Dr. Fabian Gurau, Dr. Alexandru Paun and Dr. Oana Sciboz Grobnicu
Today we are talking to three young enthusiasts, intelligent, beautiful and cosmopolitan. With solid fingerprints either in Sweden, Switzerland, Belgium or Romania, however, what do they have in common? They are plastic surgeons, dedicated and passionate doctors, who have decided to improve by working with the best.
■■ When did you know you were going to have plastic surgery? What was that moment that made you understand that this is your path and not another?
Dr. Fabian Gurau: Ever since I enrolled in college I knew I would pursue this specialization. Along the way, I may have been attracted to other specializations, but not to the same extent as plastic surgery.
Dr. Alexandru Paun: The first contact I had with the plastic surgery specialty was when I was still in high school. My aunt, anesthesiologist resuscitator, invited me to attend a guard with her, in the idea of distracting me a bit from my very productive activities as a high school student during the summer vacation. The first patient I saw was a polytrauma, a kid with his arm amputated after a crazy race on the highway. My aunt was undergoing anesthesia when the team of plastic surgeons entered the scene. They managed to reimplant the arm after a long operation. I was overwhelmed and amazed. After 1 year, the kid moves his fingers. It was a shock that lasted a few days. Later, I returned to high school activities… but that click would come to the surface later.
Dr. Oana Sciboz Grobnicu: Plastic surgery attracted me from the first year of college, when I did my first summer internship in this field, at the County Hospital in Focsani, at which point, it attracted me like a magnet. The diversity of this specialty is incredibly vast because it integrates reconstructive surgery (for example after breast tumors), hand surgery, surgery for malformations in children, surgery for burn patients, microsurgery and cosmetic surgery. Everything in one specialty is fabulous!
■■ Is there a medical tradition in the family? How important is it that medical information is already circulating in the family environment? Is it an advantage or a disadvantage?
Dr. Fabian Gurau: Yes it exists, I am the 3rd generation of family doctors and I really consider it an advantage. Growing up in such an environment you become much more familiar with medicine in general, and during the specialization you can ask for extra advice.
Dr. Alexandru Paun: Yes, there are many doctors in my family. I have not analyzed this aspect enough. Certainly, participating in medical discussions since childhood, something remained in the subconscious. However, initially, medicine was not in the first position when I had to choose, but later it overtook the other options and did well. As for me, advantage.
Dr. Oana Sciboz Grobnicu: I am the first doctor in the family, my parents working in completely different fields. However, I believe that an advantage exists when one of the parents works in this field, because the medical basis can be done even within the family, and their experience and advice can be beneficial in this career. By the way, I don’t know the exact statistics, but I noticed that many of the children raised in a family of doctors are inspired to do this job in the future.
■■ Each of you has had experience with aesthetic medicine in other countries. Can we make a comparison? How can you place what is happening in Romanian plastic surgery compared to your experiences outside our country?
Dr. Fabian Gurau: The surgical techniques themselves are quite standardized and I consider that they are also applied in Romania. For example, in Sweden, where I have worked a lot with breast aesthetics, many pre-operative measurements are made to obtain a result suitable for the individual. It’s like going to a shoe store and buying the right size. A shoe with two larger numbers will never fit your foot.
Dr. Alexandru Paun: Professionally, the longest period I spent abroad corresponds to the one in Brussels, where I trained for 2 years. I felt good, I can say that I would repeat that training stage if I had to start all over again. I learned a lot there. Compared to Romania, I am not able to compare because I was not in Romania at that time. What I can say is that the Belgian residency program is more organized and structured. In Romania, I learned the discipline and methodology, perhaps the most precious qualities that a plastic surgeon must have and without which you cannot advance.
Dr. Oana Sciboz Grobnicu: From the point of view of aesthetic surgery, I consider that the level is as high in Romania as in other European countries. In general, as everywhere in the world, doctors are kept informed of new techniques introduced through congresses, conferences or courses. At present, there is a tendency to standardize these surgical techniques at European level, especially in cosmetic surgery. In Romania there is a great interest in innovations in technology and surgical techniques.
■■ Is the profile of plastic surgery patients different in other countries?
Dr. Fabian Gurau: The profile of patients depends on the case. The biggest differences instead come from the beauty standards in that country and the influences in the online environment.
Dr. Alexandru Paun: It goes more naturally in French speaking countries where I studied. Now this trend is reaching us. God help!
Dr. Oana Sciboz Grobnicu: From my experience in France and Switzerland, I noticed that patients start cosmetic interventions at a much older age than in Romania. Statistically, in Romania, a majority of patients are represented by patients under the age of 40, which in other countries is completely the opposite.
■■ What is the intervention that you like to lean on the most and that gives you the greatest satisfaction?
Dr. Fabian Gurau: I like everything related to cosmetic surgery, but if I had to choose I could say that I am particularly fascinated by breast surgery.
Dr. Alexandru Paun: The preferences of a cosmetic surgeon change over time and with the experience gained by each. At the moment I prefer breast cosmetic surgery, namely: breast augmentation intervention, reduction, mastopexy, mastopexy-augmentation. But at the same time, tummy tuck, liposuction and body remodeling with their own fat are part of the beloved interventions. Rhinoplasty is also in the top 5.
Dr. Oana Sciboz Grobnicu: The interventions located at the level of the face attracted me from the beginning of the residency, reason for which I carried out in depth studies, where I obtained a university degree in Nice, France. But honestly, although pure aesthetic interventions on the face give me great satisfaction, the greatest professional fulfillment is represented by surgery for a malformation located at this level, the fact that through an operation you can change the face of a person born with these deficiencies, which is different from the “normal” of today. The satisfaction that such a patient can have in the postoperative period gives me the most smiles on my face.
■■ Do you see yourself doing aesthetic medicine in Romania for years to come? What is the country where you feel the most when you practice? What procedure / intervention did you perform abroad and in Romania it is still insufficiently exploited or does it really not exist?
Dr. Fabian Gurau: Although I am from Stockholm, I have lived in Romania for over 10 years and I like to work here. When I worked in Germany I participated in many breast reconstructions with autologous tissue. It is a good option with extraordinary aesthetic results for patients who do not necessarily want to reconstruct the breast with an implant.
■■ In which western countries did you have the opportunity to prepare?
Dr. Alexandru Paun: In Belgium, France and Luxembourg.
■■ As a woman, have you ever tried to convince a patient that she doesn’t need a certain intervention? How much does the Swiss approach differ from the Romanian one in the relationship with the aesthetic medicine patient?
Dr. Oana Sciboz Grobnicu: I am not the doctor to approach an intervention, if I consider that it is not necessary. Some patients have unrealistic expectations regarding surgery. And any surgery has risks. If we give a patient the necessary time to explain in detail why an operation is not or is not necessary, they generally understand. Compared to the Swiss approach in the relationship with the patient of aesthetic medicine, I would tend to believe that there is no difference in the doctor patient relationship.
■■ What is esthetic surgery that you would never do as a woman?
Dr. Oana Sciboz Grobnicu: I am not closed for any esthetic surgery, if necessary. As a reconstructive aesthetic intervention, I would certainly not resort to sex change and not because I have something against the surgery itself, but because I am fulfilled with the fact that I am a woman.
■■ If you had to change one thing in plastic surgery in Romania, what would it be?
Dr. Fabian Gurau: There are many interventions in plastic surgery that are not subsidized by the state that would help improve the quality of life. A good example would be tummy tuck. An individual who has lost a lot of weight will be left with a leather apron that makes life uncomfortable and difficult. Imagine that you can’t find a pair of pants that match thanks to that leather apron. The same operation can greatly help women who have given birth and remained with weakened abdominal wall muscles.
Dr. Alexandru Paun: The law!
Dr. Oana Sciboz Grobnicu: Probably, the introduction of some interventions considered aesthetic in the state hospitals, would be in the help of the population. As an example I could give the breast reduction, in the case of women who suffer from daily back pain due to the weight of the breasts. The introduction of these procedures, called aesthetics, could improve the quality of life of patients.
■■ When do you think that the hormonal implant will make its place in Romanian medicine?
Dr. Fabian Gurau: There must be a discussion between the patient and the gynecologist to get the right contraceptive treatment for each.
■■ What country do you think is now the world capital of plastic surgery? Given the multiple exchanges of experience in various countries, do you consider that Romania is well represented worldwide in aesthetic medicine?
Dr. Fabian Gurau: In my experience, the answer is South Korea. I was in Seoul for some cosmetic surgery courses and I was amazed by their progressive way of working, but also by the way in which cosmetic interventions are accepted in society. We still have work to do on this, not only in Romania but also in Sweden and Germany.
Dr. Alexandru Paun: I don’t think there is a world capital. There are several countries that have a tradition in plastic and cosmetic surgery such as: USA, Brazil, Belgium, Sweden. Romania, of course, also has its internationally recognized representatives.
Dr. Oana Sciboz Grobnicu: According to current statistics, Brazil and China are the leaders in cosmetic surgery. In plastic surgery in general, the USA has been the world capital for many years. Romania is the 25th country in the world top of the countries where most cosmetic surgeries are performed, I tend to believe that it is well represented.
■■ Do you think that Romania also needs legislative changes? Do you think that the doctor is well protected legally in the relationship with plastic surgery patients?
Dr. Fabian Gurau: I believe that the law is made to protect both patients and doctors alike.
Dr. Alexandru Paun: The access of young people to the experience of a famous, internationally recognized surgeon is invaluable both theoretically but especially practically and technically. I can say that I have been lucky since I stepped on this path. I had the opportunity to collaborate with teachers, exceptional surgeons who taught, advised and encouraged me. I had the chance to meet Dr. Constantin Stan at a very important moment in my career. It is still an honor to work with him. Imagine that there are surgeons from Germany, Belgium, Italy, Poland, even Patagonia who come to visit him to see “how he does it” and “how it is done at Cronos Med”. I say that it is “done” above any expectations, especially in Romania.
■■ Do you consider cosmetic plastic surgery a luxury that will gain ground in the coming years or will minimally invasive procedures increase? Is aesthetics a prerogative of luxury?
Dr. Fabian Gurau: Sometimes it can be considered a luxury, but as I mentioned earlier, I believe that many interventions help patients in their daily lives, improving the quality of life. Other treatments can help a lot psychologically. It is often important to understand the patient and what is behind the desire to have cosmetic surgery, whatever it may be, before considering cosmetic surgery a luxury.
Dr. Alexandru Paun: I tend to think that the 2 will go in parallel for some time to come on the one hand because the problems to which the 2 approaches respond are different in terms of the indication determined after the evaluation, examination of the patient, and on the other hand technology in cosmetic surgery is somewhat out of step compared to other branches of surgery (oncological, urological or thoracic surgery) in which minimally invasive surgery performed with the help of the DA VINCI robot, for example, pays off. With the incredible scale taken by social networks where most users expose moments in their lives that they want to be “luxurious” in the idea of astonishing more and more people resort to cosmetic surgery.
Dr. Oana Sciboz Grobnicu: My opinion is that there is a current trend towards minimally invasive interventions. Surgery finds its place where minimally invasive interventions may not be sufficient. No intervention can be considered a luxury, if it can improve a patient’s psychological health.
■■ Thoughts for the readers of our magazine. Thank you.
Dr. Fabian Gurau: I recommend to those who want aesthetic changes, to consult a specialist and analyze why they want that change.
Dr. Alexandru Paun: Breast augmentation with silicone prostheses is the most common cosmetic surgery in Romania and even in the world, which is why the motto “Choose wise not size!” Is my advice to all women who want to perform this surgery.
Dr. Oana Sciboz Grobnicu: An aesthetic intervention, whether surgical or aesthetic, if necessary, really changes a person’s quality of life. Addressing a specialist in the field is essential as a first step towards a decision.
