300 Rhinoplasties Per Year — with Sam P. Most, MD

300 Rhinoplasties Per Year — with Sam P Most, MD

Catherine Maley, MBA: Hello everyone. And welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery and how Dr. Most performs as many as 300 rhinoplasties per year. I’m your host, Catherine Maley, author of “Your aesthetic practice — what your patients are saying”, as well as business consultant to surgeons to get them more patients and more profits.

Now today’s guest is Dr. Sam Most, who performs 300 rhinoplasties per year. He’s a board-certified facial plastic and reconstructive surgeon at Stanford University School of Medicine right here in my neighborhood in California. So, Dr. Most is a division chief and fellowship director in facial plastic and reconstructive surgery, as well as professor in Stanford, departments of Otolaryngology and head and neck surgery.

Now, Dr. Most is a leader in the field of head and neck plastic surgery. Having traded thousands of patients trained, and having performed 300 rhinoplasties per year. Hundreds of doctors taught internationally and leads humanitarian efforts domestically and abroad. His efforts have been recognized by his peers with multiple national awards. Dr. Most, welcome to Beauty and the Biz.

It is a pleasure to have you.

Sam P. Most, MD: Thank you. That was quite the introduction and really the pleasures, all mine. So, thanks. So, psych so much for having me

Catherine Maley, MBA: Well, I’m really excited about this because you’re my first full-time academic surgeon and you perform 300 rhinoplasties per year. Because we usually talk to surgeons who are in solo practice or in multispecialty practices.

So, I’m very excited to learn. Number one, how did you end up being? I I’m always surprised at doctors who are facial plastic surgeons. I never even heard of that. You know, when I was a kid, did you come from surgeons? And how did that happen?

Sam P. Most, MD: You know, it’s I, I’m not going to sit here and say that I was 10 years old and I had this epiphany that I wanted to be a facial plastic surgeon.

Because that just, that just wouldn’t be true, you know, it’s but, but when I look back at, at the things that really excited me when I was a kid, it, what what’s happened is totally made sense. But you know, I just really first knew that I really liked science and I really wanted to help people and I wanted to be a doctor.

And then you go to med school and you realize you’re, you know, you really like being a surgeon. And then you decide, you know, for me it was, I really liked the head and neck anatomy and all of that. And then as we, as I did my training in head and neck surgery, I really enjoyed doing reconstructive and aesthetic surgery.

And then it just was sort of a gradual thing. But the things about it that, that I alluded to that seemed to make so much sense when I think back in my life are that, you know, I really have always loved doing things with my hands and have always built things and loved doing that kind of work. And I’ve always had an interest in graphic design and photography as well.

So, there’s a little bit of artistic side and this sort of brings it all together and with what I do on a daily basis. And, and I just feel really fortunate to be where I am.

Catherine Maley, MBA: Then, how did you end up at Stanford? Cause that was, that was going like straight to the top to perform 300 rhinoplasties per year.

Sam P. Most, MD: Yeah. I mean, it’s a great, it’s a fantastic institution.

I came here for medical school. In way back when I won’t say when a long time ago… Yeah. And I, I I’m from Michigan and I came out west and I just loved it. I loved the institution. I loved all this I stood for with, you know, innovation and science. And I went away for my, my training at the time to one of the top places in Seattle for, for head and neck surgery and reconstruction and aesthetic surgery.

And then I. Was working there as, as a, at the university of Washington. And I had the opportunity to come back. Stanford came calling and I just couldn’t really resist. And that was hard to believe. 16 years ago, that I came back down to Stanford. Wow.

Catherine Maley, MBA: Okay. Now you have to forgive my ignorance in regards to performing 300 rhinoplasties per year, because I’m not exactly sure how university medicine works.

Yes. Is it, is it CA are there any cash paying patients? Is it all insurance or reconstructive? Sure. How does that work?

Sam P. Most, MD: Yeah, you know, that’s a great question. And I, I often get this you know, from, from folks asking me if I actually practice as a position because I’m at the university. The fact of the matter is I practice as a position five days, a.

And I operate three days a week. And I see patients the other two and, you know, research happens on nights and weekends with my research team. So, I I’m quite busy that way. And yes, you know, actually 70% of my practice is aesthetic cash pay practice. So, I mean, we you know, do the full gamut of surgical procedures here.

And right now, you know, more than two thirds of my practice is aesthetic.

Catherine Maley, MBA: Oh, that’s so interesting and how that ties in with performing 300 rhinoplasties per year. I had no idea. Huh. And then I also noticed, like I was looking around and researching you and I looked at like your Instagram and it looks like you’re very heavy into rhinoplasty. How what’s the percentage of rhino versus facelifts versus Bluffs or do you also do nonsurgical?

Sam P. Most, MD: I do some non-surgical work all the day. I’m so busy that I’m, I’m having my nurse practitioner do most of that, to be honest with you. And she does a lot of that work. I’d say that in my aesthetic practice, probably about 65% of it is rhinoplasty and 35% of it is aging, face surgery, meaning facelifts and a blepharoplasty.

And what have your brow lift?

Catherine Maley, MBA: Okay. Regarding performing 300 rhinoplasties per year, are you doing a lot of revision rhino or, or primary or what what’s that, you know.

Sam P. Most, MD: I’d say about 30 to 40% of my rhinoplasty practice is revision. Wow. And it seems to be growing. I get a lot of requests you know, prior to COVID I was seeing a lot of patients from around the world.

I think with COVID it’s sort of. I get the requests, but I it’s hard for folks to come here with COVID, although it’s, it’s relaxing a little bit, I think, with the entrance requirements, but I see a lot of folks from all around the us and it’s just seeming to be something that for whatever reasons, a growing part of my practice.

Catherine Maley, MBA: Well, to put it in perspective in terms of you performing 300 rhinoplasties per year, the average plastic surgeon will do less than I, 10 20 maybe rhino classes a year.

How many are you doing per.

Sam P. Most, MD: Oh boy probably around 250 so I mean, we’re, I, I, 200 to 250, I think it depends on the year. You know, the last few years, I think we got up to 300 at one point. But I think we’re back down to around 220 to 250 and. I haven’t really done the math on it, to be honest with you, but when I’m doing six or seven in a week, you know, there’s, you just kind of do the math on it.

I, I, there are obviously some weeks I take off, I take a little vacation every now and then, but.

Catherine Maley, MBA: Yeah, you’re working with the most difficult patients on the planet. Like rhinoplasty patients are notoriously known for being, you know, very SPD about things. And, and, and, and I don’t blame them. Like, they’re, you know, they’re looking in the mirror in the middle of their face all the time. Yeah. What, how, how have you had to, at this point doing this many rhinos (performing 300 rhinoplasties per year!), you must have some systems set up to avoid some of the, the, the crazy that.

Or, or not?

Sam P. Most, MD: Well, I mean, yeah, I, I don’t know if I use the term crazy so much, but I think that the, a lot of things happen with rhino posse. I think there’s a lot of misinformation and I think patients come arm with a lot of bad information. And I think that a lot of it is setting expectations and understanding you know, which of your patients you’re on the same wavelength with and you know, My system is that I really try to make sure I, I put myself out there in terms of what I think is honestly possible.

I do computer simulations for rhinoplasty 99% of the time, and it’s a communication tool. And I can tell if somebody’s. Desires aren’t matching up. What I think is realistic for them or what would look good. And I think that they start to see that too, if I’m not showing what they want. So, there’s a self-selection process.

And you know, I, I think it’s all about communication. And I saw a couple of patients today who came back for second visits and. I encourage them to do that. You know, I don’t want to book somebody for surgery after one visit, if there’s any, if there are any qualms about what we’re going to do, what our plan is.

And I think that it’s, it’s working, it’s never a hundred percent. I, I still have patients where I kind of regret that I’d operate on them. Even if everything goes perfectly well. With the surgery, you know, and they’re just, for whatever reason, they’re just not satisfied with what we did and, and that can sometimes happen.

And I think that I I’ve kind of flipped it around to see really more as my responsibility than theirs to make sure that I don’t take those folks to the operating room. And I think as a physician, now that I’ve got a few gray hairs I I’ve had, I’ve had 20 years of experience. Now this, this is my 20-year anniversary of finishing my training.

I can look back and think about where I’ve, you know, made mistakes and where I can do where I can do things better. And a lot of its patient, patient selection. It’s such a big thing. It’s one of the things that, you know, probably by the time I retire, I’ll completely figure it out.

Catherine Maley, MBA: Yeah, like give, give us some tips though and how that relates to you performing 300 rhinoplasties per year.

And what, what are the yellow or the red flags for you?

Sam P. Most, MD: Yeah, I mean, I think, I think that if patients come in and, and you talk to them and you feel like you, you know, you’re, you’re not able. To do what they want. Don’t feel pressured to try to accommodate that because it’s not going to happen. And then, you know, if you, if you do that surgery as a surgeon, then it’s, it’s just going to get you into trouble.

I think that if you have a gut feeling about a patient that it’s just, just not right, don’t do it. And you know, I still have situations rarely now, pretty rarely where I, I feel like, you know, I, I, my gut’s telling me I shouldn’t be doing this. And If I get that feeling even up to the day of surgery, I’ll cancel it.

And that’s not ideal. Fortunately, that’s pretty rare. Usually you can, you can figure it out before that, but sometimes patients keep throwing up red flags, you know, they, they kind of get through the system. You should talk to your staff. Your staff’s really good at this. You know, if patients are really unreasonable or, or combative with them, but then they’re really nice to you.

You know, that’s not a good sign, you know, they, and. And, you know, you have to take the whole thing into context, understanding where patients are coming from and you have to have some empathy, but ultimately, you know, you take a patient and put them under the knife. It’s really your responsibility to make that decision.

It’s not theirs. They can’t tell you to do surgery on them. This is elective surgery.

Catherine Maley, MBA: How many rhinoplasty revisions, out of the 300 rhinoplasties per year will you do on one person?

Sam P. Most, MD: Of my own? My own case, well, or. Yeah. I mean, so I guess there’s two parts to that question. One is how many revisions are safe to perform on a nose period. And, and I think that that’s not an easy question to answer.

You have to look at the blood supply to the nasal skin and all that kind of stuff. But in terms of revising like a patient of my own, we all have them. You know, I think you, you, it’s all about how confident you are. You think that you can make things better and how, how much you feel that. Something really didn’t go right.

That you can improve. If you, for example, the classic example, somebody with an asymmetric nose and you take them to the operating room and you tell them up and down, it’s not going to be perfect. And it comes out and it’s pretty good, but it’s not perfect. Now the question is, do you think it’s not perfect because you didn’t do something right?

Or just something. You know, moved in the healing process and you can improve on it, or is it just really about as good as you can expect? And if it’s the ladder, then you shouldn’t take them to the operating room, as much as you feel like you have to sit down and have a difficult conversation with them saying, well, remember we talked about this, this is as good as it’s going to get.

I think that’s where we are. I think we’re at the point of limiting, you know, limiting returns. If you feel like, you know, looking at your off note, I think, I think I could have, could have done this and it probably would’ve been a little bit better choice. Not that anything was done wrong, but I think I can try this and it may help that person then.

Catherine Maley, MBA: Sure. Yeah. I just know the rhino patients, I, I interviewed somebody. You would know him and I can’t remember his name. It’s like Constantine he’s in New Hampshire, but I don’t think he’s performing 300 rhinoplasties per year.

Sam P. Most, MD: So, cons Mark Stanchion is a friend of mine. He’s a really good.

Catherine Maley, MBA: He wrote a book on it (but not about performing 300 rhinoplasties per year) and oh yeah. It’s just so insane when you’re trying to deal.

You’re dealing with the patient’s anatomy, but also their psychology and, and boy, there’s nothing easy about that when you’re dealing in the little, little, little millimeters that you deal in, like, it’s not like body it’s face and it’s in the mirror all the time and that, oh boy. Yeah, you, you pick them.

Sam P. Most, MD: He’s actually, he and I are both very interested in understanding more about how to predict which patients are going to go down that path. And he’s written some research on it. And actually, I’ve done some research in this area as well, and we’ve written about it together even so, oh, one of the things that That he’s realizes a lot of the patients have significant body image issues.

A lot of its related to childhood trauma and that’s something he’s done a lot of research on. And one thing that that we’ve found is that there’s this thing called sort of nasal self-esteem, which is related to what he’s talking about. And we have a questionnaire that we give every patient. That’s called the appropriately.

It’s actually a validated patient reported outcome measure. So, it’s a, it’s a really scientific instrument and, and we encourage all surgeons to use it, by the way, all Ram posy surgeons. It’s just 10 questions. But one of the questions is about SNA self-esteem it’s question five. It turns out that if patients get a certain score on that, there’s a really high likelihood controlling for all the other variables that they’re going to request a revision.

In other words, if they have a really. If their self-esteem is really tied up into their nose and there’s all sorts of ways, you can kind of paraphrase that, you know, like obsessive or whatever, they’re highly unlikely to be unhappy no matter what you do. Whereas if they. You know, with the same physical appearance, if they have a lower score in that they’re not as invested or tied up in terms of their self-esteem, into the shape of them by the shape of their nose, they’re less likely.

And its sort of intuitive if you think about it. So, if somebody has sort of a healthier body image and they just want something done here versus the same exact physical person, but they’ve sort of emotionally tied a lot more into what the shape of the nose looks like. Those two people are going to actually have different sort of satisfactions with the same exact physical operation.

And so that’s one of the things, and you were asking about how we, you know, how we determine which patients’ part of it is the questionnaire, you know, and, and that’s part of get this questionnaire. It’s free. It’s we published it. It’s free for anybody to use it’s out there.

Catherine Maley, MBA: You called the SCHs questionnaire.

Sam P. Most, MD: Yeah. A lot of people are familiar with it, but yeah, it’s, it’s actually advocated for use by all surgeons, private practice, you know, not just academic. Oh, interesting. So, it’s a lot of Guidelines from the government coming down are going to be that you have to use questionnaires like this.

They’re called patient reported outcome measures in your practice and just documented in the chart. So, we made one that’s really simple to use, but that, that particular question does have value predictive value for how patients are going to do a surgery.

Catherine Maley, MBA: So, the patient is able to tell you how their self-esteem is attached to their nose, which must tie in with you performing 300 rhinoplasties per year.

Cause I’m thinking as a patient. Would I have figured that out because if I don’t feel good about myself today, I think it’s my nose. If you nose and still don’t love myself, I’m going to another body part. Don’t you, right?

Sam P. Most, MD: Yeah. Yeah. Or on the other hand, if you look for any imperfection and whatever is all you get, and then you’ll be dissatisfied or you’ll think that my job or whatever, my relationship is tied up in the way my nose looks, and then you get your nose fixed, but those things don’t get.

And, and so that, that’s another way of looking at it, but so it’s just a simple question. It’s just a zero to five answer on a question like you know, about nasal self-esteem and how much of it affecting your quality of life basically. And so, if they score really low, then they’re really not super tied up into it.

If they score pretty high, then yeah. It raises a few red flags.

How different Facelift patient it. Do you feel like you have a different approach to those?

Sam P. Most, MD: The, the, well, the obvious answer is the aging face. Patients are usually a little bit older, but having, having said that in all seriousness, the aging face, patients come in a little differently.

They tend to be more mature. Yeah. I think they tend to be in a different place in life. So, I think that they just, their outlook on life is a little different than someone in there. Early twenties or late teens, you know? And so, you know, what I talk about with those patients is more, what we can achieve the same thing.

I don’t do simulations and all that I talk about what’s bothering them and It is a little different approach. We don’t use the computer simulations and, you know, we are, of course we do have red flag issues as well. You know, patients can have body dysmorphic disorder you know, anywhere from 10 to 25 to, in rightly C populations, 40% of patients who come into the clinic have BDD diagnostic, BD D so those are all sorts of research has shown that including stuff from our clinic.

So. You have to kind of be cognizant of that, but you know, you just the same things, you, you want to talk to them about what are realistic outcomes that they’re expecting, what do they hope to achieve? You know, if they say I’m trying to, you know, just look younger because I just feel like this is happening here.

And they’re very concrete about it. That that’s better than sort of abstract things. Like, I just feel really sad and I, I want to my save my relationship with my husband or my spouse. I feel like this is going to help me. That’s really not a great indication for surgery.

Catherine Maley, MBA: You know, the, what I’m thinking about you is I would think if people are going to you, they care a lot about your credentials.

I mean, you just have such credibility backing you up since you’re performing 300 rhinoplasties per year. So, I would think those people would be, I, I would think you have a nice clientele there. I mean, I, I would guess that most of them are coming because they love your CV. They love all the research, the clinical is that true? Or.

Sam P. Most, MD: You know, it’s yes and no.

Sometimes patients come in because our office is right here in Palo Alto to a small office here. It’s not, it’s near Stan, it’s on Stanford campus, but work their private practice doctors on. Sometimes they don’t even realize, oh, do you work at Stanford? Really? Other times. People come in and say you know, yeah.

The things that you talked about, they kind of understand all the other stuff. So I, I, I don’t know exactly how to answer that question. I, I, I think I feel fortunate to be where I am and, and to have worked with all the people I’ve worked with over the years and be in this institution and also feel privileged to be able to kind of provide a little more private practice you feel to, especially the aesthetic practice.

I think you need to. I think the people want don’t want to feel like they’re in a big, giant, you know, university setting. And my office is not like.

Catherine Maley, MBA: I saw on the internet. You had, isn’t it a new office for you where you perform 300 rhinoplasties per year?

Sam P. Most, MD: It’s yeah, it’s relatively new. It’s probably about seven years old. Now we should probably update the website and it looks brand new.

It really is a pretty office. And it’s state of the art. We have, you know, computer screens in the walls and all sorts of stuff. So it’s, it is a pretty nice space.

Catherine Maley, MBA: All right. So let me just ask you a stupid question in relation to performing 300 rhinoplasties per year. Who, who work do, do people work for you or does Stanford hire them and then you work with them?

Like how, how does that work? Like your, the people surround?

Sam P. Most, MD: it’s a little bit of both. I’ve built the practice with my own staff and so on and, and interviewed them and hired them. But they’re hired by their hired by Stanford, their Stanford employees. So it’s a little bit of both, but technically there’s Stanford employees, but we’re part, we have our little facial plastics team of nurses.

And so…

Catherine Maley, MBA: So, does that present any challenges for you if they don’t think they work for you? How does that impact you being able to perform 300 rhinoplasties per year?

Sam P. Most, MD: Does that, you know, that you’ve hit the nail ahead? I mean, I think having a team mentality is so critical to providing good care or any, anything you want to do, especially in the service industry, which is basically what this is.

Right. So how do you build that team mentality? When you’re not paying the check yourself directly. Well, I mean, I think there’s ways to do it. I think there’s ways to entice people, to feel have some agency in terms of how the operation works. And operation, meaning the, you know, not the, not the surgical operation, but the how the operation of the facility works and giving them some power to make, to some decisions and so on.

I think that’s the way you do it. I think you run into kind of the same problems though, that I’ve talked to my colleagues in private practice. It’s the same thing right now with COVID it’s hard to keep good staff. It’s hard to, you know, we’re struggling with that. Like a lot of folks are and you know, the, the Stanford thing is a lot of people want to work actually at Stanford employees cause they get really good benefits, honestly.

Catherine Maley, MBA: Yeah, it looks really good on a resume, you know?

Sam P. Most, MD: Yeah. Yeah. It is.

Catherine Maley, MBA: So do you have like other revenue producers in your, in your team? Like, are you mentioned an NP, do you have injectors? Do you have esthetic? Yeah, my

Sam P. Most, MD: NP is my NP is an injector. My patient care coordinator is an esthetician as well. Oh, okay.

And so they do some, they do some things here in the office and yeah, so we have we have a whole team doing things.

Catherine Maley, MBA: Oh, very nice. Yeah. So you are kind of like, like a regular practice yeah? Except you’re performing 300 rhinoplasties per year!

Sam P. Most, MD:. And I, and I have my own cost center, so I mean, okay. You know, we have our own gross and, and, and you know, we have direct indirect and we have net and revenue and all that stuff that we generate.

Catherine Maley, MBA: Well regarding marketing to get you booked to perform 300 rhinoplasties per year, I did, I’ve tried a couple times to help. A long time ago. I’ve been at this for a long time, too. And we were just trying to do some simple things in one of the departments. And we, we didn’t get anywhere. It was it was painful like I, as, as a vendor who gets paid by time it was just you know, I couldn’t get anything done that made any sense.

Because Stanford name had to be on it. There are awful lot of people involved. Do you, do you find that, is that an issue for you or?

Sam P. Most, MD: Yeah, I mean, I don’t do a ton of marketing right now. I mean, I do the social media stuff. But Stanford, I think institutions in general, this is the second big university that I’ve worked at as a physician.

They have interesting rules around marketing and I think that You know, print ads and things like that. I think they want to be really careful with how their logos and things are used. So I think there’s some strict rules around that, but I don’t really do much of that anymore.

Catherine Maley, MBA: And it looks like you don’t even have your own website.

You’re using Stanford, you know they have you on?

Sam P. Most, MD: Yeah. I used to have my own website, Dr. mos.com, but they made me shut it down.

Catherine Maley, MBA: I was thinking why wouldn’t have his, then you show photos because they actually don’t show any before and after photos of your 300 rhinoplasties per year.

Sam P. Most, MD: No, there’s some on there. There’s some, there’s a bunch of rhinoplasty ones and stuff, but you know, I just use Instagram now.

Right. There’s some hundreds of patients that, you know, of course with permission that I posted on Instagram and that’s. That’s where the, you know, my target group looks mostly, they don’t really talk about my website, much. My website’s more a placeholder kind of like a yellow pages thing just with my phone number and stuff.

And yeah, I think in an ideal world, I’d have a private side and I’d have more control over it. I think that’s been, that’s been a big downside, but social media’s really helped with that because I have control over that. And that’s been, that’s been really good. It’s a great way for me to communicate to my patients.

A little bit about me personally, as well as. Some professional things to my colleagues around the world. So I do lectures on there and stuff. Yeah.

Catherine Maley, MBA: And no, you have thousand followers amongst your 300 rhinoplasties per year, and I was really surprised. I didn’t expect that from, from you. Yeah. Tell me kind of, are you putting into it? And by the way, I want to compliment you.

The team building, you can see you’re doing the team building on Instagram. You’ve got them involved. Yeah. And I think that’s very helpful as well. And you’re doing a little personality. I, at first I thought, huh? I don’t think he has a family. I think he just has dogs.

Sam P. Most, MD: Yeah. I mean the family showed up.

No, there’s, there’s there are very few family photos. It’s a, of a rule in my house. Yeah. Okay. I put a few photos like from a long time ago when the kids were little and stuff. Right. But so there’s lots of pictures of the dogs. Dogs the dogs make kids. And I do pictures of the staff as well.

And, and just try to, you know, keep that up, keep that up to date. And it’s, it’s fun. Actually. I spend probably, you know, I spend a few hours a week and, and I do all of that, you know, I do all of the graphics and all the design and, and all that stuff. So wow. So, and like I said, I had a, I had a back background in.

Not formal background, but I enjoyed doing graphic design and artwork and that kind of stuff and photography. So it kind of fits into that. I play with Photoshop and that stuff and, you know, design logos and that kind of stuff. So it’s, it’s kind of fun for me, but probably a few hours a week.

Catherine Maley, MBA: Wow. Okay.

Good for you. I had no idea you were actually doing it yourself. Most people seem to have somebody like, like their, their kid at home. , you know, since you’re performing 300 rhinoplasties per year.

Sam P. Most, MD: Yeah. Right. I know. No, it’s me right on this computer or other computers or whatever home even to, yeah.

Catherine Maley, MBA: Now, are you feeling the pressure to put together a few dance videos on TikTok to help you get those 300 rhinoplasties per year?

Sam P. Most, MD: You know, I started a TikTok account and I. I haven’t really done much with it and no, I, I will not do the dance. I, I, I guess I’m kind of drawing the line with that. I don’t feel like, I think that’s really, I don’t know. I don’t think that’s me. I think it needs to be sort of, it’s sort of disingenuous.

I think if I do that, if I did it in the moment with my staff, we’re having some fun maybe, but if it was just a whole big stage thing, I just don’t feel like it’s me. And I don’t feel like that’s. Really honest.

Catherine Maley, MBA: Well, now the reels are so popular. There are so many video apps now that yeah. Can really help with that.

I’ve watched a lot of surgeons. You can tell that somebody knows what they’re doing behind the, the scenes, right? So the surgeon, all he has to do is like point to things.

Yeah. Or the, the syncing and there’s some music. So there are things you can do nowadays where you don’t have to dance, but I’ll tell you, I’m watching my 16 year old niece. Yes. And she doesn’t even go to Instagram ever. She’s just on TikTok and Snapchat and right. And, and that’s your audience, you know, that, that right.

I thought that’s interesting because I thought we have to learn TikTok now, you know? Yes. Are you kidding? Like, do you have a, like, do you have a marketing plan or like how you’re going to stay in front of that group if they do all seem to surge over to

Sam P. Most, MD: TikTok? Yeah, no, I, I have thought about what I need to do, but I hope I don’t have to do all the dances and all that stuff, but I think that a lot of the stuff that I do for company just poured over there.

Some of it’s just before us and actors and that kind of stuff and putting some music, I’ve done some of that. And, and there’s some results that kind of go viral. I mean, there’s, there’s a couple of my patients that I did that just kind of exploded and that, you know, gained thousands of followers just from one result.

And there’s some of those things, I think when I. Do them over there. I think that I’ll get a little bit of that, but I haven’t I haven’t lost sleep over it, but I realize that that, that that’s the way it’s going. Just like it went from Facebook to Instagram. It’s going to go from Instagram to TikTok.

And I’m still trying to get a. Get a handle on like you were alluding to, what is it different about that? What’s different about that content besides the music and the dancing? I mean, if I look at other surgeons, what they’re doing, they’re not just doing all that. There’s also just sort of befores and afters, a little bit of inoperative video stuff.

And I can do that. I’m doing some of that. I did a real that I posted just today on Instagram, about a revision rhinoplasty. And I think that that kind of stuff, you know, people are still doing just over on TikTok.

Catherine Maley, MBA: It’s just TikTok is just known for entertainment, period. Yes. And Instagram, you still have a chance at education and how it relates to performing 300 rhinoplasties per year, right.

You know, and that’s with, I just think I I’m good with, I

Sam P. Most, MD: I’m hearing that some people and you, if are doing kind of some informational stuff on too, is that not true?

Catherine Maley, MBA: If it’s fascinating. My niece has the attention span of Ann and I’m shocked. You know, watching the teenagers, have you watch, you have teenagers, don’t you?

One of them I think is a teenager.

Sam P. Most, MD: No, no, they’re in their twenties now.

Catherine Maley, MBA: They’re in their twenties. Oh God. Yeah. All those pictures are really old.

Sam P. Most, MD: OK. They’re old pictures. Yeah. They’re-

Catherine Maley, MBA: I was wondering kids are really watch teenager. They don’t even finish sentences. Like I went out to lunch with three of them.

It was my, it was my niece’s birthday. Yeah. And there was a guy and a girl and the three of them literally were in 44 different conversations that started stopped when another way. And I thought, I wonder, what’s going to happen with that crowd, you know?

Sam P. Most, MD: And they could follow each other probably just fine.

Right. You were fine. But we had no idea what they’re talking about. I was lost. Yeah.

Catherine Maley, MBA: Whatever. But, but you know what kids will always go a different direction than the, the people before them. So if Facebook was popular, then Instagram and now they now they’re bailing and going to TikTok. So that will always happen.

Right. You want to keep up with it and your 300 rhinoplasties per year, you know? Right. Like, you know, is that what you want to do? And frankly, I think it’s a great way to go, especially if you’re a rhinoplasty. I don’t know, you know?

Sam P. Most, MD: Yeah. I mean, keeping up, I think I need to keep up the content on, on Instagram and, and port some of it over to TikTok and then see what, what happens.

You know, someone, someone actually had posted one of my results that had gone viral on, on Instagram, on TikTok nice two years, two years ago. And I heard about it, you know, and, and. It’s one of these sort of, I don’t know who exactly who it was, so it’s interesting. And then all those people started following me on Instagram saying the camera were coming from TikTok.

Catherine Maley, MBA: I is it an influencer who like, how did it, how?

Sam P. Most, MD: I Don’t know, I, I think it was, you know, there’s these, these aggregating sort of plastic surgery sites that pull images off of plastic surgeons, social media, and post them. Which is totally fine, as long as we’re giving credit. And it was something like that.

And I had my name on it. Nice. I didn’t have a TikTok account. So people were like, who’s this guy. And then they were going to Instagram. I should have started a TikTok account then , that would be a good idea. Yeah. But I’m, I’m going to post that in some other ones at some point and just. You know, I’m waiting for the right moment.

Catherine Maley, MBA: Well, actually one of your colleagues that, you know, very well, he actually asks on his patient intake forms. How many followers do you have on Instagram? Wow, really? Yeah, because he is all about. The influencing mechanism to it, to social media.

Sam P. Most, MD: So, so if they have a lot of followers, then he accepts them as a patient.

Catherine Maley, MBA: Yeah. Interesting how something like that could impact you performing 300 rhinoplasties per year.

Sam P. Most, MD: That’s another currency. You don’t in your bank account to foreign surgery and you don’t have enough followers then we’re not going to. Yep. and he said it, he said it, it never even occurred to me. Yeah.

Catherine Maley, MBA: And I thought, wow, well now he’s also in a very posh area. But I just thought that was super interesting, you know?

Yeah. He, you know, he’s just trying to make the most out of every surgical procedure.

Sam P. Most, MD: that’s interesting.

Catherine Maley, MBA: Yeah. So let’s talk about now this year and you performing 300 rhinoplasties. Aren’t you the president of the rhinoplasty society? Yes, I am. Congratulations. Thank you. So like, what are the challenges. Coming up for that society. Like what do you guys talk about?

Yeah. And I I’m shocked at how much you can talk about rhinoplasty. I was at that meeting last, I don’t know, last year or something. And for two solid days, they were doing five minute talks. I mean, all nose, all rhino. And I thought, how much can you talk about this?

Sam P. Most, MD: No, we can really nerd out on this stuff. Trust me.

You could go to sleep thinking about it, wake up, thinking about. And that’s what I think makes it so fascinating. It’s a challenging operation. So, so the rhinoplasty society is all about trying to You know, get a group of surgeons who are dedicated to the science and the art of rhinoplasty surgery to educating the public and our peers about rhinoplasty surgery.

And it’s a, it’s a mixture of facial plastic surgeons and plastic surgeons. And so, you know, the, the challenges are just like they would be for any other group with those types, sorts of goals. They are to continue with a changing environment with the way education’s working in medicine. Now, as you know, it’s changing, it’s gone from a lot of in-person stuff with COVID.

We’ve gone to a lot of. Virtual now we’re kind of going back to these hybrid meetings to providing the education, the platforms that we use, it used to be textbooks and lectures, and now it’s YouTube videos, it’s webinars, it’s you know, all these things. How do we, as a society, stay current with that and provide to our members are the educational content that makes it you know, worth it for them to be a member of the society.

And how do we continue to educate the younger surgeons coming up and encourage them to get really interested in rhinoplasty to become rhinoplasty nerds like we are and, and to dedicate themselves to just keep, you know, keep trying to get better. And those are the, those are the challenges.

Catherine Maley, MBA: How do you educate the public on what are you looking for a surgeon for nose reshaping or revision and your 300 rhinoplasties per year?

And do you call it your job or do you call it rhinoplasty? Do you think a lot of people nowadays know the word rhinoplasty?

Sam P. Most, MD: I think so. I think they do. I mean, those hashtags are going crazy as you know, on TikTok and Instagram, but you know, I think that we, we, we try to stay away from labels, you know, first of all, Certifications in that.

I mean, plastic surgery, facial plastic surgery. That’s fine. Really. I think if you’re a patient looking for any surgical procedure, whether it’s plastic surgery or something else in the body, you know, you want to look for people with experience who specialize in it. You know, I think that that’s sure for anything.

And so it’s really no D. My mind for than for, you know, anything else. Cause Ryan class is the same way. So do you want to see somebody who does a couple a year or somebody who, who is dedicated themselves and do, does at least X number, whatever it is per year, or at least goes to meetings and tries to get better?

At whatever it is that you’re looking for. I think those are the things that we would, would try to try to point out. And, and, you know, the, the rhino society is not in the business of certifying people as rhino, ply surgeons or anything like that. But to be a member of the society, you have to show some dedication to it to the procedure experience and dedication.

And so you know, our members I think are, are, are good surgeons that.

Catherine Maley, MBA: You’re also involved in clinical research and innovation, like what’s new in the rhino

Sam P. Most, MD: world, you know? We in rhinoplasty, the latest thing you probably heard is this, this talk about this thing called preservation rhinoplasty.

Catherine Maley, MBA: Which he’s hearing about preservation and how it can relate to you performing 300 rhinoplasties per year.

I’m what, when did that happen? I never heard that before. Yeah.

Sam P. Most, MD: It’s really a new term for an old procedure. That’s been around for 130 years. Okay. So basically we’re talking about with this, the main thing is this thing called dorsal preservation. Okay. And so, you know, one of the most common things people come to me and other surgeons for is to reduce the dorsal hop of bump on the nose.

And the way most of us have been doing it in north America is to cut the top off and break the bones and bring it together. It’s called the Joseph hum production or whatever. And you know, it turns out there’s another way to do it. And 130 years ago, people started doing a thing where they actually cut all the way around the edges.

Don’t cut the top and then push it into the face. And it kind of flattens a little bit, not completely, but it looks good. Yeah, it fell out of favor in the United States. There was a surgeon named Maurice coddle who was very much a proponent of this and it fell out of favor for whatever reason, but it was kind of kept alive in south America and Mexico in some parts of Europe.

And kind of rediscovered in the last 15, you know, 10 years and sort of made a resurgence and then a surgeon by the name of Rawlin, Daniel coined the term preservation to call that because you’re preserving the door. And even though it’s not a new surgery it’s been around forever and sort of took off.

And part of it is because. Now that more surgeons were doing it, we were kind of refining it. And I think there were some problems with the way it was being done before. That’s why it was abandoned. And so surgeons such as myself and a few others started doing this more in north America and in the us and were kind of coming up with.

The reasons why it didn’t work and how we can get past them and why we can make it a better way of doing things in the right patients. And so it’s just another way of doing things and it’s a really hot topic. I’ve written a lot about it, talked a lot about it the last few years and it’s pretty cool.

It’s exciting as a surgeon to after, you know, like I said, 20 years now in practice, I have this other whole way of doing things that we’re kind of investigating and improving on and adding it to our repertoire of things we can offer the patients. So it’s pretty cool.

Catherine Maley, MBA: So you. You would want to do this because it’s faster, less painful.

Why, why would you want to do it in terms of 300 rhinoplasties per year?

Sam P. Most, MD: Oh yeah, no, thanks. I mean, I guess I didn’t explain that it’s when you do this, because you’re not cutting the top, you, it it’s like completely natural. It looks com it looks completely natural, lower risk of some of the other complications you can get with like irregularities and things like that.

Gotcha. But again, you have to do it on the right patients and you have to know what you’re doing. So The Joseph method still works great. The traditional method. And I think you can get slightly better results with this in the right patients. And, and a lot of the stuff that I’m doing and other people are doing is figuring out what the definitions are, which patients should have it done, which way.

And you know, the trend in rhinoplasty in the past 20 years has been to preserve more and more, not to cut so much cartilage out of the tip and not to make it look like a tiny little pointy Barbie tip. And, you know, because over a period of a decade, it might look terrible. So or the airway might collapse or something.

So it’s about structure, it’s about preservation and it’s about creating a natural looking result that still works really well.

Catherine Maley, MBA: How helpful has Michael Jackson’s been for you before you, you know, don’t you use him a lot to try to explain things like what you’re saying right now.

Sam P. Most, MD: Yeah, no, I mean, I don’t use them because it’s sort of like, we don’t like to use the Michael Jackson word in the rhinoplasty clinic, but I, I know what you’re saying.

Yeah. I, I think that it has been good because a lot of people I think can see what the perils. And even if you don’t bring it up, they say, I don’t want my nose to collapse and I don’t want it to be pointy and strange looking. And they may not say his name, but they may, you know, Talk about other people that have had the same kind of thing happen, but yeah, it’s Michael Jackson was unfortunately just a terrible situation and it never goes away.

Catherine Maley, MBA:  I probably see it online at least once a week, you know, it’s just, oh really? He is all over the place. It just, it, because it’s like, you know, inked, it’s really sad.

Sam P. Most, MD: Yeah. I mean, it’s really sad.

Catherine Maley, MBA: So you also are the part of the evidence based rhinoplasty research group. So is that how different, how many groups do you belong to? How do you have time in performing 300 rhinoplasties per year?

Sam P. Most, MD: Oh, yeah, but so that’s a great example of another way we’re educating. Right? So the, the evidence based rhinoplasty research group was founded by Miguel fer. Friend of mine in, in in Porto Portugal. And he asked me to help him get it running, but he really runs the show mostly. And, and I help with that.

It’s a telegram group. So another medium, right. And it’s got 15 or 1400 numbers. Now, these are all round plastic surgeons around the world and we try to post high level papers that are interesting for all of us to read and discuss. In rhinoplasty and we do poles of rhinoplasty surgeons. So understanding what sort of, what people think, what are trends and stuff like that.

So it’s just another example of an entirely new way that rhinoplasty surgeons can very quickly on a weekly basis or even daily basis post. Things and have a bunch of other expert surgeons and surgeons from around the world comment on things. And there are other groups like that too.

There’s a preservation around plastic group that BARR, checkers running there’s all sorts of stuff like that. So it it’s really interesting how the education has changed. For example, in the a F P R S one of the things where we get concerned about, and I was a member of the board for a long time, was.

How the model’s changing because our revenue, you know, our revenue was from educational meetings, a large part of it and membership. And if members, if people don’t need to be members to get the education that they, that they need, you know, how are you going to keep the society going? And these are the same things with thrive society.

So how do we provide value to the group? And it’s. It’s interesting. So you asked me how many groups I’m a member of. I don’t know. wow.

Catherine Maley, MBA: And you also run the fellowship program, right? At the same time you’re performing 300 rhinoplasties per year?

Sam P. Most, MD: At Stanford. Yeah. I’m the director of the fellowship here. Yeah. Oh my gosh. Well, that’s, that’s really privilege, you know, you get really, really bright people that come out of residency and dedicate another year of their lives to, to spending it with me.

And I appreciate that. And they’re really outstanding.

Catherine Maley, MBA: And then of that, how many of them stay in the academic world versus go.

Sam P. Most, MD: I, you know, for our program, I try to get people who are going to stick into the academic world because we have resources here that we can provide people to launch them in that way.

In addition to getting a really strong clinical surgical experience. So I’d say probably 70% of them are going to academics.

Catherine Maley, MBA: And then would they stay at Stanford or…?

Sam P. Most, MD: Would they no, they find jobs all over. Yeah.

Catherine Maley, MBA: I’d rather stay at Stanford. That’s a place to be recruiting at Stanford is tough.

Sam P. Most, MD: I mean, I think that, you know, you think as a surgeon you could just buy a house or something, but it’s really tough.

The it’s, it’s just a tough market here.

Catherine Maley, MBA: It’s I assume it’s the cost of living.

Sam P. Most, MD: Yeah. And mostly it’s just getting into a home. I mean, it’s not the buying groceries and the gas. I mean, those are more expensive here than other states, but it’s just, you know, what kind of home can you buy if your dream is to own a home or something?

It’s one thing to live in Palo Alto. It’s another thing to live really anywhere else. I mean, except Manhattan and a few other places where there are too many places that.

Catherine Maley, MBA: Well, how much did Facebook buy? Didn’t they buy like all of Menlo park?

Sam P. Most, MD: they bought a bunch of the land, I think down. Yeah. It’s sort of down towards 1 0 1 down towards the highway.

Yeah. That didn’t help. No, it didn’t help. And then all the people that, you know, they bought that land, but then all the people that got their stock options bought the homes over here.

Catherine Maley, MBA: nice. Yeah. So do you have any words of wisdom in regards to performing 300 rhinoplasties per year? Just in general for anybody who’s thinking, do I stay in the university?

Do I go out on my own? Like any words of wisdom for that?

Sam P. Most, MD: You know, I think you just have to do, what’s going to make you happy, you know, because if you, if you really like, if you really, really like. Doing the things, for example, that I do on the academic side, like writing papers and, and giving a lot of lectures and that kind of stuff, you know, academics is going to be okay if you’re really more business oriented and you just want to.

Make a lot of money. And that’s the only thing. I mean, I’m not saying that’s not important, but if that’s really the only thing and you really want to run an efficient operation, some of the things that we deal with in the university will probably drive a few nuts and, and, and don’t get me wrong. We make a good, I think it’s Stanford, especially we make a good living.

It’s I’m not talking, but it’s different. So we have different priorities. And I think you have to think about what really makes you tick. What makes you happy? So. You know, I tell my fellows the same thing. You know, if you really like doing the types of things that you see me doing, you know, going around lecturing internationally and publishing a lot of papers, writing it written two textbooks this past year.

And It’s hard to do in private practice. It’s not impossible. But I also am very busy clinically and I, and I, you know, I’m happy with the income I make. It’s a good balance. But I think that if you’re, you’re kind of more dead set on one thing like the business side of things, it might drive you a little crazy to deal with the bureaucracy of an academic medical center and believe it drives me crazy sometimes too.

But I think you just have to kind of do what your gut tells.

Catherine Maley, MBA: And I just say it all the time, just know yourself, you know? Yeah. I just know who you are and what you can tolerate and what you could get up every day and do you know, right.

Sam P. Most, MD: You’re going to do this for an awful long time, right? Yeah. 20 years goes by in a flash, but if you’re miserable, it takes forever.

I can say that I’ve been fortunate. I’ve been pretty happy and I can’t believe that it’s been 20 years in practice, but it, it seems like it’s gone back pretty. Good.

Catherine Maley, MBA: Well, tell us something we don’t know about you that doesn’t relate to you performing 300 rhinoplasties per year. And I do know that you like fishing and you have…

Sam P. Most, MD: That was what I was going to tell you.

Okay. Yep.

Catherine Maley, MBA: And no, you have to pick a different one German and then a little funny dog. And do they get along?

Sam P. Most, MD: Jerry and oh, they’re best buddies. Griffin is my Norwich terrier. And Jerry’s a rescue German shepherd. I’ve had three German shepherds that are rescues over the years. It’s a, Griffey’s the first non-res dog I’ve ever had.

Aww. And he’s he and Jerry get along. Great. They’re they differ by about 90 pounds in weight. One’s 105, and one’s about 15.

Catherine Maley, MBA: And Jerry has the floppies ears for German shepherd.

Sam P. Most, MD: He does. That’s probably why he was left in a shelter. but he’s a great guy. You know, I What, what can I tell you?

What, so what do I, what do I enjoy doing besides those things? You know, fly fishing is one of my passions. I don’t get to do as much here as I did in Seattle. Mm-hmm one thing I do for fun is I’ll tell you two things about me. You might not know I’m a massive YouTube fan. Nice. And I was actually on XM radio.

On the YouTube station. Good, good. For 2021. Yes. They have a thing where if you’re a fan, you can call in and you get to DJ for half an hour. So I did that. You what’s that you DJ yeah. You pick the songs, you introduce them. It’s prerecorded, but you know, it’s, they play it a bunch of times. So I’ve got a recording of that.

Maybe someday I’ll play it for you please. May I might do it again sometime pick five different songs and do it again. That’s that was a lot of fun. And the other thing is, you know just for kicks I still do a hobby that I did when I was a, when I was a teenager and that’s designed and silk screen and print t-shirts.

So if I see something really cool that’s that I want to make like a cool YouTube tour shirt. For a show that I saw that I know I can make a few and like no one else is ever going to have them. I’ll make them. In fact, I, I made one of those and I was walking around Los Altos where I live and this gentleman stopped me and said, where’d you get that shirt?

And I said I thought he was maybe going to say it’s a copyright thing, but I don’t sell them. It’s just for me. So I said, I made. And it was like, it said you two zoo TV tour, like 1992. He goes, I was the production manager for that tour in 1992 . Oh, that’s cool. So we had conversation about it. But it all went back to the fact that I made that one of a kind like shirt that I just wore from an old design that I found.

So that’s another thing I like to do as far as you, like, I had this sort. Artistic side that I like to,

Catherine Maley, MBA: well, I think, I think you you’re screaming for a Spotify kind of website with a little store, little

Sam P. Most, MD: I I’m learning guitar, which is the last thing you want. You probably want to know about me. I’m learning I’m not ready for Spotify though.

Catherine Maley, MBA: Okay. Well, you know, those stores, what are they called? I think it’s, isn’t Spotify.

Sam P. Most, MD: We go Etsy, no Etsy. We can go Etsy and sell, but I have to be careful of the copyright. I can’t sell the you YouTube stuff there.

Catherine Maley, MBA: Ah, gotcha. Well, you a lot of creative ideas, so you can there’s there might be a part-time gig there for you to go along with you performing 300 rhinoplasties per year.

Sure. Sure. So thank you so much for being on beauty, the BI. I really appreciate it. I hope to see you at a. Someday.

Sam P. Most, MD: Yeah. I hope to. Yeah. I hope to see you soon. Thanks so much for having me. It’s been great. It’s been a lot of fun. Sure.

Catherine Maley, MBA: By the way, how would somebody get ahold of you if they wanted to if they have any questions on you performing 300 rhinoplasties per year?

Sam P. Most, MD: You can, our office number is (650) 736-FACE, which is 3223.

You could also, if you want to message me on Instagram, Instagram, that’s fine. And then if it’s not no patient related stuff, but if you have questions about stuff, I’d be happy to answer it.

What’s your Instagram? @MOSTMD. @M-O-S-T-M-D.

Catherine Maley, MBA: Okay, terrific. Okay. Thanks everybody. We are going to wrap it up now for Beauty and the Biz. A big thanks to Dr. Spiegel for sharing his insight on facelifts and facial feminization.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you’ve enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don’t miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

-End transcript for the “300 Rhinoplasties Per Year — with Sam P Most, MD” Podcast.