Jules Walters, MD - Plastic Surgeon in New Orleans, Louisiana

Eva Sheie (00:03):
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. You're listening to Meet the Doctor. I'm your host, Eva Sheie. My guest today is Jules Walters. He's a plastic surgeon in New Orleans, and you're one of the rare ones that grew up in New Orleans and went back to New Orleans. But what did you do in between Dr. Walters?

Dr. Walters (00:42):
Yeah, so thank you for having me. So yes, I'm born and raised in New Orleans and I went to LSU undergrad in Baton Rouge and then went to medical school in Shreveport, Louisiana, again at Louisiana State University, and that's when I decided that I wanted to become a surgeon and pursued a general surgery residency. So then came back down to New Orleans for general surgery residency. And at that point I didn't really know that I wanted to be a plastic surgeon. I had a little bit of exposure in medical school, but not a lot. And it wasn't really until my intern year, the end of my intern year where I spent a month with the plastic surgeons and did a plastic surgery rotation, and that's when I was sold. So kind of devoted my general surgery career to becoming the best general surgeon that I could be, and also making myself just ready to apply for plastic surgery residency and to be a strong candidate. So did some research in plastic surgery and was accepted into the University of Texas at Houston Plastic Surgery Residency program and spent three years in the plastic surgery program there and then came back to New Orleans to start practice in 2014.

Eva Sheie (02:06):
So you've never been north of I 10 at this point in your life, you're still

Dr. Walters (02:11):
So,

Eva Sheie (02:11):
Slightly,

Dr. Walters (02:12):
Yes, I have. So Shreveport, Louisiana.

Eva Sheie (02:14):
You're right. You're right. And we kind of joke, I mean north Louisiana and South Louisiana is completely different. So yeah, so that was the northern most part that I traveled for education and then I knew that I wanted to branch out for plastic surgery residency. I interviewed from coast to coast. I interviewed pretty much everywhere, but I was very interested in the Houston program and the Texas Medical Center is just really unmatched, the largest medical center in the world and was just very amazed by that whole campus. And so I was lucky to match there and spend three years learning plastic surgery.

(03:02):
When you did that rotation that you said was what got you hooked on plastic surgery, was there something in particular, a certain kind of case or a person or a patient? What was it that gave you the spark?

Dr. Walters (03:13):
Yeah, so I remember it very clearly. I had a very strong plastic surgery fellow who was my fellow at the time, and he's a plastic surgeon in Biloxi, Mississippi now. And I remember we did a long 12 hour free flap case and it was a reconstructive case where we were taking the patient's scapula bone, so a bone from their back and reconstructing their jaw. And I remember we were probably finishing around midnight or so, and maybe just a few days before that I was with a fellow doing a breast augmentation, a cosmetic case, and I remember him saying, look, you really have to do plastic surgery. It doesn't get any cooler than this. I mean, that's kind of the most advanced case that really you're ever going to see that surgeons do. And we do cool cosmetic cases and every reconstructive case has a cosmetic component to it. And at that point, I really did like the fine detail of microvascular surgery as well, and I just remember that night I was definitely sold and realized that's what I want to do for the rest of my life.

Eva Sheie (04:32):
Does it feel funny to go through all of that education without actually knowing up until that point, without actually knowing what you're going to do? People ask you all the time, what are you going to do? And you don't really have an answer.

Dr. Walters (04:44):
Yeah, I joke about this too. I don't come from a family of doctors or anyone really in the medical field, but I just remember as a small child and even my mom almost brainwashing me being like, you should be a doctor, and just going to the doctor's office when I was a little kid, I was always just, I looked up to doctors, I was always amazed, and I just knew from a small child that that's what I wanted to do. And I never kind of swayed from that. I was always interested in science in high school and then in college I was pre-med and I did not know what type of doctor because again, I wasn't really exposed to too much at that time and through medical school I just went with an open mind.

Eva Sheie (05:32):
Did you also have a stretch in your education there where you saw trauma or worked in the hospital?

Dr. Walters (05:38):
Yeah, so the LSU hospital, the university hospital in New Orleans has a lot of trauma. So yeah, I remember as a second year resident, we are usually in the surgical ICU, the trauma ICU. And I remember being on call every, I think Friday night in July and August, and there was, I think no less than eight gunshot wounds that would come into the trauma hospital. And just everything from head to toe types of injuries where you have to learn as a resident to think quickly, to think critically, and a lot of problem solving. And so all of that education that I had as a general surgery resident just I still use today of being a plastic surgeon.

Eva Sheie (06:27):
You grew up there. Do you remember thinking this is a side of the city I know that I didn't know before?

Dr. Walters (06:36):
New Orleans is a small big city, so I think we knew the areas to avoid and to stay out of. So I was aware, I guess I wasn't aware of all the trauma just in high school and stuff that was actually happening.

Eva Sheie (06:53):
When did you go into private practice then?

Dr. Walters (06:56):
So in 2014, so I did five years of general surgery, became board certified in general surgery and plastic surgery. I did the traditional route and it's a lot of times now patients or students are going straight into plastic surgery residencies from medical school, and that was a rare pathway when I was finishing medical school. So the traditional was the independent pathway where you do five years of general surgery or five years of ENT, and then you go into plastic surgery. And the plastic surgery fellowship used to be two years. My year in 2011, it was the first transition from two to three years. And so I did three years of plastic surgery and then in 2014 finished and came back to New Orleans and started private practice.

Eva Sheie (07:46):
Are you in the same space now that you were in 2014 or did you start somewhere else?

Dr. Walters (07:52):
Yeah, so I initially joined another plastic surgeon and we were in practice together from 2014 to the ending of 2019. And then I started my own practice in 2020 right before.

Eva Sheie (08:07):
Oh, this great timing. Just so much fun. Did you enjoy the process of putting together the whole office from zero?

Dr. Walters (08:21):
I did because I mean, it was definitely challenging and you look back and just remember all the challenges, especially right before COVID and then with COVID and then after COVID. But it's something that I knew throughout being in practice initially with another surgeon where I learned a ton, but I knew that I wanted to be in control of really every aspect and make sure that if there's any issue that arises, I can really only blame myself because everything kind of starts and stops with me. And so I enjoyed that process of hiring my team, being in charge of being in charge of the team, and really trying to set the culture that we've built, I think since 2020 of just having my team reflect everything that I want this practice to be.

Eva Sheie (09:25):
What are some things that you do differently there?

Dr. Walters (09:27):
I saw just throughout really my career of being in medical school and residency and stuff like that, that we spend the most amount of time at work. And I would see whether it was people in the hospital or even other practices that I went and visited when I was a resident, that a lot of times the staff wouldn't be happy. And you can immediately sense that. I think when you go into a place when the team isn't happy, the team isn't getting along. And so I think through seeing all of that throughout my whole career, I knew that I wanted to build a place that patients, I mean my staff was and my employees were excited to come to. And part of that was with the design of our office that we built, making sure that it reflected again everything that we are trying to stand for and have direction. Having monthly meetings to where everybody really knows what our mission statement is, what our vision statement is, what we're trying to accomplish when we see patients, and trying to just build culture where I think these are things that we don't learn in medical school. We don't learn really in residency of just how to be a good business owner. So putting my employees first and establishing a good team I think is something that we have to learn on the fly. But if you do put that effort forth, then I think it really pays off.

Eva Sheie (11:02):
Is there a quality in those people that you look for specifically?

Dr. Walters (11:07):
Yeah, I think we have a saying, and this really comes from Nick Saban, that mediocre people don't like high achievers and high achievers don't like mediocre people. And these are things that I even learned along the way to hire people better is to make sure that this is not a job where you're just going to come and sit and watch the clock and accept mediocrity. You're going to have to be a high achiever, and if you don't see yourself as a high achiever, then you're not going to be happy here. So I think setting those expectations from the beginning is just hugely important. And once you do that and you let people know what you stand for, it actually becomes easier because you start attracting those type of people.

Eva Sheie (12:03):
Is there a certain set of procedures or an age range or a specialty? Is there something that you in your practice are starting to become known for in the area?

Dr. Walters (12:15):
Yeah, that question. A lot of consultants and the Allergan consultants would visit with us, especially when I first started and in 2014, they would be like, what do you want to be known for? And at that point it's like, I just finished residency and I'm a board certified plastic surgeon from head to toe. And so at that point I loved everything. So from facelifts, rhinoplasty, mommy makeovers, liposuction, breast augmentation, breast cancer reconstruction, and initially when most plastic surgeons are starting doing some emergency trauma call, hand trauma call facial trauma call, we're so well trained that it's hard just to kind of leave that training behind and not do all of those things. It's almost like we feel like we owe everyone who trained us to be able to do all of those things. And so starting out, it was hard for me to really say that I knew that I liked cosmetic surgery and to plastic surgery is such a broad field, I knew that I narrowed it down to cosmetic surgery and really breast cancer reconstruction. And I did that for really broadly from 2014 to really about 2021. And then around 2021, that's when I really went solely all cosmetic surgery. And since then, I think we've really, our practice is known for rapid recovery breast augmentation, mommy makeover type surgery and facial aging surgery, especially now with the deep plane facelift that's so popular.

Eva Sheie (13:59):
Tell me more about rapid recovery breast aug. What is rapid in your definition?

Dr. Walters (14:04):
It's really a technique that was popularized by a plastic surgeon in Dallas many years ago, and it's based on the gentle technique, minimal incisions, minimal trauma to the breast tissue, really picking an implant that is customized for the patient, something that's not excessively large, and doing precise measurements to show that patient in the preoperative appointment, what are the implants that are going to be safe for that patient? And so really customizing preoperatively, executing that plan in the operating room in the least traumatic way for the patient. And then starting a protocol postoperatively that involves high dose anti-inflammatory medications and really having the patient do arm exercises immediately after surgery to keep the muscle loose and then actually encourage the patient to go to dinner that night of surgery. And with all of those things, I tell my patients, 99% don't need any type of narcotic pain medicine. And about 90%, if not more, are at dinner the night of surgery. And so it really kind of encompasses all of those things preoperatively, intraoperatively, and postoperatively. And if all of that goes together, patients can really recover very quickly.

Eva Sheie (15:20):
So they're totally back to normal within 24 hours or they just?

Dr. Walters (15:23):
So what I tell patients, that's what rapid recovery means, 99%, no narcotics, 90% at dinner the night of surgery, and really the next day you're feeling like you can do most normal things. It's as opposed to how things were probably 10 even 15 years ago where surgeons would put wraps, sometimes drains, they would tell the patient to take off a week of work, not move their arms, don't really do anything for a couple of weeks, and patients are able to really have surgery on a Thursday or Friday and they can be back at work really on Monday or so.

(15:58):
And so what it does not mean, and I tell these patients all the time, what rapid recovery does not mean, it does not mean that you can get back into the gym, start lifting heavy things because there's an incision and whether I make a one centimeter incision or a 30 centimeter incision on the body, it takes about four weeks for that to heal. And that's extremely important for implants because if you overdo it and that incision breaks open, then that's a major problem because then the implant could be exposed to the outside world infection, all of those things. So rapid recovery means that it's not to where you just have to take off a week or two weeks of work, it means that you can actually be in the social setting as soon as 24 hours postoperatively.

Eva Sheie (16:38):
Do you find that you like to try new techniques and you like to be out there learning what other people are doing to try to make things better?

Dr. Walters (16:47):
Yeah, yeah, absolutely. I think I like to just stay up to date and see what's out there. And I think most notably that's really with facial rejuvenation and aging face surgery. When I was in training between 2011 and 2014, most facelifts throughout the United States were really kind of SMAS plication facelifts, so meaning lifting up the skin, dealing with the SMAS layer, which is the underlying kind of muscle layer of the face and really just tightening it and suturing it. I think if the patient has the right anatomy for that, you can get a good result. But if you really look at say, consecutively, your last 10 patients, your different anatomy on different patients like that don't always get a great result. And I would see that with some of my mentors and I would be very impressed with maybe three out of 10 of those facelifts, but the other seven out of 10, they maybe looked a little tight, they looked a little bit strange, they just looked maybe unnatural, and I didn't really understand that initially. What was the reason for that. And for those reasons, I wasn't really drawn to facelift surgery when I first started because I thought sometimes people just looked a little weird.

Eva Sheie (18:12):
You're not the only one that thought that.

Dr. Walters (18:14):
Right. It's interesting because I think when I started practice from 2014 to really around 2020 if not a little bit later, that's when the filler, I think epidemic really started and people were really pushing nonsurgical facelift, which those terms really shouldn't go together. A facelift, any type of facelift, breast lift, lift means surgery, so you can't have a lift and it be nonsurgical in anything. It does not exist. Now, marketing efforts try to say otherwise, but it does not exist. But I think because facelift techniques were not as advanced as they are today, that was the reason patients were scared of having facial rejuvenation surgery. They were scared of facelifts. Everybody saw celebrities that looked a little strange and looked a little tight and wind blown and just pulled in the wrong direction and whatnot. And so I think over the last couple of years there's been this trend for us to realize that hey, filler is not the answer.

(19:20):
Filler doesn't necessarily lift. If you really need surgery at some point you need surgery. You can't really expect to have good results with a nonsurgical facelift. And luckily during that time, I think in the last really five years, facial rejuvenation surgery has advanced to where we're now kind of going in the deeper layers, and we were doing deeper layers I think 20 years ago. But still the technique has advanced to where we really keep the skin attached and we lift the face as one unit and we understand facial anatomy, I think better now. And we understand that there's ligaments that need to be released, and it's not really a pulling and a tightening. It's more of a releasing and repositioning. And when the skin is attached as one unit and we're not separating the skin and treating that differently from the underlying muscles of the face, I think patients get much more natural results.

(20:15):
And this all started, in my opinion, what I saw as a plastic surgeon or a facial plastic surgeon in New York, Andrew Jacono in 2018 was posting everything about the deep plane, his technique and the extended deep plane facelift. And what he was posting was patient after patient after patient who were getting similar results. And it was like what I was saying before, it was different anatomy on different patients, but he was getting these consistent results, which all looked natural, and they looked just beautiful and not weird, not pulled, in my opinion, that technique with the advancements in really everybody rushing to social media, he was able to show this technique and the whole world really changed as far as wanting to learn the extended deep plane facelift.

Eva Sheie (21:05):
How long have you been doing it?

Dr. Walters (21:07):
Really since about that time. So what your question was kind of learning new techniques. That's when I was around 2020. I was like, there's something with this. And as my mommy makeover patients and tummy tuck patients and breast lift patients and breast augmentation patients were getting older. I knew that there was something that I had to be able to offer them. And like I said, we learned a lot of deep plane techniques, but there's some nuances to the procedure that are a little bit different now. I started traveling the world, going to Istanbul Turkey and going to courses and going to Florida to different cadaver courses and really visiting surgeons in St. Louis who Mike Nyak is known for, the deep neck lift and extended deep plane facelift and brilliant teacher, brilliant surgeon. And being able to watch people perform this surgery well and learn from them and become friends with them has really helped advance my understanding of this surgery.

Eva Sheie (22:14):
Are you seeing more younger patients or people who've lost a lot of weight coming in for their face and neck now?

Dr. Walters (22:23):
Yes, and again, I owe that now to social media and surgeons really showing their results and being able to show results that don't look pulled and they don't look like the facelifts 20 years ago. And so it used to be where patients used to really wait until their sixties and seventies and now patients are really wanting facelifts almost in their forties. And I think that in most patients it tends to be a little bit too soon, but I think it's definitely changed to where patients in their fifties are getting facelifts and are great candidates for it.

Eva Sheie (23:06):
It was explained to me a couple years ago that in the earlier days that you're talking about, you really had to wait until it was really bad and then do it and then you would look 10 or 15 years younger almost overnight, and it was very jarring.

Dr. Walters (23:20):
Yeah, I mean that's when, exactly, if you wait till your sixties and seventies, there's multiple reasons why that might not be a good idea. Number one, your tissues are older and not as healthy. And so when you're kind of tightening that or repositioning now and putting sutures in, it doesn't hold as good sometimes. And if you're trying to be a little bit undetectable with it and not let the whole world know if you're 70 and you're getting a facelift, well then once you're healed, everyone's going to know. And so where a lot of times when patients get it in their late forties or early fifties, it's noticeable, but it's less of a change to where patients, the responses that they get from their friends who they haven't seen in a long time is like, wow, you look great.

Eva Sheie (24:10):
Yeah, I just went on vacation for once.

Dr. Walters (24:11):
Right. And then the whole weight loss thing, that is where with the new weight loss medications, I think that does take where patients potentially can be a candidate for a facelift now with advanced techniques when they're in their early forties. Or even if you lose a hundred pounds and you're 35, again, there's no nonsurgical treatment that is going to really correct the deep tissue laxity. And you can only correct that so much with fillers because the filler is only going to correct the volume loss. And I was just talking with my patient coordinator about someone inquiring about surgery and she's, I think 40 years old and lost weight, and she tried every nonsurgical thing in the book for her neck and her lower face. And that becomes important because now she's inquiring about surgery and some of these non-surgical treatments can be not detrimental, but you don't want to intervene too soon after the treatment.

(25:09):
You want to sometimes have the skin and the underlying tissue heal from some of those treatments, a lot of energy-based devices that really cook the tissue. And if you try to go separate those layers too early, it can be very, very challenging. So I asked her to ask that patient, can she tell us all the treatments that she had and just the list of all the treatments that she had and the money that she probably spent, because I know what those treatments cost. There's no way that she was ever going to get any improvement based on what those treatments do. And so it's a shame because these patients, they don't know sometimes and they see some places that promise them the world on all of these treatments and at best that you hope that these treatments are going to work, but at best they probably don't work. And sometimes at worse, they can be detrimental where they melt too much of the fat that is the good fat of the face, or they can damage even the skin based on some of the radio frequency and energy-based devices that are out there.

Eva Sheie (26:16):
Which one? I just was reading something the other day that one of them maybe was it microneedling can cause you to lose fat in your face?

Dr. Walters (26:26):
So not microneedling by itself.

Eva Sheie (26:28):
No RF microneedling.

Dr. Walters (26:29):
Microneedling by itself is an excellent procedure, I think to help the skin and to improve fine lines and pores and everything like that. Radiofrequency microneedling can be dangerous in the wrong hands, and I have both in my practice, but it really depends on the depth that the radiofrequency can go into the face. And so again, people are trying to give facelift results by utilizing non-surgical treatments, and that's when you can really damage the tissue because once it goes too deep, it can start melting kind of fat, and most of the fat in the face is really precious and we need that fat as we age.

Eva Sheie (27:17):
I haven't asked you this yet, but it seems to me that some of the reason why you named your practice the modern is because you are doing a lot of modern things. Is that where it came from?

Dr. Walters (27:29):
It was a lot of reasons. That was the one thing to really, again, initially put it out there that for our patients, we are going to stay up to date. We are going to offer the latest and the greatest, but be able to vet these procedures and not just bring in something that doesn't work. And there's a lot of treatments that I think plastic surgeons and other doctors have brought on too early that have shown not to work. So I tend not to always be the first person to bring on especially these non-surgical treatments, but we want to stay modern and stay up to date, but to be able to not over promise. And I think that's what we tell a lot of patients when they come see us. It's like, let me kind of decide what is really going to be out there that is actually going to give results for you. I don't want you to pay for things that I know doesn't work. And so there's a lot of things that we don't offer in the nonsurgical world, even thread lifts and other types of things that promise really fat reduction or promise skin tightening. And so I think that's very important because now throughout the United States, there's med spas popping up all over the place. And when a place only offers non-surgical treatments, it's not that they're sometimes bad people, but

Eva Sheie (29:10):
Everything's a nail.

Dr. Walters (29:11):
Right. And so people get sold these treatments all the time that are never going to work. So I think being able to have patients understand that we're going to have the latest and greatest, but whatever we do have is going to kind of do what it says and it's going to offer results.

Eva Sheie (29:26):
Well, let's pivot a little. We've been talking for a long time, could probably talk for another two hours, but what is it that you like to do when you're not at the office?

Dr. Walters (29:38):
People talk about work-life balance. And my job in building the practice is my passion and it's my hobby as well, but things that I do outside of the office is in South Louisiana, we all like to, or a lot of us like to hunt, so duck hunt, deer hunt during hunting season. And then mainly just hanging out with friends and family and going to dinner and just taking it easy and relaxing. That's the main things.

Eva Sheie (30:10):
You have all the food choices right there. I mean, it is the best food city in the world, I think.

Dr. Walters (30:16):
It is. There's a lot of options.

Eva Sheie (30:18):
Yeah. Yeah. I guess there's probably new stuff opening all the time.

Dr. Walters (30:23):
There is. Unfortunately, what we've seen this summer is some restaurants closing and tourism in the summer is slow for New Orleans because it's so hot and humid. But my mind's always, it's hard for me to kind of check out because I'm always thinking about growing the practice. And so it's hard for me to do that right now. I mean, we're in growth mode and we're continually continuing trying to add to the team, build a practice, and I think if you're going to be great, you have to be all in.

Eva Sheie (31:01):
Well said. Where can we find you online? Follow you on Instagram?

Dr. Walters (31:06):
Yeah. So on Instagram we have two Instagram pages. So my personal page for surgery results and other things for plastic surgery is Dr. Jules Walters. At Dr. Jules Walters. So D-R-J-U-L-E-S, Walters, W-A-L-T-E-R-S. And then our practice page is the Modern at the modern Nola NOLA, because the name of the practice is the Modern Plastic Surgery and Med Spa.

Eva Sheie (31:35):
I will put those in the show notes and make 'em easy to find. Thank you. Appreciate it Dr. Walters.

Dr. Walters (31:41):
Thank you for having me.

Eva Sheie (31:44):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at MeettheDoctorpodcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, theaxis.io.