James Marotta, MD - Facial Plastic Surgeon in Smithtown, New York

The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor.

Welcome back to Meet the Doctor. My guest today is Plastic Surgeon James Marotta, practices on Long Island in New York. Welcome to the show, Dr. Marotta.

Thank you for having me. Appreciate the invite.

Good to see you again.

Good to see you as well.

You're one of the few people who had the, I'm not sure it was a privilege of being on the very first podcast I ever built, which was the Real Self University Podcast, and I learned so much from doing that. And so what that tells me is that you're the kind of person that likes to try stuff and is up for marketing experiments. So I appreciate that.

I like experiments with marketing, with technology, with anything in the plastic surgery world, aesthetic treatment world. I like new stuff. It's kind of fun.

And so you've been in practice for how long now?

I've been in practice for 18 years.

And I also think you hold the distinction of being one of the few plastic surgeons in the world who's written a book for patients. Am I remembering that right?

I've written a book for patients as well. Yeah, it's called You're Not A Vanity Purchase and was, yeah, a work of maybe about four or five years ago I started it and it was kind of a labor of love. I had patients come into me continually questioning themselves. Why were they so motivated to undergo plastic surgery procedures, particularly older people, like the people I was doing, lots of facelifts and facial rejuvenation procedures on a woman would come in or early, mid seventies and say, my husband's gone. I have nobody to do this for, but I don't know, just, am I vain? Am I crazy? Why do I care about the way I look at this point? And so it got me to thinking what drives people to undergo these cosmetic procedures? Obviously great personal expense recovery, obviously all the fear that I have to overcome, the fear that's involved having a plastic surgery procedure.

(02:34)
So there had to be a big motivator beyond vanity. So that's the title of my book. You're Not a Vanity Purchase. And I delve into what those motivations are, what societal, cultural, physiologic, biologic, there's all kinds of motivations why people have a biological drive to look as good as they possibly could beyond just attracting the obvious of just attracting the opposite sex. There's a whole host of reasons why people have such a strong motivation and desire to be in our field and do this stuff. So yeah, it was an interesting journey for me. I learned a lot in writing the book and I present that to the patients and patients just love it and hopefully brought a unique perspective to that part of the journey for people.

And so you're talking to people who are already in front of you, they all overcame their guilt or their obstacles in making that decision. Did you ever find a pattern among them? Was there something they had in common around how they decided to convince themselves to go forward?

Yeah, I mean it might sound trite, but the old, I'm just doing it for me kind of thing, where people kind of navigated that whole complex of guilt and vanity and are they spending too much money? Are they taking away money from their family members? And they just said at the end of the day, a lot of times, and obviously 90% of our field is women and they are the caregivers, they're the people that, and I'll hear all the time, I spent my whole life caring for someone else and now my mom's passed away and so I'm going to do this for myself. Or now my kids are in college and now I'm going to do this for myself. And I think that is probably the healthiest perspective on it is if you're driven by your desire to please other people other than yourself, I mean, you're kind of driven to fail because sometimes people won't necessarily recognize what you've done or approve of it or I've had that experience a lot of times with patient motivations, unfortunately whole family making this... My vivid example of the poor woman who was having a facelift and forehead lift and upper and lower eyelids and the whole deal.

(04:44)
And she didn't really tell her family, but her family was dead set against it, and they just made her life a living hell in recovery and telling, what did you do? You're going to regret this. And it was a whole kind of emotional thing that we had to support the patient through. And long story short, once she got through the process, she healed well. She looked great. Her family came around and said, oh, now I get why you wanted to do this, but put her through a living hell in the process. So yeah, it can be emotional around a plastic surgery for patients. So the book was really a way to help people navigate those situations and to help them feel that they're really not alone. We have a Facebook community too centered around the book that helps people to share their stories about motivations and guilt and things like that that surround our field because kind of a strange phenomenon. It's getting less, obviously with social media, with everybody putting everything on Instagram and sharing the younger people being much more willing to share their surgical experiences and their kind of before and afters and what they went through and it being more, less and less taboo as every year goes on. But for the older generation, I think that's still somewhat taboo.

Did your experience writing the book change the way that you practice every day in terms of how you communicate with your patients then?

I think so. I mean, I think you have to be a really good communicator in my field. You have to because the secret to meeting getting, and I always say this, I have the greatest patience. People are pretty much universally happy, they're grateful, and it's because communication style weeds out those patients that I can't make happy, that won't be grateful, that will never be satisfied because I'm a pretty honest person. I try to meet people where they are and deliver their expectations as well as I can. And if I can't meet those, I try to stop the conversation or give them something else that may meet their expectations. And so I think that's helped me in practice and I've learned that not only over the years of practice, obviously the book also helped me flesh that out, but I've really done that. I luckily trained in great places to learn from master surgeons and who were not only great surgeons but great communicators with patients as well. So I think modeling that really helped me in my early career and then gets carried through to them.

You mentioned a facelift patient earlier. Is that something that you're known for is facelifts?

Yeah, I'm known for deep plane facelifts. Rhinoplasties rhinoplasty is another big focus of mine. I love rhinoplasty and feel like I'm more advanced techniques are my game in that I do open structure, I do dorsal preservation, rhinoplasty, and then more advanced facelift work, like deep playing facelifts with buccal fat removal at the same time, deep neck work where I'm removing this submandibular glands or the deep submental fat, contour neck contouring, jawline contouring. I do facial rejuvenation surgery, the gamut of it, eyelid surgery. I do tons of eyelid surgery and we have a hair restoration practice. So I grew from a single practitioner now I have an associate, I have a PA, I have two nurse injectors, two aestheticians. We're practice of about 35 people We're expanding our current space from, we're a single location, but I kind of outgrew building that I built about 10 years now. We've been in this location, we've out grown, so we're expanding the building to hire more people and have more practitioners under the same roof. And then probably we'll go to a multi-location situation within a few years.

This is coming back to me because I think when we spoke last time, you were still, I think you were still shut down for covid and couldn't see people.

Yeah, that was something, boy, that was a strange period and very scary I'm sure for all the aesthetic practitioners out there who had a small business that you had to shuttle for several months and not know what was going to happen. And thankfully, P P P got us all through that and it was a way of learning a lot about yourself and a lot about your practice. We were able to keep every employee that we had on, which was great, keep the team communicating. We actually worked through that situation by seeing virtual consults and a lot of our systems and things that we had done, we kind of adapted in covid and carried them through. For example, like a virtual waiting room. Obviously if you want to wait in your car and things like the ability to do virtual consultations and virtual imaging expanded while we, we'd always done that, but that expanded during covid. So as scary as it was, I mean, it's always that situation in life. You can be challenged, face a challenge, and you can kind of fold or crumble from it or you can take the best from what you can from it and learn from it. And I think that's what our entire practice did.

I know pretty often these days I say something like, well, that turned out to be a silver lining from whatever we learned during covid, and I wonder if you had a few of those too.

Yeah, I think it's also personality type. How you look at the world that has to do with your response to crisis, I think is a major test of your medal in that sense. And for me, it was really, okay, well what's the alternative? I mean, you either have to find a way to make the best of this situation and come out of it stronger, or you can sit there and cry all day. I don't know. So for me it's always, okay, how do I take a seeming negative and turn it into a positive or something we can capitalize and learn from? And that's really what keeps life also interesting if you can learn from those experiences. So we tried to do that through Covid.

I know there's a lot of us who support plastic surgery practices and we talked to each other too, and I recall seeing a very distinct separation. There were the people who let their staff go immediately, and there were the people who tried to save them and hung on as long as they could. And some of the ways that that happened really shocked us, and I find it remarkable that you hung on to everybody all the way through, especially in New York where you were shut down longer than most.

Yeah, I was kind of shocked that hearing the number of practitioners that did that almost immediately, and for me it was the thinking, okay, well this will be a few months, and obviously you're taking a major financial hit from that, but when things are back up and running, I am going to need that staff to make up that lost income potentially. So and why incur the additional cost of now hiring new people? Every staff member you lose costs you tens of thousands of dollars in training and lost productivity. And so that's where my thinking was is like, okay, well yeah, it's costing me here in the short run paycheck, but in the long run I'm going to be saving money if I retain this great employee who I've had for many years who already knows the system. And sure enough, post covid what happened to our field, the post covid boom, I mean it was 2022 was a great year, and we were just so busy that we needed every staff member that we had retained and thank God we did.

The way you did that tells us a lot about you and how you feel about your staff. And I wonder if you ask them, how would they describe you?

The word that patients, staff, everybody uses us around us is family. We just had a patient, I mean actually a staff member who she was thinking about leaving. She was offered more money in a position in a field that she likes, not plastic surgery, but it was a different field that she's kind of been involved in for years and came back and said, you know what? I can't leave my Marotta family, literally crying. Because we do try to understand that beyond the employee, obviously as a person that we develop a relationship with a bond with. And when we hire somebody, we usually hire extremely talented people, so it's not a matter of their abilities to produce or be great. And if you're not, we do make a mistake in hiring we realize that pretty quickly. And so everybody we have on staff is phenomenal. And if you go online and look at my reviews and you'll see as many accolades about me as you'll see about my staff, the staff was incredible.

(14:13)
My experience was topnotch. It's because we treat them like family and we have a nice little cycle. You know, we call it, and actually they have it posted called the Happy Cycle. You have happy employees, happy employees produce happy patients, happy patients produce a happy business. And so the cycle goes round and round and we never forget that. And so we try to keep our employees good work environment where people can grow and learn and treat them well. And I mean, we can't do everything for everybody. And there are plenty of times where we've seen talented people decide to leave the practice, but our employee retention or what's called e-net promoter score, where your employees will recommend you to work to somebody as a place is always through the roof, and we monitor these things about employee productivity and happiness and our practice and how we do it is by cultivating a family environment.

Giving all your secrets away. It's just surveys and happy staff is the secret to success.

That's it. It's easy.

You won't get any arguing from me. I think the best thing I have ever done in my career was I spent five years surveying patients and it informed the way that I think about everything, and then it helps me spot the good ones too, which is really nice.

Yeah, yeah. It's eyeopening sometimes because you can lose sight of that. You can be a really great practitioner and you can be doing well for years and then something changes and you lose sight of what got you there, which is one happy patient sends another happy patient, sends another happy patient. I've seen many, many physician go down the wrong path where they lose sight of that and become either too greedy or too uncaring or too focused on the bottom line to take care of patients well, and then they get a bad reputation because all that stuff went by the wayside and how they started. So it can go the other way. I mean, I've never, to me that's the most enjoyable part of the job is seeing that happy person. If I didn't have that, I wouldn't be doing this anymore because I just feel like you at the end of the day, I'm here to make somebody tell me that I changed their lives, I made them happy, I made them cry because they were happy.

(16:49)
I made them have confidence, I made them to me, that's my legacy. When I'm gone, I'm going to have left, maybe some people will say, oh, Dr. Marotta, oh, he was a good guy and he changed my life for the better at some point. In the world of cosmetics, cosmetic surgery, superficiality, all those things, at the end of the day, what makes me sleep well at night is that I think about all those patients that told me that literally in tears are crying that have changed the way they look at life from a physical change. And I mentioned that in the book, the physical transformation can lead to a spiritual transformation for people, and if you lose sight of that, you can be callous in this world, and cosmetic surgery. So you got to really kind of keep that in mind. Yeah, so that's what makes me get up in the morning, that.

You mentioned having great mentors in your training, and I'm curious if this is, or if one of them was an influence on the way that you think about this now or did that come from somewhere completely different?

My mentors were certainly, obviously I learned the technical parts of what I do from them. I learned the patient communication portions of what I do from them. I think for me, some of the things I'm talking about now, were more kind of a journey for myself. I think if you had asked me as a young person or even as a 20 something or 30 something year old going into medicine, I would end up being a cosmetic surgeon who does vanity stuff. I would tell you, you were crazy. My goal initially was to go into, I was going to be a, first was going to be a psychiatrist, and then I was going to be a neurosurgeon. Then I was going to, I was thinking about oncology and all these kinds of things where you're in the situations where you're helping people at their worst parts in their lives, and to go onto something that's a vanity kind of thing would've been least possible field I would've chosen. But coming around to it, I think that some of the things, the way I look at things now is more part of what my journey was from a rationalizing and a spiritual kind of place about feeling good about what I do.

You've done a fair amount of humanitarian and what's the word I'm looking for? Philanthropic work. You want to tell us a little more about that and what you've done?

Sure. Again, I think that's something I've learned from great mentors to give back and also to kind of reconnect with your roots about why you became a physician in the first place. Because I mean, let's face it, yes, you have the opportunity every day to do good by patients, but in the fee for service world, you're exchanging, you're being paid a lot of money to do as well as you can for that patient, so you better deliver on those, that promise. But to be able to care for people who really need it the most, who you're not getting anything from it other than the satisfaction that you're helping another human being, that's always been something that tickles your heart in a different way. So I've done from the get-go, I volunteered for the National Domestic Violence Project run through the A F P R S, and I've done some work with them.

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I've done some charity work with, we have a Long Island chapter against LA A D V against the domestic violence. Then I've done some mission trips as well to Guatemala where we do cleft nasal surgery for people born with cleft palate. They'll have cleft nasal deformity or mycrotia, which is where you're born without ears. And so I've done some mission trips there and I intend to go back again. I missed the mission trip this year, but I'm going to go back again next year to do that. So yeah, that's always been a part of my career too as well. I think that's something that keeps you just really grounded and makes you feel that you're doing some good by what you, using your skills to be able to help other people is the greatest reward as a physician for sure.

You also said really early on, I think in the first question that I asked you, you mentioned being a bit of an early adopter with technology. Is there anything that you're excited about that's out right now or kind of emerging on the scene?

Yeah, we're always looking for the holy grail of non-invasive skin tightening and being a surgeon, obviously, as I mentioned, I do a lot of deep plane face lifts and deep plane neck work, but there's patients who are, they're early, they may have early laxity, skin laxity that you want to kind of tighten up, and so pretty much every non-surgical device that we have claims to in one sense or another, cause skin contraction or skin tightening. One of the latest, and I'm pretty excited about, we're kind of doing a small study on it, it's called Ellacor. Ellacor is a dermal micro coring, which removes these tiny little cores of skin, which are so small that you can actually heal from the standpoint without scar. So essentially scarless, you can remove skin from anywhere in the body, five to 8% depending on where you do the settings at a time, and you can do multiple treatments.

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So I think theoretically it's probably the most promising thing that we've had for skin tightening and it's still relatively new. There's some clinical studies out obviously from the company, but we're doing our own clinical study on it and excited to see where the results head. It's great. It'd be great for just touch up kind of things too, if patients have a little bit of laxity that they need addressed, and we're hoping maybe it has some effect on dermal remodeling for scars and things like that. So that's kind of an exciting technology. Some of the newer stuff that we have, like with muscle stimulation, we have Emsculpt Neo, which basically builds muscle while it's melting adipose tissue. You're seeing improvement in skin tightening and cellulite, and we have really kind of a technology driven business because there's three branches. There's Marotta Plastic Surgery Specialist, which is the surgical branch, then Marotta Med Spa, which is our med spa branch, and then Marotta Hair Restoration. We do hair restoration as well. So all those three branches, and we try to get obviously the latest technology for the med spa, and that portion of our practice is going to be expanding as we expand the building. We're going to double in the next year, probably double the number of exam rooms that we have in the practice and create a whole new second floor with office space. And as we just outgrew the building that we're in.

Again, you outgrew that? Another Building?

Again. Yeah, we started in a smaller 3,100 square foot practice, and then I bought a piece of land and we built from the ground up a 6,500 square foot facility, and we thought that was going to be so much space that we could never outgrow it. Two operating rooms and seven exam rooms, and within short order within, as I said, about eight or nine years, we've outgrown that and now we're going to double that to maximize the square footage that we can get in this building. And then after that we'll be looking at other locations and things like that. So a lot of exciting stuff on it in the horizons, certainly for the next year and for the future.

It sounds like it, and you're also relatively chill about it. You don't sound stressed or worried about it at all. If you are, you're hiding it.

Talk to me in a few months, once we break ground and the bills start rolling and that's when the stress starts. We're in the design phase right now, so that's the honeymoon period where I've done this, and every time I go and the person says to me, and you want to do this again, I started my initial office in the rental space and I renovated that, but it was a relatively small scale project, but then we built this entire building from scratch and now we're going through and I built my own, we built our private home, and now we're building this. So I've done, and anybody who's gone through a building project, you know how a nightmare it could be. But I keep inviting these nightmares back to myself in Canada again, and this is hopefully, well, it probably won't be the last one.

Probably not. Your track record is starting to speak for itself. Before we talk about who you are away from work, I want to ask you if there's anything you want your patients to know about you before they come to see you, if they don't already know you.

I love when patients just come in and are honest and open with me. I'm a pretty easy guy to talk to. I want you to come in with an open mind. You may think you have it nailed down in terms of what procedures you need. Most people are very respectful and ask for my recommendations and strategies and things like that and what I want them to know. It's a collaborative kind of atmosphere where I want to meet you, where you want to be met in terms of your results and your expectations and be realistic about it. And I want to make sure that you know what can be achieved and what can't be achieved, and that's what the consultation processes and you should have a good relationship with whoever you're going to have operate on you. I think the wrong approach is to think that everybody, everybody's skillset is the same.

(26:45)
Everybody's equal and to shop on price because that's not a good way to pick a person that's going to be operating on you. And I think my advice would be, I may not be the right individual or person for you, but if you come in and explore that, you should do that with multiple surgeons to find out who that person is. I think that's the most important thing for patients to do. Obviously, you check credentials, board certification is extremely important. Background training, where you trained what you did, how many surgeries of the type that you do per year. Ask all those important questions, and if you have any patients have any questions about that, you can look for some tips in the book as well. I kind of go through what I think is important in terms of looking at comparing before and after images. How do you do that precisely? How do you really vet the different surgeons you're considering?

That's great advice. Thank you. If someone is interested in coming to see you, where should they look for more information?

Website's easy. It's Marotta md.com, so it's M A R O T T A md.com. You could find us on Instagram, Marotta Plastic Surgery Specialists, Dr. James Marotta is my individual account, hashtag. That's how you can find us.

I'll put all of those links in the show notes and make 'em easy to find.

Great, thank you.

What do you like to do when you're not at work?

Nowadays, I've become golf obsessed. Yeah. I didn't have a lot of time to, I grew up around golf courses. My dad was a great golfer and he tried to introduce the sport to me when I was young and I was too into baseball and football, and I thought golf was boring and slow moving. And then I played maybe once a year on average, or maybe even once every three years while my kids were little because I had never had the time and I didn't have the money and I didn't have the ability to go out and play. And in covid, golf courses kind of took off because everybody had nothing else to do, and it was a wide open space you can go to. You don't have to worry about catching covid out in the outdoors. So golf memberships went through the roof, and I was one of those guys who joined during Covid, and I realized that I missed all those years and I missed them for a good reason though, because I was starting my practice.

(29:19)
I was a resident. I didn't have money to be a country club member and my kids were little, and I couldn't leave my little kids and my wife for five hours on a Saturday or Sunday to go play golf. I wouldn't have been a good dad if I did that. So now that my kids are older, my son's second year in college, my daughter's a senior in high school and they don't want to spend as much time with their dad anymore. That freed me up, and I have some more time on the weekends, so I play a lot of golf and I'd become obsessed. I dropped my handicap. If anybody knows about golf, it's, you know handicap is your gauge of how good you are at golf. And most people started at a very high number, around 27 handicap, and that's kind of where I started, which means you're shooting in the hundreds and then within three years now I'm down to being a nine handicap, which is pretty good. About 70, maybe 75th to 80th percentile in golf. And my goal for next year is to get into that elite group where I drop it to low single digits, and we'll see if that happens. But that's my obsession.

That's a good goal. You'll never quite, it'll never be perfect. So I think that's suit your personality pretty well.

That's right. I'm just, you know what? I can't do anything just for fun. I got to make it always, but it's more fun when you're getting better at something. I don't like to do stuff and just hang around at the same level. I like to challenge myself and get better. So

Good luck with the golf and all the expansions and the projects.

Thank you.

Thank you for joining us today. It's really a privilege to have you on.

Thank you so much for having me, Eva. I really appreciate it.

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