Day One – January 7, 2013

This morning, I arrived early to Ganchi Plastic Surgery in Wayne, NJ, operated and run by Dr. Parham A. Ganchi ’87. I was welcomed by Karen, who later gave me a tour of the facilities, including patient rooms, waiting rooms, and operating rooms, and oriented me to the day’s schedule. I soon met more staff members, including Michelle, Carly, and Leyla, before finally greeting Dr. Ganchi.
 
As today was a Monday, their longest “Office Day” of the week, I was told that I should expect to see a rush of patients, especially later in the afternoon. Fortunately, some patients were either late or early, so the appointment schedule was more staggered and less congested than we originally anticipated. Patients came in for many different and interesting reasons: the most common was for Botox or filler treatment, while others included breast implant repair, buttocks implants, liposuction, breast augmentation, gynecomastia, rhinoplasty, and face-lifts. It was so fascinating to be able to witness such a variety of consultations, as I was able to learn more about the many different kinds of opportunities there were in plastic surgery. I also particularly enjoyed seeing such a diverse group of people, each with their own backgrounds and needs, and hearing their personal stories.

In every appointment, I was impressed by how compassionate and informative Dr. Ganchi was with his patients. He made sure that everyone who came into his office felt comfortable and at ease, and fully understood the ramifications of their procedures and even why he was taking a certain approach. As Dr. Ganchi explained to me when I asked about the difference between operating a small, private practice versus working in a large, academic hospital, he is more able to spend time with each individual patient and cater to his or her personal needs. I picked up on this immediately when I realized how careful and attentive he was with his examinations and treatments. He later told me that he takes before and after photographs of every patient to track their progress and to remind them of how much their appearance has changed over time. More importantly, he said, this collection of photographs is a guide for him to learn from, so he can personally track his progress and improve in the future.

When we had down time, Dr. Ganchi and I discussed an array of topics, ranging from the mechanisms of his procedures to my academic and career related questions. We discussed Princeton and how Dr. Ganchi majored in Molecular Biology, a concentration I am highly considering. His main piece of advice was that I must pursue and study what I genuinely like, which applies to everything beyond college as well; otherwise, the process will not be as fun or as rewarding as it should. Another particular insight that struck me was when Dr. Ganchi said that even after surgeons are finished operating on their patients, they are still responsible for them when they leave. He noted that at times this could be particularly frustrating, especially in plastic surgery where recovery and post-operational instructions are essential. Dr. Ganchi also discussed the diverse field of medicine as whole. He explained the difference between medical doctors, who are typically more analytical, and surgeons, who are typically more tactile, as well as growing political concerns surrounding health insurance. Through discussing the benefits of cosmetic plastic surgery with Dr. Ganchi, I realized that while this field may not have the same curative aspect as other surgeries, patients are still “cured” in an equally important way when they gain more self-confidence. Having a physical abnormality your entire life can be emotionally debilitating and difficult to overcome; after seeing patients in their follow up appointments, I realized the power of making someone happy and confident in their physical appearance. 

Day Two – January 8, 2013

I was especially excited for today’s events because I would be able to sit in on surgeries in Dr. Ganchi’s operating room. Carly provided me with scrubs and, after I finished changing, I met Dr. Lee, the anesthesiologist. The staff had told me the day before about how well versed Dr. Lee was in his field, so I was particularly excited to learn about his work.

Dr. Lee first showed me his cart of chemicals that he used to prepare the anesthesia for his patients. He told me that, unlike most hospitals, they developed a combination of drugs that was unique to each patient, based off their blood work, medical history, and reactions to a small, prepared sample of anesthesia. I watched as Dr. Lee hooked up the IV to the second patient of the day, who was coming in to have work redone on his previous gynecomastia surgery, which treats abnormal development of mammary glands in males. The first patient was a woman who came in for labiaplasty, which I was not able to witness, given the sensitive nature of the procedure and the fact that she would be awake during the surgery.

During the operation, it was interesting to see how careful Dr. Ganchi was with his patient. He told me he made as small of an incision as possible so that there would be less scarring during recovery, even if it meant having to perform a more difficult operation. Overall, I enjoyed seeing the many different steps Dr. Ganchi took in this procedure: scrubbing the patient with betadine, detaching fat from the muscle, injecting numbing medication, liposuction of the breast area, cauterizing blood cells to prevent bleeding, and excising hard “lumps” or glands that the patient wanted to be removed from his chest. I also noticed how carefully Dr. Ganchi stitched together his patient after operating; he explained to me how he uses dissolvable stitches from the inside out, mostly for the patient’s benefit. Aside from explaining the details and choices he made in his procedures, we also discussed our hobbies and interests. I learned that both Dr. Lee and Dr. Ganchi enjoy traveling, and that Dr. Ganchi has been learning Spanish in preparation for his vacation to Costa Rica and to communicate better with some of his patients. As someone who has studied Spanish in high school and college, I enjoyed speaking with him and discussing different Spanish vocabulary words, such as scalpel, cheek, eyelid, etc. Lastly, I liked how, throughout the duration of two hours, there was an element of teamwork between Dr. Ganchi, Dr. Lee, and the medical assistant Michelle, all of whom worked together to make sure the operation was smoothly run and successful.

After having some lunch, I went in again to observe the second operation of the day, which was a face-lift for a woman that flew in from another state. Dr. Ganchi told me how even though most of his clients come from the tri-state area and nearby states, he has had clients from Texas, Florida, and other parts outside the US. After doing similar preparations as the first surgery, such as betadine scrubbing and markings, Dr. Ganchi used liposuction to remove some fat from the patient’s abdominal area. He told me he would use this fat by injecting it into her cheeks so that they would have a more youthful, round appearance. Then he started the actual face-lift with an incision under her chin that would allow him access to parts around her jawline. After reshaping the outline of her jaw and chin by removing some extra fat, he then cut alongside the area of the cheek that touches the ear on both sides of her face. Subsequently, he separated the fat from the tissue, and began stitching underneath the skin to create a tightened appearance for her cheek. Dr. Ganchi told me that many other plastic surgeons would instead pull the skin upwards to create this “lifted” look. He expressed two concerns with this: one that it looked too tight and unnatural, and the other that this would ultimately give out and lose its appearance over time. Dr. Ganchi finished the face-lift by carefully cutting away the extra loose skin after tightening, repeating on both sides, and stitching in a very careful zig-zag manner to promote faster healing. He finally put gauze on areas that would bleed, wrapped her head with cloth, and left in a draining tube under her chin to prevent build- up of blood and fluid. I was amazed by how beautiful and flawless the end result looked.

After the second surgery, which took approximately four hours, Dr. Ganchi took me into his office to show me photographs from his previous surgical and training days. While showing me before and after photographs of patients who had lost hands and even faces in accidents, children with abnormal finger or brain growth, and cancer victims with missing muscles and tissues, he explained in great detail not only physiology, but also different procedures surgeons use to solve these issues. He told me that you have to be creative in reconstructive surgery, and provided examples of solutions he came across in his training. For instance, I learned that muscles, which have great blood flow capacity, could be relocated to different areas of the body to replace missing parts; one man had his calf muscle moved to cover a missing area above his kneecap.

Overall, I truly enjoyed this experience. It gave me a comprehensive glimpse into the daily routine of Dr. Ganchi and his staff, and solidified my interest in pursuing a career in medicine. I learned a lot about the human body, the field of health care, interacting with patients, surgical operations, Princeton and academia, and myself, as well. I would like to thank Dr. Ganchi and his entire staff for providing me with this amazing opportunity, and highly recommend this Princeternship to anyone eager to learn more about plastic surgery and medicine as a whole.