"I simply don't operate on a patient with an unrealistic idea," says plastic surgeon Svatopluk Svoboda, who speaks openly about the limits of business and beauty
Most people associate plastic surgery mainly with aesthetic modifications, but there is a much broader world of medicine behind this field - from reconstructive surgery after severe injuries to work with birth defects. MUDr. Svatopluk Svoboda is one of the doctors who have been following and co-creating this development for more than four decades. He came to plastic surgery as a medical student in the early seventies and since then he has been through a number of clinical departments, foreign internships and demanding operating theatres. He was at the beginning of microsurgery in the Czech Republic, worked for a long time in the Burns and Intensive Care Unit and gradually started to focus on aesthetic medicine in addition to reconstructive procedures.
Today, patients seek him out not only for his experience and precision, but also for his open-minded view of the changes in the field - from the influence of social networks to the boundaries he believes a plastic surgeon should never cross. In this interview, he talks about the early days of his career, why plastic surgery is so much more than just "tweaking your appearance," and how patients and their expectations have changed over the years.
Doctor, when you look back on your career, do you remember the moment when you decided that plastic surgery was the field you wanted to dedicate your life to?
I remember that quite well. I was in my third year of medical school, it was 1972, and we had internships in the plastic surgery clinic at that time. We learned the basics there - suturing, knot tying, that sort of thing. One day the then head of medical education, who was in charge of the practical exercises, came to me and said, "You're quite handy, would you like to come to my services? You'd learn more on the job, you could help out and see how things work." In those days it was called a research assistant. Of course I agreed, but I was given a clear rule - once I didn't come, I wasn't supposed to come at all.
Services were usually once a week, plus weekends, Saturdays or Sundays. I started going regularly and I must say that the associate professor didn't recognize any holidays or exceptions. I remember that my friends and I went on the Vltava River and she was on duty on Thursdays. On Thursday morning I picked myself up somewhere near Vyšší Brod, hitchhiked to Prague to be on duty at four in the afternoon, and the next morning I caught up with my friends again by hitchhiking somewhere near České Budějovice. It was difficult, but I learned a lot. I liked plastic surgery, especially trauma, hand surgery and so on.
When you say plastic surgery, most people nowadays think of nose jobs or similar procedures.
That's one of the big misconceptions. What you're describing is so-called aesthetic or cosmetic surgery. But plastic surgery is an extremely broad field. It includes the treatment of congenital defects - cleft lip, cleft jaw, cleft palate, supernumerary fingers and so on, i.e. defects in children. It also includes the treatment of post-traumatic conditions, cancer, especially skin tumours. This is our daily bread - various skin carcinomas, basaliomas and others. It also includes reconstructive surgery after injuries. Aesthetic surgery is really just one subfield of plastic surgery.
The fact is that many doctors who were excellent surgeons in trauma hand surgery or microsurgery have found over time that they can make more money in a week of cosmetic surgery in private practice than they can in two months of clinic work. So many of them moved exclusively to aesthetic medicine.
Are you more into general plastic surgery in your practice?
I've been doing general plastic surgery all my life, especially hand surgery and trauma surgery. However, I have also had my own private practice since 1992, where I also do aesthetic surgery once a week.
I guess that job requires a lot of manual dexterity...
I'm sure it does, a clumsy surgeon would be a problem. A surgeon has to be manually skilled, that's basic. In plastic surgery, you also need imagination, because you're often modelling, reshaping. And in addition to skill and imagination, patience is also essential - not only in surgery, but also when working with patients.
As a doctor, what fascinates you most about the human body and its transformations to this day?
I can't say exactly. The human body is, of course, a beautiful material, albeit a living one. Plastic surgery, or surgery in general, is a craft - a craft like any other. But I can't say that I'm so fascinated by something that I'm completely ecstatic about it. Of course, there are operations that give me great pleasure. Whether it's trauma surgeries, where you sew someone's severed fingers from a circular, or maybe they bring in a hand that's been cut off at the wrist, we operate for ten, twelve, fourteen hours, and the patient whose severed hand is brought in a bucket, three weeks later, walks away and shakes that hand and thanks you. That's a great joy.
It's actually such a miracle of modern medicine that even such injuries can be saved today.
And it's the same with cosmetic surgery. When someone manages to make beautiful breasts, the patient leaves excited and satisfied, it's also a great joy.
I'd like to stop with aesthetics for a moment. You said you've been in private practice since the '90s. How have the people who come to you changed in that time? Have their motivations changed?
It's changed mainly in the last few years because of social media. Women used to come with certain wishes, but nowadays everything possible and impossible is discussed on social networks and the internet, often even complete nonsense. A patient comes to you who feels that she got great information from the internet, she wants exactly that, and you have to explain to her that either she has to get surgery according to the internet, or that a lot of the information is wrong or misunderstood and definitely doesn't apply to everyone.
Do you find yourself trying to talk patients out of their wishes when you see that they are not realistic?
Of course. When a patient comes in with a completely unrealistic idea, a reasonable plastic surgeon simply won't operate on her. The fact is, I'll send her away, but she'll often find another plastic surgeon who will do anything for money. I have my limits. A patient with an impossible or very difficult to fulfill wish, or a completely unrealistic idea, should not have surgery.
Do you think that social media in general is exacerbating the pressure on appearance and that it is stronger today than it used to be?
Definitely. The pressure is much stronger today than it was years ago when social networks didn't exist. Almost every other young girl today has pouty lips that look like Donald Duck. Personally, I don't like it at all and I don't do those procedures. There's hardly a young woman today who hasn't had Botox injected everywhere and hasn't had her face waxed. These are things I try to avoid and definitely don't do.
Can you be more specific - what problems or requests do patients most often come to you with?
Every plastic surgeon is known for something different. People often come "on a first name basis". They know that this doctor does breasts well, which is my thing. I have a private practice in Cologne and it is said that the most beautiful breasts are in Cologne. In recent years I have also become known for female genital modelling, which is a very delicate operation, but which brings great relief to patients.
What about men? What do they come up with most often?
The most common are simple surgeries, typically upper eyelid surgery, where the droopy eyelids fall over the eyes. Also common are surgeries for so-called gynecomastia, or enlarged breasts in men. It's quite common nowadays because a lot of guys go to the gym and take various hormones that make their breasts grow. Some people want a tummy tuck after losing a lot of weight. But men only make up about ten percent of my patients.
Do you think it's because men generally care less about appearance than women?
I think so. I think a man should be just a little bit prettier than the devil.
How much do these procedures cost these days? I understand it's very individual.
It's extremely individual. Every plastic surgery practice has its own price list, and of course there's a price range. Today, common plastic surgeries cost tens of thousands of crowns. But I've heard of much higher amounts. But if people are willing to pay for it, it's their decision.
I suppose it's often a more affluent clientele.
Mostly, yes, they tend to be more affluent. But I have patients who take out loans for surgery. There are places that do plastic surgery on a pay-as-you-go basis. I never do that, because I've encountered about twice in my life - and it's been many years - where a patient has wanted an operation on hire purchase. I operated on her, but I never saw her again. Plus, of course, if I give her silicone breasts, I won't take them back if she doesn't pay. So if someone can't afford the surgery, they have to take out a loan from a bank or other company and then pay it off themselves. With me, it's always paid in full up front.
You mentioned women who get breast augmentation. Do you also encounter the opposite request, that is, women wanting to have their breasts reduced?
Of course they do. Sagging or overly large breasts are a common reason for surgery. Women wanting to have their breasts reduced and sculpted is a fairly common procedure.
But any intervention in the body carries a certain risk.
Every plastic surgery operation is a medical surgical procedure. Some patients think it's like going to a hairdresser, which is of course complete nonsense. Every surgery has its risks and it is an intervention in the human body with all the possible complications. These depend on many factors - not only on the care of the surgeon, but also on the personality of the patient and, of course, whether he or she carefully follows the post-operative regimen. A surgeon who claims to have never had any complications is either lying or not operating. The important thing is that the doctor faces up to the complication. I personally do not "let patients out of my sight" until they are completely healed.
Do you avoid certain types of practice, such as so-called plastic surgery?
Yes, I avoid it on principle. What a lot of plastic surgeons do is they bring in a "bus" of women from Germany or England, they do their breasts and send them back home. I think that's nonsense. I take each patient from consultation through surgery to complete healing. If a patient comes to me from abroad, I will gladly do the operation, but the condition is that she stays here until she is fully healed, which means three weeks to a month. Not many people do that. To operate and send her to a hotel the next day and home three days later is not my way and I have never done it.
How long is the hospital stay after the procedures?
Most of the time it's minor surgeries with overnight hospitalization. For larger procedures, such as breast or abdominal modeling or breast augmentation with silicone, I keep patients hospitalized for two to three days.
We've talked about how sometimes you discourage patients from having the procedure when you find their vision unrealistic. But have you ever seen anyone develop an addiction to plastic surgery?
Yes, there are patients who do have an addiction to plastic surgery. I try to avoid them and convince them that the way they look is fine and that there is no need to change anything else. Of course, I also have patients who have had their breasts done, then later their stomachs and then their eyelids. This in itself is not a problem, as long as there is a reasonable time gap between the procedures. But I consider addiction to plastic surgery to be a kind of psychological disorder.
So it's a specific kind of addiction.
For me, a careful consultation with a plastic surgeon is crucial. You have to sit down with the patient, she explains her idea and you say whether you are able to fulfil it or not. If not, you'll recommend that she go to someone else. Once you feel at the beginning that you and the patient do not "fit" humanly, it is better not to go into surgery at all.
Do patients today come in with, say, Instagram or TikTok photos and show you exactly what they want to look like?
Yes, they do. But I explain to them that you can never get the exact image based on a photograph. With breast surgery, on the other hand, I ask the patient for a photo beforehand - to show me what type of breasts she likes. I look at it and tell her if I am able to create this or a similar result from her breasts. It's all about matching ideas. But to come up with a picture of a nose and say "I want this one", that's nonsense.
Is there anything you would never operate on?
Actually, I already mentioned that. I would never operate on a patient where I see an unrealistic idea or a psychological problem that could lead to dissatisfaction regardless of the outcome.
I was thinking more of a particular part of the body that might be at risk that you wouldn't operate on.
I don't think so. As I said, every surgery has its risks and the patient must approach it knowing that those risks exist. He or she needs to be thoroughly educated about the possibility of bleeding, infection, wound breakdown and a whole host of other complications. Today, all this is spelled out in detail in the informed consent, which is several pages long - about eight so far. We are not yet in America, where informed consent is, say, eighty pages long, and it says that you can go blind, you can become paralysed, and you can even die. The doctors are protecting themselves so that nobody can say that the doctor didn't tell them. But you can't tell the patient everything anyway. There can be complications that are completely unforeseen. That's just an occupational hazard.
You've already talked about it in part, but you're quite famous for your female genitalia. Why is that such a prominent theme? And do you also operate on trans women?
I rarely operate on trans women. Genital surgeries on trans people are usually performed by urologists, and I have to say that this is not an area that is close to my heart. But female genital modelling is a procedure that is not extremely long or technically insurmountable. I've been doing plastic surgery since the late 1970s, and until 1998 I had never actually heard of plastic surgeons doing these operations. In 1998, I did a long-term fellowship in Brazil, and that was the first time I saw anyone doing it systematically. I went to the operating room of a very famous professor in the morning and saw a woman in the gynecological position. I was taken aback.
He explained that gynaecologists are too crude for these procedures and that they often lack aesthetic sensitivity. I talked to our gynecologists about this when I returned, and one of the chiefs at the time told me that when he sees forty women a day in the outpatient clinic, he thinks that some of them could look better. And so I went for it. Gradually the word got out, and today almost every clinic is doing these operations. But we were one of the first in the Czech Republic and we are still one of the few offices that do complete genital modelling, not just labioplasty. Over the years, I have done dozens to hundreds of these surgeries and so far, knock on wood, I have never had a dissatisfied patient.
If anyone is considering the procedure - what does the whole process look like from consultation to surgery?
We sit down, we talk. The patient tells me her idea, I examine her, look at her, and then we talk again. We discuss what to expect, how long the surgery will take, what the risks are, how long the recovery is. They often come with a long list of questions and I try to answer everything. That's why I don't do plastic surgery. When they bring you a bus of patients, you see them for the first time half an hour before surgery and you know nothing about them. And it's during the consultation that you find out which patients are suitable for surgery and which ones I think are not. As soon as a red light starts flashing in my head, I'd rather keep my hands off it.
Are there any contraindications when one should not undergo plastic surgery?
Yes. Firstly, psychological - we've already mentioned that, unrealistic ideas. And then medical. In aesthetic medicine, we have to operate only on practically healthy patients. If someone has severe heart disease, a heart attack, diabetes or other serious illnesses, aesthetic surgery is pointless and an unnecessary risk.
Do patients come to you for liposuction?
They do, but I don't like to do liposuction. I don't enjoy the procedure and I try to avoid it. Sometimes the results are nice, sometimes less so. Moreover, liposuction today requires high-tech equipment - laser, ultrasound methods and so on. And I don't want to invest hundreds of thousands in equipment for surgeries I don't really want to do.
When you look at the future of aesthetic medicine, what's in store for us in the coming years? Is the field moving any further?
I don't think aesthetic medicine is going to move much further. The field is so far gone today that any further movement could be more of a disadvantage. For example, I meet patients who have had surgery in Turkey, where they now go for cheaper procedures. Plastic surgeons there are often very adventurous and will perform two or three operations on one patient at the same time, which I would never dare to do here. So far they have often succeeded, although of course we have encountered serious problems. For example, a patient came to me who had been operated on in Turkey and three days after the procedure she flew home - her breasts had fallen apart.
How is such a situation handled?
Badly. It has to be reoperated.
So the patient didn't really save much money.
No, not really.
If I ask you, as someone who's worked with human appearance all his life, what does beauty mean to you? And does that look change with age?
I still like beautiful girls, but of course beauty is a very relative concept. Someone seems beautiful at first sight, someone only becomes beautiful when you talk to them. Beauty has a lot of factors and there is actually no general definition of beauty. Personally, I like rather slim women, but they have to be fine as personalities as well.
