The Voice of Aesthetics, Vol. 4
Nayak protégé, Dr. Milind Kachare, on the surgeons who shaped him and the complexities of plastic surgery pricing.
I recently had the pleasure of interviewing double board-certified plastic surgeon Milind Kachare, MD, for a story on the inner workings of residents’ and fellows’ clinics, where plastic surgeons-in-training operate at discounted rates, with the goal of honing their aesthetic skills and learning advanced techniques. The piece delves deep into safety and supervision, results and pricing.
During our call, Dr. Kachare described the rigors of plastic surgery training, the highlights (and controversies) of residency and fellowship, and how he came to work alongside leading facelift surgeon Mike Nayak, MD, in St. Louis—all of which informed our story. But since Dr. Kachare was one of a dozen or so doctors interviewed, I couldn’t include every detail he shared.
I know I’m once again veering into broken-record territory when I tell you how it pains me to take an hour of a doctor’s time and then have to reduce our conversation to a quote or two. (Truly, I lose sleep over this.) While I can buck a word count with the best of them—because it’s all fascinating! all essential!—cuts inevitably happen and they’re mostly out of my hands.
Lucky for us, here, in this space, we can delight in the superfluous! Luxuriate in all the words! So, let’s: Ahead, Dr. Kachare opens up about his partnership with Dr. Nayak, explains the rationale behind his reasonable (for now) surgical fees, and more.
Masters as mentors in residency
I went to the University of Louisville for my plastic surgery training—but that wasn’t always the plan. I grew up in the Northeast and figured I’d stay in the Northeast. I was looking at NYU and another program. But my older brother, who’s also a plastic surgeon, went to Louisville. He knew I wanted to do aesthetics, and his biggest piece of advice was, Come here—you’ll get a lot more exposure to aesthetics compared to other programs.
He was right. I got a strong exposure to breast and body and face aesthetics in my residency. We had a lot of private practice plastic surgeons in town who were associated with our program. I got to shadow Dr. Bradley Calobrace, a big name in the breast world. And Dr. Gerald O’Daniel, a big name in the face world, took me under his wing early on in my first year of residency.
I’d seek out aesthetic opportunities [separate from] my academic world. I’d ask to scrub in with surgeons or observe them in the OR. Dr. O’Daniel was doing full extended deep plane face and neck lifts, taking out the glands, addressing all aspects of the deep neck. He’d walk me through the dissections, so I could see every nerve.
Nowadays, taking out the submandibular glands and doing the deep neck is more common and accepted, but five or 10 years ago, it wasn’t. So, I would watch Dr. O’Daniel do it, but then, in my academic world, we were told: If you do that, you will fail your boards. That is blasphemy. Do not do that.
[Editor’s note: Dr. O’Daniel has been performing and educating on safe submandibular gland reduction for 25 years. He says that while the procedure has long been perceived as risky, its popularity is suddenly exploding. He and other deep-neck specialists are now voicing safety concerns, as a growing number of inadequately trained surgeons are adopting the technique and, in some cases, causing “catastrophic complications.” So, yes, glands are trending, but there’s more to the story.]
Advanced body contouring + finesse facelifting in fellowship
Because I got a lot of exposure to aesthetics in residency, I wasn’t planning on doing a fellowship. However, one of my mentors, Dr. O’Daniel, came to me and said that his good friend, Dr. Ozan Sozer, had a fellowship that would be perfect for me. Dr. Sozer is on the board of ISAPS, the International Society of Aesthetic Plastic Surgery, and he has people coming over from Colombia and different parts of South America. The way body contouring is done in America compared to how the South Americans do it is very different. And Dr. O’Daniel was like, I know you’ve already done eight years of training, but if you’re open to doing one more, this would be a great opportunity to learn this dramatic difference in body contouring.
Dr. Sozer really does everything. We did a lot of body contouring, breast surgery, and face and neck. He also does gliding surgeries using the surgical net.
In fellowship, I got to meet surgeons from all over the world, including Dr. André Auersvald, who created the Auersvald net [shown below]. I got to see Dr. Alfredo Hoyos do body contouring and rib fracturing live. I got to scrub in while Dr. Renato Saltz was doing his endoscopic facelift.
