A Conversation with Dr. Patrick McMenamin

Hi Dr. Mack! How long have you been in Sacramento?

I’ve been in Sacramento since the late 1980s, but I was born and spent much of my childhood living in Navy housing in Honolulu, where my father – a Navy chief – was stationed. It was a great place for a kid: no bathtubs, no seasons, and island weather. Later, we moved to Massachusetts and then, at the end of my high school years, to an area near Washington, D.C.

At what age did you decide that you wanted to be a doctor?

I knew I wanted to be a doctor from the time I was in second grade; in fact, I still have a photo taken of me back then wearing a doctor outfit [laughter.] Not that I had a great start in school. My kindergarten teacher thought I might be mentally challenged because I was a hyper kid, with a strong will and a lot of curious energy, so I guess I wasn’t doing what she wanted me to be doing! But I turned out to be an early math whiz and an intensely self-directed kid. When I proclaimed that I was going to be a doctor, I understood that others thought that was special, which made me feel special… and that gave me motivation to work hard.

Please describe your medical background and the types of procedures you currently focus on.

I had excellent training at the University of Maryland School of Medicine in Baltimore and did my general surgery residency at nearby Union Memorial Hospital. Then I completed my residency at Johns Hopkins Hospital in their highly regarded Department of Otolaryngology/Head and Neck Surgery. When I joined the Air Force, I was assigned to medical duty at the major teaching hospital at Travis Air Force Base near Sacramento. I worked in an academic medical practice staffed by doctors at the University of California-Davis and it was a fantastic experience for me.

After I completed my military service, UC Davis hired me to be their Chief of Head and Neck Surgery, where I was surrounded – as I was at Johns Hopkins – by exceptionally brilliant surgeons who taught me a great deal. We worked on some of the most difficult cases you can imagine, and as a head-neck cancer surgeon, I performed surgeries that often lasted 15 to 30 hour – and operated on 1,265 cancer patients during my head and neck career..

Intense interaction with patients and their families really resonated with me in my early years as a doctor. I actually considered psychiatry in my quest to understand people, life and philosophy, but could not resist the lure of a surgical practice.

There were myriad factors in my decision nineteen years ago to pursue further training in cosmetic surgery after a decade in head and neck surgical oncology and reconstruction. But in my deliberations, one of the aspects I was most reluctant to part with—and was most apprehensive about missing—was simply “doctoring” my patients. After all these years, that’s still my essential desire – to take great care of my patients…to be a true doctor.

Why did you leave successful practice as a head and neck surgeon to pursue your career as a cosmetic surgeon?

I made the decision to switch from head and neck surgery to cosmetic surgery in order to devote more time to my family and to make full use of my surgical skills. And, once again, I was fortunate. I was invited to spend a year in Fellowship with a truly great surgeon (Leslie Bernstein, MD, DDS – a venerated member of the American Academy of Facial Plastic and Reconstructive Surgery), and had the opportunity to perform many surgeries under the guidance of a master surgeon.

I realized during my training that cosmetic surgeons were able to take care of people more intensively, because surgeons I knew were developing relationships with people who truly wanted to improve their lives. I really came to understand that the way we feel about our faces and bodies has a huge impact on how we feel about ourselves overall. Once I began this work, I never looked back. I went into private practice as a cosmetic surgeon in 1990 and continued down my path of intensive learning – liposuction, laser technologies, breast augmentation, and other innovative techniques.

Then when lasers came along, I wanted to learn all I could and laser procedures have come to play an increasingly important role in my practice in recent years. We’re in the 4^th generation of laser technology now, and my patients love the results that can be attained. Laser surgery offers numerous benefits: it’s ideal for those who don’t yet need major surgery, less invasive, and the recovery period requires less down time. Laser procedures – including innovative technique for performing laser facelifts – have become procedures I’m known for doing well.

I’ve also had a good deal of success using lasers for the inner thighs and triceps – areas that are hard to treat with traditional liposculpting methods. However, I want to clarify that lasers and other technologies are only as effective as the surgeon is skilled and experienced. They can be potentially dangerous if they’re not used properly, and it’s critically important to be both conservative and to remember that the patient’s safety always comes first.

Which procedures do you perform most frequently?

These days, about 40% of my patients come for facial procedures, 30% for liposuction, and the remainder for breast enhancements. Non-surgical laser procedures and facial fillers are also in great demand. Almost all of our patients are referred by former or existing patients, or by other physicians. We love what we do, and we do everything we can go give patients a great experience.

How do you define beauty or physical appeal?

I often hear it said that symmetry is the important factor when considering physical beauty, but I don’t see this as the central truth. If you look at children and really study adults, you see qualities of youthfulness that draw the eye. That vibrant, healthy look derives, in part, from a nice distribution of supple skin over toned muscles. But beauty also has a more intangible quality and can’t be explained by a single feature, even if that feature is exquisitely shaped or formed. If you look at individual features of the body – hands, knees, and feet, for instance – you will see that there’s often awkwardness to them when you look at the individual elements separate from the whole person.

But there’s a kind of harmony of features in the face and body that most people will define as beautiful or noteworthy. For example, this is particularly apparent in professional dancers; many are certainly attractive in repose but may not command an unusual amount of attention. But when they bring their facial expressiveness and all of the parts of their bodies together in movement – when they dance - they are simply extraordinary.

Even walking down the street, many dancers are compelling – confident in their bodies and what they are capable of. There’s an overall quality of beauty that emanates from them.

When I look at individuals, I find that their beauty is in the gestalt, or the sum total, of who they are – the combination of the face, the body, the expressiveness, the way a person moves, the way they feel about themselves, the way their inner nature radiates outward. Nothing stands out as not “fitting” – they just seem right in their own skin.

Then there’s the beauty ideal that each person holds – how they define beauty and physical appeal for themselves. My patients and I take time in consultation to talk about what looking good means to them. You have to know what’s going on in a patient’s heart, as well as in their head.

My purpose is to understand what they see when they look at themselves and to help them attain the appearance that they personally define as appealing. 99% of my patients are very pleased with their outcomes and that, in part, can be attributed to the fact that I am acutely focused on them as individuals, on what they want and need, and on what can be realistically accomplished safely, utilizing techniques that I know will yield the best results for them.

How would you define your philosophy of patient care?

First and foremost, it’s not about me: it’s only about them…so it’s important to me that I connect as a human being to my patient. I want a thoughtful practice, one that reflects my personal values and beliefs. I do things the long, right way and don’t believe in taking shortcuts to reach a goal. I begin and end each day in gratitude, philosophically speaking, because we are given such astounding capacities as people…one can only marvel at it and experience awe.

I want my patients to attain optimal surgical outcomes, of course. But I also want them to feel self-love. Just imagine what life would be like if you were as good to yourself as you are to a beloved friend. The notion that being happy is a conscious decision we make every day informs and shapes my treatment planning with patients. I only operate if I know they’re going to be happier afterwards. If that isn’t likely, I’ve done nothing for them or for myself.

You have to truly work with your patients, to learn about them and what’s important to them. We sit and we talk. After all, I’m a doctor. It’s always my desire to make a small difference in someone’s life – to make life a little nicer. My goal is always the same: to have the best interests of my patients in mind at all times. I want everything to be right for them – no hassle, no grief, and no regret.

I see my patients and talk with them regularly both before and after their procedures, and I always want to know, “Are you glad you did it? Are you happy with your results? Is there anything my staff and I could have done differently that would have made your experience with us even better?”

I want my patients to have an improved quality of life as a result of taking life into their own hands and doing something wonderful for themselves. It’s one thing to get by; it’s another thing to thrive. I want my patients to thrive.

What’s your focus during a consultation visit with a new (or returning) patient?

I want to make sure that my patients are emotionally and intellectually ready for an aesthetic procedure; that the timing is right for them. This means it’s important for me to know what concerns them and to know what their hopes are. I want to help them feel better about themselves: that’s what I do and I do it by acting on their behalf. To accomplish this, I need to know what bothers them, what the focal point of their concern is, and what their expectations are.

I never underestimate the power of one interaction, one face-to-face time of discussion, reflection, and deep listening. I want my patients to understand the pros and cons of any procedure they’re considering, and to make choices that are self-affirming. I focus on quieting my world enough to hear their world…do you understand? When I do this, my patients will tell me where they’re at – with their outer, physical reality and in their inner life, as well.

Sometimes I encounter patient who doesn’t really know what they want. They’re unhappy with their appearance but unclear as to what can be done to correct what concerns them. I show my patients what they can expect and teach them what to look at when they look at themselves. An honorable, ethical doctor should always take the time to educate patients – and they need to understand that it’s not about me: it’s about them.

The more I learn about what they don’t like about their appearance, the more I can assist them in making the best decisions. I show them what I see. I let them know what can be altered and improved. I tell them what they are not going to like, what the limits are. I have books and books of photos that I use to deepen their understanding about what is possible and what kind of outcome they can expect.

I also make sure that the opinions I convey to my patients are honest. That’s the first step in being able to act in their best interests. The media likes to perpetuate the myth that cosmetic surgeons can do anything with the right technology – the “latest”, the “newest,” the “best,” but they don’t take into consideration the fact that each individual is different.

Age, skin quality, the unique way a patient is built structurally – these are just a few of the factors I’m considering when I’m putting together an optimal treatment. I like to show my patients pictures that help them see and understand what is and isn’t possible surgically. The more they know, the better they are able to make realistic choices they can feel good about.

How do you interact with your patients during the post-op recovery phase of their care?

I have to say it: I’m really good at post-op care! I either see them or call them everyday, knowing that they will be vulnerable after surgery, that they will have questions, that they will want to know if they are doing well. They need, and deserve, a lot of care. I talk with them about what they can expect and reassure them that what they are experiencing during the days of recovery is normal. I understand the healing process very well and how to get the there. In fact, most of my patients don’t require pain medication beyond simple Tylenol.

A part of being there for them means that I routinely give patients my home phone and cell phone numbers so they can reach me when they have questions, concerns, or needs. Patient satisfaction is the reason I’m fortunate enough to continue doing the work I love, and that’s why they refer their friends, family members, and co-workers to me.

There’s no higher compliment for me than to know I’ve earned the trust of my patients and to see them handle the process in a positive way. They’ve given themselves the opportunity to change something about the way they look that’s invariably bothered them for some time. I’m fortunate to partner with them as they negotiate the experience and to see their happiness and increased confidence.

Your office seems to run so smoothly. How do you pull that off with such a busy practice?

Well it starts with my understanding that an important aspect of good ‘doctoring’ is being respectful of my patients’ time. We usually run our schedule here right to the minute, and I attribute that to having a really well organized and efficient office. It would be impossible without a great staff, and I believe I have the best of the best working with me. Every one of them has been with me for many years, and we work together with great compatibility and common purpose – to give our patients a wonderful experience and excellent results. Both Gina and Cathi have been here for over 20 years. We also have a beautiful, relaxing, and serene environment for our patients, designed carefully with their safety, comfort and ease in mind. We want them to be happy here and are proud of what we’ve created for them.

Which innovations in your specialty are most exciting to you these days?

I’m particularly excited about laser facelifts and laser-assisted facelifts. I’ve done many of these procedures over the past few years and the results are quite stunning. Of course, without proper technique and the right tools you’re not going to give patients the results they deserve. I’ve been involved in a lot of research with these technologies and techniques and am getting outstanding results using laser energy under the skin.

In fact, I organized a laser study group awhile back, putting together a group of some of the best surgeons in the country. We share what we’ve learned, critique each other’s techniques, and conduct research to carefully evaluate the results we get. I’ve learned a lot from participating in this ongoing endeavor. For instance, I can now get better results in the nasolabial fold area (the vertical lines and folds that run vertically from the base of the nose to the bottom of the mouth), the lower part of the lip, and the jowls than can be achieved with a standard facelift. And using this laser on the neck yields results that can be as good as those achieved by doing a traditional facelift.

In many cases, these laser procedures can also produce excellent skin tightening, as well. A group of my colleagues and I have been working with fellow surgeons who are interested in learning the laser facelift techniques we’ve developed and continue to refine. It’s gratifying to share what we’ve learned and to continue advancing our techniques.

Lasers are powerful, after all, and should ideally be used by highly experienced surgeons who’ve had the best possible training. Our laser study group has been a tremendous source of learning for each of us involved, and definitely benefits our patients.

What do you say to those who criticize the whole idea of cosmetic surgery?

Critics of cosmetic surgery like to discount the importance of changes in the patient’s outlook or self-image, but I have learned from my patients that these physical changes can add significantly to one’s quality of life.

If I can make someone feel better about their life – whether it’s by way of a simple treatment that fixes a few lines and wrinkles or a facelift that restores the appearance that reflects the way they feel on the inside – then I’ve done my job well. Some seriously underestimate the positive impact an improved appearance can make on a person’s sense of self… on their feelings of self-regard and confidence.

You were elected President of the American Academy of Cosmetic Surgery in 2009, and you're an examiner of potential candidates for the American Board of Cosmetic Surgery. What do these accomplishments mean to you?

The American Board of Cosmetic Surgery (ABCS) is the only certifying board that exclusively tests surgeons’ knowledge and experience in cosmetic surgery, and we’re dedicated to the specialty of cosmetic surgery and the patients who choose to have elective surgery. I have tremendous respect for this distinguished organization and have served on the Board of Directors in many capacities. The ABCS identifies and certifies extraordinary surgeons who are already in possession of at least one recognized American Board of Medical Specialties (ABMS) board certificate before they're even considered as candidates to take the rigorous written and oral exams.

Diplomates of the ABCS demonstrate the highest standards of training, knowledge and expertise in the medical field of cosmetic surgery, and we continually promote safe and ethical practices within the specialty. In fact, most cosmetic or plastic surgeons don’t even qualify to take our board exam because of the very strict qualifications. Since no other board tests an individual exclusively in cosmetic surgery, the American Board of Cosmetic Surgery prides itself on holding to the highest standard in the specialty for surgical excellence and exemplary patient care.

It was an honor to be elected President of The American Academy of Cosmetic Surgery in 2009. This organization has grown to become the leading representative of the aesthetic medicine disciplines, including facial plastic and reconstructive surgery, dermatology, and maxillofacial surgery, to name a few. The AACS is the nation’s largest organization representing and helping to train cosmetic surgeons, providing them with post-graduate medical education opportunities specifically in cosmetic surgery so that the public is assured of receiving the highest quality medical care.

Thank you so much, Dr. Mack.

Thank you!