I am a plastic surgeon who specialises in children with facial and skull deformities. I work with Operation Smile.. A video I made in Brazil has brought smiles for people around the world. I love that sooo.. AMA :)

First and foremost: thanks for doing what you do. It's really heartwarming to see lives touched so positively, especially given recent events...

My question: do you hear from any of the people you help long after? I'm not sure the girl in that video truly comprehends how much you've probably changed her life, but in 5, 10 years I know she will. Do you hear from people long after like that?

I hope you get to. You deserve to hear how much positivity you've undoubtedly brought to their lives.

Hey thanks so much. You know I do..

In the hospital where I work I get to see them every few years. I LOVE it. Its like having your own family. I liken it to being like a gardener. You tend to you plant and give it really good soil and spend your time giving it the best u can ( like the operation) and then you just watch them grow!

In the developing countries I go to I try and get back as much as I can. I remember in Cambodia one particular lady walked back to see us from her village with her girl we had operated on the year before and she was so happy because her village had told her to leave the child to die. And now they were so amazed and she was soo happy

With regards to Talita.. we recently saw her and fixed her palate. We will do a little update soon :)

YOURE THE SHIT DAVID C.

shucks :)

do i know u?

Thanks for making the kids and us smile! When I first watched the video I was kind of bummed out, but the way she lit up after she saw herself. Wow! I just wanted to say thanks and keep doing what you do, you're awesome!

Thanks Alex I really appreciate it. I feel blessed to have found something I love to do.

I just wanted to say THANK YOU for all that you do; helping kids in such a huge way is an amazing thing. I've watched that video four times over the past few days, and cry like a baby every single time.

Thanks Morning star. I loved it. You know not all kids are like Talita. They usually understandably are upset after their operation and most just want their mum/dad. She was special and we captured a miraculous moment. I still get teary when I see it.

How often due the children you help, require further surgeries years down the road as they develop? How are their cases handled?

It depends on the extent of the problem. If they have a full cleft lip and palate they will need at least two operations. Operation Smile goes back to sites regularly and partners up with local medical teams to ensure that all the kids get followed up as much as possible.

There are now centres built to provide constant care. I have worked at the one in Guwhati India and its amazing!

Do you refuse to do completely unneccesary cosmetic surgery?

Absolutely. Its so important

How do you get permission to break confidentiality of these kids? Do the custodians sign waivers? Do they know the images will end up on the internet?

not snarking, really asking.

its a great question and thanks for asking. The parents do sign a consent form prior to their operation in the knowledge that their kids may be used to help us spread the word about our work.

Thanks! If the parents don't sign, what happens to the kids?

edit: I'm honestly concerned, but not out to make hay.

I am sure they would still get the operation but a note would be made that they are not to be used in teaching/publications etc..much like what would happen in USA/Australia.. I would say though that mostly the parents sign.

Just wanted to say you're awesome.

Thanks Tupacorbiggie. Love your name

Hello! before I ask my question, just wanted to say what you do is truly amazing. I am sure you hear that all the time.

• My question is, do you have a family of your own? I know that it might be hard with all the traveling and such. I am also trying to get into med school and take that route but I am afraid I will not have time to start a family or have time for them if I do start one. Thank you in advance for answering!

I dont have a family of my own but I dont think that has much to do with medicine . I know plenty of other plastic surgeons who have had great family lives .

But you raise a good point. Initially I think when you go through medicine you love what you do..and you can run into trouble with spending too much time there.. sometimes not by choice ( eg cardiac surgeons or neurosurgeons) sometimes by choice ( eg work too hard and loving too much what you do at the expense of family)

I would love to have a family someday and I thin I can do but have to say during residency you have to have a very understanding spouse!

Not really a question, just wanted to say thank you so much for all the good you do. I like to think I'm a manly man, but I must confess when that little girl smiled when she saw her smile for the first time I shed a manly tear.

I can only hope that one day I have half the job satisfaction you must have (but I'm training to become an accountant, so that's probably not going to happen).

edit: I have a question! How old were you when you realised this is what you wanted to do with your life?

Hey Fernsy thanks so much for dropping by. Yup she really gets you huh. It makes me realise whats important in life. And how much time I waste worrying about stuff thats not.

You know I reckon part of the whole thing is no matter what we do, we can love it and we can make a difference. Everyday. Whether its giving your seat up to an elderly person through to inventing the vaccine that cures AIDS

Good luck in Ethiopia. I hope your team can share to us the joy brought to those you help like Thalita.

will do thanks for the wishes.. i am new to reddit.. what do u think the best way to do that would be?

How are the children chosen for the program? Are there times when potential patients are turned away?

We prioritise treating children with cleft lips and then cleft palates and then revisional surgery.. Generally unless the child has other issues or we go to an area thats so unmet that we are inundated, most of the children will be done.

The most painful thing is turning away kids. No doubt. And during the screening process, the announcement of who is being done is a very emotional scene.

We try and go back as often as we can to places, as well as training the local surgeons to care for the kids we cant. Its as much about sharing our techniques with the local surgeons..as well as learning from them

First of all keep on keeping on, your a real hero.

I also have a question: As someone with a mole slightly larger than a pencil eraser on their cheek, I've always been curious about getting it removed, but I'm afraid that it could only make it worse. So whats the skinny on mole removal these days? Would the scar be a long line, looking like a long cut?, or would it be a dark patch? Are there modern ways that wouldn't scar?

Thanks for your question PP :)

You have to accept that the length of your scar will be roughly two and a half times the diameter of your mole. I am pretty happy to tell people hat I can make them a great scar but unfortunately there is the unpredictablity of healing. No real modern ways but worth going to see a reputable surgeon

As a pre med student, can you detail me on your education that led you to working in these impoverished nations?

People like you are what inspire me the most for getting into medicine :]

Sure thing.

You know I was a big fan of travelling and I just spent a year travelling through AFrica and just really felt like thats what I wanted to do. I must admit at that stage I thought I would live there and work there but as I have got older and gone through my residency I found myself working in an increasing specialised area here and becoming more academic. However I still travel to different nations three times a year. I still dream of doing it full time one day. I hope that answers your question

One thing hold onto your dream . You can do it..

Thanks for posting

I am in dental school now and was inspired as a kid because of these types of videos/documentaries on the discovery channel. You have my deepest respect.

A year before dental school I volunteered to help patients be more comfortable in the omfs emergency clinic. I got into the dental school at the same hospital and still observe/assist one day a week to continue giving back. I keep a running list of the procedures I see and questions that I have for the residents/attendings. I really want to go on a Mercy ship one day and a mission trip. How do you go about doing this? When do you start planning on doing it? I am a first year dental students and I am not perfect didactically and accept that oral surgery is very difficult to get into, and a huge time commitment. But it is my dream to do one day touch and improve lives much like you have. It seems like the most purest form of joy. thanks!

Thanks for your message. Actually the guy who inspired me was an OMFS surgeon on the mercy ships. It happened quite fortuitously.. I wanted to take a year off after working hard through med school and the opportunity came up. Their website tells a lot.. I loved it.

Dont doubt on your dreams. If you feel you really want to do it. I agree its the time thing. Its so long and the hours are huge but if you love it you wont care so much..

No question here, just thanks for what you do. I got an opportunity to meet a teenager who has recently been helped by Operation Smile in Mexico. Awesome stuff.

I made this video for his sponsor back in the US. Its the first time we've caught him on video actually speaking.

http://www.youtube.com/watch?v=lU6aq1lxiqw

thanks so much for sharing this. he looks like a wonderful young man!! he still has signs his palate is not working quite so well. Has it been repaired?

He has had 2 operations. About a week before that he had gone back for his 3rd operation but the doctors decided that it was too risky at the moment and they didn't operate.

He is a special case because his first operation took place when he was 11 years old. He's made great progress in the last 3 years but still has a ways to go.

I'm so glad he has had the help and support of people who care for him now. I often say to parents that the biggest head start for any child matter what the issue is to have their parents ( and others!) love them

Watched that video the other day and I sobbed.

Was explaining the video to my brother the next day telling him to watch it and I got a lump in my throat and had to stop and collect myself.

You do fantastic work and you make me want to be a better person.

No question, just wanted to say thanks.

wow thanks for stopping by to tell me. i try and be a better person everyday. I aint no saint but we all can try huh?

First of all thank you for being awesome. I'm a medical student and have a dream to travel and work and create smiles on peoples faces just like you do ! Other than plastic surgery, do you meet doctors with other specialities that you feel make as big a difference as plastic surgery? If so, what are these specialities ?

nice name sternocleid.

I do. I think we all make a difference in different ways. I always appreciated the eye guys too. I reckon restoring sight to people through removal of cataracts must be awesome.

No question but I just want to thank you for all you've done and all that you're going to do. You are truly an amazing person.

Thank you for existing.

thank you my friend. its lovely to get affirmation from a fellow soul on this lifepath. Peace.

Just wanted to say you are a hero. Recognized you as soon as i saw your picture.

Truly thank you. But just one cog in the wheel. Definitely fallible :)

No question just wanrted to say you are a legend

Thanks Storm. Appreciate you stopping by

As a guy with cleft palate.. Thank you so much for what you are doing!

Thanks Toxic. Has it affected you much in your life?

Wow, you've answered EVERY question, that's impressive.

Thanks for the video, I thought it was very inspiring.

Can you give us a bit of an insight into how these missions work?

So a charity organises the trip and the staff all give up their time for free?

How many patients are you likely to treat per mission?

I know there are similar organisations that do cataract repair etc in third world countries, can you suggest some other charities that are worth supporting for this type of thing?

Please come back after your Ethiopia trip with another update

Thanks Hokers.. I think its the perfectionist side of me..and I think well every well meaning question deserves an answer..

Well the mission is started well before we arrive with the local members of the team spreading the word as well as organising a local group of medicos and nurses for us to work together with. Its often overwhelming for them on their own and alot of the local surgeons are very skilled on their own right.. they enjoy the camaraderie

Each of us pay $500 as a team fee.. no matter what you do. Each mission is different but on average about 100 to 150 children.adults are treated and many more due to the training and infrastructure that we try and achieve in increasing places.

I think there are so many worthy causes. And I believe they all should be supported. We are all called to different thing and my passion happens to be facial deformity so I advocate for them..

I think the Fred Hollows foundation is also amazing just to name another one.. cataracts ..wow to restore sight!

Thats a great idea.. I will try and update after Ethiopia..

You're doing amazing work, it sounds like you have a great passion for what you do and your willingness to help those less fortunate in such an impactful way is very generous of you.

I work in a hospital and some of the staff have just returned from a trip to Bangladesh where they did around 100 surgeries. The photos and accounts from the team, not to mention them volunteering their time and paying their own way, are quite inspiring and the gratitude of the patients and their families must be very rewarding for those involved.

thanks so much for your interest..

I have been to Bangladesh too. Wow that place is crazy.. Really really poor. I worked on the USS Mercy off Chittagong. You should come join us!

If you had just lied and said you worked on boobs, you would have made the front page.

haha. but then would i have met the same cool people i have?

You never know. All kinds of people like boobs.

true true. different cool people..or maybe the same ..maybe alot more!

Can you comment on this quote from the wikipedia article? I think your program is great and that video is totally heartwarming, by the way!

In November 1999, specific patient deaths[31] brought criticism on Operation Smile's medical procedures, suggesting the organization prioritized publicity and volume over patient welfare and safety.[32][33] In response, Operation Smile conducted an internal review. Initially, the organization "promised to make public the full findings of the review," though later chose not to release the findings, considering the review "an internal matter". Several directors disagreed with this choice and left the board. Four months after announcing the review, the organization publicly admitted organizational flaws.[34] By 2002, the organization also established medical credential standards, improved medical monitoring of patients, and implemented quality and financial controls.[35]

Hi and thanks for the question I must admit as someone who has commenced volunteering for op smile for the last 5 years I am unaware of the politics of the organisation prior to my involvement. I do know that the organisation does emphasise safety and there has been constant audit and change as it strives to be the best it can.

Safety is my number one concern on every mission. I have now been involved in 17 and have not seen any patient deaths on my personal missions.

I suspect it's come a long way since 10 years ago but it's hard for me to comment on the workings of the board back then. I'm not involved at that level at all but certainly care a great deal about safety.

Thanks for the question though and I will try and find out more!

my nephew (10) was diagnosed with oral carcinoma and had half of his maxilla removed. he's 1 month post op and going through chemo and radiation. I live in the pheonix area and was wondering if you could lead me to the right direction on how to obtain some information to get him a prostetic for his upper teeth area and cheek bone? Any advice would help

I am really sorry. I would just be guessing here. Being based in Australia I don't know how your local system works. Sorry I couldn't help you more

Im really sad I missed this one. I'll take a shot in the dark anyway because no one asked yet. What does that little girl look like today?

Hey thanks for asking the question! We are about to do another video to update everyone on talita. She is doing great and an amazing little character. We repaired her palate recently and will share out catch up so stay tuned :)

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I've always wanted to film this! It's pretty amazing the organisational requirement. We is the local operating rooms in the hospital but every condition is different. We bring along a biotech who helps us to adapt to local conditions. We bring all out own instruments and anaesthetic machines as well as sutures which are donated by Johnson and Johnson .

This usually takes a full day to set up and a full day to pack up! We will often leave equipment behind to share with local teams especially if its a site we come back to often

Increasingly we have sites which are permanent facilities we have built so the set up is more permanent and this is increasing the model the organisation is moving to!

I know I'm a bit late to this, but is there a particular case that stands out for you? Also, thank you for what you do. I have been meaning to donate to Operation Smile but hadn't gotten around to it. You just reminded me how great it is and what a difference it makes in these kids' lives. I will make sure to get around to donating.

Thanks so much :) I do remember very much a 27 year old lady who lived her whole life with a complete cleft lip and palate. She lived in India and told me she cursed the day she was born. And then to see her face light up after she saw herself made me teary.. We have so much to be thankful for..

I have to say every mission there are at least 3 or 4 stories that stand out.. Another one I always recall is this man who picked up an abandoned baby girl in china with her cleft lip. His devotion and love for her was so palpable it was ..well...u know.

Hello,

How long are you on these missions for each trip? How did you get involved with Operation Smile? What are the qualifications?

Its usually about 10 days. The local team though is often working much longer before and after.. to follow up the kids. There is usually Two days of screening followed by a day of set up..then 7 days of surgery and then a day of pack up. A post op team stays longer to check on all the kids and then the follow up is continued with a local team as well as the next Op Smile team that comes to the area. We cant do these trips without working with the locals.. which I love. The brotherhood of man..

I got involved after meeting the founder Bill Mcgee while I was a junior plastic surgeon. I was impressed by his passion and he got me involved.. My first trip was to Kenya.. and I loved the way the organisation worked with the locals. And to see how people from every walk of life and country and colour and religion came together for the betterment of another life.

You can get involved at so many levels and does not have to be just medical. We have photographers, medical records people, child life specialists.. come along!

i am graduating in may with my BSN....id love to do this!

Great news!.. love to do a trip together someday!

did you ever watch the show Nip/Tuck? if so, what did you think of it?

Hi I never did watch it.. I know it was really popular but I thought I got enough it at work :)

Do you see many severe Tessier clefts?

We do see some.. And if its straightforward we will do them at the site but often we will try to get them into a tertiary centre. We also see Chancrum oris

Thanks. :-)

are u medical ?

Nah but I have read an enormous amount about birth defects. I have a friend who has a daughter with a chromosomal deletion. Before she was diagnosed I waded through a lot of stuff on birth defects and kind of got hooked.

Yup pretty amazing huh. There is so many differences..

It is! The thing that gets me is why all the possibilities for disaster how anyone normal gets born at all. It was also personally interesting because I found out I have a soft sign for genetic abnormalities and then found out sometime later that I have a pair of mitochondrial heteroplasmies which are making me ill.

yes i agree .. so many opportunities for things to alter and yet the vast majority of time the process is without issue. Its miraculous the way the embryo develops. How did u find out that?

Hi there. I've watched this video a dozen times or so over the last several days every time I needed a pick me up after what's been happening all week. Talita is adorable, and you are an inspiration. I just donated to Operation Smile. Keep up the stellar work!

Jackamu thank you so much. I still love watching it! And thanks for your donation. Its so appreciated.. Its like another set of hands..

Get ready for Part 2.. :)

No question. Just wanted to say thank you, and you're awesome.

Thanks krepitus! Great name! Assume you must be medical with a name like that but the way you spell it could be an awesome name for a band..

Wish I was medical. Waited to long to go back to school. I'm working on my masters in Ex Phys. My daughter has Osteogenisis Imperfecta. Krepitus is the name I use for my gaming characters. I do it sort of in her honor. What you guys do is fucking awesome. That can never be said enough. That video makes me tear up. It's just beautiful.

thanks man. thanks for sharing.. loved the experience of this whole thing..meeting great souls like you

What made you decide to become this type of plastic surgeon?

You know I spent one year travelling abroad when I was a junior doctor and spent time with an amazing surgeon who worked on the Mercy ships. And he really had a big effect on me,

It amazed me what effect the face has. And why we judge each other by the way we look. When I was a kid I got teased for being chinese and it really used to make me feel different as I could not do anything about it ( not that I wanted to!) So these kids have people judge them for something they can do nothing about. And if we can help them then thats amazing!

I think it's wonderful that you took those experiences from your own childhood and, rather than letting them make you bitter, used it as motivation to help others. Bravo.

Working with Operation Smile, what's the age range of the kids you help?

Thanks :) Have to break the cycle no?

The youngest we operate on is 6 months ( safety first always) and making sure they are the right weight.

I have done people as old as 53 years! Its amazing that some of these people live their while lives with it. Unfortunately sometimes even though we repair the defect, psychologically they remain scarred. The scars we dont see are often the hardest to heal

Is there anything surgery could do for bell's palsy? I had it when I was 2, and I had no treatment. Perhaps in the future I would really like to look into something.....

hi yes there is.. how old are you now may i ask?

the treatments depend on the extent of your palsy and the complexity of the operation that you would want to go through. Quite often its a staged process that requires a few operations..

I am 20 now. It is very embarrassing and since I am a nursing student and we studied CN vII, it is more obvious to my classmates

Hey Rawrz3dg. How much assymetry is there.. is the whole side of your face paralysed?..or just specific muscles?

Not really sure how to describe it...I can move it a little, like a tiny smile and it squints when I do

If it worries you I would see someone for sure. You can message me or if you are comfortable to let me know here.. where abouts do u live..which city? I can find out the best centre..

I am near Toledo, and go to school Cleveland. I would love to fix this...

One of the biggest centres is in Toronto. They are world famous for this work..

I cried when I watched that video.

I've had surgery myself twice and my quality of life has improved immeasurably. I really can't begin to express how thankful I was towards my surgeon and I know he was well paid for it. That didn't really detract from the overwhelming gratitude I felt and to know that there are guys like you doing charitable work for those who really need it absolutely warms my heart

There's just a sadness of having to deal with something shitty like that every day, even though you always know it's there it still at least to me came as a surprise to realise just how great I felt with it lifted. I probably don't have to tell you this but you change lives in more ways than you could possibly imagine.

Thankyou.

Thanks for sharing that with me....

You know I cant begin to imagine it. But I know the feeling when I look into someones face when something like that is lifted. Its worth more than I can describe. TO know that someones life has changed so much that they no longer have to live with that dark cloud that can be so haunting. And as you say you dont realise the effect until the sun comes out and the cloud isnt there anymore.

Thank you for sharing that.

For the child's mental health, how do you help them prepare prior to medical procedures? How do you explain cleft palate surgery to a child who is about to receive it? Thanks for the AMA and doing what you do. :)

Thanks gormia. In alot of instances it the parents who we need to explain things to prior to any surgery which we do with the help of the local teams.

However if the child is old enough to understand then we have a child life specialist who comes on all our missions to help explain to the child what is being done and how he or she will feel after the operation.

Hello, I loved the video and what you do is inspiring, If you could work in any country, where would you like to go with operation smile?

Do you keep in touch with some patients after surgery?

Keep on being awesome.

I do definitely try and see as many patients as I can. I certainly get to see all of the patients in my own country and I love seeing them grow! I get invited to their birthday parties too!

In developing countries I love the chance when I go back. I have been back to Cambodia 3 times and each time I get to see my little friends!

Do you work with older people too if their case is severe or just kids?

Edit: Thanks for answering

No I definitely work on older kids and adults too. Its most gratifying.. I particularly love being able to make a change that older patients are just not expecting.. and its amazing to see it. I recently had a 28 year old man who cried ( happy !)when he saw himself ...I misted up myself ..

Wow.. I love all the countries really.. i am so happy to be able to use my gift to see the world. I love how every country is different. I am about to head to Ethiopia which is definitely one of my favourites

Hey! I was wondering, does the organization consider bringing nurse anesthetist along, or do they only allow anesthesiologist?

Hi

They definitely do bring RNA's and I have worked with two myself..

Sweet! Thank you! And you're awesome!

thanks!..hope to meet you on a trip one day

As a mother of a daughter with a unilateral cleft, thank you for doing what you do. <3

Thanks so much. I love what I do.. All goes well with your daughter?

Absolutely! She had a cleft of the lip and gums but thankfully was spared her palate. She is 6 and just had a bone graft into her gum line from her hip. She is getting tubes in her ears next month, but other than that, she is a happy and healthy 1st grader.
I worry because the kids pick on her at school, but she just tells me not to worry cause "we all look different and some kids dont understand that."
God I love her spirit.

amazing.. thanks for sharing. I love it.

what med school did u go to?

University of Western Australia

Where did you go to medschool and got any advice for a current medstudent?

University of Western Australia.

Advice.. hmm..

Love it. Gravitate to what you love best despite what others say. Look at the drs who different specialties and see how they live and whether they look like they are enjoying it.

Realise you have been given an amazing opportunity to help others and embrace it..

As a 21 year old who's gone through multiple cleft palate repairs, (no lip), thank you for doing what you do. I was so lucky to have access to amazing care and surgeons in Canada, and if my own surgeon hadn't travelled and gotten to learn from other doctors through programs like Operation Smile, I'd still have a fistula to this day (complete repair occurred when I was 17). You're making such a difference for so many.

Thanks so much echiz.. are you in Toronto?

Maritimes actually.

awesome,. I spent two years in Toronto. Love your country.

You are amazing. I have so much respect for you! How long have you been a doctor for?

Thanks Alessia. Im old. I graduated in 1993..20 years. I cant believe it. Time flies...

Not sure if this AMA is done, but.. have you ever worked on Middle-Eastern children disfigured by American drone strikes?

No I haven't. But I have worked in Jordan and loved the warmth of the people there. One of the strongest local organisations I have been involved with..

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sorry this is not my area

Mine wasn't diagnosed until I was in Kindergarten.

I think it becomes more obvious with time..depending on severity. It affects mostly women from my understanding and may not be picked up til puberty..

Ever given a kid a joker face just for the hell of it?

No cant say I have