Meet Dr. Gwen Maxwell, MD, FACS
Q: What initially drew you to the field of plastic surgery?
When I first started into medical school, of course, it’s a huge opportunity to pick almost anything that you would want to be. You finish your first couple of years of medical school that are really intensive (I have friends who said it was like drinking water through a fire hydrant) and after those first two years, when you’re introduced to all of the basic sciences, you get to start rotations.
The first rotation that I did was surgery. The first time that I was ever in surgery, it was just miraculous. First of all, surgery is very ritualistic. You scrub your hands to prepare, you gown, and you glove, and so there’s literally some theater involved. The two surgeons that I happened to get to observe at that level of my training were the senior resident and another attending, and they were treating a Vietnam veteran who had a bowel obstruction. I will just never forget not only how definitive the surgical process was, but how incredibly beautiful it was as well.
Obviously, needles and blood don’t bother me. After some reflection, I realized that general surgery wasn’t as creative as I thought, so it didn’t appeal to me. I did a plastic surgery rotation, and at that point, I was pretty much hooked. I never have thought that I “came to work.” I always have felt that I come to do my art and to hopefully transform people and their experience with that particular operation into something that they’ve always wanted to be. Not that we’re able to change people, because we’re not. We’re not able to make you into a movie star. But we work with what you have, enhancing your own natural characteristics and beauty. And it’s just the most incredibly rewarding thing I’ve ever done.
Q: What skills make a surgeon a good surgeon?
I started sewing my own clothes when I was a child. I grew up in a small town in southern Arizona, and I was, of course, a Girl Scout. We did some merit badges, but we also were involved in something called 4-H, which was a rural program where you could either raise cows or do other things, but I made clothes.
And so, I started sewing my own clothes when I was very young. I continued to do that all through college and pretty much stopped when I was in medical school just because there was not a lot of time to continue that. So, the ability to do things with your hands, whether it’s playing the piano, creating, drawing, painting, or sewing I think does give you an edge when you start thinking about the aesthetics of the human body and what you want to do. You learn what’s going to work and what’s not going to work.
What really ends up making you a better surgeon or a good surgeon is, of course, practice, but also the ability to reflect and to think about your own ability to express that artistry through that other person.
Really, it’s a combined effort. Because what you have to do is you have to really find out what’s at the heart of what is bothering the other person. Then you have to realize what the constraints are within the confines of what you want to do. Let’s say it’s a tummy tuck or a breast augmentation. Those are things that, through your interactions with the patient, you ultimately determine not only what the patient wants, but what their budget is going to be able to afford and what they’re going to feel comfortable doing.
Q: What’s your favorite part of being a plastic surgeon?
It’s a real privilege to be able to take care of patients, and even though everything we do is for cosmetic concerns, we truly do make a difference in people’s lives. I can’t tell you how many patients have expressed this to me. Whether we are addressing an overhanging stomach, sagging breasts, loss of breast volume through pregnancy, or aging of the face, being able to see a patient’s confidence increase after surgery is incredibly rewarding. Of course, all of those things are things that we have really tried to pride ourselves in, and to, ultimately perfect, as I have practiced the art of plastic surgery. Plastic surgery is very different from other fields in medicine because it’s very definitive, it is more invasive. But because it’s more invasive, it’s also more effective.
So, what we try to do here at Maxwell Aesthetics is present an honest representation of what you can expect and where you’re going to get the most value out of your money. Everybody has a limited budget, and certainly, you have limited time. People have constraints with family, for recovery, so we really try to dispel all of the myths and come up with an operative plan and a surgical plan that really fits with all of the things that we want to accomplish for that patient.
Q: How critical is it for a surgeon to have a good surgical staff?
Every surgeon can be good or bad on their own. But, just like John Donne said, no man is an island. No person or no surgeon is an island, and I certainly can’t do any of the things that I do without all of the support staff behind me. I have been so fortunate in my life and in my career to be able to attract extremely talented people, and for them to have stayed with me.
A good staff is absolutely critical, I mean they’re the first ones that greet the patients. I can only spend so much time with them and a huge part of the time that I do spend with them is time in surgery.
So that extra extension of myself becomes actually the essence of Maxwell Aesthetics. I can really feel that a lot of these patients really feel like they’re family to us and I think that they reciprocate. I think that they feel that we would take care of them.
There are so many times that we have been asked questions that aren’t even related to cosmetic surgery. We’ve diagnosed everything from venous insufficiency to gallbladder disease to various neurologic things just based on the fact that we have time and take the concern to be able to listen to what patients have to tell us. We always like to feel like we’re the go-between because patients need advocacy in medicine these days because practitioners just really don’t always have the time to listen to them.
Q: Plastic surgery really seems to be very challenging, yet you enjoy it. Why?
Very simply, for the creativity, it’s hard. It’s easy to take out a gallbladder or an appendix or treat high blood pressure. Those are very formulaic. You do it the same way every time. But plastic surgery is unique and individual for every single patient. I never do the same operation twice.
I do some of the same steps every time when I’m doing breast augmentation, for instance. But every breast is slightly, subtly different. And that becomes the challenge and responsibility; to pay attention, to really learn the anatomy, and to learn some of the nuances that different patients bring to you.
Another thing that’s really important in plastic surgery is Making sure that the patient understands the constraints of their own anatomy. That was a skill that took me a while to learn. And that’s probably one of the reasons why we take a lot of before and after photographs. Patients never remember all of the subtleties of their anatomy that I am tuned into. And so afterwards… There will be many times that people will say, oh what about this little fold here? It’s always due to some anatomic issue that existed prior to surgery, not something that gets created by the surgeon.
Surgeons are good at changing some things, but we’re not gods, we don’t create the different parts of the anatomy that existed before we got started on patients.
Q: Do you have a favorite surgical procedure you perform?
Favorite procedures are one of those things that evolve with time. So, when you start out, even a breast augmentation can have some challenges and some subtleties and nuances that require different techniques. Then, you start becoming fond of tummy tucks; that’s probably the next amplitude of difficulty. You finally get to the face because the facelift has the most nuance. Each of those particular things require a certain discipline and certain observations of anatomic variations that have to be held to very specifically or your results will really show it.
Now the patient may not notice it, but I notice it. And I think that’s only fair. The surgeon should notice things that the patient would never notice. And the real challenge of integrity then comes from noticing things that the patient probably has noticed but you’ve got the courage to say, “hey, I think, this could be just a little bit better.”
I’m fairly liberal with doing fine little tweakings or little refinements to my procedures based on little things that I see that I think could be improved. Similar to that though, the other side of that coin is sometimes things can’t be better. They are as good as they are going to be, given what the patient wanted and was prepared to pay for.
Q: Do you have any big success stories of major transformations?
I guess there are a few that I can think of. I think that obviously there’s something that we talk about in plastic surgery that the degree of the deformity oftentimes can be transposed into the most dramatic results. And so, we’ve done some extensive bariatric surgery on patients where we take off a lot of the extra skin.
And I remember one patient in particular whom we had done this particular surgery on where we had taken off the whole skirt, it’s called a belt lipectomy, all the way around. And she was walking through a store with her husband and her husband couldn’t find her because he was looking for somebody bigger. And here she was multiple sizes smaller after the surgery. So, when you hear stuff like that, it melts your heart…
When you see a facelift and they look at themselves in the mirror and they tear up because, this is something that they’ve saved for the last ten years and they are naturally beautiful people but all of the soft tissue has gotten in the way. Seeing somebody tear up over that is very rewarding.
A lot of times the person who is the recipient of the gift is the husband. Because the wife has better self-esteem, or the girlfriends feel better about themselves, their sexuality, their sensuality is improved with the breast procedures that we do. I can think of hundreds of cases where that has been the reality. And so, you get to make sometimes, not just one person happy, but two people happy. And I can’t think of any other field where that’s the case.
Q: Are there any people who are not a good candidate for plastic surgery?
There is something called Body Dysmorphic Syndrome, and every plastic surgeon has operated on somebody with Body Dysmorphic Syndrome and regretted it. And so, you do have to be very careful with your patient selection. And I think over time the surgeon can get a feeling, and certainly the staff can get a feeling for the patient, for their motivation, the things they say, the way they say it, the way they carry themselves.
So, you become a study of patients and patients’ psyches, if you will, if you’re good at your job and you’re paying attention. I can honestly say that in my entire career, I have never tried to oversell or upsell based on my own gain or my own greed. I have tried to really keenly listen to what the patient has to tell me, what they want, what their ultimate goals are, what their motivations are, and it’s only then that you get somebody who’s happy.
I still make little slips in judgment, but not to the degree that we see sometimes people coming to see us who have inadvertently picked the wrong surgeon for the wrong reasons and have either no results or bad results. Those are the real heartbreaking things. It’s patients who have been sold a bill of goods, who have spent their money and not only now don’t have a good outcome but have a poor outcome and have to spend more money to correct something that they were misguided in believing was going to be the result that they had paid for.
That’s the hard part of cosmetic surgery. The reason for that is because it’s a fee for service. So, we don’t charge or bill insurance. Patients pay for this out of their own pockets. And I think that because of that there are a lot of charlatans who really do take advantage of patients and their naivete. It’s sad.
Q: What’s your favorite part of your job?
It has been, and it still continues to be just wonderful; I cannot imagine working for better people. I can’t imagine having more lovely clients to be able to operate on. And I don’t know if there’s such a thing as a perfect storm, then this is it. It has been a real pleasure.
