“I was born into a medical-surgical fish bowl and have never managed to escape it”
By Thierry Piolatto
My mother was a professor of anaesthesia at Pitié Salpêtrière, my father was a pharmacist, my grandfather was a surgeon, my aunt was a gynaecologist and my grandmother was a midwife, so my “given” career path was set out from a very young age. I was lucky enough to spend time in operating theatres from a young age, as my mum would get me to do my homework in the corner of the theatre while she worked. I saw my first appendicectomy, performed by my grandfather, at age 12. Operating theatres, clinics and hospitals were part of my daily life and my holidays; it was familiar territory for me, along with that “hospital smell”.
My vocation was clearly mapped out, but my choice of speciality came from a forward-thinking interview that changed my career.
Originally, surgery seemed like the obvious path for me. My mother (an anaesthetist) introduced me to prominent surgeons, her “bosses” (Professors Mercadier, Garnier, Clot, Bacourt, etc.) who took me under their wing. I would like to take this opportunity to thank them: these “hotshots”, who allowed me to ride on their coattails, very soon told me a disappointing truth: “You shouldn’t continue specialising in our fields (digestive and vascular surgery) because in a few years’ time, the type of surgery we are teaching you will become obsolete thanks to the progress made in prevention, medical treatments, all types of endoscopy, interventional radiology, etc. The only surgical specialities that will survive these evolutions (for a while longer) will be orthopaedics and addressing ‘physical flaws’, whether objective (deformities) or subjective (purely aesthetic).”
I followed their advice and opted for aesthetic surgery, a speciality that was almost unmentionable, even shameful to practise at the time. I quickly came to love this speciality, as it allowed me to combine my surgical skills with an artistic aspect that I had not found in the other specialities. It was while operating at the Belvédère clinic that I met Dr Tessier, who became my guru. He was an extraordinary man who really left his mark on my career. He was known worldwide for his operations to correct cranio-facial deformities that pushed the boundaries of the impossible. I really loved this man; he was authentic, connected to his roots, almost self-taught and hated qualifications. His business card simply stated, “Dr Paul Tessier, surgeon” and nothing else! That is rare nowadays. He was such an extraordinary surgeon. I worked alongside him for three years, at the Foch hospital and the Belvédère. Later on, I set up on my own on Rue de la Faisanderie in Paris, and operated at the Marignan clinic. I spent the best few years of my life in this “office surgery” on Rue de la Faisanderie; I was free, fulfilled, and my patients were happy.
Aesthetic surgery, surgery of the appearance: Captivating but highly complex!
We are doctors and surgeons of the appearance; a highly complex branch of medicine. Going from an unwanted appearance (by whom? why?) to the appearance one hoped for (but to what aim?) is quite a difficult leap! However, the only aim of an aesthetic procedure is to make the patient happier and perhaps improve their self-esteem. This is why the medical component is fundamental: listening to and understanding the patient, their personality and their hopes, finding out whether we will be capable of satisfying them, otherwise the operation will be a failure. We need to know when to refuse to go ahead with an aesthetic procedure, when to say no.
We have become preoccupied with our image; we no longer treat the patient but their appearance, which is certainly not etiological (apart from in the case of a morphological disfigurement).
Doctor, surgeon and artist: three essential requirements in an aesthetic surgeon
What I like about this job is the doctor-artisan-artist tripod. Though the medical aesthetic component is theoretically there, and the different techniques have been learnt and mastered, nothing guarantees the quality of the results. We all know how to perform a lift, operate on a nose, but no surgeon will have the same emotional result. Paradoxically, the only thing that is not taught in our speciality is the aesthetic aspect. This relies on the surgeon’s own sensibilities, their taste, their culture and their predispositions. Performing a procedure is easy; what to do, why and where to do it is art!
In this respect, it is only by pulling different faces that we are able to see the signs of attractiveness, age, charm or even charisma, which is fundamental in two respects: what to do and where, and what not to do in order to preserve the positive features and expressions, and not damage them. The objective analysis of a flaw must be replaced by a subjective analysis, that is, considering the positive or negative qualities of the perceived flaw.
The future? Mini-invasive treatments: Preventing, preserving and limiting irreversible damage!
All procedures can cause physical and psychological damage, especially when the demand is only triggered by temporary fashions rather than a pathology (fat lips, large breasts, etc.). This is where the medical and ethical component of our profession needs to be expressed: knowing when to say no, explain, help patients understand and direct them towards an image that might not fit society’s norms but which is exclusive to them. Like all surgeries (except, perhaps, morphological surgery), aesthetic surgery is likely to disappear. It is through prevention that we will manage to limit invasive surgical procedures to rejuvenate the face, such as face lifts. This includes a healthy lifestyle (avoiding alcohol, sun, smoking), tissue inducers, liposculpting, PRP, nanofat, machines (EBD), toxins and tensor threads, which offer a percutaneous lift and will surely revolutionise the next decade with their non-invasive nature, their curative effect and their preventative effect on facial tissue ptosis.
With regard to fillers, I am becoming less of a fan of anti-aging fillers, which fill and deform instead of rejuvenating, as they are incapable of lifting. They are absorbed less and less well, and can migrate. What is more, I am against the theory that we lose volume with age if we stay the same weight: the volumes spread and drop. If the weight is stable, there is no point in adding any more weight; all we need to do is concentrate it and lift it, which tensor threads do very well. However, I am a fan of tissue inducers (which do not create volume) and “morpho fillers”, injected in contact with the bone, which can modify the facial lines and contours, to beautify and give the impression of rejuvenation.
My professional interactions.
I have been scientific director for the AMWC Monaco (Aesthetic & Anti-Aging Medicine World Congress) since 2015 and I am founding president of the SOFCEP, an active member of the SOFCPRE, the ISAPS and the ASAPS. I will also speak at the AIME Paris alongside Pr Jean-Paul Meningaud. I have been actively involved in the AMWC for the last 10 years, and this has enabled me to have contacts all over the globe, to think up interesting and innovative sessions, and to find new speakers. This year, we have managed to increase our capacity by opening up new rooms and pushing anti-aging which is, in my opinion, not highlighted enough. In fact, anti-aging and aesthetics are inseparable.
Any hobbies?
Yes, outside my professional life, my life revolves around music and horses. Before my internship, I toured France with my rock group…Unfortunately, that hobby very quickly became incompatible with my career. I gave it up, but retained an unrestrained love of music, which I cannot live without. Horses are a passion of mine that I got from my wife, who is a superb horsewoman and rides beautifully, like a queen. The pure harmony between a woman and her mount gives me goosebumps. This is the main reason I moved my practice to Nice, that and moving house in 2008, to a superb property with stables in St Paul de Vence, a real paradise…
As for books, I love re-reading Mila Kundera’s “L’insoutenable légèreté de l’être” and “Tyranny of the Minority” by S Levitski, because I have a keen interest in geopolitics but am very anxious about the future and can’t even imagine the future my children and grandchildren will have!
Where to find him : Palais de la Régence – 2, rue Verdi 06100 Nice
