getting ultra-violet rays. There’s three things that make you age. One is genetics, which you have absolutely no control over; two is smoking, which will age you prematurely, and three, the sun, which you don’t have to completely avoid, just use a good sun screen. A good part of my practice is reversing sun damage to the skin. So the number one easiest thing, sunscreen. Two a good healthy lifestyle. Eating properly, drinking water, exercising, not letting your weight yo-yo because that has an effect on your skin (it will lose elasticity). And then there’s also skin care, good skin cream, Skin hydration is important. It has no long-term effect, no benefit on wrinkles, but it keeps the skin looking better. Even a $6.00 basic skin cream will do the job.. Of course, getting a good night’s sleep and limiting the stress in your life is good too.
Where do you see the future of cosmetic surgery?
I see the trend of the non-surgical expanding and growing. There are things that we can do today that weren’t available five years ago. It’s amazing, just the last five years with the amount of technology….But there are three things, in my view, that will be the big movers and shakers. On the surgical side, one is robotic surgery, which has already made its entrance into Urology and other surgical specialties. They’re already using a robot to do microsurgery in the US and it’s a matter of time before robots will perform cosmetic surgery. Of course, these robotic devices are still controlled by human hands but who knows, one day… Two is tissue engineering, which has been going on for many years. They can now grow complex tissues in a petri dish – collagen, bone – but they’re not quite at the stage yet where they can create a multi-tissue organ .
So what would you then do with that?
Well if someone loses an ear in an accident, we now have to reconstruct it with skin from another part of the body, cartilage taken from the ribs etc. But if you can grow skin and cartilage in a petri dish then you can literally grow somebody’s ear and graft it on. We have been doing it awhile with skin, for skin grafts. But now we’re getting into more complex tissues. This isn’t only restricted to plastic or cosmetic surgery, Imagine if you can grow a liver or a kidney in a lab.
But one of the most exciting developments, and it’s already being used, is stem cells. Because one of the things we didn’t know before is that fat is one of the richest source of stem cells. Adipocytes stem cells are phenomenal. And we’ve been using fat injections for a long time, to make lips bigger, to fill in wrinkles and scars etc. so fat grafts have been around for 25-30 years. But what some people have observed that if you graft below a scar it will improve and nearly disappear in some cases, and no one really figured out why. It’s now hypothesized that it’s the stem cells in the fat that are differentiating into new dermal cells and so minimizing the scar. We can now isolate the stem cells from the fat and inject them into any site . If you do liposuction, for example, instead of throwing all this extra fat away you can put it into a machine and it separates out the stem cells. You then take these concentrated stem cells and you put them back into the fat, inject this super charged fat into an area and not only get a better cosmetic result, through better survival of the fat graft, but the stem cells can perhaps differentiate to improve the quality of the skin in the area. So scars are one thing but the potential for this is amazing. Imagine stem cells that differentiate into cardiac tissue when injected in the muscle of a defective heart, or that differentiate into bone or cartilage or other needed tissues. We ‘re not quite there yet but that’s where we’re going.
And this is an element for cosmetic surgery?
Well it applies to cosmetic surgery because we use fat grafts anyways. For example in Europe, and in some trials in North America, they’re already doing fat grafts for breast augmentations instead of using implants. You’re taking a patient’s own fat and injecting it into the breast.
You’re recycling. Instead of using a silicone implant.
Yes, you are recycling. So for some patients who don’t want to use implants this may become an option. So the issue now is getting the stem cells to differentiate into the different tissues that we need like the bone, the heart, the muscle or intestine. So to me that’s a really exciting aspect of plastic surgery and medicine in general. And it’s ongoing right now; it’s not a pipe dream.
Well Dr. Benchetrit I thank you very much! This was all very interesting and I can now say I fully understand the intricacies of cosmetic surgery.
Interviewed by Emily Shore