S04E79 - Nice Guys DO Finish First: The Journey of Plastic Surgeon Dr. Sidney Rabinowitz

Renowned New Jersey plastic surgeon Dr. Sidney Rabinowitz shares his extensive journey and passion for connecting with people. From his early beginnings in chemical engineering to becoming a triple board-certified plastic, general, and hand surgeon, Dr. Rabinowitz reflects on the skills and experiences that shaped his career.

Known for his selflessness and collaborative spirit, he emphasizes the importance of pre-visualization in surgery, continuous learning, and balancing professional dedication with family life. This episode provides an in-depth look into the nuances of hand surgery, the evolution of surgical techniques, and the impact of mentorship and empathy in the medical field.

Don't miss this inspiring episode with one of New Jersey's most exemplary surgeons, filled with wisdom, experience, and a profound commitment to patient care.

#PlasticSurgery #MedicalPodcast #SurgicalLife #SurgeonSpotlight #HandSurgery #DoctorInterview #HealthcareHeroes #InspiringSurgeons #MedicalJourney #PodcastLife #SurgeryEducation #FutureSurgeons #BotoxAndBurpees #BotoxandBurpeesPodcast #LifeInMedicine

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S04E79 SIDNEY RABINOWITZ

Transcript

[00:00:04] Dr. Sam Rhee: Dr. Sidney Rabinowitz is a people person and that was never made more clear than in this podcast interview with him. We just finished the interview and I have to say he is truly an exemplary plastic surgeon how he connects to people. I am not someone who really loves hand call, uh, when I was taking ER call. In fact, I really hated doing hand surgery injuries, probably my whole career, which is why probably I ran screaming into craniofacial as a specialty.

And there were a number of times when I would be faced with some sort of complicated hand injury in the ER and I would contact Sid and invariably he would help me out. And that's not normal. I don't know. I don't know about the rest of the country, but certainly not in North Jersey, and he was always gracious.

He was really kind. And he really was wanting to help others, his fellow plastic surgeons, as well as, you know, Uh, most importantly, the patients. And after we finished talking, he continued to talk to me, about, especially when he was a younger partner, he would talk to patients for quite some time, sometimes up to a half hour.

And the senior partner would notice this and say, why are you taking so long with the patient? And he said, well, I needed to know about the patient and the problem. And the senior partner would just not understand. But we need more of those surgeons in our lives. And it was very telling. He said, if I got through a very good history and talk to the patient, listen to them, understood them, I could figure out the diagnosis even before I examine them 90 percent of the time. And that is the mark of a great clinician and someone who is so skilled in terms of connecting to patients. And that is a skill that I think most people should have in life. It's something Dr. Rabinowitz has in abundance. And it's something that I have and will continue to strive for with the people around me and my patients.

And he is one of those old school generalists who does handle so many different issues, particularly in terms of uh, trauma, reconstruction, and of course, hand. So without any further ado, this is my interview with Dr. Sidney Rabinowitz.

Alright, welcome back to another edition of Botox and Burpees, the surgical series. I have with me one of the, uh, great surgeons in New Jersey. This is Dr. Sidney Rabinowitz. I've known him for a very long time, and he has a couple outstanding characteristics. One is, he is, uh, you know, they say nice is sort of pejorative, but in this case, being nice is, you know, is the best way to describe Dr.

Rabinowitz. He is truly a kind, caring individual. I will say, um, one of the tough things, uh, uh, about being a plastic surgeon, especially when you're, uh, in the thick of things is that you have to take a fair amount of emergency room call. And, uh, Dr. Rabinowitz is. In my mind, one of the, uh, most selfless and, uh, helpful people I've ever seen in plastic surgery in regards to, um, aiding other surgeons, aiding patients, uh, usually in a time of need, and, uh, and we can get into that a little bit later, but let me intro Dr.

Rabinowitz and, um, Dr. Rabinowitz. And give you a little bit of his background before we, uh, we get into the meat of things. So Dr. Rabinowitz graduated with a degree in chemical engineering at Wash U, uh, Washington University in St. Louis, uh, and then did his, uh, got his medical degree at NYU school of medicine in New York.

Um, you, uh, did your, um, general surgery residency. So you're an old school surgeon where you did a full general surgery residency at, uh, SUNY Brooklyn. And then subsequently did, uh, a. a plastic surgery residency at UMDNJ New Jersey Medical School, uh, here in our home state, and then did a hand and microsurgery fellowship at California Pacific Medical Center in San Francisco, California.

So you're triple board certified in plastic surgery, general surgery, as well as hand and microsurgery. Now, who was your mentor at California Pacific Medical Center for hand and

[00:04:29] Dr. Sidney Rabinowitz: Uh, that was Len Gordon. Uh, Len Gordon is a, uh, Greg Bunke disciple from Davies Medical Center, and he's an orthopedically trained, um, uh, hand surgeon, but interestingly, he's from, uh, New Zealand, and he also trains in plastic surgery, so it was kind of fascinating that he Although he's orthopedics, he loves getting plastic surgery fellows to do his orthopedic fellowship.

[00:04:55] Dr. Sam Rhee: I know a couple of people who were plastics guys who did say like an ortho hand fellowship like at HSS or at your institution, uh, much more, um, wide ranging hand fellowship. I would say from from the experiences that I've heard. But then after that, you're now, um, Chief of the Hand Surgery Section at Hackensack University Medical Center, and you're the Head of Plastic Surgery at the Department of Surgery at Valley Medical, uh, Valley Hospital, which recently moved and is now in Paramus, New Jersey, uh, which, uh, was quite an event.

Um, and like I said, I've known you for ongoing event right now, yes, uh, and I've I've known you for a long time, and, uh, like I said, um, uh, I I think of you as one of the, uh, best, uh, around, uh, my practice area for sure. So, um, I never really talked to you about this, but I really wanted to first ask you about your training experiences and, um, whether or not, uh, what was it that sort of led you into plastic surgery or micro, um, hand in particular?

What kind of experiences or was there anything really formative that sort of put you on that path?

[00:06:09] Dr. Sidney Rabinowitz: It was a determined happenstance from the start. And first of all, thank you for that kind introduction. When you hear those words, boy, I sound like a really nice guy. And again, hopefully not in the pejorative because, you know, they say nice guys finish last. Hopefully not this time. Um. I was one of those people that never wanted to be a doctor growing up or never, let me rephrase that, I was not one of those people that wanted to be a doctor since I was five years old.

Um, as a matter of fact, um, I dropped out of nursery school, which is now called preschool, and um, because I came home and I told my mother, uh, I'm not going back, I have all the same toys at home. And she thought it was a compelling argument. And so I stayed home for a year and then went to kindergarten.

And, um, and then in kindergarten, she said, well, we have to go to first grade. And I said, well, you know, school doesn't really appeal to me. Um, and at that time I was so fascinated with sanitation workers. I loved the garbage men. So much so that I used to sneak out of the house in the morning in my pajamas, um, and watch them.

And, and they all knew me because I did that routinely. Uh, and I had several younger sisters, so my parents couldn't be concerned with me and they let me sneak out. And, and, and I remember very, I still remember being five years old and telling my mother, look, I, I'm not going to first grade. I'm going to be a garbage man.

Um, so I really don't need to read. And she said, okay, I'm fine with that. She's really smart, and then I said, Wait a minute. How will I read the street signs? And she said, Well, maybe just go to 1st grade. Take it from there. So she was very smart about it. She didn't force me. I went to 1st grade, and thereafter, you know, So the My My education continued, but, but to answer your question about why medicine, as you said, I was a chemical engineer in college, and it was a little before they did biomechanical engineering, and my idea was that I was going to be a biomechanical engineer, and I was going to design myoelectric devices for amputees.

I thought that was fascinating. I was always a STEM guy. I loved math. I loved equations. I loved when there was right and wrong. Shades of Grey didn't appeal to me. I liked black and white. And it was really about my junior year in college, and I hope this is not too belaboring, this whole discussion. Um, Junior year in college, uh, and this was before personal computers, as much as I loved my HP 41CV calculator, which was just stupendous, I, I, I, I, and I did love it.

Still do. I, I, I decided that I liked people more. And, and you've alluded to that. I, I love people, I love talking to people, I love hearing people talk, even though I'm doing most of it now. Um, So I made the switch in my junior year in college to pursue medicine. And fortunately as an engineer, I had all the prerequisites so I really didn't need to do much except take the MCATs and the rest is history.

Now in terms of going into plastic surgery, there were a couple of events that led to that. Um, at NYU, I I really kind of love the surgical specialties more than internal medicine. What I didn't like about internal medicine is that you treat people for 30 years and they still have the same diabetes. Um, and, and what I liked about surgery is surgery is like a two hour movie.

You have a beginning, you have an exciting middle, and then you have the end. And then in two hours, it's done and you have an answer, right? There was a problem. I fixed it. Move on. And I love that aspect of it. Um, and I love being able to fix things. Um, I used to teach woodworking in high school because I, I just love working with my hands.

Uh, and then in terms of plastic surgery, I, I, uh, I, I, first I was gonna be an going to be an OB GYN, but then realized after I went to GYN clinic in downtown Manhattan, that it really wasn't for me. And also babies tend to come at night after midnight, which didn't appeal to me. Um. So, I wanted general surgery.

My father, unfortunately, had taken ill and was cared for by a very, very terrific doctor at Memorial Sloan Kettering. He was a colorectal surgeon since retiring. And I was so impressed with his demeanor. I was impressed with his professionalism. I was impressed with how he talked to us in a way that was educated us, but at the same time was so professional and caring.

Um, so that may have been my first role model. So I thought general surgery and that's why I entered into general surgery program. And then right about my second year in general surgery, I ended up at Long Island College Hospital doing a rotation in plastic surgery because it seemed kind of interesting and no one else wanted it.

[00:11:36] Dr. Sam Rhee: Mm

[00:11:37] Dr. Sidney Rabinowitz: I work with a doctor named Dr. Kaplan. And it was just me and him, and he took me under his wing, and I was smitten after a month with him. And what I loved about plastic surgery, and you'll probably echo those same words, Sam, is that it's men and women, so it's not like urology where it's all men or GYN, it's all women.

It's children, it's adults, and as opposed to trauma surgery, most of my patients will not die, okay? So, I liked having healthier patients and I love the fact that we operated on patients from head to toe. And I also like the aspect of plastic surgery that we were the problem solvers.

[00:12:21] Dr. Sam Rhee: Yeah.

[00:12:27] Dr. Sidney Rabinowitz: or general surgery, if they have an open wound and they can't close it. They call us. We're like the firemen. And I like being able to think out of the box and use knowledge to solve novel problems that perhaps are not written in black and white on the books, but you have to use your knowledge and be creative.

So in a way it's emerging for me of Engineering and science and biology. I love it.

[00:12:56] Dr. Sam Rhee: Yeah, that's that is what plastic surgery is. I had a mentor at Michigan and he had a diagram of plastic surgery at the center of the surgical universe, because we interfaced pretty much with everybody. We interfaced with vascular and ortho and oculoplastics and, um, ENT and, uh, you know, thoracic and, uh.

Every, you know, like you said, head to toe. Uh, we had to be pretty familiar with the anatomy. We had to know a lot of the functional stuff, especially in the head and neck, which is pretty complicated. And then with the hand, um, and then like you said, any complicated issue with soft tissue, um, they, they, They really call us.

And that is very much, uh, um, our calling, especially when we, uh, are in training for that, but then you, you also decided to go into hand and micro, which, um, is a big part of your practice, not all of your practice, but a big part of your practice and, um, and speaking about, um, coming in at midnight and not wanting to do that.

Like there, there's a lot of hand injuries. It's the most common ER injury out there. So. Um, what led you to that? And, and you are still very much a very active micro and hand, hand surgeon at this point. So, so what is it that appealed to you and still appeals to you at this point?

[00:14:19] Dr. Sidney Rabinowitz: It does appeal to me. It still appeals to me. It was, um, it was part desire and part practicality. When I was doing my plastics fellowship at Rutgers, my immediate supervisors were Drs. Rauscher, Dr. Boss, Dr. Bykoff, who were all in a group at Hackensack, and they were a dominant group in the hospital. My wife was from this area.

She wanted to stay in this area. And they evidently thought that I was a good resident and wanted me to join the practice, but they said, you know, we really need a hand surgeon. We had someone who did hand surgery. He left and went to South Jersey. We have, um, Craig Hall, who's craniofacial, you know, we have, uh, uh, Bill Boss, who's microsurgery.

Uh, Rauscher did a lot of breast and, and, uh, face, um, and cosmetics. And we need someone to do hands. So there was some practicality to it. And they said, if you, if you really, if you do that, we would love for you to join our practice. Uh, so it was, it was, Partly because I wanted to work here and join this group, but I thought it was a great opportunity.

But, but it, it, it also collided with my, uh, interests, which I like fine, intrinsic work. The hand, as you mentioned, like head and neck is, there's a whole lot of structures in a small area. Um, Other little tidbits about hand surgery, usually two hours, right? And you sit down. It's kind of, it's a gentleman's surgery. There's very little blood loss. It's all under a tourniquet. So there's a lot of appeal to that. Uh, And, and, and, you know, as you know, literally there's hundreds of operations in a small area and they're all very nuanced and, um, like anything else, some of the procedures are hard to do or some of the procedures are easy to do, but hard to do well.

That's what I always like to say. Uh, so that, that appealed to me, that, that you have to really work hard at it and, and hone your skills and, and constantly re educate yourself and, and learn more, uh, to be really good at that. Um, So it worked out well for me.

[00:16:41] Dr. Sam Rhee: Now, as a hand surgeon, and I have heard you at Hackensack MNM conferences, you have obviously a tremendous amount of knowledge. You are constantly, like you said, educating, re educating yourself. So what is it that you strive, I mean, and like you said, there's so many operations and they are constantly. And I'm sure that for all of us, what we did 10, 15, 20 years ago is different for many operations than what we do now.

Um, what do you do or how do you approach your surgeries to make sure that you continually become better as a surgeon?

[00:17:18] Dr. Sidney Rabinowitz: Well, that's a great question because, um, we, we do have to continue. Well, first of all, having residents around keeps you young. Okay. Cause the residents are constantly reading and I'm going to read something esoteric and throw it at you. And if I've heard about it, great. If not, I'm learning about it because I want to keep up with them.

Uh, Enhanced Surgery, you know, the device companies, um, and I'm a big fan. I don't want to shamelessly plug anyone, but there's one company that I like quite a bit and they've really done a great job in terms of, as far as I'm concerned, revolutionizing the problem of how do we get How do we mimic what ligaments do?

That's the biggest problem in hand surgery, right? We know what tendons do. We could always borrow a tendon from somewhere else. We have excess tendons, but what we're bad at is ligaments because ligaments are very thin. Thick, relatively avascular, tough structures that are inelastic, and for years we've tried ways of recreating it.

We've, we've gone to the foot and taken, you know, bone, ligament, bone grafts to try to fix scaphoid lunate injuries. Uh, We, we've tried burying them. We, we, we, we've tried putting bone tunnels and using ligaments and I'm sorry, using tendons to weave, but the tendons don't have the same elastic profile and recoil that ligaments do.

So, one of the companies has been very, very, uh, ingenious in developing these bone anchors and that to me has changed everything.

[00:18:56] Dr. Sam Rhee: What company is it? It's okay, mention it.

[00:18:59] Dr. Sidney Rabinowitz: Uh, this is Arthrex, uh, and they, they have these, um, both, uh, titanium and bi absorbable, uh, anchors that we use, and that really has changed everything. These, these are anchors in which we can, uh, put tendon grafts or even, uh, You know, synthetic suture tape or, or, or, um, uh, label tape.

And they do everything that ligaments could do. And it's much easier and it's kind of revolutionized how we do shoulder surgery, knee surgery, wrist surgery. Uh, I can now reconstruct the scapholunate ligament

[00:19:42] Dr. Sam Rhee: Uh huh.

[00:19:42] Dr. Sidney Rabinowitz: and it will be very strong and will have the same tensile properties and people will avoid things like bad arthritis later on down the road.

Uh,

[00:19:52] Dr. Sam Rhee: so these are the tech, the same technology they use for say, like ligamentous injuries in the knee are the same ones you're using in the wrist to reconstruct disrupted ligaments there.

[00:20:03] Dr. Sidney Rabinowitz: absolutely.

[00:20:04] Dr. Sam Rhee: Wait, do you, are you a consultant? Are you, do you own shares in Arthrex? I'm just

[00:20:08] Dr. Sidney Rabinowitz: I do not.

[00:20:09] Dr. Sam Rhee: Oh, okay. Just wondering purely just from your own clinical experience.

That's pretty

[00:20:14] Dr. Sidney Rabinowitz: It is, you know, I, I, um, you know, I, I look at all companies and I'm constantly looking to see what products are produced and which ones would help me. And I try them out and they just have a, um, a strong array of products that I find works well. And has, has done quite a bit. Like, a perfect example of that is, let's say, you may have heard of skier's thumb, uh, people, or, or, or gamekeeper's thumb.

It's, you know, at, at your thumb, you, you disrupt your omiclateral ligaments at the MCP joints. And for years, we would try to repair it, or we'd drill bone holes through the, the bones, which are probably, They bone tunnels and, and use a, use a tendon to weave it through. But now we can use these little swivel lock anchors with suture tape.

And the big difference is, whereas it used to be a five month recovery, is now an eight week recovery.

[00:21:12] Dr. Sam Rhee: Wow,

[00:21:12] Dr. Sidney Rabinowitz: Um, People who have thumb, uh, CMC arthritis, the most common arthritis in our hands, it used to be a four month recovery from doing procedures. Now, when we do these internal brace procedures, and you've heard these now because it's like what Aaron Rodgers had done with the Speedbridge.

Most football players now get the internal brace repair when, when you're doing a, um, a CMC or, or thumb metacarpal joint, and you're better in, in really four to six weeks now. It's much quicker.

[00:21:44] Dr. Sam Rhee: yeah, it seemed to make sense. Like the Aaron Rodgers, the, the other tendon type repairs, ligamentous repairs, to have that Resorbable type of structure that helps support it. I don't know why we didn't think about it 20 years ago I'm glad you guys are doing it now that it totally makes sense so When you operate then, what do you do to set yourself up or in your prep or in your routine to make sure, is there something you do every time you operate, like in terms of setting yourself up for success for that particular procedure, whatever that, that procedure is?

[00:22:18] Dr. Sidney Rabinowitz: That's a great question, Sam. And I think we all have our own, um, procedures for what we do. Um, you know, first of all, as you know, the success of an operation starts well before you operate. You have to think about your approach. The incision is very important. And I always tell the residents, you know, anyone can sail on a calm day.

It's sailing in rough seas that differentiates the sailors from the amateurs. And when I go into surgery, no matter how simple the procedure, I really, in my mind, have two or three alternates in case I encounter something I didn't anticipate. And as a result of that, so it's all in the preparation. My incision is going to be key because it's, it's my initial approach, but it also incorporates any fail safes that I may need.

Uh, and then after that, I know it's really dumb, but I still do scrub preps. Um, and that's old school because as you know, Sam, one infection It, it, it's devastating. It's really devastating to get a surgical side infection. So I, I, I try to avoid that and

[00:23:35] Dr. Sam Rhee: prep, meaning you do a full scrub as opposed to, say, just like the chlorhexidine stuff that, that,

[00:23:41] Dr. Sidney Rabinowitz: yeah, I'll, I'll do a, I'll do a scrub and then I'll make, I'll do Chlorhexidine, or if it's an open wound, I'll do Betadine, and I'm really kind of manic about that and about the draping. Um. And other than that, it's, everything is fairly routine. You know, for hand surgery, you use four drapes. It's not hard.

So you do the same thing every time.

[00:24:01] Dr. Sam Rhee: Now, um, it's so interesting. You, I don't think I've met a surgeon yet who has not talked about pre visualizing the procedure at length prior to operating. And I, and I do know from my previous experience way back when in hand surgery, your incision and your exposure is everything because you can burn a lot of bridges or hurt yourself tremendously if you don't make that right incision.

Um, Uh, you could, you could really screw up your operation. So I, I forgot about that, actually, until you reminded me. And I was like, yeah, that's right. That's, that hand surgery is really about that. Um, so, uh, when you do your setup, let's, and you're in the OR, what do you listen to? Do you have a particular type of music you prefer or something

[00:24:48] Dr. Sidney Rabinowitz: So music is always, um, and it's funny, Sam, you think of how it evolved. I remember as a general surgeon, we used to bring those five CD changers into the OR and we used to make the nurses change the CDs out.

[00:25:05] Dr. Sam Rhee: Yes.

[00:25:07] Dr. Sidney Rabinowitz: And then of course, you know, iPods changed everything. Like how in the world can you get 10, 000 songs on this thing?

That's, you know, that is the size of a matchbox, a matchbook. Um, so, uh, I am, I have playlists that I've developed and, um, there's nothing from the 21st century. It's only from the 20th century. So I have my 60s, 70s mix, my 80s mix, which is alternative, and then my 90s mix. And then. I do read The Room, and if it's only Millennials or younger, I'll ask them, I'll ask them what Pandora or Spotify station they want, and then I'll humor them, because I just, to me, it really doesn't matter what I'm listening to.

I'm not so much a, um, you know, a rap gangster person, but there is a, uh, there's a subset of people at Valley Hospital that I love country. Uh, so I've been listening to country. Admittedly, I still don't get it, but, um, but I don't mind it. It doesn't bother me.

[00:26:10] Dr. Sam Rhee: Hmm. That's so funny. I do remember, when I was a resident, I would, uh, at that time music was important, so I would bring big albums of CDs with the CD player, ask people to play, and, and there was one vascular surgeon I remember in particular. He only liked three albums, so we listened to Dire Straits, so we listened to Dire Straits, Brother in Arms,

[00:26:33] Dr. Sidney Rabinowitz: I remember that well.

[00:26:34] Dr. Sam Rhee: Yeah, some Broadway thing, like Man of La Mancha, I don't know why.

And, and, uh, I forget what the third one was, but like, it was on repeat. So if we had a really long vascular procedure, you had to really, you really had to like that music after a while. So it's nice that you're very flexible in that sense. And, and you, um, are considerate of the others in the room because, uh, I think you're right.

I think a lot of, I mean, it's really interesting. Actually, I hear a lot of different, uh, responses in terms of music and, uh, yeah. Uh, yours is very considerate, like, uh, and I wouldn't expect anything less from you about that. Um, so who is particularly important to you, say, either in your OR or as part of your whole team, like, you know, team Rabinowitz in terms of you as a surgeon, like, who, who really helps you function your best as a surgeon?

[00:27:24] Dr. Sidney Rabinowitz: Yeah. Um, I, I know we, you know, we kind of talked about this a little bit and touched on it. Uh, you know, for me it's, it's a little different because I, I work, I don't work in a sur center very often. I, I have over the last 20 years and there were some, uh, there's the same people I work with, but I don't, I'm not so reliant on having the same scrub person or the same circulator.

Uh, I, I am. Very flexible. Uh, my, my, um, preference card states very specifically what I need. Uh, obviously I'm really impacted by an inexperienced scrub tech. It's hard, especially when you do micro, that's very difficult. Uh, So I do have a couple of PAs in my practice I work with, and I found working with them has been terrific because they, uh, they know what I like.

They, they, and they can almost mirror my moves and anticipate what I'll need next. And that does make the operation a whole lot easier.

[00:28:25] Dr. Sam Rhee: Do they scrub in with

[00:28:26] Dr. Sidney Rabinowitz: the one area where I think if, if, in, in, when you're doing micro and you really can't look up from the scope and you really just kind of put your hand out and say, You know, give me the needle holder, give me the scissor.

You want the right instruments handed to you.

[00:28:39] Dr. Sam Rhee: Now do they, so they scrub with you at all of the hospitals that you work out of? Okay, wow, that's great. Yeah, that's huge. Um, so, uh, is there any particular operation you really love doing still? Like, you really get a ton of pleasure from?

[00:28:56] Dr. Sidney Rabinowitz: You know, it's funny. That's a, um, well, let me ask you, do you have a favorite operation first?

[00:29:01] Dr. Sam Rhee: Uh, I mean, I have, uh, When I was a craniofacial guy, I really loved cleft lip, uh, obviously, and I still do that when I travel, uh, go overseas and do surgery, but, um, I don't do that in my general, my, my regular practice anymore. I would say, um, probably, uh, I would say for younger patients, it's, it's so, it's, it's really about impact on the patient.

Right. So I think it's for me, it's no, it's not so much like the technical wizardry or, you know, feeling flashy or cool as a surgeon doing a particular operation, which certain operations I used to feel that like a really technically difficult operation would make me feel. Like, I am a real surgeon. Now, it's like, what kind of impact am I making?

And for young patients, on the aesthetic side, honestly, it's a breast augmentation. Like, that makes people feel very different. Like, and, and maybe it's a very simple, uh, impact, but it's a pretty powerful one. And then, I think in, in older patients, it's, um, It's probably still an, uh, abdominoplasty, like a really nice tummy tuck, like, uh, for patients who've had multiple children.

Like, that's, that's very impactful for them. And like I said, it's, it's really not about, is it a tough operation, easy operation? It's just what kind of change, you Are you affecting it? And these are changes to me that they can't do themselves. So, no matter, like, there are a lot of things that you do in body contouring, for example, which, you know, um, the patient can really help you out a lot if they, uh, really, you know, did some fitnessing or nutrition or whatnot, but you can't, um, exercise yourself into larger breasts.

And you

[00:30:50] Dr. Sidney Rabinowitz: right.

[00:30:51] Dr. Sam Rhee: uh, diet or exercise yourself into getting rid of all of that extra skin that has developed after two or three kids. And so, so these are, um, you know, powerful changes that you are helping them make, uh, regardless of, um, what they can do for themselves probably.

[00:31:09] Dr. Sidney Rabinowitz: Yeah. And, and, and to add onto that, you know, I, I still do some cosmetics. It's not the bulk of my practice, but I enjoy it. And, and the operations you just mentioned, let's say breast augmentation, tummy tuck, um, even, I would say breast reduction. Those are operations that are easy to do, but hard to do well.

And there's a difference. And there are nuances in that. And, um, and that's with experience. You really get better at that. You know, it's, uh, instead of just putting the biggest implants you can put in there, you have to look at the person. Most importantly, listen to the person. See what they like. Um, and you're right, it does change them dramatically.

Um, in terms of opera, and I agree with you about the whole technical thing. Like, I remember when I first started, you know, doing a, um, a replant that's successful is, is amazing. Being able to put someone's fingers back on and have them work is amazing. Now, realistically, we know that when you put fingers back on, depending upon what the zone of injury is, um, Sometimes it looks good, but doesn't function well, and that's, that's hard, um, but, um, but, but also, like a perfect example is, I work with the cardiac people quite a bit at Valley Hospital, and I do a lot of sternal wounds reconstructions, and it's, it's a fun procedure for me.

Uh, technically it's, it's, you know, something where it's not terribly difficult, but it's something that we do as plastic surgeons and they don't do. And you're essentially saving someone's life. I mean, someone has this, this cardiac surgery, they have an infected mediastinum, you're looking at their heart and you can move muscles around and skin around and get it to close and, and get them to walk home.

So that's very satisfying.

[00:32:57] Dr. Sam Rhee: Yeah,

[00:32:58] Dr. Sidney Rabinowitz: And I would. Go ahead.

[00:33:00] Dr. Sam Rhee: No, I think you're right. The thing that just struck me was, uh, what you said about what, what the best surgeons do, the experienced surgeons do, is do the common things uncommonly well. So when, when you do something, it's easy, like you said, easy to do. Like, I remember doing, uh, many sternal, not many, yeah, a fair amount actually, of sternal wound closures.

And, but it's, it's doing them. Like, efficiently, like, there is a grace and an elegance and a beauty to doing a very simple, like, not, it's not simple, but like, like you said, not

[00:33:34] Dr. Sidney Rabinowitz: It's straightforward.

[00:33:35] Dr. Sam Rhee: straightforward, really well, uh, that is the mark of, of a, of a great surgeon, I think, and, and not overly complicating things, because I think, especially when I was a younger surgeon, I would, I would try to make it a bigger deal sometimes than it was, instead of, you know, Really getting to the heart of it and addressing it and, and making sure that it wasn't, uh, that I, I, I did it with a minimum of effort as opposed to a maximum of effort, maybe.

[00:34:01] Dr. Sidney Rabinowitz: And as you know, with these procedures, especially let's say, sternal wound reconstruction, the biggest error that we on the whole, as surgeons, or plastic surgeons, the biggest error we make is actually inadequate debridement. You know,

[00:34:16] Dr. Sam Rhee: still the number one problem? Still?

[00:34:19] Dr. Sidney Rabinowitz: is. It still is, uh, because we're so focused on harvesting the muscle and getting the pedicle on the muscle and moving the skin that the stupidest thing is if you do inadequate debridement your operation is doomed to failure and, and the easiest thing to do is debridement.

[00:34:39] Dr. Sam Rhee: The funny thing is, is I remember very vividly as a resident, the old greybeards in the room saying that. And growling it. And I

[00:34:49] Dr. Sidney Rabinowitz: I'm

[00:34:51] Dr. Sam Rhee: you know, that wasn't, you know, debrided back properly. Yep. And I remember being yelled about that by not clearing out the sternum, uh, adequately enough in, in a case, uh, you know, getting back to healthy tissue and.

And, uh, I hear that in Eminem still. I hear Rick Winters yelling about that, especially in complicated lower extremity trauma. And to hear you say that, like, it validates the fact that we probably have all tried to get away with it when we were younger, and, and it always comes back to bite you, and so these lessons, uh, You know, uh, biology is still biology.

It hasn't changed whether it was, you know, 1990 or 2024, like you can't make human tissue, you know, different in terms of how it responds in that

[00:35:36] Dr. Sidney Rabinowitz: Right. And it's the same thing with dealing with, you know, implants, you know, breast implants or other implantable acellular dermal matrices. Um, you know, if there's infection, you can try to gill the lily, but if you're unsuccessful, eventually you have to learn to be a grownup. And take it out and tell the patient that and say, look, I'm really sorry that you can't have your breast implant, but we will go back when it's safe and do it.

Um, and that's hard because they're paying customers and they're looking for results and that's very difficult for us, but we have to sometimes.

[00:36:10] Dr. Sam Rhee: Well, let me ask you this. So you are one of the. Plastic surgeons I really admire and look up to in terms of how you interact with other plastic surgeons as well as your patients. You are, you truly are, like, I would never have pegged you for an engineer because as a STEM person you have a tremendous amount of empathy and sensitivity and, and, and kindness when you talk to people.

Was that something intrinsic or did you help hone that? Like did you learn some skills as a surgeon coming in? Like I have had some surgeons who said they were kind of, uh, Not such great people, uh, surgeons. And then they develop those skills over time. Like where is, how did you get to where you are in terms of how you interact with people?

[00:36:52] Dr. Sidney Rabinowitz: Well, that's, you know, it always reminds me of my favorite joke is, how do you know when an engineer likes you? And the answer is he stares at your shoes.

[00:37:03] Dr. Sam Rhee: That's good.

[00:37:06] Dr. Sidney Rabinowitz: So engineers do have this, you know, reputation of being probably a little bit on the autistic spectrum. In answer to your question about my personality and how I interact with patients, how I interact with others and how I interact as a human, I'm just fortunate. You know, I'm fortunate that I, cause autism you're born with, right?

And the way you interact, it's, you know, obviously some of it is socialization, how you grew up in your family, all your life experiences, but I've I think part of my success as a surgeon, and I tell a lot of people this, is my ability to speak to people. Not only to speak to people, but to speak to patients in clear English, not technical.

To look at them when I'm speaking to them. And even more importantly, know when to stop talking. So I could hear them talk. Um, it's amazing how much that makes a difference and, and how much patients will respond to you when you actually engage in two way conversation in English.

[00:38:11] Dr. Sam Rhee: How do you deal with conflict? Cause one of the things I've seen you do. And we do, as plastic surgeons, uh, there is always some conflicting interests, there's always, you know, we all have our own self interests, and every time I meet with a bunch of plastic surgeons in most of our hospitals, there's always a little bit of head butting, or, uh, complaining about this, that, or the other thing, or, Thank you.

You know, uh, railing against hospital administration, or this, that, or the other thing. And, and this is not any different from most jobs, I would say. Like, most jobs probably find some similar types of situations, or analogous situations. But you have a good way of mediating, or sort of working with people that I've seen.

Um, how is your approach to that? Especially when you have these pretty, I mean, honestly, a lot of plastic surgeons have pretty big egos. They're smart, they're, they're well trained. How do you deal with all these people when you're, sort of, You know, handling conflict in your situation.

[00:39:09] Dr. Sidney Rabinowitz: Well, if, if I make it look easy, I assure you it's not. And you're right, you are dealing with personalities. Um, I try to look as objectively and as emotionless, um, when I approach a problem as possible. I'll, I'll use whatever, uh, data I have. and other information that's available to me to help mediate the problem.

Like a perfect example as director, and you know, because she was the assistant director for quite some time, you know, I, I, I, first of all, I've always talked with the administrators. Um, I'll refer to the bylaws and I'll see if we are behaving within the, the, um, Uh, the, the guidelines of the bylaws of the hospital, and I'll, I'll let, I'll, I'll, I'll let current dogma, current, um, rules and regulations help guide me.

Does it always help? No. There are, and we, we have problems now, as you, as you know, there's not a single plastic surgeon that wants to take call at any hospital at any time now. Uh, But, but, but that's difficult. And, and, um, and it's necessary. Uh, so we, it takes some cajoling sometimes. Um, other times I, I defer to hospital, uh, existing guidelines and bylaws.

Uh, But that's a very specific thing that I'm talking about. I just try to mediate, uh, using, uh, using whatever knowledge I have, um, treating the other person as an important and respected person as well. Seeing their, seeing their perspective, but also if I have to be firm, I have to be firm. And there are people that, uh, let's face it, they were absolutely dead wrong sometimes,

[00:40:59] Dr. Sam Rhee: hmm.

[00:40:59] Dr. Sidney Rabinowitz: and they feel as if they have some entitlement and, and, and that's not fair to the others.

Um,

[00:41:07] Dr. Sam Rhee: schedule, how has that changed over the years? Because honestly, from the outside, it looks like it's as busy as ever, maybe busier. Like, you still take a ton of call and everyone knows how crazy that can become, especially since you are one of the few go to hand people in the area. So, Um, how do you maintain a, you know, a good quality of life schedule, uh, as, as you progress?

Because a lot of people at this point would be like, this is nuts. I don't want to do what I did 10 years ago or 15 years ago in my practice, but it seems like you're still going strong. Like, do you, are you on methamphetamine or like, how do you, how do you maintain your energy level to, to keep up this kind of schedule?

[00:41:57] Dr. Sidney Rabinowitz: I don't think any of the drugs I use are illicit, but they, they may be, they may be off brand. Um, certainly I may, I may use it for a different purpose. No, no, it's, um, but ever since I'm young, I am not. I am not a sleeper. I am not someone that required a lot of rest. Even as a high school student, it was crazy. So I am relatively high energy, but I'm, but I'm almost like a moderate amount of energy that goes for a long period of time, as opposed to someone who's high energy and then burns out.

Regarding, you know, my practice has changed over the past 10 to 15 years. Um, there are some procedures I don't do, like I used to do rhinoplasty. I don't do those anymore. Um, there's, um, I don't prefer to do, um, replants or micro cases, so I've really kind of, you know, cut back on those. Um, I've, uh, I'm actually phasing out call at one of the hospitals and the other hospital.

I'm only taking about three per month because I'm required to as, um, uh, as an active staff member. Uh,

[00:43:09] Dr. Sam Rhee: huh.

[00:43:13] Dr. Sidney Rabinowitz: better after the No Surprise Act went through and, and the ERs, um, again, this is very specific to plastic surgery. I'm not sure all your listeners would, would, would know about this, but, you know, we're not getting reimbursed anymore for these, um, vanity calls.

And, and as a result, it's, it's hard to get not just me, but any plastic surgeon into the emergency room, you know, if they know. They're not being, now they've reimbursed fairly, they're not even being paid for these things anymore. So that, that is, that's part of the issue, but obviously if someone has a dog bite to the face, has, has a bad injury that requires our expertise, paid or not paid, Charity care or otherwise, I'm going in, I'm going to help, I'm going to help, uh, there's been a few ortho people that have called me in where they've had particularly tough cases or replants and I've gone in and helped it and, and I find that because I have an expertise, because I have a few gray hairs, because I've seen it before, um, ultimately it helps the patient and that makes me feel really good about what I do.

[00:44:20] Dr. Sam Rhee: So, how does work life balance figure into your future goals as a surgeon?

So, you're, you're still, um, extremely active. Um, I, you know, we know surgeons who, um, have, uh, been very active for quite some time. So, as you as a surgeon, like some of your mentors actually too, like the people back in, uh, when you were training. So Uh, what are your goals as a surgeon at this point, uh, in your career?

Do

[00:44:52] Dr. Sidney Rabinowitz: what I do. Um, but, but I recognize that aging is not a myth. Aging is real. And I know at some point I'm going to slow down. Um, You know, in terms of my horizon, I really haven't thought about it, uh, because I still enjoy what, what I do, but in terms of work life balance, I, I, I do feel that, uh, I am, I, I feel very balanced.

I, I have, uh, two wonderful kids, I'm married, my wife, we have a great relationship, I, I have four grandchildren, and I see them Quite a bit. At least every week I see him, you know, two or three times a week. So, so I always like to say I work hard and I play hard. And, um, and it's a balance that works for me and most importantly works for my family.

I don't think they feel as if, uh, I've neglected them at any stage of their life.

[00:45:51] Dr. Sam Rhee: you feel like you're going to take on more administrative responsibilities versus clinical in the future? Like you've already taken on quite a few administrative responsibilities. Do you plan on taking more?

[00:46:01] Dr. Sidney Rabinowitz: No. Um, Because, as much as I enjoy being a director, and I think that I'm an effective director, and I think I'm a fair director more than anything, um, there are periods of time when it's a thankless job, and, and if you put a gun to my head and said would you rather, uh, be at a board meeting or in the operating room, You know, listening to, um, you know, a nice 70s, 60s mix and, and, um, hanging out with a PA and a scrub tech and a circulator.

That's what I'm taking every time. I mean, that's, um, that's much more enjoyable for me than anything administrative.

[00:46:46] Dr. Sam Rhee: So then how much longer have you thought about doing surgery? We know surgeons who would literally operate until like, like draft, old draft horses just, you know, drop in the harness dead, you know, with a scalpel in your hand. Or some who figure out some sort of exit plan and like know that at some point this is, whenever I feel like it, maybe not right now or not right in the near future, this is what my, uh, my future holds for me.

[00:47:15] Dr. Sidney Rabinowitz: Well, I'm, I'm clearly closer to the end of my career than the beginning. Uh, this is 28 years for me. I'm in my early sixties, so, um, so I, again, I, I can't imagine doing this, uh, much past age 70 or 75, but probably 70 is a better number. But I am not absolutely holding myself to that. Uh, it's more about, and I, and also we could scale it, Sam, which is nice.

We can, we can work three days a week if we wanted to. We can work two weeks and then take two weeks off if we wanted later in our career. And, and if I felt that that was necessary or it was, was better for my brain at that point, then I would certainly do that. But right now I'm very comfortable. Working a full schedule, but again, it's, it's 3.

30 in the afternoon when we started our conversation and I was home and you were out of work. So that's a good thing, right? When I first started, I would have been in the hospital till midnight. So it's not always like that.

[00:48:21] Dr. Sam Rhee: If someone were to hear you and say, you know what, that is what I want to be, Dr. Rabinowitz, in the future, like, what kind of advice would you give them for them to be or to think or have a mindset to sort of get there for you? Mm hmm,

[00:48:38] Dr. Sidney Rabinowitz: Wow. Um, you know, I, I, I talk to medical students all the time. I talk to college students, uh, talk to, you know, friends and family about this all the time. As you know, medicine is, is, is not an easy field. It's, it's a field in which you, you have to commit yourself and, um, you really can't do it halfway, uh, in, in my opinion.

Um, and, and my career path within plastic surgery, as, as you know, is a little more unusual. Like, you're a craniofacial person that focuses on, at this point in your career, more cosmetics, and, and that's what you do.

[00:49:17] Dr. Sam Rhee: hmm, mm

[00:49:18] Dr. Sidney Rabinowitz: Um, whereas I do probably about, uh, 65 percent hand surgery and the rest is mostly reconstructive and or cosmetic plastic surgery.

[00:49:28] Dr. Sam Rhee: hmm,

[00:49:29] Dr. Sidney Rabinowitz: But for me, I've always enjoyed the variety and the mixture. Um, you know, there are some orthopedic surgeons, all they do is knee replacements or hip replacements.

[00:49:40] Dr. Sam Rhee: right,

[00:49:42] Dr. Sidney Rabinowitz: But if that's what they like and they like that routine, that's great. But I probably have, you know, a couple of hundred procedures that I do.

And, and you could tell, you know, Because when you go to some of the orthopedists, when they finish with a case, they, they already have their, their pre dictated op note because they do it the same time every time. And I don't, except for maybe carpal tunnel and trigger fingers. But otherwise it's, it's a new adventure every time.

And it's a little nuanced and a little different. So I like that. So if I were to offer advice to someone, I would say, first of all,

[00:50:14] Dr. Sam Rhee: hmm,

[00:50:20] Dr. Sidney Rabinowitz: you enjoy it. The hard part, of course, as you and I know, is trying to figure out what you enjoy.

You know, most people don't come out of the womb and say, you know, I want to be a craniofacial plastic surgeon. It's by life experience. But I think, you know, what's the phrase? If you do what you love, you never work a day in your life, right? But, um, If, if you do what you love, it's, it's certainly a whole lot easier to wake up in the morning and go to work and be a productive, you know, member of our society, you know, whatever job that would be.

Uh, I do think that the, what I do in terms of doing both hand surgery and plastic surgery works for me, but it's, it's more unusual. Mm-Hmm.

[00:51:06] Dr. Sam Rhee: Yeah, I, are a classic plastic surgeon in the sense that you feel comfortable doing such a range of things. And nowadays, most of us will hone down pretty quickly and let all the other skills atrophy. Like there's no doubt that's it used to be. And it's probably still is when you come out of residency training, you feel like you do everything right.

You know, you can do an orbital floor fracture, you could do, uh, a metacarpal fracture, you could do a sternal wound closure, you could do lower extremity, like, you could do a free flap for, uh, you know, like, uh, uh, a severe tibial, uh, tibial injury. And now it's like, you know, You come out and then you hone down pretty quickly and then all those other skills you had kind of fall away, but you still do your, the, the range, which I think, uh, keeps you interested, keeps you stimulated.

I think if I had to choose, if I had to put my money on someone who would least be likely to develop dementia as they get older, it would be you because your brain has constantly been stimulated by dementia. You know, working on all these operations, as opposed to, say, the ortho guy who does the assembly line knee knee knee knee knee knee knee.

So, um, so, so that's pretty awesome. Um,

[00:52:27] Dr. Sidney Rabinowitz: Yeah, it does keep it, it does keep my mind fresh. But also, you know, you know, there is a phrase that, uh, Jack of all trades, master of none. And I always worry about that. Um, so I, I do tend to focus more on the hand surgery for that reason. And, and as you mentioned, you know, we all did so much in residency and I quickly dropped, like, um, maxillofacial trauma.

Because even though I enjoyed it, I just felt like I, I wasn't expert in it and, and I didn't want someone to get an ectropion or entropion and even now I'm shying away from various cosmetic things that I just don't do as often as I did. Certainly, as I told you, I stopped doing rhinoplasty because I really feel that's one area where you really need to do quite a bit and before you have a comfort level.

[00:53:15] Dr. Sam Rhee: yeah, I, you know, I loved rhinoplasties and obviously I felt very comfortable with them, but I dropped them too a couple of years ago, just because either, you know, You had to be all in on them and do a

[00:53:25] Dr. Sidney Rabinowitz: Exactly. Mm hmm.

[00:53:27] Dr. Sam Rhee: because, you know, that, that is something that, um, I respect tremendously and you have to know like where you stand on it.

Like, so I agree with you. That's, uh, so I personally feel very much like you do about like figuring out where your strengths are, what, what I do do. And like I said, it's not that I don't feel like. I've lost my touch. It's just, listen, you know, when you have to do something, uh, you got to get your reps in and if it's, if I'm not getting my rep, if I'm not getting my reps in, then I'm, I'm doing a disservice.

So I want to, and, and you make choices in your practice. So had you chosen, I want to still maintain an active rhinoplasty practice, then, then you push for that. You, you know, and we all know like, um. We can, we can develop any part of our practice that we so choose. It's just what, where you focus your energies on.

And that was, that wasn't something I wanted to focus or, or, and you make your own choices as well as, as a plastic surgeon. So

[00:54:26] Dr. Sidney Rabinowitz: Yeah, absolutely. And, and as you know, with rhinoplasties, you can do a perfect rhinoplasty and unfortunately get a suboptimal result. Um, now you, you could make the argument that if you did a thousand of them, you would get less suboptimal results over time. And that's what probably I was experiencing. You know, I just wasn't doing it often enough.

[00:54:47] Dr. Sam Rhee: I always felt like I could do a rhinoplasty. Like I have a way of doing a rhinoplasty, but all of the subtleties in terms of like, the different ways of modifying it or changing it or if it wasn't exactly what this patient needed or wanted like maybe their anatomy was slightly different like so I could do a vanilla rhinoplasty but anything other than vanilla if you wanted mint chocolate chip or you know strawberry like I was like I I don't know I don't I that that that's not And like you said, you do a thousand of them, yeah, then you can offer up every, you know, variation that you needed, but it was one of those things that, like, Yeah, so I agree with you on that.

[00:55:32] Dr. Sidney Rabinowitz: Yeah, and even now, like, uh, you know, my, uh, partner is Hakan Yusuf, and Hakan and Cary Cohen have done maybe about 2, 000 deep flaps, okay? After 2, 000, they are really good at it. So if anyone came to me and said, I want a deep flap, I'm not doing it. I'm giving it to them, okay? Because after 2, 000, you have a pretty good handle on any problem you could encounter.

[00:55:58] Dr. Sam Rhee: Absolutely. I mean, we all, um, know, I think, especially in, in our areas, who really, uh, focuses on what and, and who we know who is expert at it. And, and, and I've relied on you for so much of that over the years, and I really appreciate that as well. So, um, yeah.

[00:56:16] Dr. Sidney Rabinowitz: Well, thank you very much. And you know, I, I admire your work and, and your work ethic and, uh, it's been terrific working with you and, and, uh, and being a colleague of yours for all these years.

[00:56:29] Dr. Sam Rhee: Thank you so much, Sid. I really appreciate you taking the time. I know how busy you are with you and your life and as well with your family. So, thanks again. I'll see you around. We do all the Zoom conferences now, so I'm sure I'll see you at the next M& M. But, thank you again. Much gratitude to you.

[00:56:50] Dr. Sidney Rabinowitz: Very welcome. Thank you. This has been a pleasure. All right.