Beauty may be in the eye of the beholder, as the cliché goes, but confidence has to come from within. Leading plastic surgeon Dr. Karim W. Rafla chose to go into the field to give people that confidence. Defining his work as an art, more than anything, Rafla explains it is “the pinnacle of what man can do; you use surgery, which can do much harm, and you utilize it to aesthetically better something. You use a scalpel or a needle to make art.” After more than 20 years studying, training and working in some of Europe and North America’s most prestigious hospitals, Rafla brings back his cutting edge techniques and vast expertise in reconstruction as well as aesthetic surgery to Cairo, where he has set up his own practice.
“Aesthetically better” are the operative words, says Rafla who maintains that “plastic surgery should make you look better, not different. So I always tell my patients that we should not exceed by putting more fillers or Botox; you have to keep your beauty and better it. Plastic surgery is not meant to change the way you look, it is intended to ensure that one is the most beautiful version of themselves possible. I always try to make people look natural. There is a misconception that plastic surgery makes one look fake, or that it should augment one’s natural beauty. It all comes down to using the right amount, operating with the best techniques, and using the best products.”
With demand for cosmetic surgery on the rise—Rafla reveals “plastic surgery has become a necessity for anyone with a middle-class income. You go to the gym for your body and you go to the plastic surgeon for your face”—we visit Rafla’s clinic for plastic surgery tips and to untangle some of the industry’s misconceptions.
Why did you choose plastic surgery?
I chose plastic surgery because I like it. In my sixth year of university, when the results come out in the Egyptian system, we have to write our top three specialties and they allocate one to us for becoming a resident in the university hospital. I wrote plastic surgery as my first, second and third choice. My friends and colleagues told me that I was stupid, but [plastic surgery] is my passion. I told them that is all I want; if I do not get it here, I will go somewhere else and train, in Egypt or abroad.
It was such a baby specialty with so much room for growth, and also it has great diversity, no wound is like the other. In appendicitis, for example, there are only five common positions, so if you do 10 appendectomies; you have seen it all. But you will never have a burn like the other, you will never find an injured hand like the other; you will never operate on a face like the other; you will not find tissue loss from an accident like the other, and so on.
What does plastic surgery teach you?
Humility. It teaches you that you are never the top of the heap. If you see a burn patient, for example, the trauma that they are going through and the tragedy that the family is facing makes you humble. You are humbled by the situation. My favorite kind of surgery is burn surgery. I have done many of them in the past, and I still do a lot of them. I am happy to help people with burns, I have a lot of expertise in this and I believe that my expertise in burns’ surgery and reconstruction is what gives me an edge in aesthetic surgery.
How have you seen the plastic surgery field change over the past five years?
When I started in Guy’s and St. Thomas’s Hospital, London in 2006, we did a lot of face-lifts… the statistics yearly were 200 or 300 in the hospital, but later the amount of surgery for the face increased and we did a lot of injectables. The technology got better, brands got better, and products are better.
Also, if trained well, a plastic surgeon can get great, surgery-like results in just 20 minutes. When you are busy, you do not want to stay at home for two weeks; you want to do something in 20 minutes and then go straight to your meeting. So, when you can get the same results in 20 minutes, it beats surgery. Also, it is cheaper for your health and your pocket.
What are the most popular plastic surgery procedures in Egypt?
Cosmetic surgery is the most in-demand form in Egypt. The most sought-after surgeries are face surgery, breast augmentation and tummy tucks. Face surgery is number one. Many also seek what we call minimally invasive procedures, such as Botox and fillers; basically, rejuvenation of the face.
Can you tell us a bit about the surgical procedures?
Breast augmentation is a procedure where you put an implant underneath the breast tissue to increase the size of the breast, and to elevate the breast and nipple. This is a cosmetic surgery; sometimes we do it after cancer surgery and sometimes we do it for purely cosmetic purposes. Post-surgery, the patient is not allowed to drive for four weeks and has to wear a special medical bra for the first six weeks, and then
By what age do girls typically seek nose jobs; and what is your advice?
First of all, because I get this a lot, patients have to understand that nose jobs will not fix one’s problems in life. I see it often in girls who have not gotten married and they think that if they do their nose, they will get married. She gets her nose with the mentality that it will fix her problems, it will not. She gets a nose job and does not get married and feels disappointed. You are undergoing surgery, you have to really need it.
A lot of people who come to me seeking nose jobs are not candidates for nose jobs; their noses aren’t that bad. Your nose has to have a character, it is not a small pimple on your face; it is a nose. It is not the source of your social problems. Unless of course there is a defect, in which case we do a nose job after the age of 18 years. All surgeries, unless in the case of a previous trauma, happen after the age of 18 or 21.
Why do people seek plastic surgery?
Confidence. For example, one of the most sought-after surgeries is breast augmentation surgery. Patients are typically young and have small breasts, getting their breasts enlarged improves their confidence; she then feels she is prettier and more attractive.
What advice do you have for those who want to undergo plastic surgery?
Two points are important here: Doing your homework and making sure one augments their natural beauty, not changes everything about oneself. I just want people to do their homework as patients: look up the doctor, where they did their training, which products they use, and if they are qualified; these are all questions patients need to ask themselves. We have to emphasize that this is a medical procedure, and you can have a disaster if you use a cheap product. You might think you are saving, but you will be treated for a year afterwards from whatever you get due to bad injections.
More doctors are shifting to plastic surgery from other specialties and, with minimal training, are performing aesthetic procedures. What do you have to say about this?
Plastic surgery hugely depends on conscience and training, as training is key for being able to perform reconstructive surgery [which] is at the very core of aesthetic surgery. You have to know how to reconstruct a burnt eyelid before you try to rejuvenate or aesthetically change an eyelid. Plus, a plastic surgeon has to have top-notch knowledge of anatomy and muscles. Medical procedures need exceptional talents and training, not just good products.
There are people who are doing things without much training now. Some attract good clientele, and many patients go to them. This is a problem because they use low-grade or counterfeited products with no training. Patients have to do their homework on their doctor. They have to look into where the doctor trained and what products they use, because these doctors damage the reputation of the industry and can cause severe damage to patients due to their lack of training.
Dr. Rafla is a member of the Royal Colleges of Surgeons of Great Britain and Ireland (MRCS), Fellow of Plastic Surgery, University of Alberta Canada and Fellow of Plastic Surgery, Kings’ College London. He has performed thousands of plastic surgery procedures over the years, especially during his time at the prestigious University Hospital in Birmingham where he performed surgery on soldiers returning from Afghanistan and Iraq.