A Conversation with Beth Collins M.D.

Plastic and Reconstructive Surgeon

Dr. Collins, tell us about your practice.

I’m in private practice in Guilford, Connecticut near New Haven and affiliated with Saint Raphael's and Yale New Haven Hospitals (including Temple surgical center and Shoreline surgical center.)

I am a plastic surgeon with two areas of focus: The first is comprised of reconstructive surgery patients, referred to me by other doctors; the second centers on cosmetic surgery of the face and body.

I enjoy most types of reconstructive plastic surgery - from difficult wound problems to skin cancer reconstruction. I have a particular interest in facial reconstruction for skin and eyelid cancers or trauma, as well as breast reconstruction for women who have breast cancer.

In my cosmetic practice, I see a growing number of men, as well as a range of women from young women in their twenties and thirties who desire enhancements: from non-surgical skin care to breast augmentation, to women in their 40s and beyond who desire any range of aesthetic treatments to improve and restore their appearance using both non-surgical and surgical rejuvenation.

My office was designed with comfort in mind. When I was designing the space, I wanted to create an atmosphere where people would feel relaxed; a place to which they would actually enjoy coming. I told my design team to make people feel as if they are sitting in their living room, rather than in a doctor's office. Although I am absolutely dedicated to respecting a patient's time and minimizing wait times, I am hoping that the time that they do spend here is enjoyable.

My building, Guilford Gatehouse West is a beautiful building that feels like a European village. The space was custom built for my practice and designed to accommodate my patients. I have two exam rooms and a dedicated procedure room to minimize wait time. There is also a room designated solely for skin care, facial fillers, and other non-surgical treatments. It's a lovely space – calm and inviting. Patients like coming here and appreciate the appearance and serenity of the office.

You had the choice to go anywhere in the world to practice medicine. Why did you choose New Haven?

After finishing my fellowship in Atlanta, I decided to come back to New Haven for a number of reasons. I grew up here in the medical community. My father, Dr. Raymond Ippolito, is a general surgeon in town who has had a long and satisfying career in this community. It is the perfect combination of close-knit community in the heart of a leading university setting. I love the small town feel of New Haven, but still am stimulated by the academic edge that comes from my association with the plastics program at Yale University. Working with the residents as a clinical instructor helps me stay abreast of all the evolving technology and practices in plastic surgery. I know with that, I will always stay up to date and on the cutting edge.

How do you define beauty and what are your goals for your patients?

Beauty comes in many forms. When speaking of physical beauty, it is certainly a subjective assessment. My idea of beauty is varied. In other words, there is no "one definition" or even “universal idea” of a physically beautiful person. My goal for my patients is to understand what bothers them about their appearance and to find the best way to improve that for them so that they feel better about themselves.

I have a strong belief that it's always best to aim for a natural look. For aging patients, my goal is clearly defined: to restore the more youthful beauty they enjoyed in their prime and to improve upon that – if they so desire – in a graceful, subtle way. I want my patients to look the best they can, working with what they have and doing all that I can to enhance the physical qualities that give them their own unique beauty. Plastic surgery that looks obvious and overdone is not good surgery; however, when it is done properly, it can take years away from our appearance and bring out our best attributes.

What makes a doctor a good plastic surgeon?

To even begin to be a good plastic surgeon, you need a good solid foundation. This comes in the form of a wide variety of experiences that are offered by one’s fellowship training. I trained at Emory University, which is widely recognized as one of the premier fellowship programs in the world. Emory is home to some of the country’s most talented and innovative plastic surgeons, surgeons who have mentored me as I developed my skills as a plastic surgeon. Having trained at Emory, you are on a level that is beyond the average physician coming out of a residency just based on the experiences that you had there. When you “jump off” from that point, everything you do in practice continues to let you excel and refine your abilities.

Applying that to practice, there are a few elements that are essential in a doctor to place them among the best plastic surgeon. Certainly technical ability is the cornerstone, but there are other more subtle characteristics that, when combined with the finesse of "good surgery," make an exceptional plastic surgeon. One of those things is the doctor’s ability to interact with the patient to truly understand his or her goals. A good plastic surgeon will spend ample time in consultation to discuss the areas that trouble the patient. Each patient is unique - and shouldn’t be approached in a routine, one-size-fits-all manner. By considering each patient’s individual needs, the surgeon develops a good treatment plan, making sure that the chosen procedure fits his/her desires. That time you spend with your patient - just talking to them and understanding what they want - is indispensable to achieving good results, avoiding unrealistic expectations, and effectively tailoring your plan to really fit the goal of the individual patient.

Seeking plastic surgery is still considered by some to be an unnecessary vanity. What is your viewpoint in this regard?

I have met only a few people who feel this way. Certainly these days, plastic surgery, in any form - be it reconstructive or cosmetic - is much more mainstream. Having said that, I have had occasion to have someone tell me that plastic surgery is incongruent with the feminist movement, their message being that women should love themselves within, and not worry about outward appearance. I would say to those people that the two are not mutually exclusive. Just because you want to make the most out of your outward appearance…that doesn’t mean that you don’t have inner confidence and self worth. I agree that it is important to be grounded and to understand that your entire self worth cannot be based upon what you look like…that it also encompasses a cultivation of the mind and soul. Having said that, I, and the majority of the rest of the world, think that it is not only acceptable, but also necessary to present yourself well.

We do this already when we have our hair styled, buy nice clothes and shoes, and wear make-up. All these things yield a first impression that can affect our daily interactions. The subtle changes that cosmetic surgery provides can give a person a boost of self-confidence that can make very real changes in the ways in which they interact with other people. Recently a study out of Harvard revealed that people who were “better looking” were promoted more readily, hired more frequently, and paid higher salaries than those who were deemed less attractive. Right or wrong, this is a reality in our culture …and may even be a universal characteristic of humanity itself.

I have a feeling that this is not only a function of the way other people see a more attractive person, but also how that person feels about himself or herself. When you feel good about yourself, you are more effective.

There are critics of plastic surgery who believe that we should just accept the aging process and avoid cosmetic procedures entirely, and that is certainly one viable way to look at the issue. But the essence of feminism and personal empowerment implies freedom of choice, right? As such, I don’t think one person should decide what others should or shouldn’t do about their physical appearance. Some individuals are unhappy about their changing face or body over time and want to do something about it, and there’s no doubt that when you feel good about the way you look it impacts your outlook and sense of self in numerous ways. My experience with patients who have elected to undergo a cosmetic procedure has made it clear that physical transformation is a positive thing and that my patients are well informed and feel good about their decision.

What about the sentiment expressed by those who think we should not interfere with the natural aging process?

Those who believe we should all age gracefully and hold the view that it's superficial to seek physical improvement via surgery have to realize that their view is simply an opinion. Certainly this is a good option for some, but that doesn’t mean it's the only opinion or the only option. The point is not whether you should or shouldn’t choose cosmetic surgery; the point is that each of us should have the freedom to make the choice that we believe is right for us. It’s a personal decision and I feel that it’s a good and positive thing to be able to offer that choice to my patients.

Beyond personal choice, do you think it is healthy to want to take control of your physical appearance, as opposed to accepting the changes that inevitable occur as we age?

I think it is healthy and normal to want to look your best. I think that critics of plastic and cosmetic surgery have negative feelings about it because of what has been presented in the media. We see lots of extreme examples of either drastic plastic surgery in which a person completely changes her appearance, or tries to make herself into a Barbie doll or a cat, or some sort of crazy thing. In addition, we see so much on the Internet about botched plastic surgery. You have to understand that this is not the average plastic surgery patient and a lot of what you are seeing out there is taken out of context. The media does not present the average woman, who has had three children and has some excess skin on her abdomen and hanging breasts -  a women who feels self-conscious and would like to restore her shape. You don’t see the woman who is getting older and has a tired look all the time who comes to have a facelift to refresh her appearance. No news team goes out and shows the good work performed by plastic surgeons all over the country who reconstruct breasts after mastectomy to make women who are going through this horrible time in their lives feel a bit better about themselves.

My world of plastic surgery is very different from that seen on television with its reality shows and shock value media campaigns. My world of plastic surgery is populated with a group of very normal men and women who have identified areas that they would like to improve and want to take the necessary step to do so.

Besides an improved physical appearance, what other benefits do you see in your patients who have undergone cosmetic or reconstructive surgery?

Of course, they see the physical changes and are pleased about the improvement in their appearance. As their doctor, I share that excitement and find it one of the most gratifying aspects of the work I do. Other benefits are more intangible, but are often far-reaching. For instance, many of my patients tell me that they feel more self-confident and relaxed because they’re no longer self-conscious about an aspect of their physical appearance that has concerned them. They say that they feel more comfortable interacting with others, more effective in the workplace, and empowered because they identified a concern, decided to do something about it, and took action.

Of course, for my patients who have undergone reconstructive surgery, restoring something that has been lost is healing on so many levels. Some post-mastectomy patients do not choose to undergo reconstructive surgery, and that's absolutely their choice. Others feel a desire to regain what has been lost, and for these patients reconstructive surgery is both meaningful and beneficial. Again, what’s important here is that I want my patients to have choices and to make the decisions that best suits their individual goals and desires.

How do you approach facial procedures?

I'll start by saying that I love doing facial plastic surgery. It is high intensity work that demands focus, extensive treatment planning and decision-making…and it’s very rewarding. My goal is to enhance the face and bring out the best in my patient without overcorrecting or doing more than needs to be done. We’ve all seen individuals who have obviously had a facelift and have an unnatural appearance. This would be completely unacceptable to me. I believe that when we intervene with cosmetic surgery, our goal should be to create and restore a natural appearance. Each face is different and I carefully analyze each patient to determine the best way to proceed.

When I look at somebody who is interested in facial rejuvenation, I divide the face into thirds. The upper third is the brow and eyes, the middle is the midface - which has the cheeks and nose and those lines that go down the sides of your nose (the nasolabial folds) - and the lower third is the jaw-line and neck. People age very differently. Some people show signs of aging only in their neck and jowls; some have a perfect neck, but large bags and dark circles around their eyes. Obviously, if there is not a problem in one of the areas, it does not need to be fixed.

I divide the face into these three separate areas because they are distinct areas that need to be evaluated when I’m considering the precise type of surgery that needs to be done. By doing this, I can get an idea of the extent of the surgery that I want to do and it is a useful tool to be able to explain to a patient what they can expect in the way of incisions and results. One person may just need upper face rejuvenation in the form of a quad-bleph and endo-brow; another person may need a neck lift and lower face lift.

Some patients present with problems that can be addressed by non-surgical intervention. In these cases, Botox and fillers can be a very powerful tool in refreshing their overall look and appearance.

What types of non-surgical treatments do you offer?

I think that good skin care is the foundation of maintaining a youthful appearance. To that end, I carry several lines of prescription grade skin care that have tangible effects on improving the quality of the skin. Going a bit deeper, I am a big proponent of neurotoxins (Botox) and fillers (Radiesse, Juvederm, Sculptra). Any patient who is interested in facial rejuvenation that calls for using a filler and/or Botox will be treated in exactly the same way that I treat my surgical patients. They will be evaluated on an individual basis to come up with a treatment plan that fits their needs and desires…and budget. Then I do all of the injecting myself. For younger patients, as well as those who aren’t yet ready to consider a surgical procedure (such as a facelift), facial fillers are an excellent option.

There are many non-plastic surgeons offering Botox and fillers: how would you advise someone who is looking to get injectables?

I think that there are lots of really talented people out there who are getting really great results with the neurotoxins and fillers. There are P.A.s and nurse practitioners who are really talented and there are dermatologists and other plastic surgeons who are really talented. What I tell people about this subject is to find a reputable person who is affiliated with a physician (if they are not one themselves). Make sure that they are using FDA approved products…beware of black-market Botox (make them show you the bottle…there is a watermark that lets you know it is the real deal!) Finally, listen to your friends. They are the best judges of who does a good job. Price is usually not a good way to decide. Cheapest is not always best. Sometimes cheaper prices mean that you are not getting the good stuff (reiterating my previous statement…beware of black-market Botox!)

Do you think it is better to go to a plastic surgeon to get fillers and Botox?

Well, I would refer to my previous statement. There are lots of talented people out there who can get good results. The advantage that you get when you go to a plastic surgeon, or someone affiliated with a plastic surgeon, is that they are going to be willing to tell you when you have gone beyond the point that a filler is going to give you benefits. I often repeat the commonly-heard saying, that the man with the hammer sees the world as a nail. Unfortunately, not everything is a nail. This is true, as well, for someone who cannot do surgery when it is needed. They are going to continue to use what they know and fill problems that would be better treated with surgery. Plastic surgeons and their affiliates (i.e. a PA or nurse who is doing injections under the supervision of a plastic surgeon) will have the objectivity to be able to tell you when you need to proceed to the next level. By seeking a plastic surgeon to do your fillers, you will avoid the “puffer fish” look that we all fear!

Body procedures are sought by many who feel their bodies are out of proportion, as well as by those who have had weight loss surgery and find themselves left with a significant amount of excess, hanging skin. How do you determine what is best for these individuals?

Each patient seeking plastic surgery of the face or body has to be evaluated and treated as a unique individual. Breast surgery is a classic example of a procedure that can be performed using a variety of techniques, and the best surgery takes into account the patient’s age, body type, physical condition, and specific needs. There is no one right way that works for all patients, and this is definitely the case with body enhancing or contouring procedures.

What can a patient considering an elective cosmetic procedure expect during the first visit to your office?

The initial consultation is very important. It’s the time for a new patient to express concerns and identify what they don’t like about their appearance. It’s the opportunity to tell me what expectations they have and what outcome they desire. It’s also a time for me to ask questions and listen carefully in order to understand what matters to this particular individual. Essentially, you can consider this initial visit to be a time of discovery and interaction: looking at options, discussing possibilities, identifying the solution that’s in my patient’s best interests, and helping them make an educated and informed decision.

It's also a time for me to ascertain who my patient wants to be a part of his or her designated support team. It may be certain family members, a partner, or a special friend or two. I invite these individuals to be part of the consultation process, if my patient so desires. All patients preparing for, and recovering from, surgery need and deserve help and support. The better their caregivers understand the process, the better care and support they will be able to provide – both before and after surgery.

I don’t take any aspect of this lightly.  I'm a doctor and there’s a quality of seriousness and a continual sense of responsibility that goes along with the work that I do. I’m evaluating and determining how I will safely and competently respond to a patient’s realistic expectations and hopes.

This part of the process is a significant part of why I like coming to work. It’s about getting to know what changes they are looking for and helping them attain their goal. Each patient is an individual and deserves a unique, unhurried conversation and the opportunity to explore options in a welcoming environment. I have a wonderful staff of experienced professionals and together we make sure our patients get the care and attention they need throughout their time with us.

You are in the process of developing a center that is specifically for breast care, both for elective and reconstructive patients.

Tell us about the vision behind this endeavor and what benefits it will have for the patients you will serve there.

We already do many elective and reconstructive breast surgeries, since breast surgery is one of my areas of specialization and an area of plastic surgery that is a true passion for me. The idea is to have everything that’s needed for breast cancer patients in one place and under one roof – to meet their medical needs, as well as their emotional and practical needs.

Currently, the vast majority of breast cancer patients must go from place to place as they negotiate a complicated process of decision-making and treatment. They typically see numerous doctors – a family doctor, a general surgeon, and other specialists - and they often have imaging and lab work done in different locations, as well. They are running from place to place during a time of stress, when big decisions and many arrangements need to be made from the beginning and even after the physical recovery phase.

We are developing a breast cancer care and treatment center of excellence, in which all necessary and relevant specialists, counselors, patient educators, and technicians will be available for our patients. A patient will be able to make an appointment to meet with the general surgeon who will do their cancer surgery and then meet with me to discuss their reconstructive surgery – and they will be able to see both of us during the same visit. It’s distressing that many breast cancer patients are still unaware that they can undergo reconstruction surgery as part of their healing process – surgery that often can’t be done later. We want to make sure they have all their choices laid out for them so that each patient can decide what they want to do with regard to reconstruction.

Each patient will also have someone who manages and oversees their care – a point of contact they can depend on if they have questions or need assistance. They will receive highly personalized attention by a team of professionals who work together to make sure they receive the best possible medical care and support in an environment that's comforting and convenient. They will be able to have their images and lab work done, have access to counseling, see a bra-fitting expert, and have the option of attending monthly breast cancer support group meetings that will meet on the premises. It's going to be a very special place – a safe, medically excellent, and welcoming place for patients who deserve the best possible care and support.

Thank you, Dr. Collins.

Thank you!