A Moment with...Dr. Richard Baxter

Dr. Richard A. Baxter approaches new patients with the warmth of an old friend. He's one of the most established plastic surgeons in Washington State, having performed over 2,000 breast augmentations in ten years of private practice. His philosophy is to stay on the cutting edge of technology; he performed the first live breast augmentation on the Internet and also introduced Ultrasonic-Assisted liposuction to the Northwest. He is the leading expert in this new field. As you can imagine, his time is always in short supply. He took a few minutes to answer some questions.

BI411: What originally interested you in plastic surgery?

Dr. Baxter: That goes back to my decision to go into medicine in the first place. I started out in college as an art major. I realized fairly quickly that even though I had talent in that area, that wasn't going to be the best career option for me. I also had aptitude in the sciences, so I ended up shifting gears to go into medicine because I thought I could do some good for people as well. During the course of residency training in surgery, my eyes were opened to the whole plastic surgery world and realized that I could apply whatever artistic talents I had to the practice of surgery and benefit people at the same time. It came full circle for me, but it was something I didn't see going in.

BI411: You found a way to blend both sides of the brain.

Dr. Baxter: Yes. Art is a great discipline. I have it as a serious hobby now. What I really love doing is figure drawing, which is an interesting discipline because anyone can look at a drawing of a human body and tell whether it's right or not. They may not be able to tell you what's incorrect about it, but they'll know whether it's right or not. So all the subtle things you have to do to make it anatomically correct and artistically interesting as well intrigue me.

BI411: Under what circumstances should a woman not have breast augmentation?

Dr. Baxter: That's a tough one. There's a certain amount of self-selection that goes on. By the time you show up in the plastic surgeon's office, you're pretty well motivated. I don't think there's a perfect way to select people out who are going to be disappointed with the results, but if you know there's some expectation of specific, secondary gain - a change in relationships, or something else is going to change, that's a red flag. Those positive changes often do occur, but you would certainly not want to hold that out as some sort of guarantee. You look for people who are going through stressful situations in their life, where a lot of other things are changing at once and throwing surgery into that mix might complicate things.

BI411: What should a woman expect during her first consultation with you?

Dr. Baxter: We go over a brief medical history and make sure there's no medical condition that's going to complicate the surgery and influence our decisions. They'll spend quite a bit of time with my nurses who are very well informed on the subject. We go over all the different options and I like to start talking about what they're feeling about implant size is going to be. One of the most difficult issues is nailing down what size you want, so we spend a fair amount of time on that as well.

BI411: In the course of interviewing them, do you prepare them for the potential emotional roller coaster they may face before and after surgery?

Dr. Baxter: We have a program that prints up a very detailed package that they get before their pre-operative visit - it has all the informed consent materials in there. It also has a lot of information about what to expect. There's a chart in there that shows them that it's normal to go through a phase of questioning your decision, buyer's remorse and the blues that can occur shortly after surgery, and it also shows that they're going to get through that. It helps to know that's a normal thing and if you're prepared for it, everything's a bit easier.

BI411: The fastest growing part of the population that is using the Internet now is women, between the ages of 18 and 40, which also is the approximate demographic of women who have breast enhancement. What do you think of the Internet as a form of referral in place of the more common word of mouth?

Dr. Baxter: The reason why more women are using the Internet is because it's a great way for women to network and share their experiences with each other and that's the information you can't necessarily get from a plastic surgeon's office. You really want to know from other women who have gone through it what their experience has been. That's what I think the Internet is really wonderful for and why some of the sites that facilitate that are so successful. The Internet is a great opportunity for plastic surgeons to provide educational resources as well - you can put a lot of detail in there and that way you have more informed patients before they even show up in the office.

Of course, it's easy to get overwhelmed and try to over-interpret the information that you get. Women who try very hard to find a whole series of subjects with before and after pictures who are the same height and weight, the same cup size, and they're trying to use that information to make their own decision and it's really not something that translates very well. You have to be prepared to start from the beginning again in the consultation with the plastic surgeon.

BI411: I see that you were involved in the first live webcast plastic surgery video (baxterplasticsurgery.com/video_main.htm).

Dr. Baxter: That's right. We got involved in that unexpectedly. A few years ago, we noticed that there were some individuals who had announced that they were going to do a live webcast and it was going to be the world's first live plastic surgery webcast. It was obvious that a breast augmentation was going to be the type of case selected, since there's so much interest in that among women who are using the Internet. My concern was the people who announced that they were going to do this were really using it as a promotional too instead of an educational tool. I really wanted to set the precedent that this is something that should be done tastefully, it should respect the patient's privacy and should really demonstrate that it's an educational resource and not something that should be given away as a contest prize or used to promote any particular surgeon.

We were able to get one of the implant manufacturers to sponsor it because of those reasons - they had an interest in having it done tastefully. It was quite a project! It was a very gratifying thing to do; we've had a lot of wonderful feedback from it.

BI411: On the subject of the Internet, one of the ways we market our company is we guerilla market. We have a roomful of "computer geeks" that get on the Internet and find different chat rooms and message boards that are specifically geared towards breast enhancement. There's hundreds and hundreds of them out there. They'll chat in the rooms and put in a little advertisement about our site, "The most heavily searched site on the web for breast enhancement, breastimplants 411.com" with a little link on it. The women will click on the link, and boom, there's our site. One of the things we've noticed from doing that is there are pockets in the country where plastic surgery, especially breast augmentation, becomes an obsession with some women. They'll talk about 5, 6 or 7 other operations they want. Of course, a famous case is the Lion Woman. Do you find any obsession in the women you treat? And if so, how do you deal with them?

Dr. Baxter: Interestingly, I don't see as much of it as there probably is - maybe people in Seattle are a little bit more conservative and not as open about their plastic surgery. I don't know that there's any good way to recognize it in advance. After a while you develop a bit of an instinct for these things. I think a lot of plastic surgeons, myself included, don't necessarily realize it until you're 3, 4 or 5 cases into it with the same patient. You have to sit down and try to get a better handle on what their goals and expectations are. There is a point where you have to say, "I just don't think it's a good idea for you to have any more surgery."

BI411: The unfortunate thing is, some of these women will go out and find any number of doctors who are performing these surgeries that shouldn't be - ENT's dentists, dermatologists, who are very willing to do this. It puts a big burden on board certified surgeons because you end up taking the heat for it. In Oregon, whose governor is a doctor, they just passed a bill that allows dentists to perform facial surgeries in their offices. Now they're approaching local hospitals trying to get privileges there and of course, the hospitals are saying no, due to legal consequences. Is Washington experiencing anything like this?

Dr. Baxter: To some extent. There was some interest on the part of dentists to expand their practice a few years ago. I don't think it was successful. I just wonder why somebody would try to shift what their field of training is and go into something new. Plastic surgery is an advanced specialty. The training is very similar to what a brain surgeon or a heart surgeon goes through. There's a strange perception that it's something that a doctor can pick up after a couple of weekend courses. The fact that non-physicians would be willing to take on the risk and challenges that go along with that is pretty shocking.

BI411: Ironically, these are the guys who are advertising the most aggressively. Here in Los Angeles, we have dentists advertising plastic surgery on billboards, or park benches!

Dr. Baxter: I think there's an inverse correlation between the flamboyance of your advertising and your real qualifications and talents.

BI411: Besides for board certification, what should a woman look for in a plastic surgeon?

Dr. Baxter: Specific experience in the procedure that the patient is thinking of having done. There's no substitute for that. When I was early in my practice, I was very confident in my abilities and did good work, however, ten years later, I know the judgment I now have is better and overall I do better work now. One thing I try to discourage people from is reading too much into things like before and after pictures. You can't necessarily expect doctors to pull out pictures of their lousy results and show them to you. Hopefully what you're seeing is a good example of the surgeon's best work. If the surgeon thinks it's good work and you don't like the way it looks, that's certainly good information. With references, you can't expect them to put you in touch with someone who's unhappy. Ultimately, it comes down to a gut feeling - if you've checked out their credentials in terms of board certification, hospital privileges and experience, then you have to feel that this is somebody you can trust and relate to. It's a lifetime decision - you want somebody who's going to be there to take care of you down the road if anything needs to be taken care of.

BI411: Is there anything that would raise a red flag for you in looking for a surgeon?

Dr. Baxter: I tend to be turned off by advertising - people who are offering promotional discounts and that sort of thing. Assuming you've done your homework in terms of credentials, after that it just comes down to a matter of trust.

BI411: Do you find yourself favoring certain types of procedures or techniques over others?

Dr. Baxter: I do have a fairly strong set of preferences. One of the things I've been doing over the past year is sending a survey to all my patients, between three and six months out, asking them to rate their results according to list a specific parameters. That is confirming my belief that the type of implants does make a big difference in the outcome. I like the smooth, round implant. I'm not a fan of the teardrop, anatomical implant. The reason is the smooth implants feel a lot softer. The move a little bit like a normal breast does. The shaped implants need a textured surface to keep them from rotating out of position and that results in a very stiff, artificial feeling breast. I've had many patients who have had those implants put in elsewhere and when we switch them to a smooth implant, they feel their breasts feel much softer and more natural. I'm biased in favor of that based on my experience. I also feel muscular placement is very important. A lot of women will get a more natural appearance in terms of the slope at the top of the breast. Statistically, you're less likely to get a capsular contracture and I would like to avoid dealing with that if I can. Also, mammograms are more complete - radiologists I work with tell me they get better mammograms when the implant is behind the muscle.

One of the big problems with saline implants is ripples. There's a lot of discussion in how to prevent ripples and how to deal with them when they occur. Obviously, going under the muscle helps, but not so much for the bottom and side of the breast. What I've had some success with lately is grafting alloderm in there, which is a collagen type material. It reinforces the capsule around the implants. It disguises the ripples a lot better. That's a pretty new technique - there are only one or two other surgeons in the country who are doing it.

BI411: Is there a myth in plastic surgery you would like to dispel?

Dr. Baxter: The myth is that it's a simple thing; that you can shop for plastic surgery the way that you can shop for clothing at Nordstrom's. You really have to do your homework and understand that there's a difference between a board certified surgeon, who's put years of training to dedicate himself to the craft, and somebody who's learned it in a weekend course. It is real surgery and it's something that people need to understand is a very important decision.

Dr. Baxter is a surgeon, artist and scientist, dedicated to the medical and aesthetic perfection of each patient's surgery. Over 2,000 women have engaged his skills and are the happier for their trust in him. You can contact his office at (425) 776-0880.

Visit Dr. Richard A. Baxter's profile on Breast Implants 411