Dr. Wilner's Makeover: An interview with Manhattan plastic surgeon Konstantin Vasyukevich, MD

Many thanks to Konstantin Vasyukevich, MD, a facial plastic surgeon with a Park Avenue practice a block and a half from Central Park in New York City. Dr. Vasyukevich specializes in rejuvenation rather than reconstructive surgery. In addition to facelifts and other surgeries, he also offers Botox and fillers. These strategies serve to make people look younger and improve their confidence and self-perception. There's no medical indication.

During our 25-minute discussion, Dr. Vasyukevich answered all of my questions about plastic surgery and even did a free consultation! Apparently, should I be so inclined, multiple fixes are available for my well-worn visage!

Dr. Vasyukevich has patients who come to see him from all over the world, including Australia and Indonesia. For those who can't travel to NYC for their plastic surgery, Dr. Vasyukevich offered tips on choosing the best local plastic surgeon who can offer procedures and surgeries to help achieve a more youthful appearance.

To learn more about Dr. Vasyukevich or to schedule an appointment, please go to his website: https://www.facialartistrymd.com/

Or call: 212.380.3634

Follow on Instagram: @dr_konstantin

Bonus Poll Question:

1.  Which procedure would you recommend for Dr. Wilner?

a) Botox for forehead wrinkles

b) Blepharoplasty for eyes

c)  Facelift

d) Necklift

e) All of the above

f)   None of the above

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Transcript

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[Andrew Wilner, MD] (0:10 - 1:37)

Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. Today, I'm pleased to welcome Dr. Konstantin Vesukovich, a leading expert in cosmetic surgery. Truth be told, I'm definitely looking for some free advice here. But first, a word from our sponsor, locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory answers your questions on their website, podcast, webinars, videos, and they even have a Locums 101 crash course. Learn about locums and get insights from real-life physicians, PAs, and NPs at locumstory.com.

And now to my guest. Welcome, Dr. Konstantin. Thank you, Dr. Wilner, for your kind introduction. All right, Dr. Konstantin, now you are a plastic surgeon specializing in facial cosmetic surgery. So how does that happen? You know, one day, you got that letter, right?

You got accepted to medical school. And then like 100 years later, right after training, you turned into a plastic surgeon. So walk me through that.

How did you decide to become a plastic surgeon? And what is the required, it's not a six-week YouTube course, right? So explain how you get there.

[Konstantin Vasyukevich, MD] (1:38 - 2:35)

Right. So of course, just like all of us, I made a decision in medical school, and I always wanted to do surgery because I felt this is something I'm good at. And I also had this, like, always felt that I have a good sense of aesthetics, and I am a fairly artistic person.

So I just put two together, and they turned out to be a perfect match. There are two tracks how one can become a plastic surgeon. One is from general surgery residency track, and typically, person becomes a general plastic surgeon.

And another one is comes from otolaryngology head and neck surgery track and facial plastic surgery, which is my specialty. That's where you end up. So otolaryngology residency after medical school, five years, and then an additional year of facial plastic surgery fellowship.

So that's this, that specialized training.

[Andrew Wilner, MD] (2:35 - 2:46)

So four years of college, four years of medical school, five years of general surgery, one year of plastic surgery fellowship. And then you're ready to go to work?

[Konstantin Vasyukevich, MD] (2:46 - 2:59)

Five years of otolaryngology, and then one year of facial plastic surgery fellowship. Yes, that's, that's correct. So I, I'm not, it's too scary.

I'm not even doing the math. I'm not putting it all together.

[Andrew Wilner, MD] (3:01 - 3:08)

Well, just to say that you've had a lot of that, even before your first day at work, you've had a lot of experience.

[Konstantin Vasyukevich, MD] (3:09 - 3:22)

Oh, absolutely. Yes. As you know, surgeons are very, very well trained.

So before somebody gets to do actual surgery on the real patient, there's a lot of preparation and a lot of training goes into that.

[Andrew Wilner, MD] (3:23 - 3:30)

Can you give an example of a few types of cases? What, what might, what might you do?

[Konstantin Vasyukevich, MD] (3:31 - 3:57)

So my specialty is facial rejuvenation and practically any surgery on the face that would make a person look younger. The most effective procedure, facial rejuvenation procedure is a facelift or a face and neck lift as we like to call it. And then it followed by blepharoplasty, which is a rejuvenation of the eyes, brow lift, and a number of non-surgical treatments such as Botox, fillers, or maybe skin resurfacing.

[Andrew Wilner, MD] (3:58 - 4:01)

So the concept is to look younger.

[Konstantin Vasyukevich, MD] (4:02 - 4:04)

That's correct. Yes.

[Andrew Wilner, MD] (4:05 - 4:15)

All right. So, well, how does somebody know if they need to look younger?

[Konstantin Vasyukevich, MD] (4:16 - 7:07)

Right. That's, that's a very good question because nobody really needs to look younger unless they feel it. So this is the specialty where there's really no medical indications.

And some people in a very advanced age, they can feel, I look great. So they absolutely don't need cosmetic surgery as long as they're happy with their appearance. On the other hand, some people can go to a mirror, look at themselves and say, I'm kind of not looking good today.

Right. And it just starts the day on the wrong foot and it affects them. It, for many people, it's affecting their confidence.

It's affecting their self-perception. And those are the people that would benefit the most from cosmetic facial rejuvenation procedures or surgery. So typically, and this question comes up a lot when people say, well, when, like, I know at some point I'm going to get cosmetic surgery, right.

Because I know I'm going to be aging and I just don't want to, to watch my face every day, getting older and older in the mirror. But when do I stop? When do I start thinking about getting a facelift?

And a good test that we tell people to do, well, let me say first that of course, the easiest way to find out would be to go to a plastic surgeon and have a conversation, right? So right there, you would have an answer. But of course, we want to take matters into our own hands most of the time, or, or at least many people do.

So how do you would know that you might benefit from cosmetic surgery? So a very simple test. I tell my patients, you go to a mirror, you put your fingers in the and just lift your face so gently.

It's very important that you're not pulling, you're not stretching, you're not making your eyes look slanted or, or pulling your lips up. Just, just a gentle lift. If you say, aha, that just looks perfect as you do it, then you might be a candidate for a facelift.

If you do this and you say, well, I see no difference, right? You absolutely don't need to do it, right? And that actually a good test because it, it's a, it's a double benefit.

So first you have a sufficient amount of facial laxity that ages you, right? So when you lift your skin, you see that laxity going away. Immediately you feel like your face looks so much younger and so much more aesthetically pleasing.

And the second aspect to this is that somebody's self-perception, how people see themselves. If they see themselves just looking good the way they are, no matter how, how much they pull, they just going to say, well, that kind of makes no difference. I was happy with myself before and I'm okay with it here as well, right?

So like, why should I do this, go through the surgical procedure to accomplish the result that I'm not really looking, right? So that's, that would be a very, very good test that one can do and pull in front of the mirror.

[Andrew Wilner, MD] (7:08 - 7:26)

All right. Before we, before we get too deep here and I lose my opportunity, you know, I specifically put up my 4k camera so you could take a good look at this face and you know, we don't have to, all I want to know is, is there any potential for improvement from your point of view?

[Konstantin Vasyukevich, MD] (7:27 - 10:13)

Well, there are quite, quite a few things. So in general, the aging comes from skin laxity, right? And then wrinkles, or as we call it in medicine, right?

So both of those things, when we improve them, that they improve person's appearance, make them appear younger. So for you specifically, and if you don't mind me analyzing your face, right? And I usually start from top to bottom or from bottom up.

So first things first, those, those lines in those creases in the forehead, right? So you have those deep horizontal creases. For a man over 40, I typically say you should not have a baby smooth forehead, right?

You do need some wrinkles. Otherwise it just appear unnatural, but we don't want the wrinkles to be too deep. So wrinkles, that's like on the palm of your hand, when they start getting very deep, this is something that we want to keep under control.

So a lot of times for men, I say you need to do Botox and Botox of course is what takes care of those lines. You need to do Botox maybe once a year, just to, just to get them looking a little bit more shallow, not cross that line into the territory when those lines are very deep. Now the other type of lines I would definitely recommend you getting rid of, right?

You have those deep creases, vertical creases between the brows and they're called frown lines and frown lines appear when people who like, they don't really frown a lot from just being unhappy or angry as some people would think. A lot of times when people think about something, they have those muscles activated and those lines become deeper. But at the same time, the perception of the person who has those frown lines, right, is not somebody who is very thoughtful, but somebody who is just very stern, very serious, and maybe at times angry, right?

So those lines I typically recommend just getting rid of for good, right? So they are not doing anything there. If these lines, they express certain emotions, the frown lines, they express emotions that we definitely don't want to see on anybody's face.

Next thing, the bags under the eyes and hooded eyelids. This is something that happens with age and blepharoplasty is a procedure that just gets rid of both of those. And of course, down in the lower part of the face that you can see those deep creases, you can see extra skin here, and you see the lines down here running down your neck.

So all those things are signs of aging on your face. And we can pretty much with modern technique, with modern surgery and modern medicine, we can get rid of all of this. And at home, do a mirror test.

Just put your fingers here, lift it up. You might actually like it.

[Andrew Wilner, MD] (10:14 - 10:18)

Okay. So where is your office located?

[Konstantin Vasyukevich, MD] (10:19 - 10:26)

My office is located between Madison Avenue and Park Avenue in Manhattan on 79th street.

[Andrew Wilner, MD] (10:27 - 10:33)

All right. And I'm shy to ask, but is there any possibility of a professional discount?

[Konstantin Vasyukevich, MD] (10:34 - 10:37)

Oh, well, of course we should talk more after this podcast.

[Andrew Wilner, MD] (10:37 - 10:47)

All right. So we can talk. Now, seriously, at my age, is it still something I should consider?

[Konstantin Vasyukevich, MD] (10:48 - 11:41)

If you, again, this is a very personal decision and there is no rules and there should not be rules as far as I believe that somebody has to have cosmetic surgery, right? So there should be no pressure on people either way, making them feel like they have to do something or making them feel like when they do something, they really shouldn't be doing it. So with you, if you're happy with your appearance, which you seem to be from my perception, why do something that's not going to change how you feel about yourself, right?

On the other hand, if you tell me, oh, you know what my whole, like for the past 20 years, I was looking at those bands and it's just, I just can't, they, you know, there's something about them that bothers me so much. I really want to get rid of them. Absolutely.

By all means, you will have your professional courtesy discount.

[Andrew Wilner, MD] (11:42 - 11:54)

Now you did mention what sounded like, I don't know, a half a dozen or so of specific procedures to fix the whole thing. Is that a one-shot deal or is it staged?

[Konstantin Vasyukevich, MD] (11:56 - 12:51)

Some of those procedures you do once in your lifetime or maybe twice in your lifetime, but, but those are very long lasting procedures such as face and neck lift, for example. Most people nowadays, they just do one facelift in their lifetime, unlike in the old days, of course, and pretty much they feel they're done with it. Not to say that the face is not going to continue aging, right?

We cannot stop that process. Other procedures, cosmetic procedures are considered maintenance. Those are something that you have to do on a regular basis.

Botox, for example, that we mentioned in relation to those creases in the forehead. This is something that you have to do somewhere from three to six months intervals. And I tell people who start doing Botox that it's like going to the gym.

If you do it once, good for you, but you're not going to see a long-term effects of it, right? So in order to see the full effect of Botox, you have to do it on a regular basis.

[Andrew Wilner, MD] (12:52 - 12:58)

Is the surgery done at a hospital or an outpatient center or in your office? How does that work?

[Konstantin Vasyukevich, MD] (12:59 - 13:15)

Most cosmetic surgeries today are done either in the outpatient centers or in the office-based surgical center. And I, in my office, have accredited operating rooms. So all the standards, like everything is the same as it would be in any other surgical center.

[Andrew Wilner, MD] (13:16 - 13:18)

Is it going to hurt?

[Konstantin Vasyukevich, MD] (13:20 - 13:35)

So surgery, there's always some discomfort involved, right? So, and you should be definitely preparing for it. Of course, everybody gets pain medications, but anytime we poke somebody with a needle, it's going to hurt.

Yes.

[Andrew Wilner, MD] (13:36 - 13:39)

Is it, is something done under anesthesia or is it local?

[Konstantin Vasyukevich, MD] (13:40 - 14:41)

So most of the procedures, non-surgical procedures, they are done without anesthesia, but we're using a non-increment, for example. So things like Botox or fillers, this is the way that we create more comfort for patients. Surgical procedures are done under anesthesia, but of course there are different types of anesthesia.

So one type that became very popular recently is called twilight anesthesia, or as we call it in more medical terms, it's a local anesthesia with a mild sedation. So this is when surgery is done for a patient who is not completely asleep, but they completely anesthetized with the local anesthetic, so they really don't feel pain. At the same time, they may be dozing in and out because they're getting medications that just makes them feel relaxed and comfortable in sleep.

So we're trying to avoid heavy anesthesia types, like a general anesthesia when somebody is with an endotracheal tube and on a ventilator. So for cosmetic procedures, this really would not be necessary, at least in many doctors' opinions.

[Andrew Wilner, MD] (14:43 - 14:57)

Now, if I'm kind of on the fence about how this is going to look later, did you have like computer modeling where you could generate, it's like, well, if I do this, this, and this, you're going to look like that. Does that technology exist yet?

[Konstantin Vasyukevich, MD] (14:58 - 15:16)

Not at this stage. I'm sure it's going to be coming with the AI capabilities probably within the next 10 years, maybe. It should not be very hard to do, but with the modern technology that we were using up to date, there's just really no accurate prediction how your face would look like.

[Andrew Wilner, MD] (15:18 - 15:31)

So, and what's the recovery, say we do my eyes, they are sagging a bit. All right, so I go in there, it takes, I don't know, an hour or two, right? And I go home and they're all swollen, and how long before I'm back to normal?

[Konstantin Vasyukevich, MD] (15:32 - 16:43)

So with the eyelid surgery, I would say two, three days, you definitely should take it easy. And this is not the kind of procedure where you need to stay in bed and recover. You can do things around the house and go outside, but really no straining activities.

After the first two or three days, you can pretty much go back to your normal life. Just oftentimes people put dark glasses so nobody can see the bruising and the swelling, and they go shopping, go back to just anything they normally do with the exception of a strenuous physical activity, right? So no contact sports.

So soon after surgery, no going to the gym, but just like basic daily living activities would be perfectly fine. We typically take stitches out on day seven after this type of surgery. And after that, we encourage people just to go back fully to their normal lives.

Again, with some restrictions as far as contact sports or physical activity, but returning back to work and back to their normal situation, maybe with a little bit of makeup and using eyeglasses as a way to distract attention from some residual side of surgery. That's something that most people do.

[Andrew Wilner, MD] (16:44 - 16:50)

The face and neck can use some work too. That would probably be a longer recovery period.

[Konstantin Vasyukevich, MD] (16:51 - 17:27)

That is definitely true. It's the magnitude is going to be far greater because we have to take care of the larger area. And usually we take people to take at least one week off for recovery, and just maybe a little bit more would be ideal.

So up to two weeks. And during this time, the bruising, the swelling, and all those initial signs that somebody had a surgical procedure will fade away to the point. If anything is left there, it will be easy to cover it with just a little bit of makeup or some creative hairstyle.

[Andrew Wilner, MD] (17:29 - 18:12)

Now, one thing you mentioned that I'm just a little concerned about, the decision is really very personal and very subjective. I'm happy with my face, or I'm not happy with my face. But as you were talking, it sounded to me like that was more of a psychiatric kind of issue.

And I wonder, do you recommend that, because people who are unhappy with their face might be unhappy with their bodies or their lives or their job or their husband, it may not be just a purely aesthetic issue. Do you recommend that sort of people explore that before getting their face fixed, or is that just kind of up to them?

[Konstantin Vasyukevich, MD] (18:13 - 19:43)

So we obviously, plastic surgeons are not psychiatrists, although we definitely screen for people with body dysmorphic disorder, or people who are just not ready for cosmetic surgery, because cosmetic surgery is quite a journey. So when somebody is depressed, for example, and they feel like a facelift is going to make them feel better, definitely this would not be the right candidate for a cosmetic procedure. Typically, most of our patients that come for facial rejuvenation procedure, they thought of getting this done for at least a year and a half before booking appointment with a plastic surgeon.

So definitely there's a lot of thought and a lot of deliberation and a lot of research going into this. And again, during the initial consultation, we screen for this, because if somebody just wakes up and say, oh, I want a facelift, they go to a plastic surgeon and say, look, can you book me for next week? That's probably not going to be the most ideal scenario for somebody to get surgical procedure and be happy afterwards, right?

So but when somebody thinks about it for at least a year, and they've done all the research, they book consultations with multiple plastic surgeons just to make sure that they find the right one. I think this would be a very safe scenario to do this kind of procedure. And for somebody to be pretty sure that they know what the results to expect, and they will be happy with those results.

[Andrew Wilner, MD] (19:44 - 20:22)

Now, members of the audience are all over the country and some outside of the United States. So it may not be practical for them to come to Manhattan, although there is a nonstop from Memphis to New York from where I am. So I'm keeping that in mind.

But if they want to choose a local plastic surgeon, which just might be more convenient, how do you do that? What should they be looking for? I see you have a lot of plaques behind you, but that's kind of a given, right, that the guy went to school and passed.

How do we get sort of a deeper assessment of whether this is the right surgeon for me?

[Konstantin Vasyukevich, MD] (20:23 - 23:02)

So before I answer this question, let me just correct you. People do travel for their facelift surgery. So I don't advise people traveling for Botox or filler is something that they do on a regular basis.

Definitely, it's better to find a local provider, a surgical procedure that you do once in your lifetime. If ability to travel is within your budget, this may not be a bad idea. And a lot of people like in my practice, they come from all over the world, Australia, Indonesia, and people nowadays, because the world is so interconnected, we're so globalized, when people look for the right plastic surgeon, they look for that surgeon all over the world.

Now, if you do want to stay local and you want to find a local plastic surgeon, what are the things to look out for? Well, you mentioned board certified and being properly trained in a respectable institution. So this is something that must be a given, right?

So without that, I would not recommend even booking a consultation, right? The second step I would say is researching that particular surgeon's before and after photos. And now with the internet and social media, those are pretty easy to access.

It's not like in the old times when somebody had to travel to plastic surgeon's office to flip the pages of that before and after album. And obviously, no consultations, fees involved into going to somebody's website. So if you see those those pictures, and you find somebody that looks like you more or less, of course, we all different.

And you look at the result and you say, Oh, yeah, I can kind of see if I look like that, I would be quite happy with my appearance, right? So that would be a very good place to start. Then of course, you go for a consultation, and you just just make your assessment because you want to make sure that you like the office, you want to make sure that you like the office stuff, you feel comfortable there.

And you connect with your surgeon, which is which is extremely important. This, you know, we call it a doctor patient relationship, right? So it's a it's a two way street, we the patient have to be very comfortable expressing their wishes, desires and concerns to the surgeon.

And the surgeon should be able to explain how the procedure is done what to expect and really help the patient to go through the surgery and the recovery period. So once you you believe that you've found the right doctor, right, so the credentials are there, the before and after looks looks amazing. And you feel like you have that personal connection.

Then I think that would be a very good screening process that will help you to select the right person for you.

[Andrew Wilner, MD] (23:03 - 23:37)

Thanks for now. That was very helpful. One last question.

I think I think a concern some people have and maybe this is from older sort of years ago, but sometimes when people have plastic surgery, it's like, oh, look, she had plastic surgery. She had work done. And I mean, nobody wants to sort of look like they've had plastic surgery, even though they might want to look better.

So how do you balance sort of fixing everything up so it's aesthetically more pleasing without that sort of unnatural look?

[Konstantin Vasyukevich, MD] (23:38 - 25:52)

Right. So this is this is very interesting and very, very important question, because a lot of people up to this day have this misconception that if you get plastic surgery, you will just look unnatural and everybody knows that you had something done. And this is there's absolutely truth to that when you look historically at it.

One thing that you mentioned that nobody wants to look like they had plastic surgery. This is actually untrue, historically speaking. Right.

Because people back in the days, they wanted to look like they had plastic surgery because it was a simple step. Right. This is something that I belong to the upper class of society.

I can afford plastic surgery and I'm going to wear it on my face and I want everybody to see. Right. So that that kind of logic.

Now, of course, as this type of cosmetic surgery, especially facial cosmetic surgery, became more and more prevalent, the tide shifted the other way. So everybody looked at those old fashioned facelift that were proudly done to be so tight and pulled so hard. Faces were pulled so hard and people say, no, it doesn't look right.

Right. It's just it doesn't. I don't want to look like that.

I don't I don't want to go and reintroduce myself to all my friends after having a facelift done. Right. I just want to look like myself, but refreshed, rejuvenated, maybe 10 years younger.

Like I used to look on my pictures when I actually like taking pictures and that caused the change in our techniques. Of course, we always we always adapt. We always create new advanced techniques.

We always innovate. So and the biggest one of the biggest drives for innovation was making sure that cosmetic surgery looks completely natural. So we'll learn a lot of things along the way, like rejuvenating the entire face instead of some parts of the face, not making it look old, preserving some of the natural structures, creating a balance of the facial appearance.

So one part of the face does not look significantly older than other parts of the face. So so there are many factors that went into it. But at this point, I would say when somebody had a facelift that you really should not be able to even not not just see that they had a facelift.

You wouldn't even think that they had a facelift because they just look perfectly normal and perfectly natural.

[Andrew Wilner, MD] (25:53 - 25:55)

Just having a really positive, great day.

[Konstantin Vasyukevich, MD] (25:56 - 26:20)

And well, so the typical scenario when somebody had a facelift, even if the signs of age were quite advanced and after a week or two, they go back to work and the co-workers say, oh, you had such a lovely vacation. You just you look so refreshed. Right.

So that's that's pretty much what what you want to hear when you if you decide to get a facelift and you go back facing your friends and your colleagues.

[Andrew Wilner, MD] (26:21 - 26:37)

Dr. Konstantin, this has been very informative and helpful, and I appreciate your systematic review of the face here and all the potential for improvement. Before we wrap up, is there anything you'd like to add?

[Konstantin Vasyukevich, MD] (26:39 - 27:19)

So, of course, many, many things, but I would sell the biggest thing I would tell patients, don't take your decision lightly to get your cosmetic surgery rights and do your research. There's so many sources now where you can just just access this information firsthand. You can look at plastic surgeons website.

You can go on social media. And we want to ensure that when somebody gets cosmetic surgery, they are happy with their results and they say, oh, I always wanted to look like this and now I'm happy so I can move on with my life and just feel confident and feel good about myself.

[Andrew Wilner, MD] (27:20 - 27:24)

Dr. Konstantin, thanks for joining me on the Art of Medicine.

[Konstantin Vasyukevich, MD] (27:25 - 27:26)

It's been a pleasure. Thank you.

[Andrew Wilner, MD] (27:27 - 29:42)

And now a final thanks to our sponsor, locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency.

Locumstory exists to answer your questions about the how-tos of locums on their website, podcast, webinars, and videos. They even have a locums 101 crash course. At locumstory.com, you can discover if locum tenens make sense for you and your career goals. What makes LocumStory unique is that it's a peer-to-peer platform with real physicians sharing their experiences and stories, both the good and bad about working locum tenens, hence the name LocumStory. LocumStory.com is a self-service tool that you can explore at your own pace with no pressure or obligation. It's completely free.

Thanks again to locumstory.com for sponsoring this episode of The Art of Medicine. I'm Dr. Andrew Wilner. See you next time.

This program is hosted, edited, and produced by Andrew Wilner, MD, FACP, FAAN. Guests receive no financial compensation for their appearance on The Art of Medicine. Andrew Wilner, MD, is Associate Professor of Neurology at the University of Tennessee Health Science Center, Memphis, Tennessee.

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