Dr. Joel Aronowitz - A DAY IN THE LIFE OF A PLASTIC SURGERY PA-C PHYSICIAN ASSISTANT... IN ARONOWITZLAND!
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| Dr. Joel Aronowitz |
Bridget: “Hey guys! Good morning! Happy Friday! My name is Bridget, I'm one of Dr. Joel Aronowitz's PAs, and what we are doing today is really fun. A day in the life! So follow me, see the patients I see, hang out, and it'll be a good time! Okay, let me introduce you to the breakfast of champions. Who needs fancy avocado toast?”
Dr. Ray: “Hi, Bridget!”
Bridget: “Hi, Dr. Ray!”
Dr. Ray: “Early in the morning, you're here. You're in a good mood.”
Bridget: “Well, you told me yesterday.”
Dr. Ray: “You're all sunshine, yeah.”
Bridget: “You said tomorrow's Friday, calm and a good mood. Were you insinuating that I'm usually not?”
Dr. Ray: “No, you're always in a good mood. Hey, you know, have you been working out?”
Bridget: “I'm just coming back to check on how things are going, and Sophie's chit-chatting back here.”
Sophie: "I'm not chit-chatting, I'm busy."
Dr. Ray: “Well, you know, we're doing a day in the life of Bridget today. Yeah, look at her arms. Have you been swimming?”
Sophie: “You know what, I actually don't like anyone here. I don't know what to say. You're all really ridiculous.”
Bridget: “All right, I can't really get to work now, so that's what I'm gonna go do.”
Dr. Ray: “Okay, let's see what you do for work.”
Bridget: “Oh, okay, guys. Welcome to my crib. All right, like, I'm gonna give you a little tour. Here is where I do a lot of the injectables. I got the needles, gauze, syringes. I keep my old Botox vials because I'm gonna do something really cool and artsy, except I can't do anything cool and artsy, so I'm gonna have to find someone to do something really cool and artsy, but, like, this is where they are. If we look over here, I keep my machines, cool sculpting. We have two machines so that we can do, like, both wall panels at the same time because no one wants to sit around and wait and do nothing. Does cool sculpting work is probably the question you're thinking. It does. Some fat is better than other, but it works. Arms, abdomen, love handles, thighs, you can take your pick. And let me introduce you to the newest machine. We got the VBL for sunspots, so a lot of people have sunspot on their faces, their necks, their chest. This is the where it's at, and I love it so much, and I've done Dr. Rano's like, and here he is.”
Dr. Joel Aronowitz: “How's your day, Bridget?”
Bridget: “Hey, I have a question. Are you like a little bit jealous, like, a little bit?”
Dr. Aronowitz: “Bridget, I have to, I have to confess. I'm jealous of you, babe.”
Bridget: “Why?”
Dr. Aronowitz: “Because I'm not here.”
Bridget: “Um, okay.”
Dr. Aronowitz: "Great day.”
Staff: “We have a packed schedule. We have all of our staff on deck, ready. Oh, well, anyway, yeah.”
Bridget: “Hello, how are you?”
Patient: “Well, that's pretty good.”
Bridget: “You look great. Yeah.”
Patient: “This little one down here? Yeah, that even got better.”
Bridget: “That looks great.”
Patient: “Okay. All right.”
Bridget: “These are small, but hey, listen, you're doing really well. Did these hurt you?”
Patient: No.
Bridget: “Are they bleeding anytime?”
Patient: “No.”
Bridget: “Yeah? These look good. Are they painful? Um, washing my hands. Usually do this before and after every patient. If it's Purell, I kind of like the Purell. Then if it's, you know, especially with COVID, hashtag COVID.”
Patient: “You know, just hold very, very tight. Yeah, it's not going to hurt. It's going to burn.”
Bridget: “Yeah.”
Patient: “It's not burning as much.”
Bridget: “Okay. So, when was your surgery? I don't know. I asked you.”
Patient: “Yesterday was six weeks.”
Bridget: “Six weeks. Okay. So, that patient had shoulder surgery and she got burned by the tool that goes in and does it arthroscopically. So, as you heard, she was told right after. She's doing well. She's doing better. It's just such a slow healing wound, but she'll heal.”
Dr. Joel Aronowitz: “Bridget, can you just help me real quick? This patient has a sacral ulcer.”
Bridget: “Okay. My next patient is my favorite kind of patient of Botox. A little ice roller, pre-made Botox that I did this morning for her and we'll do it. How are you?”
Patient: Good. How are you?
Bridget: What are we doing today?
Patient: Botox, for sure. And then I wanted to talk about micro-needling.
Bridget: Okay.
Patient: And then I have a dark spot that I saw the patient use.
Bridget: Yes. Okay. Normal routine in between the eyebrows, forehead.
Patient: Lift. Eyebrow lift.
Bridget: Okay, cool. What is your concern?
Patient: I wanted to try to level out my texture or skin tone and then I have this darker spot.
Bridget: Okay. So, the micro-needling will be great for you because you have good skin. It's exactly what you said. It'll just kind of make your pores a little smaller, make your skin look a little firmer, increase your collagen. So, with micro-needling, how it works is you come in, we numb your face, you sit with just a cream on your face for like 20 minutes. Then we wash it off. There's two ways to do micro-needling. You can either do it with your own blood or like a serum. Okay. So, if you choose your blood, we draw your blood, spin it down, and that's technically like the PRP, right? The vampire facial. Yes. As for the serum, we just have a serum here that we like to use. It just helps the pen glide. Gotcha. The pen has a tip with fine needles that oscillate up and down and poke tiny holes in your skin. You'll be red for about a couple days. One to two days, really, and it's like a mild sunburn. After 24 hours, you can't wear makeup or sweat for 24 hours.
Patient: I'm dead, though. I guess we can go exercise. I can do all that. Yeah.
Bridget: As for the dark spot, so is it just right here? Yeah. You do have some pigmentation like over here. Yeah. Just normal sun damage that we all have. I would do a full face. If you were to do it, I wouldn't say like let's just do one area. I would say let's do the whole face. Do the whole face?
Patient: Yeah.
Bridget: Okay, relax. The botox is really lasting a long time.
It lasts. It's the center part that I noticed, but at the same time, I'm like, get it all done. Thank you for doing my botox. Of course.
Patient: Yes. They're still decent.
Bridget: “Oh, is this non? Non. Nothing like a good day old cookie. I'm going to break it in half and then shut it until now when I broke it in half. Hey. What are you doing? Is it her? Yeah. Oh, really? Mm-hmm. Okay, let's see. This looks so good. From where you started to where you are, it's crazy different. This patient got her wound from a previous tummy tuck. The wound opened up a bit. So she's been using a wound vac which sucks out the fluid and helps the tissue grow and granulate. You can tell by the granulation tissue, it's this red, ditty tissue. You can also stimulate a little bleeding by using a curette. This is a sharp curette. There's different kinds. There's manual debridement where it's what we're doing right now, or you can use a topical debridement. That can help sometimes, but we're just doing this each time. How frequently are you getting your wound vac changed twice a week, right? That's awesome. Yeah, you have a good weekend too. So this next patient had an abscess on his abdomen and we drained it. And now it's a pretty big wound that we've been packing. Hello. Hi. How are you? I'm good. I'm good.”
Patient: “For a while, I had just zero energy. I wasn't able to barely get off the couch and we've been doing my work again.”
Bridget: “And this is getting so much smaller. When was the last time this was changed?”
Patient: “It would have been Wednesday afternoon when I was here. So you're doing Monday, Wednesday, Friday?”
Bridget: “Okay, let's keep it like that. It was fine over the weekend the last time? Perfect. Oh, I'm like, what are you dancing with me? All right, cool. We'll see you Monday. You're like such a busy patient. Okay, so we are middle of the day about almost lunch, which is my favorite time of day. And this morning I saw a lot of wounds, wound vacs, lower extremity wounds, sacral ulcers. I also had an injectable patient. My first patient today was someone following up for their tear trough fillers. I also had a Botox patient. I'm waiting on a microneedling patient currently. I think one of the most important things for people in the cosmetic and aesthetic world is to also include things that bring you a little variety. I mean, if that's your preference for me, I don't think I could just do Botox all day. I think I would get definitely a little bored. Um, there is a lot you can do in the aesthetics world, which I like, but I also like seeing wound care patients because it gives you just, like I said, a variety. And it makes you think a little bit. Not that tearing injectables doesn't make you think, but you know, it's just a whole different breed of plastic surgery. I have a condition and it is a real one. And when someone chews loud, and my, my friends and family can attest to this. If you're like sitting next to me chewing on like almonds or anything loud, I get intensely angry, like enraged if I can hear your tongue slapping against your mouth. Like I've been brought to tears because it's like, it's a real thing. It's like a heightened sound to me, whereas to you, it might not be. So if you require therapy for that, will insurance cover it?”
Sophie: “No, actually, I think mesophonia is a diagnosis now because so many people have it. So let's just be clear that you had this before you came to work for me, so you can't claim that it's a worker's cup injury.”
Patient: “It was, it's been all my life.”
Dr. Joel Aronowitz: “Oh, where's Bridget?”
Sophie: “She's on disability for mesophonia.”
Dr. Joel Aronowitz: “Oh, really? What's that?”
Sophie: “Oh, it's a real condition.”
Dr. Joel Aronowitz: “Listen, I'm telling you, so many people are going to agree. Can you hear somebody chewing like in another state? No, in another room, like I'll be in my bedroom, but can hear someone in the kitchen chewing on chips and I'll like.”
Bridget: “Okay, I think we need to speak openly and honestly, I'm like noticing some tension with Aronowitz right now, and I'm pretty sure it's because he's not being filmed all day. I think, I think he wants.”
Dr. Joel Aronowitz: “So, this is Bridget is working very hard. This is a typical day in the life of Bridget working very hard.”
Bridget: “Wait, listen, wait, I actually have something funny to say. Because we're doing this filming the day in the life, everyone here thinks it's like roast Bridget day. I was like, here, here, film me. And then I film her and she's like, Bridget steals the pens in the office. I was like, okay, like I didn't know we had things against me.”
Dr. Joel Aronowitz: “Well, let me just ask you something. Honestly, do you steal the pens in the office? Come back to my cup. Here, ready? Come here. Did you pay for one of those pens?”
Bridget: “Yeah, I did. I actually did. I bought a pack. I did buy a pack. He would ask about who bought the pens. Let's go here. Hey, Osla, I wanted to, you know, taking a pen home is theft by conversion. I just want to point that out.”
Dr. Joel Aronowitz: “You can pick a few, but let me take the ones I like. It's like Christmas. This is a very exciting life.”
Bridget: “It is a life of this is definitely mine because I broke this one. It's like $40 version pairs. Good doing business. Okay. Look, I made everyone happy. I gave back the pens. It's cutthroat here.”
Dr. Joel Aronowitz: “Yeah, there's two different kinds. There's Restylane and there's Juvederm. In the Juvederm family, there's Ultra Plus, Ultra, Volbella, Volore. There's many others like also Voluma. Voluma is fabulous in the cheeks. Then for Restylane, I love their new one Kiss. That's wonderful for the lips. There's Silk, which is great also for the lips and L. Restylane also has Refine, Define, and Lift. So there's a whole slew of products.”
Bridget: “Knock, knock. Hi. How are you? Good to see you. How's the Botox? It's good. Yeah? Do you like it?”
Patient: “I do. It honestly was so... It's still so weird that I can't move so much.”
Bridget: “Move so much? Was I the... Did I tell you... Were you the one that I was like the first time you cried? It's gonna be very...”
Patient: “Yes. It's like very odd. You're like, what's happening? Your forehead looks amazing. It looks good, right?”
Bridget: “Yeah.”
Patient: “Yeah. My boyfriend was like laughing so hard. He's like, you literally can't like scratch your face.”
Bridget: “Yeah.”
Patient: “He's like, that's trouble that you always do.”
Bridget: “You can't do it anymore.”
Patient: “I know. I know. It's kind of amazing.”
Bridget: “Let me see your lips. Let me take your mask off. Okay. So, yes. It's not gonna hurt. You might feel a poke. Yeah. The needle is super tiny. Okay. And lip fillers have numbing in them.”
Patient: “Okay.”
Bridget: “So the first poke you'll feel and then by middle of it at towards the end, you're gonna walk out of here like you just went to the dentist. Okay. Cool. Use the ice roller while you chat. Okay. You might be swollen tonight. Okay. Yep. Little lumpy bumpy. Okay. For a couple days. Fillers take about two full weeks to set in. Yeah. So I usually won't do any corrections or add or take away for solid two weeks. Okay. Other than that bruising possible, any excessive pain, craziness, you just let me know immediately. But honestly, we'll go easy. We'll go slow. We're not overloading you. Purse your lips. Make a kissing face. Okay. Relax. All right. I'm gonna kind of be all up like my hands everywhere. Okay. I'll try not to touch you too much. How's that feel?”
Patient: “It's not too bad.”
Bridget: “Okay. So we're doing the filler and then with a drop of Botox, we can bring this up a bit and she's gonna turn. So if this right side is the after and then the left side is the before, it's a world of a difference. The filler's work is we inject it and it's kind of like a gel and then your body has water and the water, the molecules of the filler and the water interact and it softens.”
Patient: “So that's why it takes a little bit of time.”
Bridget: “But yeah, you look good. You're a little extra puffy on this side, but I put in the same amount.”
Patient: “Great. Cool.”
Bridget: “You look great. You look really good. Thank you so much. I'm so excited.”
Patient: “Is there anything I like can't do in the next?”
Bridget: “Okay. So vigorous exercise. Okay. If you like in the next 24 hours, if you like go take a crazy spin class or hang upside down, they just might swell a lot. Okay. And you'll increase bruising. Drinking alcohol, you might increase bruising. Just keep an eye on it. It's just gonna be puffy. Yeah, totally. Oh, wow. That's crazy. You just have a, so once the Botox sets in, so it'll like, like flick almost. Just ever so slightly. All right, sit back, John.”
Bridget: “Knock, knock. Hi. Hello. That's the building we were in. Hello. How are you feeling?”
Patient: “Pretty good.”
Bridget: “Good?”
Patient: “Yeah, off a notch.”
Bridget: “All right. All right, let's see how you're doing up here. This looks wonderful. This is healing very nicely.”
Patient: “I'm go glad. That's like a big hole in my head.”
Bridget: “There's no hole. I know it's a tough area for a bandage, so we're just doing a little gauze. Yeah, I like that. Yeah, it stays on.”
Patient: “I think that's great.”
Bridget: “Gives her some padding. Oh, why don't you come back on Tuesday?”
Patient: “Tuesday.”
Bridget: “Tuesday's good news day.”
Patient: “Tuesday's good news day. I love that. I'm going to steal that.”
Patient: “Hey, how are you, Bridget?”
Bridget: “How are you? Nice to see you too. You have a mohawk? Yeah, because it's been six months. I was going to say, you haven't gotten it.”
Patient: “So you are ready for the mohawks. I don't know if you are.”
Bridget: “I mean, there's a little bit up here. Yeah, raise your eyebrows for me.”
Patient: “Yeah, up here.”
Bridget: “Make an angry face. Yeah. I mean, it's mostly that I get concerned in here. That line just seems to be getting worse. And then these lines. Yeah, so this line didn't ever, as we've talked about, occur before, but because of the procedures, it seems to decide that that's where it wants to do that. So, and I know we got to be careful because if we do anything too close, we'll. Yeah, exactly.”
Bridget: “All right. Rest your head back and raise your eyebrows. Relax. You're good to go. Okay, perfect.”
Patient: “Thanks. It was so good to see you.”
Bridget: “Good to see you too. No, that was good. It's fast. You don't mess around and you never do. I love it. Well, it's easy. I mean, you have places to be.”
Bridget: “So this is the day in the life of Bridget. And I would say it's all. Do you know that my day continues after this place? It's crazy. Okay, so what can APA do in a plastic surgery practice? I think it depends on the practice. If the practice is very broad, the PA can be exposed to everything from med spot things, very cosmetic surgeries. If the practice is very reconstructive oriented, then the PA will be doing those kind of things, breast reconstruction, trauma, wounds. And in a broad practice, can be doing everything, even genital things.”
Dr. Joel Aronowitz: “So what's your favorite area of plastic surgery from your exposure?”
Bridget: “I don't know. It's a tough question. I like the injectables, but I also kind of like the wound care because you see the wounds get better. And it makes you, I think, I think doing reconstruction things. And it makes you better at taking your cosmetic things. I mean, for example, we have a patient right now who's referred by another office who had an abdominal wound for after a tendon crack, who has a cosmetic operation, but she has a major wound that needs to be taken care of. Your work in wound care helps you manage that kind of thing. And I think, yes, I love it.”
Dr. Joel Aronowitz: “Love that. I love having a PA. And I really do. I seriously really love having a PA. And the-“
Bridget: “What have you been doing all your life? I've been working really hard.”
Dr. Joel Aronowitz: “But I'd recommend a PA for any plastic surgery. And I would tell PAs to be sure to do a rotation in a plastic surgery practice if it's at all possible when you're in training so you get some exposure. “
Bridget: “Yeah, I did it.”
Dr. Joel Aronowitz: “And call Bridget for advice because she's very kind.”
Bridget: “Yeah, how can they have people?”
Dr. Joel Aronowitz: “And meanwhile, she's just going to be busy being Bridget. I'm just going to be busy being me.”
Bridget: “Busy being me.”
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