A Conversation with Dr. Sabbagh

“I don’t want my patients to have an “operated on” look; I want them to look great for their age and to feel confident and positive about their appearance. In many cases, my goal is to “put it back the way it was,” not to make the person into something they aren’t. I never tire of analyzing a patient’s face or body and determining which technique will give the best result for that unique individual.”

Dr. Sabbagh, tell us how you chose a career as a plastic surgeon and came to practice in one of the most renowned surgery centers in the United States.

I knew back in high school that I wanted to be a doctor, when I developed a keen interest in anatomy and science. I was the kid that really liked dissecting frogs! I worked in a hospital during summers after high school and decided to go to medical school. My father, Enrique Sabbagh, MD, was certainly influential in that he has been with Straith for over 40 years, practicing as a plastic surgeon and teaching other doctors who wanted to learn the techniques he had mastered. As a result, I was exposed to the wonderful legacy of The Straith Clinic where I practice medicine today.

However, I didn’t know that plastic surgery would become my specialty area until I was exposed to different types of medicine during my years in medical school. As I was exposed to the various medical specialties, I realized that plastic surgery was the most diverse specialty - encompassing cosmetic and reconstructive surgery, microsurgery, hand surgery, and breast reconstruction surgery – and that it would be an exciting area in which to practice.

I was fortunate to come into practice with other successful and very busy plastic surgeons, because I was given the opportunity to take on a broad range of surgical cases from the beginning. I was doing tummy tucks, implants, and other major surgical procedures, learning and developing my skills in a practice with a terrific reputation. Gradually, the focus of my practice shifted toward cosmetic surgery and that continues to be my passion and area of expertise today.

The Straith Clinic has been in continuous practice since 1936. Can you give us a brief overview of its history?

Sure. It’s a practice with an illustrious history that goes back 70 years - founded by Dr. Claire L. Straith, a pioneer in the field who developed plastic surgery techniques in response to his experiences treating soldiers during and after World War I. He became part of a small, international group of physicians who learned from one another and went on to eventually become founding members in what was to become the American Society of Plastic Surgeons.  Dr. Straith opened the Straith Clinic in 1952 on West Grand Boulevard, in Detroit and his reputation as an innovator and expert in the relatively new specialty of plastic surgery drew patients to the Straith Clinic then, as it continues to draw patients now.

Dr. Straith and his colleagues also helped countless individuals in the auto industry who had sustained accidents in the years before regulations made the factories safer for the workers. In fact, this group of doctors was instrumental in influencing a number of significant regulations that were put in place during the auto industry’s rapid growth.

My father, Enrique Sabbagh, M.D. was a core member of the second generation of Straith surgeons, along with Dr. Straith’s son, Richard Straith, M.D., along with several of their associates, these doctors solidified the national reputation of the center of offering the highest standard of care for plastic, cosmetic, and reconstructive surgery patients. They made the Straith Clinic one of the largest cosmetic surgery centers in the Midwest. They also developed a training program for doctors training to become plastic surgeons and in 1996 the center was relocated to Bingham Farms, MI to accommodate our continuous growth.

The Straith Clinic is now a 12,000 square foot state-of-the-art surgical center, with fully accredited (AAAHC) operating suites, and we focus specifically on aesthetic plastic, reconstructive, and cosmetic surgery. I can say without hesitation that it’s a privilege to practice here. We have an excellent reputation in the medical community and with patients, and I am certainly a beneficiary of the Clinic’s status as a surgical center of excellence. I have hospital privileges at the Straith Hospital for Special Surgery, Providence Hospital, and Beaumont Hospital. I should mention that the Straith Hospital for Special Surgery is a separate entity from the Straith Clinic. The Hospital is a non-profit JCAHO accredited facility with physicians on staff practicing a range of medical and surgical specialties, including plastic surgery. However, surgeons practicing plastic surgery there are not necessarily associated with the Straith Clinic.

We serve a wide spectrum of patients at the Clinic, which reflects the demographics of the Detroit-Metropolitan area and its surrounding cities. In general, the Midwest is a conservative region and our sensibility responds to our patients, most of whom want to look better without drawing attention to themselves. The majority of my patients express the desire to look more like they looked when they were younger. In other words, they’re not interested in looking like anyone else. This is the Midwest way, and it’s in alignment with my belief that my goal as a surgeon is consistent: to help my patients look great for their age, in a natural and pleasing way.

How do you define beauty or physical appeal?

That’s an interesting question. When I look at a person, I’m looking for facial and body features that are in balance. Each individual is unique and looks best when attention is not drawn to any one aspect of their face or body – they just “fit” into their own face and physique. The eye flows from one part to another without being drawn to any feature or body part that’s out of proportion to the whole. In essence, everything flows together and the overall sense is that the person’s look is harmonious and natural. This idea of the features fitting together is applicable to both genders, and applies to patients of all ages. In general, my patients are seeking plastic surgery to attain or restore balance in a part of the face or body that is out of balance. Often, a small correction – to the tip of the nose, for instance…or in the removal of unwanted pockets of fat such as “saddlebags” on the hips – makes all the difference. Brought back into balance with the rest of the face or body, the results are often dramatic in terms of an overall improvement in appearance.

What is your practice philosophy?

Simply put: We’re highly skilled and we’re always evaluating which procedure(s) will yield the best result. We focus on perfecting what we do, always seeking the best outcomes - achieved by our experience, knowledge, finely tuned techniques, and the fact that we always put the patient’s safety first. In addition, it’s important to note that we don’t follow the hype that the media seems to specialize in creating. Just because a procedure or a laser is the so-called latest thing doesn’t mean it’s better, and many of these so-called new tools or techniques are not better at all. Some procedures are tried-and-true with new names and some of the most recently touted methods or types of equipment haven’t been thoroughly researched or tested sufficiently to meet our criteria for implementation.

As a surgeon, I have respect for the human body and for the tissues. It calls for working naturally and gently, causing the least amount of trauma to sensitive skin and tissue. I am consistent in sticking to what really works and what’s in our patients’ best interests. If an innovation is worthwhile, I integrate it into the medicine I practice; if it isn’t, I won’t offer it. I don’t want my patients to have an “operated on” look; I want them to look great for their age and to feel confident and positive about their appearance. In many cases, my goal is to “put it back the way it was,” not to make the person into something they aren’t. I never tire of analyzing a patient’s face or body in order to determine which technique will give the best result for that unique individual.

Are younger – or older – patients coming in to request cosmetic surgery procedures?

Yes, both younger and older. People are, in general, taking better care of themselves and living longer, healthier lives if they do so. And a growing number of my patients are interested in knowing what their options are – both short-term and over the course of the lifespan. Many start younger, with non-invasive procedures that forestall the need for major surgery. They strive to attain their best look and to maintain it, doing what needs to be done when the time is right. This is a good way to go about it.

Younger men and women often start with eyelid surgery, facial fillers, or neck lifts – which enables them to wait longer before seeking a more major procedure such as a facelift. That being said, it’s also true that a growing number of my patients are opting to have their facelifts done earlier – in their 40s or 50s depending upon the way their particular faces age – and there’s no doubt that the outcomes achieved for these patients are often better than if they wait until there’s a significant loss of skin resiliency or muscle tone. Mini facelifts, not quick fixes or “lunch time” procedures, properly performed on the appropriate patient (usually the younger patient) give good results. Clinically, they don’t compare to a traditional facelift, in which the underlying structure of the face is brought back to a more youthful configuration and the skin redraped so that the result is natural and pleasing to the eye.

If a patient has lived a healthy lifestyle and enjoys good health, a facelift can be done much later in life - into the 80s in some cases, and we are seeing an increase in patients in this age group as time goes by. Cosmetic surgery is more acceptable nowadays than it used to be – a beneficial byproduct of the culture-driven desire to look one’s best. It’s satisfying, rewarding work to give a patient what time has taken away.

Which procedures do you perform most frequently?

Well, I have a very busy practice, and do over 200 facial surgeries alone in a given year – with about 70 of them being facelifts and another 60 nose refinement procedures. I also do over a 100 breast enhancement surgeries, and approximately 50 tummy tucks. Of course, I also do brow lifts, Botox®, fat transfer and/or facial filler procedures.

You have a reputation for doing excellent rhinoplasty surgery. What is it about the nose that interests you?

Thank you. First of all, rhinoplasty surgery is the most technically demanding for the simple reason that everyone’s nose is different. Many rhinoplasty patients are under 30, but a growing number of older men and women also request reshaping of the nose. The nose can be refined at 50 – or even 60 – but these procedures are challenging. The tissues weaken and stretch over time, and great care must be taken to do any rhinoplasty surgery. The nose is not just an aesthetic part of the face…it is functional, after all, and needs to “work” properly after being altered.

With rhinoplasty, it’s important not to take too much away; rather, I use great subtlety in technique to achieve an outcome that looks and feels natural. People are very sensitive about the way they look and the noses are a defining characteristic for all of us. Therefore, I’m striving for results that look good without making my patient look like someone else. It’s a fine line. Because I work carefully, my patients typically return to work within 2 weeks. There’s a minimal amount of trauma; therefore, less swelling and discomfort during recovery. Of course, I make sure that patients are well informed about the recovery process. The nose will look better almost immediately, but the final outcome is not seen for up to one year. My patients have to understand the process so that they are able to relax as they heal, knowing that they will get the result they want as the healing process draws to an end.

Do you do corrective rhinoplasty for patients who are dissatisfied with the results they’ve gotten elsewhere?

Yes, although I encourage these patients to first consider returning to the surgeon who performed their original surgery – and to not even consider corrective surgery during the first post-operative year, when healing is still underway. However, many patients are unwilling to return to their original surgeon. If I can offer them improvement, I will do the surgery and have done many corrective rhinoplasty procedures over the years. I also want all of my patients to understand that cosmetic surgery is not an exact science. It’s important for them to have realistic expectations and to understand that improvement does not mean perfection.

Do you get many requests for neck lifts?

Yes, and this is a procedure that makes patients very happy. Women, in particular, tend to be very aware of any loosening in their necks, and frequently express their unhappiness with that obvious sign of aging. They may think they need a facelift, but often they just need a correction to the neck and can wait a number of years before seriously considering a facelift. The neck lift, done correctly, involves tightening the underlying muscles – it’s not just about tightening the skin. To get the best result, I repair the muscle laxity first and then redrape the skin. This gives a beautiful result – and a result that will last for a long time.

Are you getting more requests for cosmetic surgery procedures from men in recent years?

Definitely. Men want to look good too, and many tell me that they want to stay competitive in an increasingly competitive job market. Male patients that see me for consultation commonly request liposuction for their “love handles” and lower abdominal area, as well as eyelid surgery and removal of excess fatty tissue in the chest.

Have facelift techniques improved over the years?

Well, this brings up a couple of issues worthy of consideration. First of all, patients want to look natural and better. Some patients want people to notice the change and if they don’t, the patients feel that they did not get a good result. An expertly performed facelift makes a person look great, but you’re not necessarily sure why. Are they just well rested? Did they get a new hairstyle? The eye isn’t quite sure. What patients need to understand is that some of my best results are the ones that go unnoticed.

Another important point I’d like to make is that plastic surgeons know a lot more than we used to do about how the face ages. Historically, surgical techniques used centered on pulling and tightening the facial skin to eliminate sagging. However, telltale scars behind the ears were inevitable and the overall result looked more unnatural. As surgeons, we are much more scientific about the face now, and have gained an in-depth understanding of the aging process over the years. It’s true that the skin sags, but the face ages primarily because, as we get older, we lose muscle tone and volume. Gravity takes a toll, and the face actually deflates and descends over time, giving the face a tired, worn look.

We have developed advanced facelift techniques over the past decade, in which we focus on restructuring the fat under the skin, jowls, and cheeks. By correcting the underlying structures that support the skin, we can then redrape the skin over a structure that has had its integrity restored. The result is a smooth, elegant face that with its angles and contours beautifully illuminated. When a facelift is done the right way, you should be able to wear a ponytail and not see any scars.

Many patients will get the best outcome with a combination of facelift and fat transfer to restore lost volume to the face. This combats the inevitable atrophy that occurs over time and in many cases works – and looks – better than a lift alone. The trick is to “lift and fill.” This combination of techniques yields the optimal outcome – giving the face a more radiant, youthful, and natural appearance.

Do you do facial fillers?

Yes, and I usually do them myself. I find that many of my patients appreciate the fact that I do their Botox® treatment or administer the filler. And I enjoy the opportunity to establish a relationship with many of these patients, who are often coming to the Straith Clinic for the first time. We also have an aesthetician on staff that does wonderful facials and chemical peels, Fraxel laser, as well as IPL treatments that combat the effects of sun damage. It’s always best to address the aging process on multiple fronts.

What’s your view on lip augmentation?

If it’s not done properly, everyone will know you’ve had it done and many times the results we see in the media are not satisfactory in my view. Lip augmentation procedures must be very subtle or they don’t look good. I always prefer to be conservative, and I prefer to work with hyaluronic-acid based fillers because they’re the only ones that are not permanent and are reversible. Despite the media hype to the contrary, there is no – absolutely no – good permanent filler on the market at this time. If you have permanent filler injected into your lips, you can have problems right away…and you can also develop problems 10 years down the road.

With the hyaluronic acid fillers, my patient can see the results and they will fade over time. Then a decision can be made as to whether more or less filler is desired the next time around. It’s the safest and most prudent way to go – and the only way that protects the patient. Frequently, a patient will decide that she prefers her natural lip contours after all, and that means temporary fillers are the solution. The amount of solution used can be adjusted over time, safely and easily.

Is there a procedure offered at the Straith Clinic that new or prospective patients may not know about?

I would have to say that many of our patients are surprised and pleased to know that we’re able to treat the aging chest area – the décolletage, and aging hands – with Intense Pulse Light treatments that significantly improve the texture and tone of the sensitive skin on that part of the body. IPL or Fraxel Laser® – when administered in a series of treatments – very effectively addresses discoloration, uneven texture, spider veins, and other signs of aging. I like these treatments because they enable a person to have a younger looking face without having older looking chest and hands. The effect is seamless and far more flattering. A sun-damaged chest and hands is a giveaway of aging, and IPL or Fraxel Laser® treatments take care of that.

Dr. Sabbagh, thank you so much for your time.

Thank you!