FRCS Edinburgh magazine interview between Charles Gallagher and Dr Woffles Wu
CG: Could you please talk me through your career path since leaving school?
WW: Hm okay, very interesting. I studied in England – I grew up there – and came back to Singapore when I was eleven, just at the tail end of my primary school, and barely scraped through that because of my second language.
I did secondary school here [Singapore], I did pre-university and university. So I did my basic medical degree here, then I initially wanted to be a paediatrician, and because I come from a family of family practitioners and their practice style was something that I liked – that very family-oriented family style, you see the whole family, and you get called out in the middle of the night etc, the busy GP type of scenario. Then I thought I’d like to treat children; well, let me go back one bit.
I’ve always been interested in beauty and I did think about being a plastic surgeon before I even entered med school. After going through med school, I kind of thought I wanted to help children, then I did a posting in paediatrics as a houseman, and it was very rewarding but it was very depressing as well because you get to see all these kids with cancer and you’re just giving them injections day after day, and nothing’s really happening and they’re dying in front of you and it kind of brought me back down to earth that as a paediatrician you can only help a certain group, and there’s a certain group which can’t be helped.
And then I got sidetracked back into plastic surgery again through cleft lip/palate surgery. So I went to join the department of plastic surgery with a view to becoming a cleft palate/cleft lip surgeon, which I am, actually and so I entered plastic surgery not with beauty as the end point but really helping kids, and that’s what I did in my plastic surgery career – I went on to become a paediatric and craniofacial plastic surgeon primarily, and that’s what I am – before branching out into the aesthetic aspect of plastic surgery.
So my training took me first of all to get my FRCS in Edinburgh, and from there I came back, I finished my residency here, I did my fellowship in Melbourne at The Royal Children’s Hospital, so I was there for about one-and-a-half years, and then I did a few little travel fellowships around the world – I was in Japan, I was in Thailand, I was in the Philippines and I went to the States, each one a couple of weeks here and there, just to learn the tricks of the trade, and then, eventually, I came back here to practice, and first of all I was a practicing craniofacial surgeon, but that needs to be a hospital-based thing, and gradually, through the years, I found that the way to go was to be in private practice. So now I’m in private practice I’ve kind of reinvented myself as a cosmetic plastic surgeon primarily, although I still do a little bit of craniofacial, I still do a little bit of oral-maxillofacial, and I still do some clefts but few and far between because I’m not hospital-based anymore.
CG: In the UK you have to have dental training to do any maxillofacial-type work; do you have any dental training or is it different over here?
WW: No, I don’t, it’s a different thing. When you do craniofacial, that’s the one area where if you’re a craniofacial surgeon in my day, you do not need to have a dental degree. Part of craniofacial training did involve rotations through orthodontics and jaw surgery, and anyway, we were trained to do jaw surgery, so that was kind of the in-between area at that point in time.
CG: What do you consider to be the high points of your career so far?
WW: I suppose it’s not a high point but it’s a high period; this last ten years has been a very interesting period for me, because, first of all, being in private practice has given me a certain amount of freedom, clinical freedom, and with that freedom I was able to direct some of my thoughts and creativity towards developing new procedures. And of course, it just happened to be at the same time that Botox became available, fillers became available, so I was really one of the first few in the world to start using it comprehensively, and then I added on the thread lifting. So that’s obviously something that has become associated with me, the thread lifting technique, and I added this into this whole ‘Four R’ principle approach to the skin and to the face and for non-surgical facial rejuvenation, and by doing that, I’ve really been able to create a rejuvenated look which is similar to, if not more natural than, a surgically rejuvenated look. That’s very satisfying, and of course, going around the world the last ten years to lecture extensively on this has been a very rewarding and satisfying period. So I wouldn’t say it’s a one particular thing, because they all kind of meld together, I mean, in Botox I’ve invented a couple of techniques, in fillers I kind of invented a couple of techniques; I invented the thread lift, I invented the breast ‘stealth’ scar, and it’s just putting it all together to come out as a complete aesthetic package – I guess that has been the most rewarding, professionally, for me. And then of course, being recognized for that, being asked to lecture around the world, has also added to the whole glamour and lustre of the thing.
CG: And the low points?
WW: The low points? I guess the low points always are as a surgeon, you’re never going to be able to be 100% risk-free for your patients – some patients do get complications, some of your patients get infection and that’s not a nice thing, when you get a patient who has a complication; you just have to work your way around it. And those are, I guess, in a professional regard, you’re always trying to get the best outcome for your patients, but when something doesn’t go right, if they get an infection through nobody’s fault, it just spoils the whole result. And of course everyone’s expectation is instantly lowered and everyone’s disappointed – the patient’s disappointed, I’m disappointed, and those are, for me, kind of like the low points.
I mean there are other low points with regard to my work like interpersonal relationships within – finding out that your staff has been stealing from you and that kind of thing. So those are equally low points, but they’re not career low points if you know what I mean.
CG: You are the top plastic surgeon in Asia and one of the Top 10 plastic surgeons in the world…
WW: Well that what media reports say, it doesn’t necessarily make it true. And I don’t believe it either.
CG: …You are also a fanatical art collector, a film producer, have a family, and you have represented your country at ten-pin bowling and snooker. What have you had to sacrifice in order to achieve so much?
WW: What have I had to sacrifice? Nothing really, a little bit of time here and there. I mean there are many things that I’ve done, and ‘achieved’, but they haven’t been done all at the same time. It’s not as if I’m doing a film, doing this, doing this, and all these other things all on the same day – it gets kind of split up. So if I’m doing a film, a film takes two years. To do a film is slightly more than a year and you’ve got the filming schedule, you’ve got the pre-production, you’ve got the production, you’ve got the post-production, and then you’ve got the advertising aspect. Then you’re actually screening the film, and then it kind of stops and then you’re just waiting for any money to come back in and the reviews to come back in, but then you’re already moving on to your next project, alright. So I would like to spend a little bit more time with the family – I obviously can’t be the father who takes the children to school and waits for them at lunch to come back, and talks to them, and then maybe plays with them in the afternoon, and then do lots of things on the weekend. So the time I have with them is very precious, it’s very meaningful, and it’s usually restricted to nights and some time at the weekends. So yes, that’s a bit of a sacrifice. I can’t think of any other way to do it really because the way the clinic is packed through the day, I have often meetings in the evenings, I sometimes have interviews on weekends – in fact most of my interviews are all conducted Sunday, Sunday morning before the children wake up or something, and it’s usually at my house. So we’ll have meetings there and that’s where I have interviews with students or magazines or other media things. Then of course that can eat into a little bit of the morning time, but I guess everyone’s gotten used to it, and they’ve all developed their own interests around my busy and hectic schedule.
So there is a little bit of a sacrifice in terms of the time I’d like to spend with the family, and being full time in the medical profession you can’t really excel in the other things – you can have interests in other things but you can’t really excel, because I always believe that to excel in something you have to have 120% passion for it and you have to devote 130% time to it. So it’s almost a question of being a jack of all trades and a master of none, but I concentrate primarily on the plastic surgery aspect, because that is my number one passion.
CG: You are a creative person, and one of the outlets for your creativity is your aesthetic surgery. Which other medical specialties do you think would suit someone with a similar creative streak?
WW: I think hand surgery would – there’s a lot of fine detail, a lot of arts and craftsy manipulation which is required in hand surgery. Of course you don’t have the same kind of aesthetic liberties with hand surgery as you do with cosmetic surgery because the range of what people want to look like is very vast, whereas hands are more functional. And of course there is an aesthetic component to it, but it’s more limited. But in terms of the fine motor skill required, and the attention to detail, I think hand surgery is quite similar to plastic surgery. Dermatology, or cosmetic dermatology, has got some crossover aspects with plastic surgery as well, so that tends to have a little bit of creativity as well. Those would be the two main things I would probably choose.
CG: It could be argued that some patients who seek aesthetic surgery would be better served by a psychological referral than referral to a plastic surgeon.
WW: Sometimes. I think this is an age old misconception, and it really needs to be debunked. It doesn’t mean to say that everybody who walks into a plastic surgery clinic is in desperate need of psychological assessment or is on the brink of becoming a psychiatric case. That’s really a leftover from films of the 30s and 40s where it was felt that people who needed plastic surgery were so lacking in moral fibre and self-confidence that they needed a new face to be able to face the world, literally. But it’s not like that at all, because everybody, and I think this is in-built in our genes, everybody has a desire to look good – it’s just a Darwinian natural selection thing. Even if you look at the animal kingdom, the biggest, fattest penguin gets the best mate; the hairiest, loudest lion gets the best mate, and so on through all the species. And for human beings, well obviously, looks play a part – it’s the spark of attraction. You’re not going to delve into somebody’s intellect and emotional quotient straightaway – it’s basically whether you find that person attractive or not. So there’s a very strong aesthetic component to mating, and people naturally want to look better. In the old days, all we had was make-up and hairstyle to improve us. And then came fashion, and fashion helped individualise us and make us look different. Plastic surgery now in the 20th century is just coming on the tailend of this whole concept of making grooming, making oneself look better, but it’s just giving a surgical spin to the whole thing. And in the early days, the 30s, 40s, maybe it was a bit difficult to predict what the outcomes would be, so it was like if you went for plastic surgery you either came out very beautiful or you came out very hideous, depending on the skill and expertise of the people involved. But now with training and education and plastic surgery being a firm and significant part of the surgical discipline, we’re able to recreate our outcomes more predictably. And with non-surgical cosmetic procedures, we’re now able to bring patients in, and do very little things to them which may not even involve the knife, and still achieve this type of improvement. So, to say that patients linked to wanting to improve themselves is linked in some way to a psychological deficit I think is overplayed, it’s overdone.
CG: So just linking into that, how do ensure that the patient’s you operate on are appropriate for surgery.
WW: Well, through careful assessment, careful interviews with them. Clinical consultation is the most important thing because that’s when you derive a sense of what the patient is and whether their expectations are realistic or not. If they are overly anxious, or overly obsessed about a particular feature, I mean they may be exhibiting body dysmorphic disorder, and you’ve got to weed these patients out. And if we begin to smell that a patient is not quite right, that’s when we refer them to a psychologist or a psychiatrist.
If I just to go back to the last question and this need for psychological assessment – just because you want to improve yourself. You can also extend that argument back a little and say that, well, everybody who wants to dye their hair, and not accept that they have white hair, is in denial of their aging and wants to turn the clock back, and therefore should have psychological assessment. But we don’t think anything of this…
CG: I know, it’s just society says one thing about these people and another thing about…
WW: Right, and so people who have extensive make-up, dye their hair, and do all these beauty adjuncts to improve themselves – are they psychologically wanting? Maybe, who knows? So I think plastic surgery, as I said, is so acceptable, and so predictable, and so safe today that it has become an option no different from dying your hair.
CG: Okay. Now we all know of celebrities who have destroyed their looks through excessive plastic surgery – how many, if any, of your patients develop an addiction to plastic surgery?
WW: Those who are body dysmorphic can never get enough, and they will constantly want to do more and more things. But the number of times you go and see a plastic surgeon doesn’t mean that you’re addicted because the nature of treatments today is such that they are temporary, they wear out after a couple of months and you, of course, have to go back and see the physician. So it doesn’t mean to say they’re addicted, it just means that they’re, it’s worn out. I mean, a car is not addicted to petrol – a car needs petrol to be able to run around, but it’s not addicted to the petrol. Same here with Botox and fillers, thread lifts and all these things – aging is still going to continue, and aging will eradicate some of the improvement that you get, and the drug will wear out, and you’ve got to do it again. So, aging is a constant moving target, whereas plastic surgery are like sporadic treatments that come in at intervals, so you’ve got to keep on doing them. But, where it becomes an addiction is where one person comes in and says, “Oh, I’d like to fix my nose.” Once you’ve fixed the nose they say, “I want you to fix it again.” Or, “It’s really not good enough, I want you to do it again. Do it again.” And then they develop an obsession with the eyes – “Do this eye,” and then, “Do this eye,” and then, “Well, do this one,” and then, “Do this again,” and then, “Let’s do the nose again,” and, “Well that’s good but now let’s do the eyes again,” and then, “Let’s do the chin,” and, “Let’s do the nose again, by the way,” and, “Let’s do the chin again,” and, “Let’s do the eyes again,” and then they’ll kind of go off to the breast, and then they’ll come back and they’ll do the nose again – these are the dangerous ones.
CG: And how do you deal with that, as a surgeon?
WW: Well, I try not to operate on them, I try to get them psychological assessment, but sometimes that doesn’t work because the toughest thing is getting a patient with body dysmorphism to go and see a psychiatrist, because they categorically deny that there’s anything wrong with them, so it’s an uphill battle. So if you just turn them away, all they’ll do is they’ll go to somebody else, and their looks will become bastardized, and they’ll look terrible.
CG: In a field of medicine such as aesthetic surgery, you need a strong moral compass to ensure you’re working ethically. What are your overriding moral principles?
WW: Oh it has to be, I mean, you have to be treating the patient, really – you have to be looking after the patient. Sometimes patients don’t even know themselves and they come in with ridiculous requests, and that’s where your own judgment and assessment has to come in. I think the number one thing is try never, never to think about the money because that can really ruin a lot of people’s judgment. Patients come in who clearly should not have this surgery, but doctors do it because it’s a source of income. And I’ve talked to some doctors before and I’ve said, “Well why did you do this surgery?” And they’ve said, “Well, the patient asked for it.” I said, “But they don’t really need it.” Right, so you’ve got to have that conviction that what you’re doing is right for the patient. And that, well there’s a Latin phrase isn’t there, that if you’re going to do anything make sure you do no harm, right? And I just try to be very vigilant in identifying the patients that I treat, and make sure that they all come out satisfied and happy, and that we haven’t created any damage. Of course, that’s not always possible because complications happen, and you have to go back in and re-fix things for the patients, but as long as you’ve had proper informed consent and they know what they’re getting into, and you haven’t tried to pull the wool over their eyes, and you’ve set really realistic expectations for them – then they can kind of, they can navigate their own emotions within that spectrum, within the goalposts that we set for them.
CG: One last question – I want to do orthopaedic surgery, and within orthopaedics you look at sub-specialties, and spinal surgery – it’s well-paid but the patients are never happy; knee surgery, the patients are always really happy. How do you find the patients in plastic surgery? Do you sometimes think to yourself, you know, these patients are so neurotic, I wish I was doing…
WW: Oh, so neurotic. Sometimes I just want to retire, instantly, because they’re just annoying. Some people can be so annoying and it’s difficult to talk to them because they’re mentally obtuse, and they want a certain thing or they discuss one thing and then the result comes out close to what they expect but they turn round and say well that’s not want they wanted. And sometimes you get really neurotic patients who I try not to operate on but they’re just sitting there, and they say, well, “Please do this,” and “Do this,” and I say, “Well I’m not going to do that,” they say, “Well do this, I promise I’ll be very good.” And then you do something for them and they say, “Well I don’t like it. I want it to be reversed, I want, something…” and I say, “Well I told you this, I told you this!” I just had a recent case where the husband came in with the patient, and the patient was lying to the husband, and said that she’d been seeing me and only me for the last ten years. And I said, “That’s not true, I’ve got the whole case-sheet filled with all the doctors she’s been going to see and they’ve been doing all little things to her and big things, and that’s been ruining your face! And you think that I’ve been doing her face exclusively for ten years,” and I said, “That’s not correct,” and I confronted the patient in front of the husband and she broke down in front of the husband and said, “Yeah, blah, it’s true,” etc etc, “and will you please…” And at that you just want to say, “Look, time out, get out of my office, and I never want to see you again.” But you can’t, because you have to help your patient. And even with my patients who I get really exasperated with and I tell my staff, “This patient, if she makes a call for an appointment to say I’m full for the next ten years, I don’t want to see them.” But eventually, I relent, and I do see them again and I try to talk to them, so I’m quite patient, but it is exasperating.
CG: And if your son or daughter said to you, “I want to follow in your footsteps”?
WW: I’d let them. I mean, you have to follow the spark that ignites you. You have to just follow your passion. So if you love spine, you just have to do spine whether or not the patients appreciate what you do, which is to do it and you have to do it well. So, I mean, being a plastic surgeon is glamorous superficially, but it’s not a bed of roses. There’s a lot of heartache, there’s a lot of exasperation and frustration behind the scenes, but overall, yes I’d do it again, of course, because it’s something I like to do.