Plastic Surgeon Builds Relationships Through Empathy

For Luis Macias, MD, FACS, getting on a scull and rowing up and down the marina near his home is a great way to start the day.

“It’s a great workout,” says Macias, who is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. “It’s a nice way to start your morning.”

And it no doubt contributes to Macias’ calm demeanor and warm bedside manner.

“Patients need to have a provider they feel cares about them,” he explains. “This is surgery, and complications can occur. And when those complications occur, you need a physician who’s going to be there with you.”

No epiphany

Macias says he never had the epiphany moment that some people have regarding career decisions; it was more evolutionary. In college he loved physiology and doing research, so he enrolled in a summer program for individuals who were considering a medical career. That program also exposed him to volunteering.

“I didn’t know what I was going to go into, per se, but I liked the aspect of helping and caring for others,” Macias explains.

He almost became an OB/GYN in medical school, but decided that surgery was the better path—likely a carry-over from his love for working on cars, and his tenure as an avionics technician in the Marine Corps before attending college.

“I liked repairing things, and knew early on it was going to be the hands-on portion of medicine that I was going to be involved in,” Macias says. “I wasn’t going to like doing the things that were just prescriptions and things of that nature; that I was going to want to do something that I could see an effect and a change immediately.”

Being creative

Macias is the creator of the 360 Mommy Makeover. He explains that recently there has been a huge increase in requests for gluteal augmentation, which requires a fair amount of liposuction grafting to the buttocks. It can be a time-consuming procedure, but Macias has been able to streamline the process.

“New technology in the form of a high volume precision autografter allows liposuction to be performed in a closed system, then reinject the fat into the gluteal region,” Macias explains. “That has allowed us to compress the time that we can perform that procedure.”

Macias has been able to combine that procedure with the traditional Mommy Makeover, leading to the 360 Mommy Makeover.

“It takes that fat, and instead of throwing it in the garbage, it collects it in this canister and then I can re-inject it to the areas to help them have a more hourglass figure,” Macias explains. “Basically it’s taking what was a procedure that looked at the front of the patient by just taking care of their abdomen and their breasts, and sort of looking at it three dimensionally and at 360.”

Education orientation

In addition to seeing patients at Marina Plastic Surgery, Macias trains chief residents in the University of Southern California (USC) Plastic Surgery Residency Program. As the director of aesthetic surgery at USC, he supervises residents’ education in that area—one of the four big blocks of plastic surgery. The others are craniofacial, cosmetic surgery, and reconstructive surgery.

“So, I’m in charge of basically a quarter of their foundation of knowledge that they need for their boards,” Macias says.

Macias also travels the United States and abroad to learn from others. He’s been to Taiwan to learn from experts in the field of microvascular reconstructive surgery, and credits leaders like Miami-based Constantino Mendieta, MD, FACS, with sharing his philosophy and grafting skills. He also traveled to Brazil to learn from Raul Gonzalez, MD, who “wrote the book” on gluteal implants.

“Gluteal implants have had a bad rap in the United States,” Macias says. “But Raul Gonzalez has been very successful in Brazil. I figured there was no reason we couldn’t do them here if they can do them in Brazil.”

Plastic surgeons in Brazil use different implants than those used in the United States, but Macias wanted to learn Gonzalez’s procedure and see what could be done to modify it for his own practice.

“They have an overnight stay thing, and they use epidurals,” Macias says. “We’re not going to use that. So, I’ve been able to change the practice a little bit and make it work for us here in the United States. And it’s worked really well. I’ve been successful with all my gluteal implants. And it’s been a nice addition to the practice.”

Self-discipline

Macias says that the self-discipline he learned in the Marine Corps has helped him in many ways—in particular, overcoming challenges.

“It’s knowing you can get through just about anything if you keep moving forward,” he explains. “And right when you’re about to quit, just put one foot in front of the other, then concentrate on the next foot, and then the next. All of those feet pile up, and then you’ve conquered the mountain. That has really helped me throughout my entire career.”

Macias laughs when reminded that patients like his warm bedside manner.

“That’s funny, because I’m a little sarcastic,” he says. “But apparently, it’s a warm sarcasm.”

And through that warm sarcasm comes empathy.

“Patients want to know that you’re on their side, and you care about their trials and tribulations throughout the recovery process,” Macias says. “You’re with them for the entire ride, and not aloof about the whole situation.”

That translates into patients feeling more comfortable coming back if they encounter a problem during their recovery.

“The more frequently you see them, the more care and attention you give them, the better they do,” he says. “And the better the relationship, the less likely you are go get a bad Yelp review or a lawsuit.”

And as a reflection of the changing times, Macias adds, “Nowadays, bad reviews are worse than lawsuits.”