Theda Kontis, MD
Aesthetic Center at Woodholme
Associate Professor, Department of Otolaryngology-
Head and Neck Surgery,
The Johns Hopkins University
President, American Board of Facial Plastic and
Reconstructive Surgery
Former President, American Academy of Facial Plastic
and Reconstructive Surgery
JT: Dr Kontis, I'll start with my first question. I
want to know what you love most about facial plastics. And what you dislike
about it, if you can pick a thing or two.
TK: Excellent. I think about this every day. I love
facial plastics because I can help someone feel better about themselves. And… it
is such a gift to be able to give that to someone. People come in upset about
something in their appearance, and I know if I can fix it or not. And when I
can fix it, and I see their response, to me, that's just the best gift. And
it's something as little as doing injectables on someone, and you hand them the
mirror, and they say, wow! That looks great! And they look 10 years younger! Of
course, with neurotoxins, it takes longer, but fillers is right away.
My routine is that at about 6-8 weeks after cosmetic
surgery I print up before and after pictures for the patients. Mostly they can
see the changes because some people can't, but also so they can show their
friends and maybe get me some new patients.
JT: So you actually give them the pre- and post-ops?
TK: Yes. Yes. I print up their pre- and post. and I
give it to them in a big envelope, on photographic paper, with a letter
thanking them for trusting me with their surgery, asking them to post a review
if they're so inclined. And a lot of them will actually take pictures of the
pictures I gave them and post them.
JT: That’s amazing.
TK: Sitting with someone after you've operated on them
and fixed whatever they were unhappy with, is so gratifying! When I was a
little Greek girl, I had a big nose. And was very self-conscious about it. So
when I was 14, I had a rhinoplasty and it changed my life. I mean, it changed
my whole psyche because I thought that I was deformed. I was teased about it,
and, you know, I look at pictures now, it really wasn't that bad! But to me, I
thought I was a rhinoceros- I just thought it was terrible. So, I guess I kind
of relive that when I look at before and after pictures with my patients and
it's just very gratifying. It's so fun to be able to help someone like that.
When you take pictures of people pre-op, they are so
uncomfortable having their pictures taken. And you can tell, you can just tell
the way that they sit on the chair. They won't look where you want them to
look. It's just awful. It's a terrible experience with the pre-ops. With the
post-op pictures, they ask me: “when are we doing the post-op pictures? Are we
doing them today?” with a big smile on their face. Sometimes they'll wear
makeup or have a new haircut or something because they kind of want to show off
that they feel better about themselves. And you can see it in the before and
after pictures, you can just see it in their expressions, that they just feel
better about themselves.
So that's why I love it. I haven't hated it until
recently: Social media and the expectations of patients has made facial
plastics almost unbearable. Patients expect perfection. If they're not happy,
they will threaten you with bad reviews. I just had 1 patient come in a couple
days ago with an AI generated picture of herself. And she said, AI says you can
do this with fillers and neurotoxins. It was totally impossible. So I refused
to treat her because she would not be happy. She had facial asymmetries that
were skeletal, and AI fixed that perfectly. I can't fix it. So the expectations
of patients today are sometimes unattainable. They see perfect before and after
pictures online. Who knows if they're perfect or if they've been manipulated.
It's very frustrating. It's very scary. It makes me glad that I'm near the end
of my career because I expect it to get worse and I don't know if I would be
able to handle it.
JT: Both are very interesting perspectives for me.
First of all, the fact that you said that you experienced this yourself
probably helps you understand and appreciate what you're hearing, especially if
it's not in line with what you are seeing. Like you said, you think that it
wasn't as bad as you felt at the time, but you can probably relate to other
people describing it as such, their own facial appearance. And then the AI, the
AI thing, I never thought about that, that how much it contributes to
unrealistic expectations. I would assume.
TK: Yes.
JT: Photoshop does, like someone publishes their
results in their Photoshop, and other people see and have unrealistic
expectations, but never thought about AI, but that's such a great point.
TK: It just happened, last week. It's the first time,
but it's going to be worse.
JT: Yeah, yeah, I'm sure, I'm sure it will.
TK: You know, when I talk to a rhinoplasty patient, I
tell them that I had my nose done, and I tell them, I can tell you 5 things
that are wrong with my nose. But I don't care. Because it's so much better than
it was. It's not perfect, but I don't focus on it anymore. And you know
sometimes you'll find patients who have good expectations for what we can do
surgically. But my point is that we're generating potential patients who don't
have the right expectations.
JT: My next question is moving in a completely
different direction. Recently, a friend of mine was taking the board, so I
learned that you're the president of the board, amongst other things that
you've done, and my attendings informed me that you are, I believe, the second
female president of the American Academy? Yes. And I understand you have an
amazing multifaceted career, training residents, training fellows, running a
successful practice is my understanding, several leadership positions. Which
role, and I'm sure that I'm not capturing all of them, all of your professional
roles, but still, which one would you say that has taught you the most?
TK:
Being a mother? I'm sort of joking and sort of not joking.
JT: I believe that.
TK: It's certainly given me the most joy in my life.
You know, of all the physical accomplishments you can do in the world, having a
child is probably the best. But to truly answer your question, every leadership
role is fun. Nothing that I've done has been a chore. And, and I think that's
why I have never had burnout because I really do find the joy in being a
leader. Leadership involves mentoring people, making the organization move
ahead, being a visionary. And that's really fun. So, you know, in the Academy,
you're only a president for a year, and it doesn't give you much time to get
things done, but I did a few things that may stick for a while. So you get
satisfaction out of doing things to help move the organization along. Same with
the board. I've initiated a few things that are just fun. But I think I've
learned the most running my own business. I secretly wish I had an MBA. At this
point, it wouldn't help me very much in my life to have an MBA, because I've
had on the job training really, but the Maryland Medical Society set up an
MBA-like course for physicians years ago. I was probably less than 10 years in
practice. And I was so excited about this program. It was a nighttime course,
once or twice a week. And I signed up immediately, because I thought it was
going to be sold out. But there were approximately 5 doctors that took it. It
absolutely floored me how few doctors there were, but I learned so much about
running a business and understanding negotiations. I mean, just learning about
negotiating. Changed my whole life.
I buy all our cars and my husband rolls his eyes when
I'm negotiating, but I get really good deals, So that's fun too. It's fun to
run your practice and with running a practice, you have to deal with the good
and the bad. Every business has tough things to deal with. Human resources is
one of the parts of running a business that I hate. I don't like hiring, I
don't like firing, and I could tell you stories about theft that would make
your hair curl. And it happens. It's just the hard truth of running a business.
And it happens in academics, and it happens in private practice. I had a very
trusted young lady, who actually went to jail for embezzling from us. I'll bet
you, almost everybody my age that you talk to will have at least one story of
some sort of horrible thing that's happened in their practice. I remember the
detective said to me: “You probably feel right now that you can't trust anyone
ever again in your practice. And you can't do that”. You have to trust people.
You can't run your practice by yourself. I mean, we were, all devastated by
what this young lady did. She babysat for my partner, we went to her wedding,
she worked for us for years!
JT: That's devastating.
TK: It's devastating, and it's devastating on a
personal level - how can someone do that to you? How can you think you know
someone and have them do something so horrible? So running the practice really
has taught me many lessons. Overall, I love it, and it's fun, and it's been
fun. When I joined Dr Ira Papel’s
practice, we had 3 employees, now we have 25. So…
JT: Growth.
TK: Yeah, you grow it and it's fun. But everything has
its ups and downs. As I said, an MBA would have been really fun to have, but you
don't have to! And sadly, a lot of people in your generation are very nervous
about private practice. And I've mentored quite a few young physicians who are
looking for another job and don't even consider private practice because they
think that academics is the only way to go, and you have to have a salary.
That's okay, but in private practice, you work really hard and you do very well
If you don't work hard, you don't do well. And it's really gratifying to work
hard and build your business and see it flourish. There's a lot of joy in what
I do- I'm sure you can tell from my explanations of things!
JT: I sure can. And the enthusiasm that comes with it,
I think it's contagious. I really admire that. If you had to pick one thing
that you're most proud about contributing to the field -and that cannot be your
daughter- what would it be?
TK: I wrote a textbook on injectables. And that was a
bit of a journey. My partner, Dr Ira Papel is pretty well known for rhinoplasty.
I was his first fellow, so when he hired me, I said to him, are you sure you
really want another facial plastics person in your practice? And he said,
absolutely! My dream is to have a facial plastics focused practice. So I
thought “well, great. I can't compete with him for rhinoplasty”. I mean,
because we're both in the same office, I don't want to be taking his patients, or
him taking my patients, so I thought, what could I potentially master that
wouldn't tread on what he's doing, basically. And, what could I take to
meetings? I was like one of a handful of women in our academy at the time, and
I thought, what can I teach these guys? They don't want to hear from me about
facelift surgery, so injectables were just starting to come out. And I thought,
well, I can master that.
So, I learned about it, and I taught about it, and the
companies, a lot of times, would want me to train other doctors. And I realized
that there was not a very good textbook for training. So I approached the
publisher Thieme, who does a lot of medical textbooks, and I fought with them
about this book, because my vision was for it to be small in size, very
targeted, almost like a cookbook of exactly how to do each procedure. And I
wanted an artist to draw just the anatomy that was necessary. And they fought
me on that. They said “we've got all these anatomical pictures, can't you use
these?”. And I said, no. I said to them “you have no idea about the amount of
interest in these injectables. It's not just going to be facial plastics, it's
going to be nurses and doctors and dermatology, and it's just going to be huge”.
So they did believe me, eventually. Now, I just finished the third edition. It's translated into five or six languages. So I
think that's my biggest donation to the facial plastics world, and that's been
fun too.
JT: That's so exciting. I was looking at that, and I
don't know if he was a co-editor for the first edition too, but I noticed that
the most recent edition, your co-editor is a Jefferson alumnus, is that right?
TK: Victor Lacombe?
JT: Yeah.
TK: Yeah, so I asked Victor to write the book with me,
because I wanted it not to all be the Theda Kontis book of injectables. I don't
know Victor very well, but I know he's an injector in California, and that
ticked off the two things that I wanted. I wanted somebody who was very
knowledgeable about injectables, and I didn't know his techniques, and he's on
the other coast. You know, it wouldn't help me to have somebody down the street
write. And it worked out great. We collaborate very well and we don't do
everything exactly the same. And that's what I wanted.
JT: If you were to start over again what would you do
differently? Not with a book, with your training and career pathway overall,
assuming that, of course, you're doing facial plastics again. Knowing what you
know now.
TK: Boy, that's a hard one. I almost feel that my
career path was okay. I'm not sure I would do anything differently, but I would
probably treat myself better. I think that my generation is very big on work,
work, work-we are the workaholics. We're the people who have 500 sick days
saved up. And, and that's okay because we get stuff done. But we don't enjoy
life as much. And I think your generation has it figured out that work is fine,
but you've got to also enjoy life. And, I'm realizing that now, and I'm trying
to. Take more trips, and have more fun, and work a little less.
JT: What you're saying makes me wonder if it's a
generational thing or it's a time thing. Earlier in your life, you have to work
hard to build something, to build the foundation, like you said earlier, to get
to a point, that you can actually enjoy other things. But coming from the
privilege of knowing that you've built that and you've allowed yourself to
enjoy all those things.
TK: Yeah, I think that's true. And you know, I didn't
have it easy growing up, and I didn't have the means to travel and to do all
those things. So you're right, part of it is work really hard and make money so
that you can go out and enjoy life. But you don't really have to. You don't
really have to be successful and wealthy to take a break, and just relax, and not
be a workaholic. When I'm in my free time, I'm at the computer, reading a paper
or doing something with the academy. So I think relax more, enjoy life more, and
the success will come. But, you gotta take care of yourself.
JT: Thank you for sharing this. Now, you've already
prefaced that by saying that you don't love hiring, you don't love firing, but
when you have to -and I'm sure you have- do it extensively on all different
levels, residents, fellows, employees in your office, faculty, etc. what are
you looking for? What are the key things that you value the most?
TK: Well, I have a trick question I ask people who are
interested in working for me. I asked them if they looked at our website. You would be amazed how many people don’t. They have
no idea where they're going for an interview, what we do, who we are, they just
show up. It amazes me.
JT: That surprises me a lot, actually.
TK: So, if anybody says “yes, I looked at your website”,
immediately they go to the top of the list!
JT: They did their homework.
TK: Yes. So, it's also a team sport. So I look for
people who are willing to be in a team. Not say I only do what's on my job
description and nothing else. And that's really hard to find these days. So personality
is important. Teamwork is important. Curiosity is important. But you know,
these people become like family. They're our work family, so it has to be
somebody that you feel that you can get along with.
The firing part is not fun, and there's a saying in
businesses to hire slow and fire fast. That is such an important rule, and I
break it all the time. I hire on a whim, and then I just want to give the
person another chance, and another chance, and another chance, and they should
have been fired months ago, and you just string them along, and it doesn't help
anybody, really. So that's a really good thing to remember: “hire slow and fire
fast”.
Another thing that makes me feel better when I fire
someone is that they've really fired themselves. You know, if they're not
working out, there's a reason for that. And it's not that anything I did. It's like that when you fail someone on an
exam. I do the ABFPRS oral board exams,
and when we examiners have to fail someone, we feel terrible about it. And you
have to just think, well, this person is not safe. They don't know. They can't
figure out the clinical problem, and so I have to fail them. But in reality they
failed themselves. I'm not failing them. They're not safe. They need to go home
and study and take it again. So putting that blame onto the person rather than
internalizing it does help.
JT: That's very helpful. Are there any red flags for
you that, when you notice you say “this is not a great person for my practice,
or this is not a great person for Johns Hopkins”. Anything that you can think
of that immediately raises a red flag.
TK: I don't know. That's a, that's a tough question,
because you'd have to think in generalities. I don't know that there's anything
that would immediately make me worried about hiring someone. It's more finding
out what other people think of them through recommendations and evaluations.
First impressions that you make with people are sometimes good and sometimes
not, so especially when people are nervous it's hard to say that they didn't do
a good job on their interview, because if they're nervous, they're not going
to. But if their recommendations and their evaluations raise any doubt about
their honesty or their integrity or their ability to work with other people
then you take that very seriously. And even sometimes you have to call where
they worked before and talk to them. The best question is, would you hire this
person again? And there have been times that the person would say no. Then I’m
not going to hire them either!
JT: What's the difference between a good and a great
surgeon?
TK: There are a lot of good surgeons who think they
are great surgeons. And there are a lot of great surgeons who don't think
they're great surgeons. So I would say being humble is probably what makes a
great surgeon, because there's more to it than being technically excellent.
There's the interactions with the patient. That can make a surgeon great, I
think. Surgery is not always flawless. Frequently, we have issues, we have
complications, we have things where we have to treat the psyche of the patient,
not just the flesh of the patient. So the ability to take care of the patient completely,
I think, is what makes a great surgeon. You need to help them through their
complication and be there for them.
There are some famous surgeons who are known for this
or known for that. The patients don't even get to talk to them. No bedside
manner and no follow-up. The nurses take care of the patient afterwards. They
may be a great surgeon, but it's not a surgeon I would want. So, I think that
the compassion and the humility is much more important to make a great surgeon
than just knowing where to cut.
JT: Thank you. I think there's a lot of wisdom in
that. Thank you. I really want to stay on time, so I'm going to move on to what
I think will be my last question. I have a ton of questions, but I…
TK: Am I talking too much?
JT: Haha no, no, no, quite the opposite. I'm trying to
keep myself in line and not go over time because I'm sure you're busy and you
have a lot of things to do. So my last question would be, what would you like
to be remembered for? What would you like your legacy to be?
TK: I do like teaching and I do like mentoring. Part
of being a good leader is being a good mentor and role model. So I think I
would like to be remembered for being a trailblazer as a woman in our field,
and mentoring young women to push ahead in their careers and continue to
increase the numbers of women in our specialty. I'm the second woman president
of the Academy and of the Board, because there weren't any women who were
available to be the President. We have just slowly increased our ranks. I mean,
quite literally, there were no women fellowship directors when I started my
fellowship. So it was 100% men in our academy. 100%! So when we were trying to
figure out how many women were in the Academy, the Academy couldn't tell us
because they never checked the boxes for male or female because everyone was
male. So times have changed a lot, and I kind of want to just be remembered as
a trailblazer, as somebody who just helped get in the academy and the board
more women interested in the field and more involved.
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