Oct. 21, 2025
Aesthetic Titans Series #1: Remembering Dr. Sam Hamra
Dr. Lawrence Bass honors the late Dr. Sam Hamra, a true pioneer in facelift surgery whose innovations forever changed the field. He reflects on Dr. Hamra’s path from Oklahoma to NYU to Dallas, where his curiosity and analytical mind led him to challenge traditional facelift methods and develop the revolutionary deep plane and composite techniques.
Dr. Hamra’s work went beyond aesthetics. It was about anatomy, precision, and integrity. He questioned norms, refined his own methods, and inspired a generation of surgeons to think deeper, not just cut tighter.
Dr. Bass shares how Dr. Hamra’s blend of intellect, artistry, and openness to critique set a gold standard that still shapes modern facial surgery. The episode feels like both a masterclass in facelift evolution and a heartfelt salute to a legend whose influence endures in every thoughtful lift today.
Learn more about facelift surgery
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to Park Avenue
Plastic Surgery Class,
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the podcast where we explore controversies
in breaking issues in plastic
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surgery. I'm your co-host Summer Hardy,
a medical student in New York City.
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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
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educator and technology innovator.
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Today's episode is part of our
Aesthetic Titans Series. Dr. Bass,
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what can you tell me about this series?
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There are certain individuals who have
made game-changing contributions to
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plastic surgery and aesthetic
medicine. Beyond that,
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they've continued to
actively research, lecture,
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and teach over a span of decades
in order to change the way
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these fields are practiced.
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This gives these individuals an
unparalleled breadth and depth
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of experience and a really unique and
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valuable perspective
about plastic surgery.
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Discussing the accomplishments
of these thought leaders provides
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particular insight into how
aesthetic plastic surgery is
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practiced and how we got there.
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Mostly these are physicians,
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but there are some business people
and engineers in this group as well,
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and even some in journalism and media.
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So this series is a group of interviews,
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or in this case,
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discussions about these
individuals who have contributed
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so much.
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Thank you for that overview of the series.
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So what specifically are we
discussing in this episode?
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Well,
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we're jumping this into the
schedule of podcasts that
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we've laid out over months because
of the newsworthiness of today's
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episode. In most episodes,
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we're talking with one of
the aesthetic titans to hear
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firsthand their perspective.
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In this episode,
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we're talking about the legacy
of one of these aesthetic titans
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who passed away this month, October, 2025.
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Who is it?
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It's a plastic surgeon named Sam Hamra.
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And who is he in the aesthetic world then?
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So Sam Hamra is a plastic
surgeon who developed and
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popularized the deep plane
approach to the facelift.
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And can you tell me about
his background and training?
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Sure. So he was born in Oklahoma to
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Lebanese immigrants.
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He grew up in Oklahoma and went
to the University of Oklahoma for
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his undergraduate education in history,
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which is interesting for a
reason I'll mention in a moment.
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And then for his medical school
and general surgery training.
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And after that, he spent
a year in Lausanne,
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Switzerland doing a fellowship in surgery.
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And then he came back to the United
States and spent three years under
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John Converse at NYU training
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in plastic surgery.
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And this is one of the largest
departments in the world
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and one of the top
departments in the world.
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That gave him a great deal of exposure
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to facelift surgery because
New York City and most of the
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professors that trained him
had busy aesthetic practices.
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Interestingly, in the
year that he trained,
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there were four surgeons. Dr. Hamra,
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also Joseph McCarthy,
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who succeeded Dr. Converse as the chair of
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the Institute of Reconstructive
Plastic Surgery at NYU Henry Kawamoto
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and Brunno Ristow.
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And Dr. McCarthy and Kawamoto
were both craniofacial
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surgeons.
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Dr. Hamra and Dr. Ristow were
very busy aesthetic plastic
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surgeons. And interestingly,
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Dr. McCarthy was also a history
major as an undergraduate,
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and it was very unusual in those
days for non-science majors to go
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into medicine.
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But both Dr. Hamra and Dr.
McCarthy were both history
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majors.
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That's a really interesting background.
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So when did he start working
on these advances specifically?
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So Dr. Hamra,
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training at this very
high level plastic surgery
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training program,
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was always required to
be a researcher and a
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thinker, but he was one
by temperament as well.
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And so he joined after he finished his
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training,
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a plastic surgeon named
Dr. Mark Lemmon in Texas,
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in the Dallas area where he
practiced most of his career
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and learned a great deal.
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And Dr. Lemmon had heard
a lecture about a new way
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of doing facelifts. So
at that point in time,
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most facelifts were skin only.
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And we're talking about the 1970s
again, just to put a timeline on it.
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And so skin was lifted
up and repositioned,
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and this was helpful,
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but it was not as complete a correction
as most people would've liked,
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and it definitely was not as durable
a correction as people would like.
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And Dr. Lemmon went off
and heard a lecture by a
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well-known plastic surgeon in
Sweden named Dr. Tord Skoog.
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And Dr. Skoog was
lifting up facial tissues
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deeper to the skin to
help improve the amount of
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correction in facelift.
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So Dr. Lemmon came back from
hearing this lecture before the
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articles, and the textbook was even out
and started doing this kind of facelift
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working with the young Dr. Hamra and this
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interested Dr. Hamra in reexamining
everything about how facelift was
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done.
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And they published their experience
doing hundreds of facelifts
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using this technique. But eventually,
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Dr. Hamra did quite a
few anatomy dissections,
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and that led him to move on to a
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newer technique even than
what Dr. Skoog had tried,
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or a more complete technique might
be a better way to describe it.
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And you gave some background already,
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but how did this area of
investigation get started?
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So again,
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everything in surgery relies on anatomy.
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So Dr. Hamra went back to
the anatomy lab and did
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cadaver dissections to
understand how the face is
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put together, what the layers of
the face are, what parts are there,
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what kind of safe transit zones and
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necessary releases must be
done to move things in the
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face.
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And this added to all surgeons using all
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techniques, their knowledge
about facelift surgery.
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But that was his starting point.
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And then it moved from there into
what he could do in an actual
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facelift operation. In other words,
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how the operation should be done
differently after he gathered all that
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evidence from his anatomy
dissections and research.
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Okay. And now that I've learned
a lot about the background,
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I'm wondering what motivated Dr.
Hamra to pursue this approach?
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What was the goal or the need
for a new facelift technique?
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Well, as I said,
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the skin only facelifts
were not as complete
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or as durable as one might hope. And also,
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if we think back to
facelift many decades ago,
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there were sometimes telltales
things that would show that
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didn't look completely
natural. Not in all facelifts,
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but sometimes particularly I
poorly executed facelifts that
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caused Dr. Hamra, again,
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who was really a thinker
to reexamine why that
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was happening and how
that could be avoided,
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how things could come
to a better end point.
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And then where did all of this go?
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Well,
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so Dr. Hamra did all
this research and came up
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with what he called deep
plane facelift techniques and
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started presenting his results,
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writing articles and giving lectures
at professional medical society
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meetings,
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and also training other surgeons
in how to do these techniques.
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And in fact,
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this was how I became acquainted with
Dr. Hamra because I did my plastic
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surgery training and then shortly
after joined the faculty at
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NYU Plastic Surgery.
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I had the opportunity to meet him
every year when he would visit his alma
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mater for plastic surgery at what
turned into the cutting edge meeting
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and advanced meeting for experienced
surgeons to learn the latest
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techniques. And this meeting
involved live surgery.
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So he would do a facelift that
would be video televised into the
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auditorium with all the
surgeons and the residents and
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folks at the medical center would help
with the production of the meeting.
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In conjunction with
Dr. Aston at that time,
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the meeting director or course director.
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And that meeting was originally started
by their predecessor, Dr. Reese,
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who was the head of aesthetic plastic
surgery in the chair of Manhattan or
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Throat Hospital,
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and eventually turned into the cutting
edge meeting that was run by Dr. Sherrell
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Aston and Dr. Daniel Baker for many years.
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So all of that teaching made the idea
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of a deep plane approach,
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very well known out in the
professional community,
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but with many new things.
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It created criticism and
challenge. Basically,
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plastic surgeons are very much from
Missouri when it comes to new things.
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They say, show me how
it works, why it works,
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where's the proof that it
works or that it's better?
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And this is where we get to the really
interesting part about Dr. Hamra.
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That's a very important measure
of who he was as a man and as a
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surgeon and leader in the
plastic surgery community was his
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response to these challenges,
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because we see a lot of people present
their techniques kind of, here it is,
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here's what I do, and here's
some good looking results.
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But Dr. Hamra was much
more analytical than that,
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and it says a lot about
who he was as a person.
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So what was his response then?
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Well, certainly there was
pushback to the pushback.
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So Dr. Hamra had a very
forceful personality and
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wasn't going to be a shrinking violet
and be put off by the fact that people
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didn't believe or agree
with his approach to things.
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But because of his commitment to
research and also to collaboration and
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his ability to deeply
reflect on things and analyze
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things, he did a number of things.
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He continued to do more
anatomic dissections.
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He continued to refine his
operation and his approach to
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facelifting. And all plastic
surgeons do this to a degree,
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but he did it in a very formalized way,
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publishing the results of
many, many, many cases.
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In some cases, dozens, in some cases,
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hundreds in these papers.
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And so that in some cases proved
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that some of what he was doing
was on the right track in some
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cases that demonstrated that
there was no particular advantage
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compared to alternative techniques.
But he presented all of that.
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He didn't just present it what looked
good for his approach to things to
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say, look, I'm right. He presented
whatever the data showed,
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and in some cases, that supported
his outlook. In some cases it didn't.
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But that was very,
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very valuable to the
plastic surgery community.
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And I think among plastic surgeons
versus some other specialists that work
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in facelift surgery,
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that experience and that
dialogue at the plastic surgery
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meetings still colors
our outlook on deep plane
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techniques today. Not only that,
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but he also collaborated
with other facelift
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surgeons,
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a number of whom specifically
almost violently disagreed with
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his approach to facelift surgery
to try to generate data and
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compare outcomes.
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And so that cooperation and
collaboration is something that takes
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a lot of integrity and a
lot of strength of character
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to spend and realize all
this research is unpaid time
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and just trying to get at the truth
and trying to get advancing scientific
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knowledge.
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So it takes a lot of character to
put that much time and effort into
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occasionally proving yourself
wrong and to working closely with
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your detractors.
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And I think that that was the
measure of the man in a nutshell.
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It's really interesting overall.
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You also mentioned that he
has other contributions.
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So what were those other
major contributions he had?
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So he was a prolific article writer,
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and some of the most important articles in
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facelift can be attributed to him.
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That includes the evolution
of the concept of deep plane
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to the more complete concept
of composite facelift,
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which really medically
is the more proper name.
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So early in 1990 and the early
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1990s,
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there were a couple of articles
about deep plane approaches,
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00:15:21,410 --> 00:15:25,730
but this evolved to a
later article on composite
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00:15:26,330 --> 00:15:30,920
lifting of the complete face that
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00:15:31,370 --> 00:15:35,990
also involved the development
and delineation in separate
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articles of something called septal reset.
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00:15:39,770 --> 00:15:43,430
So that is because when you
lift the face, of course,
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the cheek comes up and the cheek
is just below the lower eyelid
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and the lower eyelid changes. Of course,
in aging, everything changes in aging.
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And Dr. Hamra reanalyzed what
some of these changes were
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00:15:59,240 --> 00:16:02,240
and tried to look at, again,
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new approaches to correcting that.
And that included lifting from
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underneath the skin and
muscle in the eyelid to
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00:16:11,810 --> 00:16:13,550
where the orbital septum is,
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00:16:13,550 --> 00:16:17,240
a white membrane that's under the
skin and muscle in the eyelid,
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00:16:17,240 --> 00:16:19,340
and resetting that,
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00:16:19,340 --> 00:16:23,030
repositioning that up
towards the top of the head,
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00:16:23,360 --> 00:16:28,340
and that's called septal reset. So that
was a concept that he also introduced.
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00:16:28,850 --> 00:16:30,170
One of the final,
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00:16:30,170 --> 00:16:34,460
and I think most interesting
things is a summary
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00:16:34,460 --> 00:16:39,020
article that Dr. Hamra
wrote in which came out in
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00:16:39,020 --> 00:16:42,890
2016, shortly before he retired,
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00:16:43,430 --> 00:16:48,260
where he discussed in his
own words the story of his
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00:16:48,260 --> 00:16:52,310
journey with the composite
facelift technique.
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And I've relied on that
article to relate in brief
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00:16:57,530 --> 00:17:02,510
some of those details in this episode
of the podcast where we're talking about
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the history of deep plane facelift,
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00:17:04,490 --> 00:17:08,510
but he sort of went through his journey,
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00:17:08,720 --> 00:17:12,920
what he was thinking, how he
was trying to change things,
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00:17:13,190 --> 00:17:16,220
and how a lot of that worked out.
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00:17:17,390 --> 00:17:20,000
And how has this translated
to the present day?
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00:17:20,810 --> 00:17:21,590
Well,
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00:17:21,590 --> 00:17:25,850
there are a variety of
approaches to facelift.
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00:17:26,690 --> 00:17:28,760
There are SMAS techniques,
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00:17:28,760 --> 00:17:33,650
which were really developed in
parallel to a lot of what Dr. Hamra was
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00:17:33,650 --> 00:17:38,630
doing, backend NYU, and elsewhere
in the country and around the world,
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00:17:38,630 --> 00:17:43,460
a number of surgeons were working on
SMAS techniques that also go into the
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00:17:43,460 --> 00:17:47,810
deep plane under the SMAS
and reposition the SMAS,
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00:17:47,840 --> 00:17:51,810
but differently than what
happens in composite facelift.
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00:17:52,560 --> 00:17:56,040
So that's one major approach,
and there are variations of that.
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And then there are composite approaches.
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What on the internet gets
called deep plane facelift?
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00:18:02,880 --> 00:18:05,100
That's a major approach.
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00:18:05,520 --> 00:18:10,020
There are plication and mastectomy
approaches where the SMAS layer
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00:18:10,020 --> 00:18:15,000
is reconfigured and modified from
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00:18:15,090 --> 00:18:19,590
its superficial surface instead
of from its underneath surface.
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00:18:19,950 --> 00:18:24,840
And then there's still occasional
use of skin only techniques,
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00:18:24,870 --> 00:18:29,790
probably mostly in someone who's
already had multiple facelifts.
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00:18:30,240 --> 00:18:32,760
But all of those techniques are in use,
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00:18:32,790 --> 00:18:37,650
and all of those approaches to dealing
with the deeper tissues in the face
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00:18:38,010 --> 00:18:42,630
very clearly work and give
spectacular results in the hands of
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00:18:42,660 --> 00:18:47,100
experienced facelift surgeons.
So there's no clear
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00:18:47,160 --> 00:18:48,960
winner, if you will,
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00:18:49,650 --> 00:18:53,610
something that works better or works best
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00:18:54,450 --> 00:18:56,910
or lasts longer.
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00:18:57,180 --> 00:19:02,070
But this use of composite
lifting is something that's
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00:19:02,070 --> 00:19:06,420
still in use today and still popular,
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00:19:06,540 --> 00:19:11,460
although its utilization varies
with different specialties
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00:19:11,520 --> 00:19:14,550
of surgeons. Late in his career,
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00:19:14,550 --> 00:19:19,110
Dr. Hamra stepped away from some
of the aspects of this approach,
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00:19:19,170 --> 00:19:23,790
which again is a sign of his maturity
and good judgment rather than just
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00:19:24,090 --> 00:19:28,980
persevering with blind faith
that his process was best.
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00:19:29,340 --> 00:19:33,810
He continued to innovate
and refine what he was
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00:19:33,810 --> 00:19:35,460
doing, which again,
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00:19:35,460 --> 00:19:39,780
is a hallmark of what most plastic
surgeons are doing their entire
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00:19:39,780 --> 00:19:40,613
careers.
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00:19:40,770 --> 00:19:45,390
But he was just spectacularly
good and energetic at doing it.
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So overall,
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00:19:48,240 --> 00:19:53,010
this is a lesson in how the
process of plastic surgery should
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00:19:53,010 --> 00:19:56,640
be handled, starting with anatomic study,
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00:19:56,640 --> 00:19:59,310
which colors everything
we do with surgery.
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00:19:59,310 --> 00:20:02,760
It's all about understanding
and controlling the anatomy,
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00:20:03,180 --> 00:20:06,090
knowledge of the anatomy,
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00:20:06,150 --> 00:20:08,670
thus informing improvements,
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00:20:08,700 --> 00:20:13,590
and then critical evaluation
of the effects and results to
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see if this change or
innovation really bears the
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00:20:18,510 --> 00:20:20,910
fruit that we hope it does.
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00:20:22,050 --> 00:20:23,160
Thank you, Dr. Bass,
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00:20:23,160 --> 00:20:26,880
for bringing us this timely but sad
news about Dr. Hamra and sharing the
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00:20:26,880 --> 00:20:29,460
significance of his
legacy in plastic surgery.
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00:20:30,120 --> 00:20:34,200
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:20:34,230 --> 00:20:36,150
Follow us on Apple Podcasts,
318
00:20:36,210 --> 00:20:38,460
write a review and share
the show with your friends.
319
00:20:38,610 --> 00:20:42,120
Be sure to join us next time to avoid
missing all the great content that is
320
00:20:42,120 --> 00:20:45,690
coming your way. If you want to
contact us with comments or questions,
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00:20:45,690 --> 00:20:46,890
we'd love to hear from you,
322
00:20:46,980 --> 00:20:51,660
send us an email at
podcast@drbass.net or DM us on
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00:20:51,660 --> 00:20:53,370
Instagram @drbassnyc.
00:00:01,050 --> 00:00:03,510
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,570 --> 00:00:07,050
the podcast where we explore controversies
in breaking issues in plastic
3
00:00:07,050 --> 00:00:11,370
surgery. I'm your co-host Summer Hardy,
a medical student in New York City.
4
00:00:11,700 --> 00:00:15,360
I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
5
00:00:15,390 --> 00:00:17,340
educator and technology innovator.
6
00:00:17,820 --> 00:00:22,440
Today's episode is part of our
Aesthetic Titans Series. Dr. Bass,
7
00:00:22,440 --> 00:00:24,210
what can you tell me about this series?
8
00:00:24,960 --> 00:00:29,910
There are certain individuals who have
made game-changing contributions to
9
00:00:29,910 --> 00:00:34,320
plastic surgery and aesthetic
medicine. Beyond that,
10
00:00:34,320 --> 00:00:38,430
they've continued to
actively research, lecture,
11
00:00:38,430 --> 00:00:43,410
and teach over a span of decades
in order to change the way
12
00:00:43,410 --> 00:00:45,210
these fields are practiced.
13
00:00:46,020 --> 00:00:50,910
This gives these individuals an
unparalleled breadth and depth
14
00:00:50,940 --> 00:00:55,470
of experience and a really unique and
15
00:00:55,470 --> 00:00:58,440
valuable perspective
about plastic surgery.
16
00:00:59,190 --> 00:01:02,970
Discussing the accomplishments
of these thought leaders provides
17
00:01:03,510 --> 00:01:07,890
particular insight into how
aesthetic plastic surgery is
18
00:01:07,890 --> 00:01:10,770
practiced and how we got there.
19
00:01:11,340 --> 00:01:13,350
Mostly these are physicians,
20
00:01:13,350 --> 00:01:17,430
but there are some business people
and engineers in this group as well,
21
00:01:17,820 --> 00:01:20,970
and even some in journalism and media.
22
00:01:21,570 --> 00:01:26,370
So this series is a group of interviews,
23
00:01:26,370 --> 00:01:27,240
or in this case,
24
00:01:27,240 --> 00:01:31,920
discussions about these
individuals who have contributed
25
00:01:31,920 --> 00:01:33,000
so much.
26
00:01:33,720 --> 00:01:35,790
Thank you for that overview of the series.
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00:01:36,030 --> 00:01:38,970
So what specifically are we
discussing in this episode?
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00:01:39,750 --> 00:01:40,080
Well,
29
00:01:40,080 --> 00:01:44,910
we're jumping this into the
schedule of podcasts that
30
00:01:44,910 --> 00:01:49,680
we've laid out over months because
of the newsworthiness of today's
31
00:01:49,680 --> 00:01:52,350
episode. In most episodes,
32
00:01:52,350 --> 00:01:56,550
we're talking with one of
the aesthetic titans to hear
33
00:01:56,550 --> 00:01:59,820
firsthand their perspective.
34
00:02:00,480 --> 00:02:01,740
In this episode,
35
00:02:01,950 --> 00:02:06,660
we're talking about the legacy
of one of these aesthetic titans
36
00:02:06,930 --> 00:02:10,970
who passed away this month, October, 2025.
37
00:02:12,340 --> 00:02:13,173
Who is it?
38
00:02:13,720 --> 00:02:17,250
It's a plastic surgeon named Sam Hamra.
39
00:02:18,150 --> 00:02:20,790
And who is he in the aesthetic world then?
40
00:02:21,780 --> 00:02:26,130
So Sam Hamra is a plastic
surgeon who developed and
41
00:02:26,130 --> 00:02:30,960
popularized the deep plane
approach to the facelift.
42
00:02:31,950 --> 00:02:34,620
And can you tell me about
his background and training?
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00:02:35,220 --> 00:02:39,840
Sure. So he was born in Oklahoma to
44
00:02:40,200 --> 00:02:41,940
Lebanese immigrants.
45
00:02:42,300 --> 00:02:47,130
He grew up in Oklahoma and went
to the University of Oklahoma for
46
00:02:47,130 --> 00:02:50,760
his undergraduate education in history,
47
00:02:50,820 --> 00:02:54,720
which is interesting for a
reason I'll mention in a moment.
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00:02:55,050 --> 00:02:59,980
And then for his medical school
and general surgery training.
49
00:03:00,700 --> 00:03:04,180
And after that, he spent
a year in Lausanne,
50
00:03:05,290 --> 00:03:08,710
Switzerland doing a fellowship in surgery.
51
00:03:09,280 --> 00:03:13,990
And then he came back to the United
States and spent three years under
52
00:03:13,990 --> 00:03:18,970
John Converse at NYU training
53
00:03:18,970 --> 00:03:20,260
in plastic surgery.
54
00:03:20,260 --> 00:03:25,210
And this is one of the largest
departments in the world
55
00:03:25,600 --> 00:03:30,010
and one of the top
departments in the world.
56
00:03:30,010 --> 00:03:33,220
That gave him a great deal of exposure
57
00:03:33,490 --> 00:03:38,050
to facelift surgery because
New York City and most of the
58
00:03:38,050 --> 00:03:42,190
professors that trained him
had busy aesthetic practices.
59
00:03:42,730 --> 00:03:46,180
Interestingly, in the
year that he trained,
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00:03:46,180 --> 00:03:50,140
there were four surgeons. Dr. Hamra,
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00:03:50,260 --> 00:03:52,450
also Joseph McCarthy,
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00:03:52,450 --> 00:03:57,430
who succeeded Dr. Converse as the chair of
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00:03:57,430 --> 00:04:01,900
the Institute of Reconstructive
Plastic Surgery at NYU Henry Kawamoto
64
00:04:03,220 --> 00:04:04,930
and Brunno Ristow.
65
00:04:05,440 --> 00:04:09,550
And Dr. McCarthy and Kawamoto
were both craniofacial
66
00:04:09,550 --> 00:04:10,510
surgeons.
67
00:04:10,790 --> 00:04:15,730
Dr. Hamra and Dr. Ristow were
very busy aesthetic plastic
68
00:04:15,730 --> 00:04:17,410
surgeons. And interestingly,
69
00:04:17,410 --> 00:04:22,120
Dr. McCarthy was also a history
major as an undergraduate,
70
00:04:22,120 --> 00:04:26,920
and it was very unusual in those
days for non-science majors to go
71
00:04:26,920 --> 00:04:27,790
into medicine.
72
00:04:27,790 --> 00:04:32,050
But both Dr. Hamra and Dr.
McCarthy were both history
73
00:04:32,050 --> 00:04:32,883
majors.
74
00:04:33,370 --> 00:04:35,170
That's a really interesting background.
75
00:04:35,260 --> 00:04:39,010
So when did he start working
on these advances specifically?
76
00:04:39,850 --> 00:04:41,260
So Dr. Hamra,
77
00:04:42,220 --> 00:04:46,150
training at this very
high level plastic surgery
78
00:04:46,720 --> 00:04:48,160
training program,
79
00:04:48,490 --> 00:04:52,900
was always required to
be a researcher and a
80
00:04:52,900 --> 00:04:56,920
thinker, but he was one
by temperament as well.
81
00:04:57,130 --> 00:05:01,510
And so he joined after he finished his
82
00:05:01,510 --> 00:05:02,230
training,
83
00:05:02,230 --> 00:05:06,940
a plastic surgeon named
Dr. Mark Lemmon in Texas,
84
00:05:07,360 --> 00:05:11,380
in the Dallas area where he
practiced most of his career
85
00:05:11,710 --> 00:05:14,140
and learned a great deal.
86
00:05:14,380 --> 00:05:19,300
And Dr. Lemmon had heard
a lecture about a new way
87
00:05:19,300 --> 00:05:22,780
of doing facelifts. So
at that point in time,
88
00:05:23,020 --> 00:05:25,600
most facelifts were skin only.
89
00:05:25,660 --> 00:05:30,220
And we're talking about the 1970s
again, just to put a timeline on it.
90
00:05:30,790 --> 00:05:34,060
And so skin was lifted
up and repositioned,
91
00:05:34,420 --> 00:05:35,800
and this was helpful,
92
00:05:35,830 --> 00:05:39,940
but it was not as complete a correction
as most people would've liked,
93
00:05:39,940 --> 00:05:44,680
and it definitely was not as durable
a correction as people would like.
94
00:05:44,860 --> 00:05:49,720
And Dr. Lemmon went off
and heard a lecture by a
95
00:05:50,200 --> 00:05:55,180
well-known plastic surgeon in
Sweden named Dr. Tord Skoog.
96
00:05:57,830 --> 00:06:02,450
And Dr. Skoog was
lifting up facial tissues
97
00:06:02,870 --> 00:06:07,850
deeper to the skin to
help improve the amount of
98
00:06:07,850 --> 00:06:09,650
correction in facelift.
99
00:06:10,640 --> 00:06:14,990
So Dr. Lemmon came back from
hearing this lecture before the
100
00:06:15,020 --> 00:06:19,700
articles, and the textbook was even out
and started doing this kind of facelift
101
00:06:20,180 --> 00:06:24,770
working with the young Dr. Hamra and this
102
00:06:24,770 --> 00:06:29,630
interested Dr. Hamra in reexamining
everything about how facelift was
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00:06:29,630 --> 00:06:30,463
done.
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00:06:30,770 --> 00:06:35,060
And they published their experience
doing hundreds of facelifts
105
00:06:35,360 --> 00:06:37,910
using this technique. But eventually,
106
00:06:37,910 --> 00:06:42,830
Dr. Hamra did quite a
few anatomy dissections,
107
00:06:43,250 --> 00:06:48,170
and that led him to move on to a
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00:06:48,170 --> 00:06:51,860
newer technique even than
what Dr. Skoog had tried,
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00:06:51,860 --> 00:06:55,640
or a more complete technique might
be a better way to describe it.
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00:06:56,480 --> 00:06:58,130
And you gave some background already,
111
00:06:58,130 --> 00:07:00,950
but how did this area of
investigation get started?
112
00:07:01,640 --> 00:07:03,020
So again,
113
00:07:03,020 --> 00:07:07,940
everything in surgery relies on anatomy.
114
00:07:08,510 --> 00:07:13,100
So Dr. Hamra went back to
the anatomy lab and did
115
00:07:13,100 --> 00:07:17,960
cadaver dissections to
understand how the face is
116
00:07:17,960 --> 00:07:22,760
put together, what the layers of
the face are, what parts are there,
117
00:07:22,760 --> 00:07:27,650
what kind of safe transit zones and
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00:07:27,890 --> 00:07:32,750
necessary releases must be
done to move things in the
119
00:07:32,750 --> 00:07:33,583
face.
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00:07:33,800 --> 00:07:37,970
And this added to all surgeons using all
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00:07:37,970 --> 00:07:41,450
techniques, their knowledge
about facelift surgery.
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00:07:41,450 --> 00:07:43,430
But that was his starting point.
123
00:07:43,730 --> 00:07:48,440
And then it moved from there into
what he could do in an actual
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00:07:48,440 --> 00:07:51,080
facelift operation. In other words,
125
00:07:51,080 --> 00:07:55,550
how the operation should be done
differently after he gathered all that
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00:07:55,550 --> 00:08:00,500
evidence from his anatomy
dissections and research.
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00:08:01,750 --> 00:08:04,940
Okay. And now that I've learned
a lot about the background,
128
00:08:04,940 --> 00:08:09,020
I'm wondering what motivated Dr.
Hamra to pursue this approach?
129
00:08:09,020 --> 00:08:12,410
What was the goal or the need
for a new facelift technique?
130
00:08:13,340 --> 00:08:14,510
Well, as I said,
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00:08:14,990 --> 00:08:19,880
the skin only facelifts
were not as complete
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00:08:19,880 --> 00:08:24,500
or as durable as one might hope. And also,
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00:08:24,530 --> 00:08:28,610
if we think back to
facelift many decades ago,
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00:08:29,210 --> 00:08:33,800
there were sometimes telltales
things that would show that
135
00:08:33,920 --> 00:08:37,760
didn't look completely
natural. Not in all facelifts,
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00:08:37,760 --> 00:08:42,530
but sometimes particularly I
poorly executed facelifts that
137
00:08:42,530 --> 00:08:44,480
caused Dr. Hamra, again,
138
00:08:44,480 --> 00:08:49,310
who was really a thinker
to reexamine why that
139
00:08:49,310 --> 00:08:52,430
was happening and how
that could be avoided,
140
00:08:52,940 --> 00:08:56,280
how things could come
to a better end point.
141
00:08:57,630 --> 00:09:00,300
And then where did all of this go?
142
00:09:00,570 --> 00:09:01,403
Well,
143
00:09:01,410 --> 00:09:06,120
so Dr. Hamra did all
this research and came up
144
00:09:06,120 --> 00:09:10,860
with what he called deep
plane facelift techniques and
145
00:09:10,860 --> 00:09:13,680
started presenting his results,
146
00:09:13,710 --> 00:09:18,660
writing articles and giving lectures
at professional medical society
147
00:09:18,660 --> 00:09:19,493
meetings,
148
00:09:19,710 --> 00:09:24,570
and also training other surgeons
in how to do these techniques.
149
00:09:24,720 --> 00:09:25,590
And in fact,
150
00:09:25,590 --> 00:09:30,570
this was how I became acquainted with
Dr. Hamra because I did my plastic
151
00:09:30,570 --> 00:09:35,310
surgery training and then shortly
after joined the faculty at
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00:09:35,310 --> 00:09:37,470
NYU Plastic Surgery.
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00:09:38,340 --> 00:09:43,200
I had the opportunity to meet him
every year when he would visit his alma
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00:09:43,200 --> 00:09:48,090
mater for plastic surgery at what
turned into the cutting edge meeting
155
00:09:48,120 --> 00:09:52,920
and advanced meeting for experienced
surgeons to learn the latest
156
00:09:52,920 --> 00:09:56,760
techniques. And this meeting
involved live surgery.
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So he would do a facelift that
would be video televised into the
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auditorium with all the
surgeons and the residents and
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folks at the medical center would help
with the production of the meeting.
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In conjunction with
Dr. Aston at that time,
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the meeting director or course director.
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And that meeting was originally started
by their predecessor, Dr. Reese,
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who was the head of aesthetic plastic
surgery in the chair of Manhattan or
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Throat Hospital,
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and eventually turned into the cutting
edge meeting that was run by Dr. Sherrell
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Aston and Dr. Daniel Baker for many years.
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So all of that teaching made the idea
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of a deep plane approach,
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very well known out in the
professional community,
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but with many new things.
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It created criticism and
challenge. Basically,
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plastic surgeons are very much from
Missouri when it comes to new things.
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They say, show me how
it works, why it works,
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where's the proof that it
works or that it's better?
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And this is where we get to the really
interesting part about Dr. Hamra.
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That's a very important measure
of who he was as a man and as a
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surgeon and leader in the
plastic surgery community was his
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response to these challenges,
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because we see a lot of people present
their techniques kind of, here it is,
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here's what I do, and here's
some good looking results.
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But Dr. Hamra was much
more analytical than that,
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and it says a lot about
who he was as a person.
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So what was his response then?
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Well, certainly there was
pushback to the pushback.
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So Dr. Hamra had a very
forceful personality and
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wasn't going to be a shrinking violet
and be put off by the fact that people
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didn't believe or agree
with his approach to things.
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But because of his commitment to
research and also to collaboration and
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his ability to deeply
reflect on things and analyze
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things, he did a number of things.
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He continued to do more
anatomic dissections.
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He continued to refine his
operation and his approach to
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facelifting. And all plastic
surgeons do this to a degree,
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but he did it in a very formalized way,
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publishing the results of
many, many, many cases.
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In some cases, dozens, in some cases,
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hundreds in these papers.
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And so that in some cases proved
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that some of what he was doing
was on the right track in some
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cases that demonstrated that
there was no particular advantage
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compared to alternative techniques.
But he presented all of that.
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He didn't just present it what looked
good for his approach to things to
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say, look, I'm right. He presented
whatever the data showed,
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and in some cases, that supported
his outlook. In some cases it didn't.
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But that was very,
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very valuable to the
plastic surgery community.
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And I think among plastic surgeons
versus some other specialists that work
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in facelift surgery,
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that experience and that
dialogue at the plastic surgery
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meetings still colors
our outlook on deep plane
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techniques today. Not only that,
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but he also collaborated
with other facelift
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surgeons,
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a number of whom specifically
almost violently disagreed with
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his approach to facelift surgery
to try to generate data and
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compare outcomes.
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And so that cooperation and
collaboration is something that takes
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a lot of integrity and a
lot of strength of character
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to spend and realize all
this research is unpaid time
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and just trying to get at the truth
and trying to get advancing scientific
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knowledge.
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So it takes a lot of character to
put that much time and effort into
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occasionally proving yourself
wrong and to working closely with
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your detractors.
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And I think that that was the
measure of the man in a nutshell.
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It's really interesting overall.
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You also mentioned that he
has other contributions.
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So what were those other
major contributions he had?
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So he was a prolific article writer,
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and some of the most important articles in
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facelift can be attributed to him.
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That includes the evolution
of the concept of deep plane
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to the more complete concept
of composite facelift,
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which really medically
is the more proper name.
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So early in 1990 and the early
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1990s,
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there were a couple of articles
about deep plane approaches,
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00:15:21,410 --> 00:15:25,730
but this evolved to a
later article on composite
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00:15:26,330 --> 00:15:30,920
lifting of the complete face that
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also involved the development
and delineation in separate
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articles of something called septal reset.
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So that is because when you
lift the face, of course,
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the cheek comes up and the cheek
is just below the lower eyelid
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and the lower eyelid changes. Of course,
in aging, everything changes in aging.
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And Dr. Hamra reanalyzed what
some of these changes were
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and tried to look at, again,
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new approaches to correcting that.
And that included lifting from
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underneath the skin and
muscle in the eyelid to
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where the orbital septum is,
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a white membrane that's under the
skin and muscle in the eyelid,
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and resetting that,
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repositioning that up
towards the top of the head,
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00:16:23,360 --> 00:16:28,340
and that's called septal reset. So that
was a concept that he also introduced.
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One of the final,
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00:16:30,170 --> 00:16:34,460
and I think most interesting
things is a summary
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00:16:34,460 --> 00:16:39,020
article that Dr. Hamra
wrote in which came out in
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2016, shortly before he retired,
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where he discussed in his
own words the story of his
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00:16:48,260 --> 00:16:52,310
journey with the composite
facelift technique.
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And I've relied on that
article to relate in brief
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00:16:57,530 --> 00:17:02,510
some of those details in this episode
of the podcast where we're talking about
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the history of deep plane facelift,
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but he sort of went through his journey,
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what he was thinking, how he
was trying to change things,
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and how a lot of that worked out.
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And how has this translated
to the present day?
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Well,
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there are a variety of
approaches to facelift.
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There are SMAS techniques,
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which were really developed in
parallel to a lot of what Dr. Hamra was
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doing, backend NYU, and elsewhere
in the country and around the world,
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a number of surgeons were working on
SMAS techniques that also go into the
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deep plane under the SMAS
and reposition the SMAS,
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but differently than what
happens in composite facelift.
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So that's one major approach,
and there are variations of that.
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And then there are composite approaches.
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What on the internet gets
called deep plane facelift?
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That's a major approach.
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00:18:05,520 --> 00:18:10,020
There are plication and mastectomy
approaches where the SMAS layer
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00:18:10,020 --> 00:18:15,000
is reconfigured and modified from
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00:18:15,090 --> 00:18:19,590
its superficial surface instead
of from its underneath surface.
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00:18:19,950 --> 00:18:24,840
And then there's still occasional
use of skin only techniques,
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00:18:24,870 --> 00:18:29,790
probably mostly in someone who's
already had multiple facelifts.
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But all of those techniques are in use,
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00:18:32,790 --> 00:18:37,650
and all of those approaches to dealing
with the deeper tissues in the face
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00:18:38,010 --> 00:18:42,630
very clearly work and give
spectacular results in the hands of
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experienced facelift surgeons.
So there's no clear
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00:18:47,160 --> 00:18:48,960
winner, if you will,
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something that works better or works best
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or lasts longer.
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00:18:57,180 --> 00:19:02,070
But this use of composite
lifting is something that's
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00:19:02,070 --> 00:19:06,420
still in use today and still popular,
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although its utilization varies
with different specialties
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00:19:11,520 --> 00:19:14,550
of surgeons. Late in his career,
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00:19:14,550 --> 00:19:19,110
Dr. Hamra stepped away from some
of the aspects of this approach,
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00:19:19,170 --> 00:19:23,790
which again is a sign of his maturity
and good judgment rather than just
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00:19:24,090 --> 00:19:28,980
persevering with blind faith
that his process was best.
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He continued to innovate
and refine what he was
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doing, which again,
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00:19:35,460 --> 00:19:39,780
is a hallmark of what most plastic
surgeons are doing their entire
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careers.
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But he was just spectacularly
good and energetic at doing it.
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So overall,
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this is a lesson in how the
process of plastic surgery should
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00:19:53,010 --> 00:19:56,640
be handled, starting with anatomic study,
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which colors everything
we do with surgery.
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00:19:59,310 --> 00:20:02,760
It's all about understanding
and controlling the anatomy,
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knowledge of the anatomy,
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thus informing improvements,
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and then critical evaluation
of the effects and results to
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see if this change or
innovation really bears the
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fruit that we hope it does.
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Thank you, Dr. Bass,
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00:20:23,160 --> 00:20:26,880
for bringing us this timely but sad
news about Dr. Hamra and sharing the
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00:20:26,880 --> 00:20:29,460
significance of his
legacy in plastic surgery.
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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:20:34,230 --> 00:20:36,150
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318
00:20:36,210 --> 00:20:38,460
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319
00:20:38,610 --> 00:20:42,120
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320
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00:20:45,690 --> 00:20:46,890
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322
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