Aesthetic Titans Series #1: Remembering Dr. Sam Hamra

Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies in breaking issues in plastic surgery. I'm your co-host Summer Hardy, a medical student in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. Today's episode is part of our Aesthetic Titans Series. Dr. Bass, what can you tell me about this series?

Dr. Lawrence Bass (00:24):
There are certain individuals who have made game-changing contributions to plastic surgery and aesthetic medicine. Beyond that, they've continued to actively research, lecture, and teach over a span of decades in order to change the way these fields are practiced. This gives these individuals an unparalleled breadth and depth of experience and a really unique and valuable perspective about plastic surgery. Discussing the accomplishments of these thought leaders provides particular insight into how aesthetic plastic surgery is practiced and how we got there. Mostly these are physicians, but there are some business people and engineers in this group as well, and even some in journalism and media. So this series is a group of interviews, or in this case, discussions about these individuals who have contributed so much.

Summer Hardy (01:33):
Thank you for that overview of the series. So what specifically are we discussing in this episode?

Dr. Lawrence Bass (01:39):
Well, we're jumping this into the schedule of podcasts that we've laid out over months because of the newsworthiness of today's episode. In most episodes, we're talking with one of the aesthetic titans to hear firsthand their perspective. In this episode, we're talking about the legacy of one of these aesthetic titans who passed away this month, October, 2025.

Summer Hardy (02:12):
Who is it?

Dr. Lawrence Bass (02:13):
It's a plastic surgeon named Sam Hamra.

Summer Hardy (02:18):
And who is he in the aesthetic world then?

Dr. Lawrence Bass (02:21):
So Sam Hamra is a plastic surgeon who developed and popularized the deep plane approach to the facelift.

Summer Hardy (02:31):
And can you tell me about his background and training?

Dr. Lawrence Bass (02:35):
Sure. So he was born in Oklahoma to Lebanese immigrants. He grew up in Oklahoma and went to the University of Oklahoma for his undergraduate education in history, which is interesting for a reason I'll mention in a moment. And then for his medical school and general surgery training. And after that, he spent a year in Lausanne, Switzerland doing a fellowship in surgery. And then he came back to the United States and spent three years under John Converse at NYU training in plastic surgery. And this is one of the largest departments in the world and one of the top departments in the world. That gave him a great deal of exposure to facelift surgery because New York City and most of the professors that trained him had busy aesthetic practices. Interestingly, in the year that he trained, there were four surgeons. Dr. Hamra, also Joseph McCarthy, who succeeded Dr. Converse as the chair of the Institute of Reconstructive Plastic Surgery at NYU Henry Kawamoto and Brunno Ristow. And Dr. McCarthy and Kawamoto were both craniofacial surgeons. Dr. Hamra and Dr. Ristow were very busy aesthetic plastic surgeons. And interestingly, Dr. McCarthy was also a history major as an undergraduate, and it was very unusual in those days for non-science majors to go into medicine. But both Dr. Hamra and Dr. McCarthy were both history majors.

Summer Hardy (04:33):
That's a really interesting background. So when did he start working on these advances specifically?

Dr. Lawrence Bass (04:39):
So Dr. Hamra, training at this very high level plastic surgery training program, was always required to be a researcher and a thinker, but he was one by temperament as well. And so he joined after he finished his training, a plastic surgeon named Dr. Mark Lemmon in Texas, in the Dallas area where he practiced most of his career and learned a great deal. And Dr. Lemmon had heard a lecture about a new way of doing facelifts. So at that point in time, most facelifts were skin only. And we're talking about the 1970s again, just to put a timeline on it. And so skin was lifted up and repositioned, and this was helpful, but it was not as complete a correction as most people would've liked, and it definitely was not as durable a correction as people would like. And Dr. Lemmon went off and heard a lecture by a well-known plastic surgeon in Sweden named Dr. Tord Skoog.

(05:57):
And Dr. Skoog was lifting up facial tissues deeper to the skin to help improve the amount of correction in facelift. So Dr. Lemmon came back from hearing this lecture before the articles, and the textbook was even out and started doing this kind of facelift working with the young Dr. Hamra and this interested Dr. Hamra in reexamining everything about how facelift was done. And they published their experience doing hundreds of facelifts using this technique. But eventually, Dr. Hamra did quite a few anatomy dissections, and that led him to move on to a newer technique even than what Dr. Skoog had tried, or a more complete technique might be a better way to describe it.

Summer Hardy (06:56):
And you gave some background already, but how did this area of investigation get started?

Dr. Lawrence Bass (07:01):
So again, everything in surgery relies on anatomy. So Dr. Hamra went back to the anatomy lab and did cadaver dissections to understand how the face is put together, what the layers of the face are, what parts are there, what kind of safe transit zones and necessary releases must be done to move things in the face. And this added to all surgeons using all techniques, their knowledge about facelift surgery. But that was his starting point. And then it moved from there into what he could do in an actual facelift operation. In other words, how the operation should be done differently after he gathered all that evidence from his anatomy dissections and research.

Summer Hardy (08:01):
Okay. And now that I've learned a lot about the background, I'm wondering what motivated Dr. Hamra to pursue this approach? What was the goal or the need for a new facelift technique?

Dr. Lawrence Bass (08:13):
Well, as I said, the skin only facelifts were not as complete or as durable as one might hope. And also, if we think back to facelift many decades ago, there were sometimes telltales things that would show that didn't look completely natural. Not in all facelifts, but sometimes particularly I poorly executed facelifts that caused Dr. Hamra, again, who was really a thinker to reexamine why that was happening and how that could be avoided, how things could come to a better end point.

Summer Hardy (08:57):
And then where did all of this go?

Dr. Lawrence Bass (09:00):
Well, so Dr. Hamra did all this research and came up with what he called deep plane facelift techniques and started presenting his results, writing articles and giving lectures at professional medical society meetings, and also training other surgeons in how to do these techniques. And in fact, this was how I became acquainted with Dr. Hamra because I did my plastic surgery training and then shortly after joined the faculty at NYU Plastic Surgery. I had the opportunity to meet him every year when he would visit his alma mater for plastic surgery at what turned into the cutting edge meeting and advanced meeting for experienced surgeons to learn the latest techniques. And this meeting involved live surgery. So he would do a facelift that would be video televised into the auditorium with all the surgeons and the residents and folks at the medical center would help with the production of the meeting.

(10:11):
In conjunction with Dr. Aston at that time, the meeting director or course director. And that meeting was originally started by their predecessor, Dr. Reese, who was the head of aesthetic plastic surgery in the chair of Manhattan or Throat Hospital, and eventually turned into the cutting edge meeting that was run by Dr. Sherrell Aston and Dr. Daniel Baker for many years. So all of that teaching made the idea of a deep plane approach, very well known out in the professional community, but with many new things. It created criticism and challenge. Basically, plastic surgeons are very much from Missouri when it comes to new things. They say, show me how it works, why it works, where's the proof that it works or that it's better? And this is where we get to the really interesting part about Dr. Hamra. That's a very important measure of who he was as a man and as a surgeon and leader in the plastic surgery community was his response to these challenges, because we see a lot of people present their techniques kind of, here it is, here's what I do, and here's some good looking results. But Dr. Hamra was much more analytical than that, and it says a lot about who he was as a person.

Summer Hardy (11:45):
So what was his response then?

Dr. Lawrence Bass (11:47):
Well, certainly there was pushback to the pushback. So Dr. Hamra had a very forceful personality and wasn't going to be a shrinking violet and be put off by the fact that people didn't believe or agree with his approach to things. But because of his commitment to research and also to collaboration and his ability to deeply reflect on things and analyze things, he did a number of things. He continued to do more anatomic dissections. He continued to refine his operation and his approach to facelifting. And all plastic surgeons do this to a degree, but he did it in a very formalized way, publishing the results of many, many, many cases. In some cases, dozens, in some cases, hundreds in these papers. And so that in some cases proved that some of what he was doing was on the right track in some cases that demonstrated that there was no particular advantage compared to alternative techniques.

(13:01):
But he presented all of that. He didn't just present it what looked good for his approach to things to say, look, I'm right. He presented whatever the data showed, and in some cases, that supported his outlook. In some cases it didn't. But that was very, very valuable to the plastic surgery community. And I think among plastic surgeons versus some other specialists that work in facelift surgery, that experience and that dialogue at the plastic surgery meetings still colors our outlook on deep plane techniques today. Not only that, but he also collaborated with other facelift surgeons, a number of whom specifically almost violently disagreed with his approach to facelift surgery to try to generate data and compare outcomes. And so that cooperation and collaboration is something that takes a lot of integrity and a lot of strength of character to spend and realize all this research is unpaid time and just trying to get at the truth and trying to get advancing scientific knowledge. So it takes a lot of character to put that much time and effort into occasionally proving yourself wrong and to working closely with your detractors. And I think that that was the measure of the man in a nutshell.

Summer Hardy (14:36):
It's really interesting overall. You also mentioned that he has other contributions. So what were those other major contributions he had?

Dr. Lawrence Bass (14:46):
So he was a prolific article writer, and some of the most important articles in facelift can be attributed to him. That includes the evolution of the concept of deep plane to the more complete concept of composite facelift, which really medically is the more proper name. So early in 1990 and the early 1990s, there were a couple of articles about deep plane approaches, but this evolved to a later article on composite lifting of the complete face that also involved the development and delineation in separate articles of something called septal reset. So that is because when you lift the face, of course, the cheek comes up and the cheek is just below the lower eyelid and the lower eyelid changes. Of course, in aging, everything changes in aging. And Dr. Hamra reanalyzed what some of these changes were and tried to look at, again, new approaches to correcting that.

(16:04):
And that included lifting from underneath the skin and muscle in the eyelid to where the orbital septum is, a white membrane that's under the skin and muscle in the eyelid, and resetting that, repositioning that up towards the top of the head, and that's called septal reset. So that was a concept that he also introduced. One of the final, and I think most interesting things is a summary article that Dr. Hamra wrote in which came out in 2016, shortly before he retired, where he discussed in his own words the story of his journey with the composite facelift technique. And I've relied on that article to relate in brief some of those details in this episode of the podcast where we're talking about the history of deep plane facelift, but he sort of went through his journey, what he was thinking, how he was trying to change things, and how a lot of that worked out.

Summer Hardy (17:17):
And how has this translated to the present day?

Dr. Lawrence Bass (17:20):
Well, there are a variety of approaches to facelift. There are SMAS techniques, which were really developed in parallel to a lot of what Dr. Hamra was doing, backend NYU, and elsewhere in the country and around the world, a number of surgeons were working on SMAS techniques that also go into the deep plane under the SMAS and reposition the SMAS, but differently than what happens in composite facelift. So that's one major approach, and there are variations of that. And then there are composite approaches. What on the internet gets called deep plane facelift? That's a major approach. There are plication and mastectomy approaches where the SMAS layer is reconfigured and modified from its superficial surface instead of from its underneath surface. And then there's still occasional use of skin only techniques, probably mostly in someone who's already had multiple facelifts. But all of those techniques are in use, and all of those approaches to dealing with the deeper tissues in the face very clearly work and give spectacular results in the hands of experienced facelift surgeons.

(18:45):
So there's no clear winner, if you will, something that works better or works best or lasts longer. But this use of composite lifting is something that's still in use today and still popular, although its utilization varies with different specialties of surgeons. Late in his career, Dr. Hamra stepped away from some of the aspects of this approach, which again is a sign of his maturity and good judgment rather than just persevering with blind faith that his process was best. He continued to innovate and refine what he was doing, which again, is a hallmark of what most plastic surgeons are doing their entire careers. But he was just spectacularly good and energetic at doing it. So overall, this is a lesson in how the process of plastic surgery should be handled, starting with anatomic study, which colors everything we do with surgery. It's all about understanding and controlling the anatomy, knowledge of the anatomy, thus informing improvements, and then critical evaluation of the effects and results to see if this change or innovation really bears the fruit that we hope it does.

Summer Hardy (20:22):
Thank you, Dr. Bass, for bringing us this timely but sad news about Dr. Hamra and sharing the significance of his legacy in plastic surgery. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.