IN THEIR SKIN/ or MORE THAN SKIN DEEP: Do female plastic surgeons have a better understanding of what women want?

 Date: April 10, 2006 Author: Natasha Singer, THE NEW YORK TIMES 

MIND & BODY Last June, after Jerri Hafizi, a 5-foot-3-inch construction firm executive, lost 65 pounds, she asked a plastic surgeon to tighten the loose skin around her torso and lift her breasts.

But the surgeon seemed not to understand what she wanted. He squeezed Hafizi's skin in his fists, she said, and told her that the only way to solve her problem was with implants.

"He wanted to make me into a Barbie doll," said Hafizi, 50, who lives in Merritt Island, Fla. "But I didn't want to be made over according to somebody else's idea of what a woman should look like."

A few days later, when Hafizi consulted Dr. Roxanne J. Guy, a plastic surgeon in Melbourne, Fla., she had a different experience. Guy spent more than an hour discussing Hafizi's choices. But most important, Hafizi said, "Dr. Guy was OK with the fact that I was going for the Rene Russo look, not the Pamela Anderson look."

The surgery Guy ultimately performed was implant-free and, in Hafizi's eyes, a success. And she thinks she knows why: "Dr. Guy was more empathetic and attentive to my expectations and goals because she's a woman."

Guy runs across this kind of thinking all the time.

"Female patients are drawn perhaps to the idea that they are going to get more time and empathy and understanding from a doctor who has the same female organs as they do," she said.

That view appears to be gaining traction in the world of plastic surgery, where there has been an influx of women in the last decade. Of 7,003 doctors in the United States who are board-certified in plastic surgery -- meaning they have passed examinations to demonstrate their competency -- just 623 are women, according to the American Board of Plastic Surgery. But that number is more than double what it was in 1995.

The idea that female surgeons might be more empathetic than men -- or that they might have significantly different standards of beauty - - is the subject of much debate. The suggestion of a gender gap among cosmetic surgeons, some say, is nothing more than a marketing ploy used by some practices to attract patients.

"People should go to a female plastic surgeon because she is a great doctor, not because she is selling sympathy and empathy and all that other nonsense," said Dr. Gerald Imber, a plastic surgeon in New York City who described himself as "notoriously unsympathetic" to patients. "I care about my patients, and my heart would break if something went wrong during surgery, but I am not selling empathy. I am offering excellence as a physician and a surgeon."

Women are far more likely than men to have plastic surgery. They accounted for 90 percent of the more than 2 million surgical procedures in the United States in 2005, according to statistics kept by the American Society for Aesthetic Plastic Surgery. And an increasing number of these women are specifically asking for female surgeons, said Guy, who is the first woman to be elected president of the American Society of Plastic Surgeons.

Dr. Linda Li, a plastic surgeon in Beverly Hills, said female doctors can offer a fresh point of view.

"Patients used to have two kinds of plastic surgeons to choose from," Li said, "an older professorial fatherlike figure who told you what he was going to do to you or a young attractive male whose attention made you feel attractive.

"But now there is a third choice, a female plastic surgeon like me who patients can relate to and bond with like a mom or a sister."

Women are entering medicine in greater numbers, now representing half the students at medical schools, according to the Project on Gender, Culture and Advancement in Academic Medicine at Brandeis.

Field attracts women

And as the training period for plastic surgeons has grown shorter, the specialty has become more attractive to young women who want both a career and a family.

For example, 30 years ago Dr. Helen S. Colen, a plastic surgeon in New York City, had to put in eight years as a medical resident: five years of general surgery followed by three years of special plastic surgery training.

Today her daughter, Dr. Kari L. Colen, 31, is in a combined six- year plastic surgery program at New York University School of Medicine. And the elder Colen said she went to greater lengths than her daughter to prove she could compete.

"I went into labor while I was operating at the hospital, finished up my surgery, delivered the baby, and immediately went back to work," Colen said. "Because you were the only female plastic surgery resident, you had to be exemplary."

The younger Colen, who recently had a baby, was able to use her month of annual vacation as maternity leave.

Listening skills differ

There is some evidence that male and female doctors communicate differently with their patients. For example, in 1994 researchers at Northeastern University in Boston observed doctors of both sexes during 100 patient visits and found that the women were more emotionally engaged and less domineering than the men.

And an analysis of data on more than 90,000 doctor's office visits nationwide from 1995 to 2000, conducted by researchers at the University of California, San Francisco, found that female physicians spent more time with patients.

Dr. Sydney R. Coleman, a plastic surgeon in New York City, said he hired a young woman as an associate in 2004 in order to better communicate with patients.

Now he often invites that woman, Dr. Alesia P. Saboeiro, to join in his consultations, to offer her opinion and to answer questions patients are too embarrassed to ask him, he said.

"I am a good listener," Coleman said. "But no matter how hard I try to get into the head of a woman, I am never going to understand her completely."

But Dr. Elizabeth J. Hall-Findlay, a plastic surgeon in Banff, Alberta, refutes the notion that female surgeons automatically enjoy better rapport with female patients. "Some women plastic surgeons are tough and don't listen while some male plastic surgeons are empathetic and great communicators," she said.

The idea that men and women have different views on what constitutes an attractive female body is also hotly debated.

"A lot of male surgeons have a tendency to push bigger implants or think bigger is better," said Dr. Jane S. Weston, a plastic surgeon in Atherton. "Perhaps my breast aesthetic is different. I tend to go for a more genteel, shapely, natural look."

Attention to size matters

But others argue that it is the physician's ability to realize the patient's ideal and not the gender of the surgeon that matters.

"I do have patients who want their breasts made smaller because they feel their previous doctors made them too big, but that is not gender-related," said Dr. Mia Talmor, the first female plastic surgeon appointed to the full-time faculty of Weill Medical College of Cornell University in New York. "It's about whether the surgeon was meticulous and listened to the patient."

Shani Gonzales, 26, of New York City, said surgeons can be poor listeners. Gonzales consulted three plastic surgeons, all of them men, and told each one that she wanted to reduce her size 36J breasts to decrease her back pain and the self-consciousness she had felt since she was a teenager. But, she informed them, she still wanted cleavage.

"But all of the doctors just assumed I wanted to go from being superbig to super-small," said Gonzales, an assistant at a record company.

Each doctor showed her post-operative photographs of patients and their breasts, she said, but they all looked the same. "It was all very cookie cutter," she said.

So last month, after her mother urged her to find a female plastic surgeon, Gonzales went to see Dr. Nina Shaikh-Naidu. Shaikh-Naidu, who practices in New York, discussed at length Gonzales' aesthetic goal and her concern that surgery might diminish breast sensation or her ability to one day breast feed.

Shaikh-Naidu recently performed the surgery, and Gonzales said she has been holding "viewings" to show friends her new size 36D breasts.

"I keep wondering whether Dr. Naidu was more sensitive to what I wanted and more able to give it to me because she's a woman who has breasts herself," Gonzales said. "But maybe she's just a better doctor."