Why Plastic Surgery Isn’t About Vanity with Dr. Susan Chobanian

Podcast Introduction and Guest Welcome 0:00

Welcome to the Doctors Making a Difference podcast, where we help physicians to be empowered with the tools they need to successful in medicine, in finance, and in life. Join us as we highlight doctors and other professionals around the world who are making a difference. Hey, today I'm excited to present Dr. Susan Chobanyan, a really exciting, delightful lady who grew up in Wisconsin and she works as a facial plastic surgeon in Los Angeles. And again, I am a primary care doctor. Those of you who have listened to my podcast for a while know I work in rural Idaho.

Most of the people I've referred to are cardiologists or nephrologists or other various sub-specialties. And once in a while, I refer to plastic surgery, but not that often. It was really interesting to meet Dr. Chobanyan and hear her perspective and her kind of hometown and lovely approach to patients that she really cares for deeply. And she's also very technically proficient and has gained a great reputation for having excellent outcomes. I rarely find doctors who love what they do so much that they want to keep doing it for a long, long time.

She's one of those unique rare doctors, and she has found this gift of being able to help people. Well, I found her interview very personally motivating. But I think you'll enjoy it, too. Thank you very much for tuning in. I'm excited to welcome Dr. Susan Trebanian here with us today to the Doctors Making a Difference podcast. Dr Trebinian, would you mind introducing yourself to our audience? Hello, I am Dr Susan Trubanian and I've been practicing in the Los Angeles area. Specifically, in Glendale, California.

And I have been doing plastic surgery and cosmetic surgery for over 25 years.

Dr. Chobanyanu2019s Background and Early Path to Medicine 1:51

And it's something that makes me very happy. It makes very content. And I'm proud to say that I have operated on second and third generation patients in my practice. Oh my goodness, that's awesome. I appreciate you inviting me here. Dr. Crane, it is a pleasure to meet you. Ask me any questions you'd like. Yeah, well, I appreciate it. When most of the audience for the podcast are physicians, and I think people go into medical school with this, you know, we're all kind of starry-eyed when we start.

We want to make this big difference in this Big Splash and help lots of people. And then I people get a little ways into medicine and residency and all this stuff and they say, wow, this is very hard, but it's a challenging job. Surgery is a long path to become a surgeon. So I want unpack just a bit of briefly your history. Why did you choose medicine and then why did she choose to become a plastic surgeon specifically. Well when I was in undergraduate school I really didn't start out. to go into medicine or to become a doctor.

I went to college to became a math and science teacher and I started very early. So I graduated from high school when I was 15.I started college when i was fifteen. Wow. And I did my major in math in chemistry. Had double major and i started practice teaching and it was very difficult for me to practice teach because most of the students were my age at that time. And I thought to myself, I think I would like to go into medicine. My father was a dentist and our social contacts were doctors and dentists and people who are in the medical profession and they were the original dedicated, hardworking, day and night doctors.

And I always admired what they did, and I admired the difference that they do for people. People respected them and looked up to them for what did and who they are, who were, not for they had. That always inspired me. And so I thought to myself, you know what, I'm going to make an application to medical school, and if I get in, i'm gonna go. And lo and behold,I got multiple acceptances to different medical schools. Well,you were like the Doogie Howser of your time, age 15, graduating, starting. I mean,i bet you were a hot ticket.I bet a lot of people wanted to have you.

You know what? I grew up in Wisconsin. I'm Wisconsin raised. And I never thought of myself as a hot ticket. OK. It was a very sedate, very middle class society that I grow up. In and I enjoyed it. We had a wonderful lifestyle. we were very content and we always looked up to the medical profession for how they help people. and like I said, I started medical school when I was 19. I graduated when I was 23. At 23, I the youngest licensed physician in the state of Wisconsin. Goodness. And I never felt that I at a disadvantage being younger, academically.

When I got to medical school, there were a lot of my classmates who had more savoir-faire. Some of them had Ph.D., some of had master's degrees, some had been married, Some had children, and some were in military. One of the classmates was a graduate from West Point. And he was very savvy guy. I mean, you know, so I had to compete with that. But I enjoyed medical school and I enjoy becoming a doctor and enjoy being a Doctor.

Choosing Plastic Surgery and Building a Practice 5:30

I enjoy taking care of patients, all right. As a plastic surgeon, I just don't produce a product. I need to take care the patient and I've never forgotten that. No matter what specialty you're in, you need be a good doctor first. At first I was the youngest doctor and now my goal is to be the oldest doctor. Oh my goodness, you must love it. We talked about on the podcast, the folks who, all of us again, start off with these bright aspirations and it's hard. You went through the surgical training.

It's lots of years and lots and training and lot of challenges. And so, but you're in it to win it, like you said, You started off as one of the youngest and you are not just looking for an exit path. you want to be one the oldest that is practicing. That's quite unique actually. Well, as a physician, I think it's how you set your goals. I mean, As a young doctor, you always want to be the busiest and then all of a sudden you want. The wealthiest. And now you just want it to the oldest. and I never thought about the first two really when I first started practice, i have a nurse, my nurses work for me for 38 years.

Okay. Wow. She remembers when i was first in practice. My goal was to operate on the second generation. And I've reached that goal. In fact, I surpassed it. Some of them I even operated on the third generation. And like I said, started at a very young age. I was in my twenties when I started private practice and I'm still here and enjoy every day. Enjoy every minute. Wake up in the morning eager to go to work. That's pretty cool. So talk me through this for just a second. Most physicians are not plastic surgeons.

You know, there's plenty of plastic in the world, but when you kind of look at the balance, most doctors are no plastic surgeon. What's the day in life of a plastic surgery like? And what do you like so much about your job? Like I said, I didn't start out in plastic surgery. I trained at the Medical College of Wisconsin and the medical college affiliated hospitals. And I did a lot of head and neck cancers and head neck trauma when I was in Wisconsin. And the weather was cold and some of the cases were very challenging.

Some of them were downright depressing. I always thought to myself, if I get a chance to study something that's a little bit fun in a warm climate, I'm going to go. A fellowship in facial plastic and reconstructive surgery opened up in California. And I was fortunate to get accepted and I did it. And plastic surgery is really a merger of the art and science of medicine. OK, it really blends well. And it's not just artistic in terms of what we create, but it is also artistic and the way you handle and care for your patients.

Because we're making a difference in the patient's psyche, in a patient self-confidence. OK. Everyone has a right to feel as though they're within the realm of attractive people. in the universe and you give them or you change them physically to make them appear or make, them feel as though they're more attractive, they increase their confidence, increase, their ability to succeed in life. I think that's one of the myths of plastic surgery about vanity. They think it's conceited when in reality, it is you're dealing with the patient's desire to be successful.

And like I said, I've operated on first and second generation patients. And yes, follow my patients and they contact me. I think that's the success of my practice, making people succeed. Well, so that's really an interesting thing. So Dr. Chabanyan, one of the questions that I have been asked periodically or I've had myself regarding plastic surgery pertains to scope of practice, type of patients, and some misconceptions. I think a lot of people say like, oh, it's plastic surgeries just for the well-heeled or the people who only have vanity.

But I, think it is such a more complicated, challenging field and you come at it from the standpoint of working for years as an ear, nose, throat surgeon, having done plastics for a lot of years. What have you found are some of the biggest misconceptions about plastic surgery?

Misconceptions About Plastic Surgery 10:12

And what do you actually do? How have found that your work influences your patients? Well, I think the biggest misconception about plastic surgery is that somehow patients seek it out for the sake of vanity or conceit. They're self-absorbed or selfish people. But that's not true, okay? Patients who seek out plastic surgeries, it's just not about vanity. It's about their desire to succeed. Everyone has the right to feel as though they're part of the realm of attractive people. And they deserve the greatest amount of self-confidence they can have to succeed.

The other myth about plastic surgery is that somehow it's limited to just the very wealthy people or people who are celebrities. That's not true either. Plastic surgery, especially in Los Angeles, has become very commonplace. and actually has become very affordable for our patients. The other myth about plastic surgery is that somehow it's only for women, okay? And that's not true either, on certain procedures like for rhinoplasty procedure, I do about 50% women 50 percent men. And in fact, when I was first in practice, i shared an office with two other men and I used to get more male patients than they did combined.

Interesting. The other interesting fact is the other day I had a male patient and he says, I love going to female doctors because they pay more attention to detail. They are more accurate. That's what he told me. He said, they get a better care of the patient. I was very flattered and of course I did his surgery and it turned out very well. So those are some of the myths about plastic surgery. It is a challenging field and you still have to treat the patient as a whole, okay? I think I always talk to the patients, I try to do a very in-depth consultation.

I want to know what their goals are, where they are in their life, what they do. And I helped them succeed. And like I said, I've been in practice for many years. I have done generations of patients, and I follow my patients. My patients follow me. Daily and weekly I get messages through the internet, through social media about how their life has changed after I did their surgery. makes me feel really good. It makes continue to work. And it's the success of my practice. Well, as you said, you started off as one of the youngest, and you like it so much you want to continue the practice till you're one the oldest, which is pretty cool.

That speaks volumes to say that people have come back generation after generation. You have third generation patients who have came back and said We want your services. And then like you said, one of the things that you found most meaningful is to restore confidence and to have somebody feel I'm a normal part of society. Whether that is their perception or whether that's their reality, it's really important for people to that level of confidence. I can see why that would be quite gratifying. has been.

That's why I continue to practice really. Yeah. Okay. Another question is a lot of the listeners to the podcast are early stage. They might be pre-med students, medical students residents, people who are considering you know a long career in medicine. And so talk through for a second what would you tell someone who's considering this and maybe some of their colleagues are dissuading them from plastic surgery and someone says I really think this might, be my calling or the thing that I could do. What kind of advice would I routinely have medical students and even interns and residents come and shadow me in my office.

I frequently have people who come. So I try to set a good example. OK? I think plastic surgery is really a fine combination of the art and science. It's also a very technical specialty. Okay, you're a surgeon, okay? You have to be good with your hands. You like to work with you hands and you have be technically adept.

Advice for Trainees and the Demands of Surgery 14:33

The other thing about surgery is to sustain the practice, your somewhat of an athlete. You have to have sharp eyes and a strong back in order to last. Okay. And I can do it. I was never an athletic individual. However, in Order to maintain my physical prowess in the operating room, I work out three days a week, i'm at the gym at least four days A week and I set physical goals for myself in The gym I Can deadlift 120 now Okay. Saturday mornings. Yeah. I run 2.8 to 2 point 9 miles and 35 minutes. All right.

So I keep myself physically in shape because in order to do a good job in the operating room, you need to be physically adept. The other thing is you need to be somewhat of a psychologist. You have to talk to the patients, you have understand what their motivations are. The patients I always give them the mirror, I say take a look in the mirrors and tell me what you don't like about it. I want to know what they're perception is. Whether it's realistic, whether it unrealistic and what the goals are?

what they hope to achieve by having plastic surgery. If they think that plastic is going to change their entire social situation and give them a life that they can love, you have to be weary of that patient. But the patient who wants to look better because they want to present themselves better at the workplace or socially or wherever or make themselves feel more confident when they look in the mirror, that's very important to understand. So I always do like an in-depth consultation I have my medical students or my interns or residents, they sometimes come to shadow me in the office and I always let them sit in on the consultations so that they know how to select the patient and set the patients expectations.

That's perfect. Like you say that when it went into medicine, it wasn't necessarily just to do surgery, It was to help people. And that's what you're describing. There's a psychological aspect of it. and you need to set proper expectations. And there's a really powerful technical aspect. Then you hit on something that we don't talk about very much, which is physical fitness that's required to be able to function as a physician. You can't do this really intense job, particularly if you're doing a lot of hands-on, hours-long surgeries.

you can do it unless you are physically fit. So I think that is a valid point. I appreciate you making that. One of the other questions on that is you have become known as the queen of rhinoplasty, is what I have understood. And so I'm interested, you are forging ahead trying to make this field better than you found it and try to leave a lasting impact for patients and then also the residents and people you teach. How have you developed that technical proficiency and what have observed over your career as far as changes in the way you approach rhinoplastia or other surgeries?

The whole concept of rhinoplasty and what the patients expected years ago is much different than it is today. Years ago, we had the Estee Lauder model, and everybody wanted to look like her. It was much more regimented. We dealt, years, ago the concept that American society was a melting pot. I don't think it's any longer that. I think now America has become a salad. Everybody has their individuality, everybody has diversity, everyone has ethnicity or racial characteristics that they want to preserve.

But we want tweak it a little bit, atone it little to make them look more attractive or make more confident so that they can succeed in society, in the world, the workplace, on the corporate ladder. So I think plastic surgery has evolved and now we have to satisfy the diversity of our nation and the diverse people we have in our nation and preserve their ethnicity. Years ago, everybody wanted to look like the same model type, not anymore. Everybody wants to preserve there identity, but we want to tweak it to make them a little bit more attractive and give them more confidence.

That's an interesting take on it. Like you say, instead of having everybody look similar, we want to really preserve it and so when you do rhinoplasty, do you look at the person's family

Rhinoplasty Philosophy and Technique 19:09

history or their ethnic heritage? How do plan that? Cause a lot of times people come in with a certain thing in mind and I imagine that's kind of hard in some ways to be able to say how do I want this to look? The person is trying to verbalize it, but how did you actually plan so that a person can have the aesthetic outcome that they're looking for? I do my consultations probably differently than other surgeons do. I ask the patient first of all what they don't like about it, and then I asked them what do they want to look like, like with the nose.

What kind of nose do you want? The patient will sit there. It's very difficult for the patients to explain in words exactly what the want. So then, I'll tell them, show me some pictures. Everybody says I want a natural look, everybody says, I wanna look natural. But what's natural for one person is not natural, for another. I always take the pictures of their face and nose, get the picture printed immediately, show them their pictures, look at pictures and noses that they really love. And then I will actually draw for them on their photograph what kind of nose they want.

And they look at the picture, they looked at that nose that I've drawn on their picture and they'll tell me whether they like it or not or how they want me to change it. Okay? And over the years, I have honed my surgical skills and my surgery technique that can come very close to what I draw. I've worked very hard on it. Over the years, you have to be very self-critical about the work you're producing. The patient may be happy with the result that you've given them, but you need to look at that result critically.

And over the Mike, when you talk about technique, I do practically 95% of my nose's closed rhinoplasty. I'm working through the nostrils on the inside without any scars on outside of the nose and oftentimes I fix it functionally and I fixed it cosmetically. and I do it as in a closed technique and that's why my patient population actually they came up with the monitor. They said they called me the queen of rhinoplasty. Right. Because I try to create as natural look as possible. It depends on what the patient wants.

The other thing is Sometimes I have to put my own likes and dislikes aside because I had to deliver what the patient wants to see in the mirror. And in Los Angeles, I practice in LA, and I'll be honest with you, 99% of the patients are very accurate. The patients who seek out plastic surgery know what looks good on them. They've researched it. And actually, it's been studied that average patient will think about plastic surgeries for two years before they actually come to the doctor for a consultation to have it done.

So they've thought about this for a pretty long period of time. And most patients are actually very accurate. They're very realistic as to what looks good on them. So I listen to the patient. Like I said, with plastic surgery, it's imperative that you deliver what the patients wants to see. It's important. Otherwise, you're going to get burnout. Oh yeah, think about the difficulty of doing that type of surgery through the nostrils without cutting the skin and then especially with your background is that ENT you can fix some of the functional issues with the nose at the same time and I can see why it would be such an important and powerful thing that you could offer to those patients.

Closed rhinoplasty, honestly, has become a lost art. Open rhinoplasty is much easier. You skin the nose and you're looking right down on the anatomy. Working through two nostrils with specific lighting, I think it's more difficult, but I thinks it gives the patient a far better result. I think they heal faster. I they get less bruising, less swelling. And of course, most of the patients that come in for rhinoplasty are somewhat teenagers or young people. To put a scar on the outside of their face is not appropriate because they have to live with that for the rest of life.

As you're passing this information on to residents and fellows and others that come with you, would you say that the closed technique has reinvigorated or do you have people that are adopting that or you feel like it's diminishing? I think there's a trend to go back to closed rhinoplasty simply because the patients are more attracted to it. Okay? If the patient can have a closed rhinoplasty and you're going to do it without any scar, they're more inclined to be favorable toward that procedure. And so, I there is a tend back the closed Rhino plasty.

It's the scarless Rhinoplast. That's amazing. Well, I was curious as we go through this, we don't want to share anything that's hip or protected or anything like that. But you have these multi-generational families that you've helped. Are there any stories you could share of people that said, like, �I went and got a surgery and it changed my life, it change my career trajectory, are there things that like you can tell in a hip-protected manner?� Yeah, you know, I get cards and letters every day from patients.

And like I said, since I've operated on generations, patients will come back to me. I have done thousands of patients, okay?

Patient Stories and the Meaning of Beauty 24:36

If I go to the grocery store, if I shopping, inevitably bump into someone and they'll say, You know you did my daughter's nose 15 years ago and now she became a doctor. She became lawyer. she become a dentist. Or she got married and now she's got five children and she is very happy and you did a beautiful job and the nose still looks good. So I get stories like that all the time. I got letters. Even if you read my social media, people will say, I'm so glad you're still in practice.I saw your post,I see your videos, i love you,i follow you.

You changed my life. i had no self confidence and then you know my expanded and they'll tell me the details. There was one case I remember though, and it struck me when I was first in practice, I did a facelift on an older woman who was very successful. She was a professional woman, she was businesswoman, very well accomplished woman. And I did a facelift on her. She came to me for a face lift. As I was taking out the stitches, OK, she started to cry. And, I said, you know, Mary, why are you crying?

I say the surgery went well. You look great. Everything turned out great and she says, You know doctor, i'm going to ask you a question. and I want an honest answer. She said, am I ugly? And I said Mary, why do you ask me that question? I don't think you're ugly. I think they're a beautiful person. And she said well, I was driving down Sunset Boulevard the other day and some kids pulled up me in the car next to me and they screamed. They said look at that ugly lady in The Rolls Royce. and she says, do think I'm ugly, and said not at all Mary.

I said, beauty is the entire person. And I didn't think she was an ugly person, of course she wasn't, you know, model beautiful, okay, she isn't Lady Godiva, but she is an attractive woman. I say, Mary, your beauty was the whole person okay. We did the facelift, we tightened up the neck, tightened the jowls, lifted your cheeks, and you look great. It's really the person and I think That sort of went through me like a knife, that the reason why people sometimes seek out plastic surgery is because they want to feel as though they're part of the realm of attractive people, and it builds their confidence.

And I think my personal belief, I'm a person of faith, i think all of God's creations are beautiful. In general all of God's creations are beautiful but beauty is really the entire person and if you help that person succeed and they're content and what they do then as a plastic surgeon as A physician as the human being I've been successful and I think that's the key to having a good life and a successful profession No, those are wise words. I like what you're saying. Like when I talk to people of different specialties, sometimes people just want to talk about the technical aspects of what they do, which is interesting.

But I can tell you have a whole person approach. You really want make sure the person gets to the outcome they want surgically, but there's kind of the psychological, social part of it that's very important. And so I think it's really fascinating what should do. Hey, I could hear the passion in your voice. Can tell, you enjoy doing what's you do and why you still want keep doing it. What advice do you have for physicians at large? You know, you see doctors of different stripes all over the place and patients that have interacted with physicians, particularly as it pertains to perception of patients, how they're received and how the perceive themselves as they interact with the medical profession.

Do you any advice or insights for other doctors who are listening who may want to take something away from this? Everybody wants to treat the patient for what their specialty is, all right? But I think that we need to address the entire patient. It's sometimes very difficult and it's, sometimes, very time consuming to do that. But to deal with the issue as a plastic surgeon, it is very easy for me to say, yeah, okay, I produced the result. and I don't want to see, but I follow all my patients for one year.

My rhinoplasties, I followed for 1 year, my revision rhinoplasty patients who've had surgery elsewhere, they come to me for a revision, i follow those for up to 2 years. my facelifts,i follow for year okay,I wanna see the healing process and i wanna my patient's success okay within that year period I can see teenagers blossom I have one patient. I mean, he invited me because they're having a party for his promotion at the company he works. And I operated on him about a year and a half ago.

Advice for Physicians and Closing Remarks 29:39

Now he's got a promotion and he is a much more confident young man. If their goal was to find an appropriate mate, they've done that. That's what medicine is really all about, okay? Even in the darkest parts of medicine, I have friends that are medical oncologists. I cancer surgeons, and it's very serious and very difficult work. The limitations there and the results are sometimes just God-given. And medicine, as hard as we try, we have our limitations. All right, with plastic surgery, we can set the limitations ahead of the surgery.

We can the expectations ahead the of surgery and then when I feel that I can hit a home run, I give the patient as much hope and as optimism and when deliver, then I could see the success. No, that's great. It was a kind of difficult question, but I hope I answered it. That's really is to say, how do you live the best life you can and how can I help you be just a little bit better within the context of my training? And none of us can do it by ourselves. It takes a group of as physicians. One of the things I wanted to give you a chance to do as we wrap up our time is where can people follow your work?

Do you have a website or a social media profile or LinkedIn or someplace people who are interested to, say I want to follow and see what she's doing? Yeah, I have a website, Susan L. Chobanyan, MD. I'm on social media. That's wonderful. Thank you so much for taking the time to share your insights, your experience, you knowledge, and wisdom. And again, I'm pretty excited to hear not only what you're doing, but I think it's pretty cool that you love it enough that want to keep doing it. You're not looking for an off-ramp, You are still wanting to continue to do this, And who knows, maybe you'll be to the fourth generation someday.

From your mouth to God's ears, thank you. Dr. Crane, it has been a pleasure. Likewise, Thank You very much. Thanks for tuning into the Doctors Making a Difference podcast. And thank you for what you do to help your patients and your community. Your work truly helps so many people. We produce this content to have the tools you need to stay in medicine and to highlight the amazing work being done by physicians around the world. Please note that while I am a physician and many of the guests on this program are also physicians or other professionals, the discussions on the podcast do not represent my employer or any professional organizations to which I belong.

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