Smart People Making Other Smart People Smarter About Face Lifts

Speaker 1 (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis. 

Kirstin (00:10):
Hey, Dr. Koehler. 

Dr. Koehler (00:12):
Hey, Kirstin. 

Kirstin (00:15):
How are you today? 

Dr. Koehler (00:17):
I'm fantastic. How about yourself? 

Kirstin (00:20):
Great. 

Dr. Koehler (00:21):
Awesome. What do you got for me? 

Kirstin (00:23):
I have more about our favorite topic. 

Dr. Koehler (00:28):
Okay, go for it. What's our favorite topic? 

Kirstin (00:30):
Facelifts. 

Dr. Koehler (00:31):
Oh, yes, facelifts. Okay.

Kirstin (00:32):
In our last episode, we talked about facelifts. 

Dr. Koehler (00:35):
Okay. 

Kirstin (00:36):
So we're going to talk about more.

Dr. Koehler (00:39):
More face lift. 

Kirstin (00:40):
Yes. But this time we're going to talk about the course that you teach with Dr. Mike Nayak. 

Dr. Koehler (00:46):
Yeah, that's in St. Louis. The St. Louis Practical Anatomy. It's a advanced facial rejuvenation course. It's a great course. It's awesome. 

Kirstin (00:55):
Tell me a little bit about the course. Where do the students come from? Are they students? Are they established surgeons? 

Dr. Koehler (01:04):
Yeah, so the course has been going on now for, I don't know, maybe 12 years or so. I've been going there and yeah, it's in St. Louis at St. Louis University. And they have an anatomy lab, which is a cadaver lab, so it's a cadaver course. And the doctors come from really all over the world. I mean, we have doctors every year from Canada, Ukraine, England. There are lots of places in South America. I mean, they come from all over really. But majority of the people are coming from the United States, but all over the United States. And although they're not students, I mean, there are some students, there are some people that are participating in the course that are in their residency. And I wouldn't even really call them students, but they're not finished with their residency. But the vast majority of the people taking the course are established doctors that have been doing this for many, many years, and they're just there to kind of advance their skillset and learn from some people that are considered experts in the field. 

Kirstin (02:12):
Dr. Worldwide. 

Dr. Koehler (02:15):
Dr. Worldwide. Yes. 

Kirstin (02:17):
How many faculty teach the course with you? 

Dr. Koehler (02:21):
It varies year to year, but I don't know. I want to say there's probably about eight faculty members, and then there's some guest faculty. He'll bring in guest people that are well-known people that aren't typically part of teaching the course. But yeah, there's some pretty awesome instructors, and they come from all over the United States and some of the faculty, guest faculty have been from outside of the United States. 

Kirstin (02:49):
So are the people that take the course usually experienced in facial surgery, or are they just all over the map just coming to learn? 

Dr. Koehler (02:59):
Well, there is a little bit of all over the map. So there are some very experienced people that are taking the course. And then of course, even the faculty, we talk amongst each other. And two or three years ago, we were doing things a little bit differently. So we're all learning from each other. We're all evolving in our technique. Learning is not a stagnant thing. You don't learn it and then you're done. I mean, you learn something, you master it, and then you work at perfecting it. And perfecting it requires lifelong learning. And so that's why people come to take these courses. And the cadaver part of it is hands-on. And that's really important because when we're doing facelift, we're dealing with vital structures that we don't want to injure. And sometimes, yes, we all took anatomy and we all know surgery, but when you can get into the cadaver lab and you go, okay, I normally wouldn't dissect in this direction because I know this is a danger area, well, this is an opportunity to go and explore the danger area because you don't have to worry. You're not going to hurt anybody. Now I can go, oh, I really want to look here. How far away from when I do this, how much further can I go before I run into X problem or Y problem? And that's what the benefits of a cadaver course are, is to really refresh your knowledge of anatomy and to really dive in what you can do in a cadaver. 

Kirstin (04:28):
What does a cadaver lab look like? 

Dr. Koehler (04:33):
I don't know. I mean, it probably looks like a long list of your ex-boyfriends. I don't know. 

Kirstin (04:44):
<laugh> You know me too well, Dr. Koehler.

Dr. Koehler (04:46):
<laugh> I don't know. But 

Kirstin (04:49):
Are there 20 surgeons looking at one cadaver, or are there enough where you could have a small group of people looking at one cadaver? 

Dr. Koehler (05:00):
So when we do this part of the lab, the cadavers are torsos only. So it's not the full body. We are just sort of clavicles up. And honestly, what an honor and a privilege and people that donate their bodies to allow for these types of purposes, it's an incredible learning experience. And I dunno, some people might be like, oh, I think that's weird that people would donate their body and people are doing cosmetic surgery on them. I'm like, yeah, maybe. But the thing is, all the people taking this course that are getting the benefit of learning from the anatomy are out there doing safer surgery, and that's a benefit to the public. So I mean, even though it's elective surgery and it's not lifesaving stuff, we're doing a service to people. So anyhow, thank you for all the people that have donated to allow us to do this. 

(05:52)
So we do a demonstration in that there's a cadaver that the faculty will demonstrate procedures on, and there's usually cameras that are coming down and we broadcast it so the participants can see what the faculty are demonstrating. But then in the lab, they're paired up. So it's two people to a cadaver. And so that's good because if they're doing a facelift, one doctor will get to work on one side and the other will get to work on the other. So they each get an opportunity to learn the anatomy. So yeah, it's an excellent, excellent course. 

Kirstin (06:26):
So just while we're on the topic of cadavers, I read somewhere where I saw on TikTok that there are now currently fewer actual cadavers in medical schools than ever before. Do you know why that's happening and why this kind of training is so important? 

Dr. Koehler (06:45):
I don't really know the reason why there could be fewer. I mean, perhaps fewer people are willing to donate to that. But I will say the benefits of being able to learn from a cadaver, I don't care, virtual reality, all that kind of stuff, that's all maybe great for learning, but it is absolutely no substitute. And I think oftentimes in medical school, you're really just scratching the surface of learning anatomy. And yes, that's a great time to learn it, but after you've been out doing surgery and you come back and you revisit all that anatomy again, it's just reinforcing and solidifying all of that information that you've obtained. So it's like the first time you learn it in medical school is kind of just to learn the basics. But then when you come back as a surgeon from a different perspective, now, okay, now I want to do an operation and how do I navigate this anatomy? It's a totally different learning experience. 

Kirstin (07:47):
What have you learned from being a part of this course? 

Dr. Koehler (07:51):
I mean, I've learned a lot. I've learned from some of the course participants, and I've certainly learned from all the faculty. I just think it's been an evolution of my surgical technique, and I think it gets better and better. And we're kind of getting to where, like I mentioned in our podcast before, how the goal of facelift surgery is trying to get your technique to where we can get people looking good as quickly as possible, that we can get the best and most natural looking results without undue risk to the anatomical structures, nerves, arteries, veins, things like that. And so that is the benefit that I think I've had over the years of being a part of this course is I've learned to improve in all of those areas. 

Kirstin (08:45):
I'm sure you respect the other faculty that you teach with and you love to learn from them. Are there certain specific things you can remember that you've brought back to help improve your technique and your own practice? 

Dr. Koehler (09:00):
There's lots of things. I mean, I think, so we do the cadaver course just two days, and then on the Monday at Mike's office, he does a live surgery, and then I usually am assisting in moderating. So I've got a microphone and people are directing questions to him and we're answering questions upstairs, and people are sitting in a conference room while he's in the operating room, it's getting broadcast. But anyhow, a few years back, he was using this device and I had never used it before. And I was talking to him about it, and the downside is it's pretty expensive. One-time use device, you have to use it in a new one for each patient. But I said, you know what? That was impressive how clean that made that, and it certainly looks safer and less risk for bleeding and all these other things. So I'm going to definitely try that when I get back. And I did, and I was like, Ugh, transformational. I feel like when I do this, it makes my job easier, less stressful, because there are things at times it can be a little stressful as a surgeon, and this takes some of that stress away, and it really, it's a benefit to the patient because I feel like they get a better result with less risk. So anyhow, yeah, that was one little thing that I got from being a part of that course. 

Kirstin (10:18):
That's kind of one thing that I appreciate with your surgeries and your practice is that even if certain things do cost a little bit more money, if it benefits the patient, you're going to use the best thing available. 

Dr. Koehler (10:33):
Yeah, I mean, we have a rule. I mean, I always tell the staff, it's like, okay, if I ever have a friend or a family member or staff member or whatever that we're doing a procedure on and we start using different stuff, then we're not doing it right. We should be using the same stuff for every single person. If it's not good enough for my family, then it's not good enough for anybody else, so we just don't do it. 

Kirstin (10:59):
Love it. So back to the participants. There's an option for them to zoom. Right? They can watch via video conference. 

Dr. Koehler (11:09):
We did that the first time this year. That's the first time we've done it. So obviously you can't participate in the cadaver part, but they get to listen to all the lectures. So there's lectures that are given in the mornings, and then the cadaver lab is in the afternoon, and then the live surgery workshop is on the Monday. So the people who go on the Zoom, the doctors that come on that, yeah, they can at least get the benefit of that. It's still, I'm sure, an excellent course. It's not as good as the hands-on, but it's still pretty good. 

Kirstin (11:38):
This may be a silly question, but why do doctors continue to take courses about things that they do all the time? 

Dr. Koehler (11:46):
Because we like to take trips. <laugh> That's the main reason. 

Kirstin (11:51):
<laugh> To St. Louis. 

Dr. Koehler (11:53):
Well, I mean, any trip's a good trip, but I look a few days away from the office, we'll call it a deduction, we'll take tax deduction. But no, 

Kirstin (12:03):
Today I said, I asked one of the girls, are you going to go to New Orleans with us? And she's like, let's get this clear. I'm going to go on any trip that I don't have to pay for. 

Dr. Koehler (12:13):
The thing about it is if you love what you do, and I can tell you all the people that I'm involved with at these courses love what they do. And certainly I would say probably most of the people who are there taking the course, love what they do. It's really not work. In fact, this is a great time. It's not patient care, but we get to learn. And it's so nice. You think about when I'm working day in, day out, whether I'm at the hospital or at my office, I'm with the same group of people, my scrub techs, the people at the hospital, but I don't have that professional interaction. It's not like I can go, Hey, Dr, so-and-so how do you like to do this, or whatever. That happens at courses, that's where you might've experienced some difficult cases where you're like, Hey, I ran across this situation. 

(13:00)
I've never had this before. And you can explain it to somebody and be like, have you ever run into that? And sometimes they're like, oh, yeah, I have as a matter of fact, and this is what I did and this is how I managed this. And so you can learn a lot from other people's experiences because some stuff you may only see a handful of times in your career. And so the courses are just a great way, a collegial way to just again, absorb and learn from each other. And really, for me, yeah, it's work, but it's fun. And yeah, it's just seeing and meeting doctors from all over the world and hearing their experiences. I mean, I've made some good friends from all over the world at these meetings. It's a great time. 

Kirstin (13:42):
It sounds like smart people make smart people smarter. 

Dr. Koehler (13:49):
You said that very smartly. That was very good. 

Kirstin (13:55):
That was a good job. 

Dr. Koehler (13:57):
Yeah. I don't know who told me this, but one of my mentors growing up, was like, listen, always surround yourself with really good people. They're going to just make you better. And there's a lot of truth to that. You want to be around people that are doing it as good or much better than you, and they are going to bring you up. 

Kirstin (14:17):
Yeah. Well, do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at Alabama, the beautiful podcast.com. We would love to hear from you. 

Dr. Koehler (14:32):
I'm not going to ask about your burning question. 

Kirstin (14:35):
I'll just ask my burning questions right out loud. I am not scared. 

Dr. Koehler (14:39):
Okay. 

Kirstin (14:41):
Thanks Dr. Koehler. 

Dr. Koehler (14:43):
You're welcome. 

Kirstin (14:44):
Go back to making Alabama beautiful. 

Dr. Koehler (14:47):
All right. 

Speaker 1 (14:52):
Got a question for Dr. Koehler. Leave us a voicemail at Alabama the Beautiful podcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic surgery, go to eastern shore cosmetic surgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram at Eastern Shore Cosmetic Surgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.