V Talked To A Plastic Surgeon


Dr. Levine gives us some insight into cosmetic surgery, misconceptions of the industry and what he hopes for the future.

New York City based plastic surgeonDr. Steven Levine, sat down with V to discuss his practice. He is one of the most accredited and accomplished plastic surgeons in the city and has worked with some of the world’s top models and actresses, making his main goal to increase the self-esteem of his patients.  Read below to get his professional opinion and insight into the world of cosmetic surgery.

I know so little about what you do in general. I’m curious about what makes you different than your peers. Like, what makes someone go to one doctor as opposed to another?

Dr. Levine: Absolutely. The biggest difference between surgeons, without a doubt, is not technical ability. I would like to think that my hands are better than the next guys or girls, and I don’t know, maybe they are, maybe they’re not. Certainly if you ask my mother, she would say they are. But I think the biggest difference between surgeons is aesthetic judgement – [meaning] knowing how much to lift, what direction to lift in, how much skin to remove. The cutting and sewing – the technical part – is not the challenging part. What [patients] pay for is aesthetic judgement. The most common things people do in the aesthetic world deal with some of these minimally invasive things like neuromodulator’s like Botox, Xeomin, Eysport and fillers. [Patients are] not here for the product, [they are] here for the person using the product. I think there are, like the rest of healthcare in the United States,  2 tiers of this. You can think of what I do as a commodity, or think of surgery or injectables as commodities, and if that’s the case [you would choose the] least expensive price, that makes total sense. But, it is not necessarily true for aesthetic procedures. To me, it is reasonable that some people think this that “I get my Botox wherever is cheapest.” That’s fine. I have no knock against that. I don’t think they are doing themselves a disservice. They may even be getting a great deal that way [and] may have found this great provider who is really inexpensive. That’s a win! In general, what you are paying more for is the judgement and expertise of who is doing it. Listen, do your due diligence. What you shouldn’t do is think [that] just because someone is licensed to hold a needle or syringe, or just because someone is licensed to hold a scalpel, that they are as good as anybody else. There is a bell curve in everything. You either – depending on the procedure you are having done, maybe you are having a mole removed from your leg – maybe you don’t give a crap [and] go to the person who takes your insurance or is cheap. I get that, I totally get that because who cares. But maybe if it’s on your cheek, you think differently.

Yeah. What do most people come to you for?

Dr. Levine: Two-thirds of my practice is face. That means typically face lifts [and] eye surgery. By the way, when I say face lifts, it always means face and neck. They go together. The truth is, some of the best looking people on this planet have figured out that the funniest people have gotten too much Botox and filler… way too much. It’s common to say, like, “look at her, I wonder who does her filler. I wonder who did her surgery, it looks terrible!” But honestly, the patient probably never had surgery, the patient has just had a shit ton of filler that is completely gone. We are doctors so there should be a diagnosis and treatment. You don’t walk into your doctor’s office and the doctor looks at you and just goes “yeah, you could use some antibiotics today” or even “you don’t feel well, we’ll give you some antibiotics.” Like, no. You’ve got to be diagnosed with a bacterial infection and then you get antibiotics. Filler is a great tool, just like chemotherapy and just like antibiotics. What’s it a tool for? The symptom it treats is volume loss. It’s filler, it fills. So if I look at you and we are talking about your aging pattern and we say, well, listen, you’ve lost volume here, here and here, then I have no problem, filler is great. In general, for people who are coming here for aging concerns [and] if you haven’t lost volume, then filler is not a good tool. Most of the time, people mistake laxity, looseness of tissue, and descent of tissue for volume loss. And really, what they need is that tissue brought back up. I open everything up and I’m looking at it and I say “I’m not Michelangelo. If you don’t like the way you looked 10 years ago then you’re not gonna like the way you look after you get the surgery. I’m not beautifying you I am literally just putting things back where they were. If you are vacuuming your house and you move your coffee table away, you know where the coffee table needs to go back every time because you can see the little disks on the floor where the coffee table was. I think the same is true when I do face surgery. When I lift everything up and I’m looking at the deeper structures I think it is very obvious where they used to be. I literally pick them up and then sew it in place and that’s it. It doesn’t really feel like surgery. It feels like, oh I’m just doing some chores and I’m just like oh, this clearly used to be here, this used to be here, this used to be here, and when I’m done I’m not even thinking about it. It’s just putting things back. So, the reason I would care to educate an 18 to 34 year old about that is I’m not trying to sell them a face lift, that’s not my goal, although you would be surprised how young I do this surgery. I mean, I can certainly do this surgery for late 30’s for …

Well, I was going to ask, do you feel like your clientele, in general, for these things is getting younger and younger? I’m 28 now [and] I don’t think people in their 20’s were getting a ton of fillers. I think the Kardashian effect  has made it so normal so, are you seeing that?

Dr. Levine: Absolutely. However, what I’m sort of focusing on is more on the surgical side. I’m seeing it as a backlash to the Kardashian effect. Meaning, I’m seeing younger people coming for surgery whereas their mother and grandmothers may have done it at 50 [and] they are coming in and doing it at 40 because they don’t want to turn out looking like –

 …Because they don’t want to eventually have to get fillers, or think that they want fillers.

 Dr. Levine: Right, or they had fillers once or twice and they’re like “every time I go to the dermatologist, they tell me I need more filler, and I feel like I am going to look like one of those freaky duck ladies, and I don’t want to do that.” So, I’d rather just do this. Whereas, what you here a few years ago was, “Oh my god, I’m not getting surgery. I never want surgery, I’ll just get some filler..” Here’s my thoughts on that sentence. I don’t want surgery, perfectly valid. There are so many good reasons to not want surgery, great. Don’t get surgery. I’ll be fine.  I am plenty busy. I don’t need every person to get surgery. But, don’t say I don’t want surgery so [instead] I’ll get fillers. Just don’t have surgery. It’s all good, nobody is forcing you. Don’t think that somehow adding more and more volume is a way around getting surgery. Just recognize, at a certain point, volume loss may be there [and] it’s good to replace that volume with a little filler. But, when you go beyond the natural dimensions, you’re lost.  So, you started asking what I do. So, ⅔ of what I do is face and eyes. Here is a young girl. She’s sort of well known and is 46-47, something like that. Very pretty model. See how her upper eyelids are getting close to her lash line? So, this is her 2 days after surgery. Her eyes are more open. Right, you can just see the whole lid. It’s not a whole-sale change, right.

It’s subtle.

Dr. Levine: And that’s the point. You can’t do that without surgery. I think getting people to realize that most of the funny looking disasters they see on the street are from too much filler and too much Botox, will help them realize. Well done surgery, and by the way there are fewer people, surgeons, doing good surgery now, and that’s sort of a positive. There are probably 3 or 4 guys in the city that do the majority of facework. There are more guys doing breast and body and that’s about ⅓ of my practice. I do a fair amount stillof breast augmentation and breast lifts, liposuction, and I actually love doing that stuff but most of my stuff is face, eyes, neck, nose. It is a heavily concentrated procedure. It’s an] 80/20 rule. 80% of facelifts are done by 20% of the surgeons. So, that’s the answer for most of what I do is invasive – surgical. . But I’m not anti-filler, I’m just anti too much filler. In fact, I think– I do very few brow lifts in my practice, right. I don’t do this operation because I think it looks weird most of the time. Whereas, I think Botox or neuromodulator, if we want to be brand agnostic, [is a] great way to kind of give somebody a one or 2 millimeter brightening, opening of the brows. So, I am fully willing to admit that I think that is a better solution than surgery for certain things. I can surgically enhance your lips by putting a little bit of fascia in there or some fat, but I’m all for filler – a little filler to give you some lip volume, yes, you don’t need to go under the knife for that…that’s a no brainer. But certain things just need surgery. They just do.

Do you have a lot of people who come in and, I’m curious about this because I know somebody who I think had an issue with this, where they got a surgery pretty young, maybe like 21, and I think now they are 28, and they have just had so much work done. I just kind of wonder, when they go to a doctor – I’m almost like pissed at the doctor that they would do something. I look at him and I think, you are clearly someone who has done too much. Essentially, he has body dysmorphia and has no idea and I’m sure you deal with that all the time. Also, maybe knowing that if you say no to someone, they are probably going to go to someone else who says yes, like it’s a really tough...

Dr. Levine: So, everything you said I completely agree with. I am lucky, I don’t operate on anyone I don’t want to, and I tell people no all the time. All my patients come from word of mouth so, I’m lucky. Most people [who] come here want surgery. They didn’t find me on the internet, they come here like “you operated on my friend Jen, and “I love the breasts, that’s what I want.” And I’d say a third and a half [of patients[I say no to. Sometimes I get weird vibes, sometimes I don’t think I can make them happy, sometimes I don’t think they’re ready, um, or it might be it just won’t look good on them. Uh, so the answer is yeah, I think this of that doctor too. I think if you have a friend who has done too much, that doctor should be held accountable. Um, but you brought up a good point, now what are you going to do with this person who is sitting in your chair, and you’re like, I know if I say no, they are going to go somewhere else. So, the things I do are, I say things to them like “I am telling you no which means I am turning down a fee. Right, you are offering me money and I am saying no. Please understand that that means that I think this is a bad idea for you.  There is a 100% chance that you can find someone else to do this. I know that. I am telling you for free, –donate your money to charity, save it do something else with it – this is not a good idea, please stop. So, I’ll say something like that  We are talking like honest people here, this is how I make my living and you are begging me for surgery and I am saying no so that’s got to ring true to you. I’d be lying if I said that there haven’t been times where I have done sort of placation things for people. Someone I really like or someone I have known for a long time, and who I think is someone who sort of just wants something. I’m afraid that someone else is going to do too much…I think they basically don’t need anything but I know if I do nothing that they’ll end up hurting themselves so I’ll do something minor. That may not be the thing I am most proud of, but that exists, these sort of placation operations. Again, I don’t think that’s the greatest thing to be advertising, but if I’m being totally honest…it’s [a] rare [thing for me to do.] One or two times a year  I’ll do something that is like – by the way, take it on the low level. The person who is dying for more filler, and they already have [a lot in] and you put in a tiny little squirt, it’s not going to hurt them. I’m not doing that for the money, you’re doing it [because] they’re not leaving here without it and you don’t want…

Well, I dont think that anyone would buy it if someone said they never ever do that. Somebody that’s honest, but it’s like of course. If you told me never ever…

Dr. Levine: Right, I almost feel bad. It’s not the fee. I literally just don’t want you getting screwed up.

Is that something you do a lot though, where someone is coming in and saying “I’m so this, I’m so that” and you’re like no.

Dr. Levine: No I’m really lucky. I have a really awesome patient population. It is rare I get the crazies. People ask this all the time, like, “Park avenue plastic surgeon”… You know, most of my ladies who lunch thing [is] over. The only thing stopping [my patients] from getting surgery –because they almost always want it – t is how long is this going to take to recover. “When can I get back to work?” “When can I get back to…?” Maybe they don’t have a job, maybe they do charity work. They want to know when they can get back to the gym, when they can get back to work, when they can get back to their lives. They don’t have 6 weeks. They want to know *snaps*.  I take care of a lot of women who need to be back at work in a week…they aren’t hiding it at this point. Go back! They are a little bruised, a little swollen still and if someone asks they are like, yeah, my neck was bothering me and I had to get it done before I turn into my mom. Done! That’s it. Those are the best patients. It’s so much nicer when you can own something that you’re doing. You know, I think something the press could probably do to help people in general would be the reaction that people have when you tell them that you are doing cosmetic surgery or even Botox, fillers, or something small. Most of the time, think about it in your own life, you’re a young guy, you’re friends like “I’m thinking about getting a filler.” You say to her, “you know, but your lips are beautiful!” Imagine if you said, “that’s so exciting!” “Who are you going to go see?” Or “That’s so exciting, what made you want to do that?” Imagine if she told you that she was taking this incredible vacation.  Typically, the response is “you look incredible, you look so much younger, what do you need that for?” They obviously…its something that bothers them and they are trying to open up to you and they are not–you think that you’re giving them a compliment, you’re not. There is some sort of jealousy, maybe, of like you don’t want them to do it because you’re missing out or maybe you genuinely don’t think they should. But I think a nice thing for people in general would be to react to people’s desire to have an aesthetic procedure with like, uh, this, “wow! This is so exciting! Tell me about it.”

Yeah. For someone like myself who knows nothing about the world [of cosmetics], what would you say are the most common misconceptions you get?

Dr. Levine: Well, I think one misconception goes back to the original question of what makes one different from the other. It’s the misconception that it’s a commodity. You know, that it’s a Chinese menu of things. Like ah, I maybe want a breast lift, I want a face lift. That’s a doctor, she must be good at it! It’s just not true. I think this is something that truly blends art and science and the fact that you are a doctor and you went to medical school  means that you probably have the science down. But the art, who knows. Plastic surgery is a wide field and there are people with various amounts of certain talent and artistry and I think that it is really important to make sure that you check them out in some way.

What’s the best way to check someone out? Just by looking at their work online? Like, how do you…

Dr. Levine: No. For me, I don’t even put my work online. I mean, I literally won’t do it. The reason I don’t put it online [is] because I want people to understand that there is a privacy here and by the way, it’s so easy to see before and after. Just come and I’ll show them to you. I’m not trying to get your 300 bucks. That’s not the goal. I’m about to show you the most sacred thing I have in my professional life. Right, it’s the reason I don’t post pictures of my kids either and that’s the most sacred thing I have in my personal life. That’s mine. My before and after’s are the most sacred thing I have and my patients who have given me permission to share with other patients understand that they are giving permission to do so here, inside the office. And by–I’m sure I could ask them. My patients are awesome. I think you’ve got to make the effort at least to come in.  If someone is being referred to by another doctor, that’s another good way to know who is good. Then from another patient. Right, especially from a patient who either knows someone who’s had the procedure, has had the procedure themselves, hairdressers, makeup artists. Those are some of my best referral sources, believe it or not.   

So, it is most word of mouth then. 

Dr. Levine: Yeah, yeah. That’s all word of mouth.  It’s kind of impossible to find me on the internet. I mean, if you search for my name, you’ll find me. But,  if you type in “who do I go to for a face lift in New York City”, I don’t think you’ll find me. I know who you’ll find if you do that but I bet it’s not one of the 2 or three busiest guys in the city. You just don’t tend to do that.   The industry determines the closure rate. Right, it’s sort of a dirty thing to talk about, but it’s like what percentage of people sit in this chair and then have surgery. My percentage is very, very, very high and, I think by industry standard it would be 40-50%  and mine is double that or close to it I’d say. And, that doesn’t mean I’m great. That isn’t the point, it’s just a different demo. If I advertise more, I’d probably be busier and my closure rate would go down. All that means is that I don’t have a lot of shoppers. All it means is that “you did my friend Jannis’s so and so, and I want that.” Literally we like, talk about our kids and our families, we get to know each other for a minute, and then, like, I walk out and Courtney comes in and gives them the fees, and they figure out the dates, and that’s the end of it. That’s lovely because there is nothing worse than feeling like a shoes salesman as a doctor.  I’m not going to analyze you and tell you what I think. I just don’t have the stomach for that. If you leave this office feeling worse about yourself than you did when you walked in  then I have done myself a disservice. I have done you a disservice, I have done my practice [a disservice].I want you to leave here feeling awesome. I don’t care if you decide not to have surgery. I’d rather you leave here saying like, “that guy was awesome. He told me I didn’t need anything.” I’m happy to give them more surgery to do if I think it’s good for them but, my fear is somehow that I now give them a complex. I really try to make people feel good about themselves.  I did a facelift [for a patient] 2 years ago and she told me [that] this is the prettiest she has felt in her entire life. I gave her a hug and I said, “that’s so awesome”. You know, it’s not the famous person who I see on TV, and yeah, that’s kinda cool. That’s like a feather to the cap. But this is like, she’s happy every day. I have moved offices recently. I am building a new office that should be ready in September, and I’m renting here for the year and-and my wife is helping me move. My bottom right desk drawer had all these letter from patients. and she opened them up and she’s like, what is this? She sees a few hundred letters from patients that are not like one liners. Like, three page letters from people talking about how they never felt pretty before, they look in the mirror and they feel happy every day, and these incredible things. . I’m just saying, it turns out that making people feel good about themselves is really, really important. It’s not shallow. It’s not some silly exercising fad. When you look good, you feel good. 

You really have covered everything.

Dr. Levine: My goal, in becoming more forward facing, is I want to be seen as someone who is approachable and easy to talk to and I do think­–I happen to think I am very good at what I do. But, I think that there are a lot of myths out there. One of the things you asked on your sheet, remember you asked about do you think Botox is preventive and is that what most people are doing it for? The fact is, Botox weakens muscle. So sure, technically, my scientific answer is that if I put a bunch of Botox in your forehead then you won’t wrinkle as much, so you won’t get the wrinkles. So, there is some truth to that. It’s a little disheartening to me. That is, I don’t want young people worried about wrinkles.  But it’s nice to know that it’s sort of the whole feel. But, I want people to understand – here, how’s this for a public service announcement, and I like this as an idea. I think people should have plastic surgeons the same as they have OBGYN’s and internists. Like, I think you should have a plastic surgeon in your life who is your touchstone for cosmetic things. You are going to read stupid magazines and you are going to read about this new facial energy-based ultra facial – whatever, and  you see these celebrities are doing it. You want to have someone in your life that you can go to and be like “what’s the deal with this.” Don’t get your [medical]  information from a magazine. Go talk to your plastic surgeon. I don’t think you need to get plastic surgery, I think you should think of your plastic surgeon as, like, someone you hire. In my world, I charge people a consult fee because I don’t want just anyone walking in. So, I make you pay a consult fee but I would only make you pay it once. So once you are my patient you can come in as many times as you want, and I’ll talk to you, I’ll sit with you, and I’ll make sure you are well educated. I run my consultations as if you are going to someone else. I talk to you like I am trying to educate you and if you end up choosing me, great. If you [end up] choosing someone else, I stand by everything I say. [What] I say, I promise it’s true, whether you come to me or go to someone else.  I just want people to know more.

Yeah. Well, hopefully this helps. I really appreciate it.