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Dr. John Ferguson on How Technology Helps with Patient Education

Dr John FergusonWe take you all the way to beautiful Hawaii during this episode of Inside Cosmetic Surgery. We speak with Dr. John Ferguson, of The Ferguson Clinic, about how he uses technology in patient education. Opting for cosmetic surgery is no small decision, and being an informed consumer is one of the best ways we can protect ourselves.

Find out how Dr. Ferguson uses 2D imaging, 3D imaging, and even his iPad, during consultations to take away a lot of patients lingering what ifs.

Listen to our interview, or read through the transcript below!

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Sharon Odom (SO): Hi everybody, this is Sharon Odom from and welcome to another episode of our continuing series Inside Cosmetic Surgery. Our special guest today is Dr. John Ferguson, a board-certified cosmetic surgeon from Honolulu, Hawaii by the way of Texas. Hi Dr. Ferguson, how are you?

Dr. John Ferguson (DJF): I am wonderful. How are you doing today?

SO: I’m doing great.

DJF: Good, good.

SO: Well, thank you for joining us today to discuss how you’ve integrated new technology into your practice for improving patient education.

DJF: It’s definitely my pleasure.

SO: What does that mean exactly?

DJF: Well, the way that I was trained and one of the things that I hold dear to myself is having the patients know what’s going on. To me the days of patriarchal doctor are done, especially in cosmetic surgery. I mean, it’s a two-way street. We both, the patient and me, have to really be on the same page, so that they have a great experience and good outcomes, and the most important aspect of that is education, teaching the patients not only what to expect, but why I’m doing what I’m doing and it just makes it a better experience for the patient. Again, it makes the outcomes so much better.

SO: How did you get started using new technology in your practice?

DJF: Well, I’ve always been a little computer geek kind of person. I’ve always played with computers when I was at the University of Texas. I did a lot of graphic arts for computer journals and kind of get it in from that standpoint. It has really led me into a lot of computer graphics, which to me is the basis of my education with patients.

It all has to do with being able to talk to them, but really being to illustrate not only what’s going to happen during surgery, why I choose to do what I do, but [also illustrate] how they are going to look afterwards, and really just kind of stemmed from my working with computer graphics.

SO: Give me an example of using technology in your practice.

DJF: Well, just about every patient that comes in for any kind of procedure short of maybe liposuction or something like that, I would definitely do some imaging to show them kind of what to expect afterwards or what my goal is for surgery and that involves both 2D imaging on the computer as well as 3D imaging.

We actually have a 3D camera and programming available to actually show a three-dimensional representation of what we anticipate them looking like, whether it’s facial surgery, noses, and even breast surgery. We can show them on a three-dimensional model what they are going to look like. Now, there are some limitations with some of the 3D technology, but you can always fall back on the good old 2D technology that’s available and still give a very accurate representation of what they should expect postoperatively.

SO: You mean, you actually can show the patient what they will look like afterwards.

DJF: Yes, yes.

SO: How do you do that exactly? Is that a certain kind of program or software? What is that?

DJF: I actually have about five different software programs that I use and they all have their plusses and minuses, and it just kind of depends on what kind of procedure. If I’m doing [breast augmentation], if it’s something that’s really going entail a lot of 3D shifting like putting any kind of augmentation in, whether it’s a breast augmentation, doing a chin augmentation or cheeks, that kind of stuff, I will actually do 3D imaging.

I have a 3D camera and 3D system by Axis Three that really does a wonderful job of really, really showing what the patient is going to look like. Even with breast implants, I mean, I can dial in both brands, either Allergan or Mentor breast implants, any size, any shape, they are already programmed into the computer, so I just push a button and it comes out with Style 2375 silicone implants and it puts it in there.

SO: And the prediction usually matches up to the real life result?

DJF: Absolutely, it really does. It really does. It allows me to do certain things…you can adjust the implant. You can adjust the size of the pocket that you are going to create based upon the patient’s chest wall. With those kinds of things, you can adjust for that. Then with the different sized chin implants or the different styles of cheek implants, you can punch right in and really give patients an accurate representation of the volume and 3D changes that are going to happen.

Now, for other things that aren’t that important for three dimensional such as like noses or face lifts and things like that, 2D imaging is great. I use several different programs for that. I’ve got virtual plastic surgery software. I’ve got the old Uni-Systems, and even just plain old Photoshop works really well too.

SO: I’ve seen some of those 3D images on various websites. They actually show procedures being performed. Do you use that kind of thing? Do you know the thing I’m talking about?

DJF: Oh yeah, there is a company out there that does that for educational purposes. I actually use my own imaging that I’ve created when I’m doing patient education as far as how the procedure is going to go and that kind of thing, where I’ve basically created the images myself like taking somebody through the entire process of, say, abdominoplasty.

I take them step by step, and I like to use my own images just because you know what you are going to say. You kind of want to make sure that you say the same thing over and over, so that each patient gets the same information. It ends up I just like to use my own images.

And there is not a time that I walk into a room where a consult that I don’t have like my iPad with me with all the images that I like.

SO: How graphic do you get on these images? I mean, you don’t actually show…

DJF: These are representations. They are not actual intraoperative photos. If somebody asks, definitely, I mean, I will show what they want to see. Most patients don’t want to, but if they do, I have them available. But just showing the regular drawn anatomy just really, really helps the patients understand quite a bit.

SO: I can imagine. So how has [technology] improved the patient education in your practice?

DJF: Well, it’s just wonderful. I mean, the patients know what to expect afterwards. Doing what we do, figuring out what a patient needs based upon their desires and then doing the surgery, that’s the easy part. That’s definitely the easy part of what we do.

The difficult part is that postoperative period, because the patients, they are going into this and they are not exactly sure what to expect afterwards. There is a real trend for patients to have a little postsurgical depression and that kind of stuff because they didn’t know exactly what to expect or why something was done. [With this technology], I don’t have that.

I just don’t really have that problem. Since I started really spending a lot of time educating them and showing them why I’m going to do something, what’s the anatomical basis for it, what to expect based upon doing that, and honestly, I don’t really even get any calls from patients postoperatively. I give everybody my cell phone and I might get a call once every two or three months because the patients know what to expect.

SO: And I imagine it’s probably much better to see their own face or their own body postop in those pictures as opposed to someone else’s.

DJF: Absolutely, and one of the things that I’ve started doing over about the last two years is in addition to showing them the final results, most of the commercial programs that are available for surgery don’t let you do this, but I do this with Photoshop and show them kind of what they are going to look like immediately postop.

SO: Yes, that’s great. Because so many times, they are bruised or they are swollen.

DJF: Absolutely. Yeah, especially like doing the eyes. The eyes take sometime to heal.

And it can take a couple of weeks, and I can show them the progression that they should expect, and so they don’t come in the day after surgery or a week after surgery really freaking out because they didn’t expect this. The patients know. They know and it’s very, very comfortable for them.

SO: Awesome, so how has it affected the way that you treat patients? I mean, if you didn’t have the technology available, what would you do differently as opposed to what you are doing now?

DJF: Well, I think some of the technology that’s available, not just with imaging, but I would say some of the different devices that are available surgically like, say, the laser lipolysis, to me, that’s just been a wonder to the treatment of fat and then our knowledge that we are gaining on the treatment of fat with both removal and transfer, I mean that kind of technology that’s out there has really changed quite a bit how we treat people. It has also given us a better understanding of the three dimensional aspects of what we do.

I can tell you it’s rare that I will do a face lift where I might add some extra tissues and fat and things like that because now we know that loss of soft tissue is part of the aging process. Not only doing the external three-dimensional imaging, but the studies that have been done doing volume metric imaging with CTs over time and doing 3D re-creations with CT so you can get an idea of the volume changes that occur in the face has really made the rejuvenation process that we do here.

It has really made it much more satisfying. It gives you a much more natural look like it’s all swept back. You can take into consideration those kinds of volume metric changes that we just didn’t have. We knew the knowledge was there, but we just didn’t have a way of objectively evaluating it. Now, we do. The other thing once again is going back to laser lipolysis. I mean, that is just…

SO: What is laser lipolysis?

DJF: Well, laser lipolysis is just using a laser, a pulse laser, and it basically breaks down fat cells. The first one was the SmartLipo that came out towards the end of 2006, and fortunately for me, I was able to be the first one to do it after it became approved and so it’s just been a wonder for the treatment of fat.

I mean, I hate to say it, but yeah, I would say about 80-90% of the male lipo patients that I do are active military. As they get older, they want to stay in [shape]. But as you get older, it’s gets harder and harder to control certain aspects of your anatomy, especially fat deposition.

SO: Yes, sure.

DJF: I get a lot of them that come in, and the nice thing about using the laser as opposed to traditional liposuction is they are back doing their regular PT the next day, and it’s something that you don’t run the risk of fat emboli. The patients are up and about, so deep vein thrombosis (DVTs) aren’t a problem.

Because the cannula is only like one millimeter, you don’t really get any streaking. There is no rippling. There are no irregularities, and you can get into places that traditionally you really couldn’t do with regular liposuction, and really, in my opinion, [Laser Lipolysis] is the game changer when it comes to treatment of fat.

SO: Right. Well, can you give me an examples of some great patient stories, no names, of course, but just some examples of people that you’ve helped.

DJF: It’s just somebody I saw yesterday. This is a woman. She’s in the Air Force, and she’s been in for 20 years. She had one stripe to go to make Master Chief. Unfortunately though, she was postmenopausal and gained a little bit of weight. She couldn’t pass her tape test, and all she wanted was her last stripe. That’s all she wanted, it was her last stripe, so she could retire as Master Chief. She came in and we’ve taken a couple of inches because she couldn’t pass her tape test.

SO: What is that?

DJF: The tape test is where in the military they take certain measurements primarily around the abdomen and they have this chart that they go by.

SO: Oh, okay.

DJF: And if you are with bigger percentage, and it’s based upon your height, your weight, and certain things that don’t change like your neck circumference and that kind of stuff.

And you’ve got to fall into this chart or you are out, and that’s why I get so many military because with the way that the economy is, that’s a job.

And people don’t want to lose their jobs, but with this woman, all she wanted was her last stripe, so that she could retire and she had three tape tests in a row that she failed and with her next one, she was out. She came in and a week after we did her laser lipolysis, she called me up and she got her stripe.

SO: She passed her test, the tape test.

DJF: Yeah.

SO: It’s a great story.

DJF: And those, I do quite a bit of that. I mean, especially here in Hawaii, we have such a huge military population here. And once again, with the way the economy is, they want to keep their jobs.

SO: Yes, of course.

DJF: Especially once you get into your 30s and 40s and it’s harder to find a job, and you have been doing it for so long, but then age creeps up on you and no matter how much you exercise, some people just have a genetic predisposition to accumulate fat in certain areas.

And that’s where I come in.

But that’s what so neat about it is I can do this and they can be back at work the next day just doing their regular training. Doing regular PT without any problems.

SO: Right.

DJF: I mean, when I was in Alabama and Florida before I moved here, I had SEALS coming up from Panama City and Pensacola. They are 35 to 40 years old and they are obviously in perfect health, but they got a little paunch here or there, and we took care of that and they are back in the water the next day.

SO: Right, excellent. Well, this has been a very informative. I was really interested in how you were using technology in your practice just because technology is all around us and it’s part of our daily life, so this has been really great. So would you like to tell our listeners more about your practice and your website perhaps?

DJF: Sure. The website is The practice that I’m in right here, the first office in this particular building started in 1970 by Dr. Robert Flowers. He’s one of the godfathers of plastic surgery, and he was here up until about two years ago in this same office, and he called me up two years ago and asked if I wanted to come over and take over for him, and so about two years ago I did. It’s just a wonderful thing. I’m sitting here in my office right now with 360 degree view of Honolulu.

SO: Oh, it must be tough. [Laughs]

DJF: I’m looking straight down at the Honolulu Harbor, and it’s just a beautiful place. It’s very large. We have fully accredited surgical suite with two huge ORs that actually overlook the water and there are floor-to-ceiling windows that overlook the water.

SO: Excellent. Well, thank you so much for joining us and talking about your experiences with your practice.

DJF: Thank you very much for having me.

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