Cosmetic and Facial Surgeon in Sacramento, California
Cosmetic and facial surgeon Dr. Jagdev S. Heir is the director of Sacramento Surgical Arts PC. With credentials as both a Medical Doctor (M.D.) and a Doctor of Dentistry (D.M.D.), combined with training in Anesthesia, Dr. Heir has broad knowledge and expertise as a cosmetic surgeon and he is highly respected in the field.
A Board Certified Diplomate in Oral and Maxillofacial Surgery, Dr. Heir is a Fellow of the American Academy of Cosmetic Surgery, the American Association of Oral & Maxillofacial Surgeons, the American College of Oral & Maxillofacial Surgeons, the American Medical Association, and the American Dental Association. Read more about Dr. Heir’s credentials.
A Surgeon Practicing Two Complementary Specialties
“I began with general surgery: cleft palate, head and neck cancer, and facial trauma cases. This is what led me down the path to becoming a cosmetic surgeon. Through the years, I have continually been driven by the goal of determining the best way to perform each surgery: and also the fastest, easiest way that causes the least amount of trauma and the most rapid recovery for my patient.”
“When I started, I did such a wide array of different kinds of surgeries, including cleft palate cases, head and neck cancer reconstruction, and reconstruction following facial trauma. And when I went to dental school, I worked with my hands from Day 1, so I had intensive training using my hands and developing dexterity that carried over into my cosmetic surgeries. During my specialty training in cosmetic surgery, I performed over 600 surgeries. You learn a lot about what works when you have that kind of training experience.”
What this means is that my hand skills are dependable and have become automatic over the years. This is important, because it frees my mind up to think about the specifics of each surgery as I do them. When you can trust your hands, you can do excellent work and I’ve noticed that my patients leave with less pain and shorter recovery periods. This is because they have less physical trauma from the procedure and, in the process, require less anesthesia. It’s the combination of specialties that I practice – medicine and maxillofacial surgery – that gives me that facility. I bring my patients the best of what I’ve learned from both specialties. If I do 20 surgeries during an average week, I know that 18 of those patients will have virtually no pain.”
Consultation and the Patient’s Right to be Fully Informed and Comfortable
“I’m constantly refining my surgical skills, learning new techniques, and learning more about how to best interact with my patients. I tell them ahead of time what will happen, how the process will go, and what they can expect.
“The patient comes in and they don’t know you and they have to trust you. They have heard about you from other patients or from other doctors, but they don’t personally know who you are. They come in and they choose to trust me because I develop a relationship with them and this is meaningful to me. Why? Because this is what’s most important…the doctor-patient relationship. I never take a relationship with a patient for granted. I sit down and talk to them and I listen. And I keep interacting with them and listening to them over time.”
“It’s easy to talk about open communication, but it’s not as simple as it sounds. Educating my patients about their options and about the procedures they choose is a complex process. They have already learned the positive aspects they can expect – that they will look better, that they will feel empowered having solved a concern that has bothered them for a long time. But a good relationship between my patient and me also means that they need to understand the risks involved, what can happen along the way as they heal, and what they need to do to facilitate a good recovery.”
I Want My Patients To Have What’s Best For Them
“If a patient’s expectations don’t meet my reality – what can be improved, what kind of result they can expect, and how important it is for them to collaborate with me to do the things they need to do to accomplish our mutual goal – I won’t do the surgery.
Sometimes they don’t need what they think they want and I realize that the surgery they’re asking for isn’t necessary. Perhaps a non-surgical treatment or procedure will give them the appearance they desire. This is a key part of the consultation process: someone comes in wanting one thing and after they learn more about their options they have a different perspective and will go with what I recommend is best for them. Or, perhaps it is too soon for them to undertake a major surgery and they would be better served to wait a few years. I tell them they’re better off to spend their money elsewhere. I will say, ‘Do something nice for yourself, or for someone else.’
I remind my cosmetic surgery patients that they don’t really need to have surgery: it’s optional, and it’s a personal choice. Despite all the information available on the Internet, I find that patients don’t really know what to expect. That’s why patient education is so important. That’s what informed consent is all about.”
Why The Doctor’s Specific Skills and Experience Matter
“The wide range of surgeries I’ve done over the years – and the training I’ve had – has given me tremendous dexterity and knowledge about how to perform a surgery. When you can trust your hands, you can do excellent work and I’ve noticed that my patients leave with less pain and shorter recovery periods. This is because they have less physical trauma from the procedure and, in the process, require less anesthesia. With my breast augmentation patients, for instance…they can raise their arms up overhead the same night after their surgery. I plan meticulously: how much tissue needs to be impacted, how the procedure will be performed.”
My Patients Know They Can Reach Me
“I don’t have an answering service and I don’t want one. My patients can reach me directly if they have a question or a need. I call them the evening of their surgery. I stay in contact. For bigger surgeries – body contouring, facelifts, tummy tucks, for instance – I often go to their homes that night. I also want to see them the next day. I want them to walk, and I want them to feel safe and comfortable as they negotiate their recovery process. Any type of discomfort is relative, and how will my patients know exactly what they should be feeling after surgery? Who’s going to catch a problem, if one arises – the patient or me? I am! I know what normal recovery means, and what normal discomfort consists of. It’s my responsibility. ”
“I need to know what my patient requires; no one else can know that what they are experiencing is exactly what should be happening– not the patient and not my staff. They’re not “patients” to me, in the usual sense of the word: they’re my family.”
“Beauty is, to a large extent, culturally determined. While there are certain characteristics that appear to be coveted in most cultures (full lips or wide set eyes, for example), each culture has its own way of defining beauty. Patients of mine will often point out a perceived flaw and complain that their nose is too broad or the shape of their lip is different on one side than on the other. Asking questions and talking with them about their face or body involves helping them “see” correctly and having them understand subtleties about their appearance that they may have noticed but didn’t necessarily comprehend.”
“One of the first things I point out involves the idea of symmetry. Patients often feel that their face or a part of their body is uneven but, in fact, there is no true symmetry in the face or body. One side of the face is not exactly the same as the other side, nor is one breast exactly like the other. Each individual has a different face and body and each of us has differences within our own faces and bodies. The implications of this are significant. Many people look at their faces and they don’t really know what they need. They may think they need a different nose, when they may only need a slight improvement made on the nose. There is no reason to do a major surgical procedure when a smaller procedure will do the job. The greatest compliment after cosmetic surgery is when someone says to one of my patients, 'There’s something different about you, but I don’t know what it is. You look great.' That’s cosmetic surgery at its best.”
“There are geographic and regional considerations, as well. For instance, when I was practicing medicine in New Jersey most patients who had facelifts didn’t want others to know. In that region, a natural look tends to be the preferred outcome. However, in Oklahoma most patients wanted obvious changes and wanted that investment they made in themselves to be apparent. So, you can see there are many factors to take into consideration when determining what’s in the best interest of my patient. Helping each patient look the best they can, so that they feel good about themselves and more at ease…that’s the way I define beauty.”
Procedures My Patients Ask For At Different Stages of Life
“While there are always exceptions, in general the age of a patient often determines the types of procedures they want or need. From the mid-20’s through the 30’s, Botox and dermal fillers are already in demand, along with breast augmentation and a certain amount of liposuction for saddlebags or mid-section. That age group also requests lip enhancement, scar revision, and Latisse for fuller eyelashes. Patients in their 30’s ask for those procedures and also for 3rd molars, dental implants and either mini or full tummy tucks if they have completed their childbearing years. By time they reach their 40’s, my patients take advantage of all of the procedures I already mentioned, but they are also choosing eyelid surgery, brow lifts, and cheek or chin implants. They also seek liposuction for jowls and excess fat in the neck area.”
"For patients 50 and up (along with some in their 40’s), there tends to be more focus on the aging face and many patients see their face as the primary concern. Facelifts become the procedure of choice, along with other body procedures and anti-aging procedures like Botox and dermal fillers. In recent years, body contouring (body lifts, in effect) have also become a much requested as more and more adults lose significant amounts of weight and then want to eliminate the loose excess skin that remains behind. And at every age, the right skin care regimen is important. If you take care of your skin, there’s absolutely no doubt that the signs of aging will occur more slowly.”
On Cosmetic Surgery Procedures
“The decision to have cosmetic surgery is important, and I am fortunate to have a successful practice and an excellent staff. I know that even the most eager patient has questions, a certain amount of apprehension, and the desire to trust me to give them the results they envision and to take good care of them. This is healthy and absolutely correct thinking. You only have one face and one body and you want to feel you’ve made the best choices for yourself. My goal is to be perfect every single day with my patients: as a surgeon and as a person. Of course, no one is perfect, but that’s what I aim for with every procedure I do. It’s hard to convey, but I know that the more my patients get to know me and understand my core values, the better they feel. I am lucky to be a surgeon: it’s compelling and deeply satisfying work and the procedures I perform are meaningful and sometimes life-changing for my patients. It’s not just a doctor doing a surgery on a person. It’s a real relationship between my patient and me. I want to give each patient the very best possible. Let me share a few thoughts with you about the human body, from my perspective as a surgeon.
“Necks are a huge problem. In fact, I could do them all day long every day if everyone who had a problem with their neck came in for surgery. They’re lined, or they’re sagging, or they have too much fatty tissue. Part of the problem is that most of us don’t focus very much on caring for our necks or chests. That’s why you see so many people with a smooth, youthful looking face who have necks and chests that appear much older. Liposuction and/or a neck lift can transform the way a person looks. There’s a lot that can be done to improve the neck and chest.”
“Rhinoplasty is one of the most challenging and rewarding surgeries to do. Many of my Sacramento rhinoplasty patients want to have their noses reshaped, and have wanted it for a very long time. When they decide to do it, they focus on how they want their nose to look. Frequently, they see someone with a certain type of nose and decide that’s the nose they want. Almost always, they are convinced that their nose needs to be smaller and narrower. For a long time, many surgeons responded to the cultural standard, which dictated that the female nose should be small with a narrow tip. So many surgeons were reshaping noses so that they came out small, with a certain type of pointed tip. That was the standard of beauty at the time. And most of us have met people whose noses don’t fit their faces. We may not register why that’s so, but on some level we recognize it when we see it and we don’t find it pleasing.“
“Over the past decade, that’s changed as cosmetic surgeons continue to better understand the nuances of the human face. With nose reshaping, the best surgery involves refining the nose in a subtle way that’s harmonious with each particular patient’s face. Usually, less is better than more and taking away is not as helpful as reshaping what’s there. I take many factors into consideration before I reshape a patient’s nose: age, ethnic background, overall facial structure, which options are beneficial both functionally and aesthetically, what the patient hopes for, what is realistic and in the patient’s best interest, and how the patient will look – not only after their recovery period, but 20 years from now, as well.”
The Belly and Abdomen
“Excessive weight gain or loss, birthing children, and the aging process itself often result in excess skin and lax muscles in the belly and abdominal area. I really like doing abdominoplasty surgery, restoring a person’s body to an attractive and fit appearance – particularly after childbearing or significant weight loss. The procedures themselves are technically difficult to do, and I really like the more challenging cases and the complexity of figuring out how to get the optimal result for each particular patient’s condition. My Sacramento tummy tuck patients have a high level of satisfaction afterwards, and it typically affects other areas of their life in a positive way: eating better, exercising more regularly, and in general taking better care of themselves.”
The Body After Weight Loss
“One of my specialties is performing body contouring on men and women who have lost significant amounts of weight or who need to lose a lot of weight. Patients who are overweight need to stabilize their weight before surgery makes sense. I don’t use the word ‘diet’ because that’s not the answer. They need to learn about nutrition, develop a regular habit of exercise, and make lifestyle modifications that will improve their health and their motivation to stay healthy after their eventual surgery. I refer many of these patients to personal trainers who will consult with them before I even consider surgery. I want to see a commitment from the patient first…so some leave and others make the decision to commit and to go the distance.”
“I do have patients who are overweight, but not dangerously so. If they’re ok with the weight they carry, that’s fine with me. But if they want to lose a lot of weight, I want them to do it before cosmetic surgery so they can maintain the smooth, fit look they’ll get after body contouring. Otherwise, if they lose a lot of weight afterwards, they might end up with loose skin all over again, and I don’t want that for them. I always ask what their body weight was when they were 25 or 30 years old because that’s a reasonable weight level for them to return to.
What’s interesting and positive is that once they begin to exercise and eat well and lose some of the excess weight, they become increasingly motivated to lose the rest. They’ve already done 75% of the work. Then they can have the cosmetic surgery (body contouring) to get rid of the hanging skin and excess fat. These patients truly have new lives in many ways – active lives and relationships they couldn’t envision having when they were obese and sedentary. They are an inspiration to me and to my staff, each and every one of these special patients, and we really admire and respect what they are able to accomplish.
One of my most inspirational patients – Matt Lanza – gave us the opportunity to tell his story, in the hope that it would inspire others to change their bodies to live the lives they were meant to live: lives of promise, productivity, and happiness. I know you will find his story as special as we do here in the practice. Read our cosmetic surgery patient testimonials.