After years of intensive study, Bermuda's first facial plastic surgeon, Dr. Bruce Lattyak, has set up his practice in Paget and is ready to provide a service not so easily available locally.

Back on the Island only a couple of months, the 32-year old Bermudian is still settling in at the Bermuda Wellness Centre near the hospital and has already seen quite a number of patients. He advises them about the many types of services he provides - from minimally invasive treatments to the more complex cosmetic procedures - and finds out what it is they desire.

"We just completed building the Ambulatory Surgicentre, specifically customised for outpatient surgery," explained Dr. Lattyak, a 1986 Saltus graduate.

Ambulatory procedures make up the bulk of Dr. Lattyak's practice. Those procedures requiring hospitalisation are done at the hospital.

Some of the equipment found in the Ambulatory Surgicentre includes a carbon dioxide laser for skin resurfacing, a microdermabrader for doing superficial peeling of the face, and endoscopic surgical equipment for performing minimal incision facial plastic surgery.

"The primary advantage of the Surgicentre is that, in addition to all the specialised equipment, it helps maintain the privacy of my patients," he explained. "The kinds of procedures I do here usually take anywhere from half an hour to three or four hours. By contrast, some of the reconstructive procedures at the hospital can take up to ten or 12 hours."

He stressed that the Surgicentre meets all safety guidelines set forth by the Accreditation Association for Ambulatory Health Care (AAAHC), one of the leading institutions in the US for accreditation of outpatient surgical facilities.

After Saltus, Dr. Lattyak did undergraduate studies at the University of Chicago, before going on to medical school at the University of California, San Francisco where he also did his otolaryngology, head and neck surgery (ear, nose and throat) training. From there he studied facial plastic surgery at the University of California, Davis.

"Facial plastic surgery requires a little different training than general plastic surgery," he revealed.

"Most facial plastic surgeons first do a residency in otolaryngology, during which time they do a tremendous amount of facial plastic surgery. Since all the incisions are on the face, otolaryngologists are constantly thinking about aesthetics, whether the procedure is purely cosmetic or not. Following this they complete a rigorous fellowship program in plastic and reconstructive surgery of the face, after which they must pass written and oral board exams. The whole process takes about ten years"

"General plastic surgeons divide their time over the entire body - the abdomen, pelvis, chest, and limbs, in addition to the face, while facial plastic surgeons concentrate 100 percent of the time on the face. It's an important distinction because the anatomy and healing characteristics of the face are very different from other parts of the body."

He added: "First of all the face is a lot more susceptible to the ageing effects of the sun. You need to take that into account when deciding on the best treatment regimen for a patient. What's more, the anatomy of some parts of the face, such as the nose, the outer ear, and the eyelids, is extremely unique. These areas require specialised attention when it comes to cosmetic and reconstructive procedures."

Amongst the procedures he considers most challenging but rewarding is rhinoplasty (nose surgery).

"Rhinoplasty is a very big part of facial plastic surgery. It is a highly individualised procedure. Deciding what each patient needs requires a lot of study, patience and judgement. But it's exciting for that very same reason."

"Facial plastic surgery isn't just about surgical procedures," he adds. "We also perform minimally invasive techniques such as Botox (used for eliminating hyperfunctional wrinkles on the forehead and frown lines and also crow's feet), Collagen (for eliminating small aging wrinkles) and sclerotherapy to treat spider veins in the face and legs."

"One of the best things about Botox is that you can get treated during your lunch break and you can go right back to work without any signs that anything has been done."

Other minimally invasive treatments offered include microdermabrasion and chemical peels, as well as a comprehensive line of prescription-only skin products designed to help reverse fine wrinkling, acne scarring, and sun-damaged skin.

"That's one of the most important points I emphasise to my patients. It's not just about surgical correction, it's about getting into a programme to restore and maintain skin health."

Dr. Lattyak also works closely with the hospital, where he performs reconstructive surgery to repair traumatic injuries, defects from cancer ablation, and congenital facial defects.

"I was fortunate to do my facial plastics training at UC, Davis, which is one of the most recognised institutions in the United States for facial cosmetic surgery and treatment of congenital deformities of the face.

"Congenital facial deformities often affect both form and function, for example cleft lip or cleft palate. It's not only about appearance - these defects adversely affect important functions such as speech, swallowing, and hearing, just to name a few."

Another classic birth deformity, microtia, occurs when someone is born with a malformed or missing ear. "Microtia repair is a multi-stage procedure, usually requiring three or four surgeries in all. The first stage involves harvesting a piece of rib cartilage to act as a framework for the new ear. The results can be quite dramatic."

The results, however, are not always immediate.

"Scar maturation in the face is an evolving process that may take months to years, so the surgeon has to be very cognisant, not only of the changes he makes during surgery, but also how those changes will develop during the healing phase."

It was partly by chance that Dr. Lattyak pursued a career as a facial plastic surgeon. He was initially contemplating a career in biochemistry or molecular biology research while at the University of Chicago.

"While that was exciting and cutting edge work, it didn't provide the satisfaction that comes with treating patients," he says. "There was not enough human contact. That's part of the enjoyment of being in this field."

It was that human contact that defined his career path.

"A friend of mine had volunteered in the emergency room at the University of Chicago and suggested I do the same," revealed the surgeon.

"The University of Chicago Hospital is a level one trauma centre. The first day I volunteered there as an orderly, I saw a large number of trauma cases. Seeing the way in which the staff dealt with these complex, challenging situations had a big impact on me. I quickly changed my mind about what I wanted to do with my life.

"When I started medical school, I didn't choose a specific path right away. I knew that I would be exposed to many fields that I hadn't seen before and decided to bide my time and wait and see what interested me the most."

"I first became interested in facial plastic surgery during my rotation in otolaryngology," he continues.

"This was by far the most fascinating field I had seen, largely because it required aesthetic analysis in addition to clinical and scientific judgement.

"It allowed you to apply both clinical and artistic skills in treating the patient. It was less cut and dry medicine and more creative medicine than I had seen before."

Dr. Lattyak admits there is no such thing as the perfect face.

"While there are accepted standards of beauty within Western Culture, a lot of individual variation exists. One of the most important parts of the consultation is to determine what the patient's own concept of beauty is. I add my own cosmetic analysis of what can be done to improve the appearance, and together we establish a plan to meet those goals."

"We can also simulate surgical results using computer imaging programs. This is particularly useful for surgery of the nose and chin."

But Dr. Lattyak warns he can't perform miracles.

"A lot of patients come to me and say 'I feel young on the inside, I'm in a fitness programme, I quit smoking, I just want to look the same way on the outside'," he stated.

"That's a very healthy way to look at what facial plastic surgery can do for you. The idea isn't to make someone who is 60 years old look 20. The goal of modern cosmetic surgery is to restore balance in the features of the face and impart a more healthy, youthful appearance, while avoiding the 'operated' look."

And while women are generally more concerned about their looks than men, a significant number of facial plastic surgery patients are male, says Dr. Lattyak.

"I recently wrote a chapter on facial plastic surgery for men. The indications for most procedures in men is no different than women," he revealed.

"Most of the differences between men and women are psychological. Men tend to be more concrete about what they want and are less willing to undergo procedures that require a lot of recovery time. They want something that is more of a quick fix. That's where minimally invasive procedures come in."

So far, Dr. Lattyak has been impressed with the local interest.

"I've been very pleasantly surprised at the number of cosmetic consultations that I'm seeing already," he admitted.

"Clearly there is a need that has not been met up until now."

"Bermuda is a sophisticated society," he adds. "It's only natural that we place a high premium on looking our best."

Dr. Lattyak will be holding a series of free informal seminars open to the public. The first seminar is being planned for late October. Those wishing to reserve a spot or book a consultation can call Debbie Turner, patient coordinator at the Bermuda Wellness Centre, at 236-3531.