Norman Leaf MD FACS

From the Blog

The Revelation of Body Worlds

I was recently blown away by the latest version of the amazing anatomical exhibit of Body Works, by the inspired German anatomist/artist Gunther von Hagens, currently showing at the Los Angeles Science Center. Each specimen/display is artistically and beautifully designed, but the incredibly precise demonstration of the human anatomy profoundly resonated in this surgeon’s heart. My Medical School anatomy course taught me the scientific details of the body; Body Worlds reinforced the beauty of it for me.

As a Plastic Surgeon, it’s been my privilege to work with the surgical anatomy of the face and body for 45 years. My work has included both normal and pathological anatomy, including congenital anomalies in babies, traumatic deformities, and structures damaged by disease. My aesthetic surgical efforts, such as facelifts, have dealt almost exclusively with normal anatomy. Even in healthy patients though, there are variations that require extra vigilance. Nerves, in particular, don’t always follow the most common pathways. Looking at the exhibits reminded me of how critical it is to know anatomy and be wary of its unexpected twists and turns.

Years of study, training and experience are absolutely essential to produce routinely excellent, problem-free results in plastic surgery. If you’re considering an elective plastic surgery procedure, a trip to the Science Center to check out this phenomenal exhibit will hopefully encourage you to seek out a well-trained, experienced, board-certified plastic surgeon.

We know the anatomy.

Why is “Facelift” a Dirty Word?

In my practice I do a lot of facelifts, and I truly enjoy helping to reverse the stigmata of aging, smoothing sagging jowls, removing double chins, and lifting self-esteems and improving selfies. But it is an odd fact that most of my patients don’t like to think of having had a facelift. They prefer to call it a Neck Lift, a Mini Lift, a Tuck, a Cheek Lift…anything to avoid mentioning facelift. It’s like my grandparents who would whisper the word cancer rather than saying it out loud. Not for polite conversation.

I see this time and again with patients who are consulting with me for...well…

face work. In giving me their past history, they often say something like “I had my neck done 10 years ago” or, “I had a mini-lift in ’95.” Maybe 20% will say outright that they had a prior facelift. Of course, when I examine them, I see clearly the scars of a facelift. I know where to look. The scars may be well-crafted, very fine and hard to detect, or they may be plainly obvious and not very pretty, usually depending on the skill of their surgeon.

When I make my suggestions for what I would recommend, I have found that there is commonly a pushback when I suggest a facelift per se. I have learned to phrase my ideas more carefully. If the neck is the major concern, which is quite common, I suggest that we tighten the neck, and also bring up the lower cheek area just enough to match the neck. In truth , it’s hard to do a really good necklift without tightening the deep structures and the skin of the cheek area. By the way, that operation is called a facelift. I could use the term rhytidectomy, which translated means resection of wrinkled skin. But that’s just obfuscating the reality, and most patients don’t like such big Latin terms.

I generally prefer to be direct, and say what I mean. But to temper the blow, I may call it a lower facelift, meaning nothing on the forehead or brow. Trouble is, it’s often a great idea to do browlifting at the same time, and perhaps the eyelids as well. And then there’s the possibility of fat grafting to fill in the hollow areas of the cheeks or marionette lines. And let’s not forget about the laser…this is often necessary to smooth the very fine lines, especially around the mouth. And so it grows…

Eventually, most patients understand what I’m driving at, and usually will accept it. But I know, two to three weeks after surgery, when they’re out amongst their friends, if anyone mentions that they look really good, and ask what they did, most will say “Oh, I had a little necklift.”

The 28th Amendment to the United States Constitution: Congress shall make no law prohibiting any citizen from prevaricating, fibbing, or just plain lying about their plastic surgery.

Why is There So Much Confusion About Facelifts?

SMAS Lift, Deep-Plane Facelift, Mini-Lift, Short-Scar Facelift, MACs Lift, Mid-Face Lift, Life-Style Facelift, Doctor ------ Lift, Magic Lift...

It’s no wonder that prospective patients are sometimes confused by all these different names…I myself have been at a loss to explain several of them. But it’s not the facelift operation itself that confuses me…that part I’ve got down pat (and I should, after nearly 40 years of constantly improving my game)…it’s why there’s so much marketing-driven emphasis on the name.

First and foremost these are all surgical procedures, except for the last one, (which I just made up) and as such, should be performed by surgeons, particularly plastic surgeons. Not “cosmetic surgeons”…that title does not indicate any degree of proficiency whatsoever. Any doctors with a medical degree and no level of training whatsoever can refer to themselves as cosmetic surgeons, because there is no legitimately-sanctioned competency board for “cosmetic surgery.”

So, getting back to the wild profusion of names for similar operations, let me try to shed some daylight on how they differ. There are facelifts and there are facelifts; some are well-accepted variations on the basic themes, and others are just names meant to impress and attract patients. It’s easiest to start with the latter, because subjecting them to transparency tests reveals all.

“Life-Style Lift”: Patients have asked me…what is it? The simple answer is that it’s not an operation at all. It’s the name of a marketing company that has been seemingly successfully operating in many areas around the country. I should say had been operating, because they recently closed down after declaring bankruptcy. I feel it was morally bankrupt from the start, in the sense that their very slick advertising campaign was intentionally misleading. The campaign was, however, quite effective; the promise of beautiful, natural results at rock-bottom costs…no need to go to fancy plastic surgeons who charge much, much more…is always an appealing thought (except to us fancy plastic surgeons). In order to keep prices extremely low, the company would hire local surgeons by the day, some of whom might have had very little training or experience, and require them to complete the procedure in about 90 minutes, and then to do 3 or 4 of them in a day. Furthermore, the doctor wouldn’t have to waste time meeting with the patients in advance, to determine if the operation was suitable or even safe for the patient, or waste time with follow-up visits…the company would take care of all of that. All the doctor had to do was show up and operate.

But the most confounding thing of the Life-Style Lift was that people were led to believe it was actually a unique procedure, something that only could be achieved through the auspices of that company’s many outlets. I have personally seen more than a few patients who were unhappy with their results from the LSL, and I have found on examination that there was very little similarity between many of them. It appeared that the operations they received depended on the decisions made by whichever surgeon was operating that particular day. There was no one procedure that could properly be called a Life Style Lift…in fact, the only common thread I could see was that most of them appeared to have been done hastily and mostly in a slapdash manner. Of course, I only saw the patients that were unhappy with their results. I’m sure there were some that were pleased.

Regarding the Doctor ------- Facelift (insert name of doctor who believes that affixing his name to it would make people assume that he and the procedure are something pretty special), most of these proprietary names are simply and completely marketing ploys. It doesn’t necessarily mean the doctor isn’t adequately trained or skilled, but it’s usually a tip-off that the doctor has resorted to self-aggrandizing tactics to peddle his wares. I personally don’t know of a single plastic surgeon I respect who has his or her name attached to any procedure, although many times a newer technique will become known to the profession by the name of the doctor who introduced it. When that happens, say, following the publication in one of our highly-vetted journals, it is an acknowledgment of respect from the author’s peers, not a self-appointed bit of bragging, and it becomes a routine part of the plastic surgery nomenclature.

The moral: if the procedure is only performed by one doctor or by one company, don’t assume it’s because no one else is smart enough or up-to-date enough to do it. It’s inevitably a blatant marketing ploy, and most really good surgeons don’t need to do that, even in today’s highly competitive marketplace.

Returning to the more accepted procedures, variations, and options, it’s reasonable to first ask what the patient wishes to improve. Most commonly, it’s the sagging neck. After that, it’s the jowling of the cheeks, the loss of definition of the jawline, the fullness and loose skin of the eyelids, and possibly a receding chin or low, angry-looking forehead and brows. The fine lines and discoloration associated with sun-damaged skin is best treated with the laser, which can be used at the same time as a facelift or by itself.

Restoring the face to a more youthful appearance is much more than tightening skin…if that’s all that’s done, the skin will look pulled and the change will be pretty short-lived. And it’s more than just injecting fillers or fat…this is helpful to a point, but a bit too much and the face simply appears fat. It’s much more important to restore the infrastructure of the face first. Once the infrastructure is restored, the skin can then redrape over the newly tightened deeper surface without any pulling at all. So, how is this done?

There are essentially two ways to do this. In both cases, the skin has to be partially elevated to get at the deep layer. What’s done after that depends on the preference and skill of the operating surgeon; many feel that there is an actual lessening of facial fat with age, and others feel that the facial fat has just dropped down over time with the gravitational pull. In many cases, both scenarios apply. When facial fat has actually been lost, fat can be transferred from one part of the body, the abdomen or the thighs, to the face in a process called fat grafting.

I tend to feel that the fat has not so much been lost, but has merely descended with gravity. That which previously had provided a youthful, high, rounded cheekbone area has dropped down to create a jowl. So my goal is to elevate that cheek fat back to where it was in youth. This is generally done by isolating, lifting and securing a separate layer of the deep tissue, (SMAS…an acronym for Subcutaneous Musculo-Aponeurotic System) which includes the muscle layer, the facial fascia and the accompanying fat pads. The skin then simply redrapes without tension over the tightened framework, without looking pulled. Still, in patients with a gaunt appearance, I will also do some facial fat grafting.

The SMAS layer extends down below the jawline into the neck, where it blends with the platysma muscle. That’s the flat sheet of muscle that extends from the collarbone upward past the jawline and into the SMAS of the face. With age, this muscle forms into bands , producing the cords under the chin we see when we grimace in the mirror or in an unfortunate selfie. The platysma also acts like a hammock and supports the contents of the neck area, including the salivary glands and some fat under the chin. When we lift the SMAS vertically, it tightens everything, including the jowl and the neck. We also pull the platysma muscle backward to the area under the ears, where we suture it snugly…this combination produces a very firm and youthful neck and jawline. Often we will also sew the bands together under the chin and remove some fat there too. The operation is usually referred to as the Extended SMAS Facelift, and it’s the commonest one I do. Another term is the Deep Plane Facelift, which is very similar, except the deep layer is freed up even more, and there is less separation of the skin from the muscle layer.

How we actually get into the deep layer is variable, but always requires some incision in the skin. The goal is to make that incision as invisible as possible. The “Short-Scar” technique does, as implied, have a shorter scar than the full incision technique. While this sounds like an advantage, it is difficult to get a significant improvement in a very loose neck. If the main reason for the operation is sagging cheeks and jowls, the short scar is usually adequate; but if there is a substantial amount of drooping of the neck area, it’s best to use the longer incision, so the sagging neck muscles and skin can be moved back more securely.

In fact, the short incision and the long incision require the exact same amount of potentially visible scar…that which is in front of the ear. The longer scar is only longer when including the segments of the scar behind the ear, which is essentially invisible.

With either incision, the SMAS layer can be dealt with in several ways, other than the one I described above. It can simply be plicated, or pleated, which tightens it. A section of it can be removed (SMAS-ectomy) and the edges sutured together to create a lift, or it can be tightened by two or three long suture loops that constrict it in a laundry-sack fashion, tightening the deep layer (MACs Lift). The advantage of the MACs Lift is that it’s a pretty quick procedure, done through the short scar incision. And just to confuse you even more, an Extended SMAS Lift can also be done through a short scar exposure as well.

The term MINI-lift can refer to any of the short scar procedures, and is not really descriptive of anything else. In the past, some doctors performed a really mini procedure, removing a little strip of skin in front of the ear and pulling it together; the result looked a little better for at least a month or two, before the skin just stretched out and looked strange. Many patients who are frightened by the idea of surgery in general, prefer to use that term so they don’t think they’re undergoing a major procedure. I have seen many patients who consult with me tell me that they previously had a Mini Lift…yet when I examine them I see the scars of a full, long incision facelift incision. It’s a natural tendency of a person to attempt to minimize the extent of their cosmetic procedures, as opposed to the embellishment of their more essential, serious operations…”You had a two-vessel coronary bypass? You call that Heart Surgery?!? I had a four-vessel bypass!!” Bragging rights don’t really apply that well to aesthetic surgery.

There’s one more facelift term; the Mid-Face Lift. That’s a procedure in which the cheek fat is elevated without tightening the skin. This can be done through an incision in the lower eyelid, (exactly the same one used for doing lower eyelid tightening) or through a small incision in scalp of the temple. It’s good for patients with just some hollowing and drooping of the cheek, without a great deal of jowls or neck looseness. Of course, when any of the other facelifts is done, the mid-face is also lifted; no need for a separate Mid-Face Lift.

I think I’ve exhausted most of the nomenclature generally used to describe facelifts. The only thing I have left to say about them is this: there are well-done facelifts and badly done facelifts. Those don’t require any more specific terminology. I hate using the word botched, but you know what I mean.

The Point: no one recognizes a well-done facelift, but everyone notices a lousy one.

Aug 21 2015

The Beauty Plan

The Beauty Plan

Why are Those Celebrities so Gorgeous, and How Do They Stay Like That?

Beauty care is like a diet; it takes constancy and commitment to get a long -term WOW effect. Our celebrities may have been born more beautiful than the rest of us, but they quickly learn that if they want to keep their appearances up to the high standard that keeps them in front of the cameras, it takes work. And everyone can benefit from their experiences.

Not everyone wants or needs a facelift or an invasive procedure to achieve their beauty goals, although those procedures produce a much more dramatic result than anything less invasive. Still, there are many treatments and procedures that can make substantial improvements without anesthesia, pain, or downtime. Taken individually, results are always gratifying, but may not necessarily be the most striking or long-lasting. But taken as part of a well-planned regimen, they add up to an amazingly beautiful result, putting you on course to a lifetime of great skin. We call it our Beauty Plan.

Synergy in beauty care occurs when the results are greater than the sum of the parts. The parts of the Beauty Plan are the individual, non-invasive treatments that work together to create extraordinary healthy, smooth and glowing skin. The key is regular alternating treatments at monthly intervals.

The Plan usually starts with a medical-grade facial by Maya, our outstanding paramedical aesthetician. This will be followed by a variety of proven treatments by our two registered nurses, Joy and Yanna, involving a low-energy laser (“Clear and Brilliant”) and Micro-needling using the remarkable Rejuvapen. This is a small device that creates tiny little needle holes in the outer layer of the skin, allowing our Growth Factor serum to penetrate deeply into the dermis. For problematic acne scarring, the device can be “tuned” to create much deeper holes, almost like a tattoo machine, but without ink. Research has shown that micro-needling greatly increases collagen formation, helping to smooth out acne-scarred skin dramatically. Both the Clear and Brilliant and the Rejuvapen even out skin tones, reduce pore size and brighten the complexion.

The above treatments are painless (I know, it sounds like having a bunch of needle sticks wouldn’t be painless, but honestly it is…I’ve done it myself and can personally attest to that.) Any down-time is less than 24 hours, and is limited simply by the fact that your skin will be a bit red afterward. At worst, it looks like a sun-burn, which of course is something everyone should avoid!!

There are other treatments available also, including the Intense Pulsed Light (IPL) by our new Ellipse machine from Denmark, the ultrasound treatment Ulthera, and other kinds of light peels. And of course, there’s the multitude of fillers (Restylane, Juvederm, Voluma, et al), neuromodulators (Botox, etc) and elegant and powerful skincare products. BUT, don’t get overwhelmed and confused. Maya, Caroline, Joy and Yanna are all here to help plan the best course of action for your particular skin and beauty needs. It will be very well structured to fit your schedule and easy to follow.

And if you do follow The Beauty Plan regularly, in a very short time you will be quite amazed at how fresh, youthful and clear your skin will become. Of course, I see patient’s for consults on Wednesday’s should you decide you’d like to proceed to a more aggressive surgical approach. But, if facelifts and such are not on your To Do list, consider the Beauty Plan… it works wonders.

The Doctor Wears Prada


The Breakfast Room at the Pierre Hotel, New York City.

"By the way, we're starting a line of Ready-to-Wear," Patrizio mentioned off-handedly via his translator.

Two hours had flown by quickly since we sat down to breakfast with Miuccia Bianchi Prada, her husband and Prada CEO Patrizio Bertelli, her brother Alberto, and Massimo Brandigi, the director of retail for the USA. My wife Judy and I reacted to the news in silence, not wanting to reveal any concern or disrespect. The morning had been too exhilarating for that. After all, we were on the verge of making a deal with what was about to become the hottest new fashion house in the world. Their unique bags and accessories were just beginning to take off among the East Coast fashionistas. Adding clothing to the mix at this stage seemed to be just muddying the waters. How were we to introduce an almost unknown brand to Los Angeles, especially with this new complication? And how did I, a seasoned Beverly Hills Plastic Surgeon but a rank neophyte in the world of couture, fit into this scenario?

The answers came out eventually: slowly, and somewhat awkwardly.One month earlier, Ritz Hotel, Paris.

In February of 1989, we were in Paris for a wedding. Judy was shopping in the St Germaine area, and got caught unprepared in a downpour. She ducked into a shop to get out of the rain, and looked around. It was the new PRADA store, the first one outside of Italy.

Judy had worked in the fashion world most of her adult life and was a very astute observer of that scene. She had in fact seen the original PRADA store in Milano years before, when that shop was known for its old-world leather goods craftsmanship. It was not thought of as a fashion brand in those days. Now, standing in the Paris store, Judy was awestruck by the very new, fashion-forward nylon backpacks and quilted nylon chain bags with the triangular logo. Nobody had done such imaginative things with industrial materials since Levi Strauss took denim from work clothes and made blue jeans.

She grasped very quickly that something very exciting was happening at Prada, and just as quickly grasped several bags and flashed her AMEX. Judy had a long-standing fascination and familiarity with fashion…as a buyer for a retail chain, as a stylist, and as a consumer. She knew what fashion excitement was when she saw it. I was at the hotel when she returned. Judy opened her shopping bags and excitedly covered the bed with her purchases.

"Something's happening at Prada; I don't know what it is, but it's very, very hot!" she said. "Someone should open this boutique in Beverly Hills!"

I had never heard of Prada before, but I trusted Judy's instincts.

"Why don't you do it?"

"I don't know the first thing about opening and running a shop"

Then, my remark, which I regretted, but only for the next two years: "How hard can that be?"

Returning home, I happily turned to my profession lifting faces, breasts, abdomens and self-esteems. Judy began making calls and found that Prada had just opened their first US store on 57th Street in New York. Massimo Brandigi was the newly appointed director of retail development in America, and he and Judy struck up a very friendly banter on the phone. He told her that he had been thinking of Beverly Hills for the next Prada boutique location, and that her call was fortuitous. He made plans to meet her in Los Angeles a week later.

The meeting apparently was successful, and plans were made for us to fly to NYC the next weekend to see the new store. I had not yet even considered the financial burdens this project would create…I'm a doctor, and retail business concepts were quite foreign to my background. Perhaps if I had more experience in that sphere, the whole thing would never have happened. Call it dumb beginner's luck.

The store on 57th Street off Madison was small, elegant, and very old-world appearing, but the merchandise was uniquely modern. Afterward, we had a drink with Massimo at the Plaza Hotel Oak Bar. He started asking me business questions; my medical training had given me the ability to be quick on my feet, even when I wasn't sure of the answers. Apparently, my answers were marginally adequate, because he then looked at me and said, "This is probably going to be a $2 million investment for you."

That was it. I nodded, as if to say that was what I expected. In truth, my nodding was just a cover for my sudden inability to speak. Two million dollars…that was not even close to what I had considered. In fact, up to this point, this whole thing was a lark, based solely on my respect for my wife's great sense of fashion. Hearing that number brought the whole thing crashing down for me.

We graciously thanked him for the meeting, suggested that we would be talking to him again soon, and left for the airport, in near-total silence…barely a word for the entire 5+ hour flight home. There was simply no way we could come up with that amount of money. It was a non-starter.

Two days later, Massimo called from New York. "The Prada family is coming here next weekend and they'd like to meet you."

What to do? We had agreed there was no way we could manage the finances needed to get the store going. But do you turn down an invitation from the hottest new designer in the world of fashion? Probably not. So we flew back, having no idea where the meeting would lead us.

They were cordial and greeted us warmly, altho Muccia maintained a sense of old-world reserve and propriety. Much of the conversation was Patrizio speaking brusquely in Italian to Massimo, who translated with great deference. Every sentence would start out with "Mr. Bertelli wants me to tell you," or "Mrs. Miuccia says that…" Miuccia's brother offered nothing but meek silence, which, as we later learned, was at east partially a result of Patrizio's overwhelming personality.

After about four hours of coffee refills and penciled notes, we shook hands on a deal. Were I less of a doctor and more of a businessman, it probably wouldn't have happened. As it was, we walked away thinking we had snared the deal of the century, and that we simply couldn't help but make a huge success. The terms were such that I felt that all we had to do was to come up with enough money to build out a store, and the sales would take care of everything else from there. I was blissfully unaware, or perhaps chose to ignore the fact that bills would need to be paid before enough sales had come in to pay them.

The most fortuitous part of our agreement was that, at our insistence, we would have the exclusive right for sales of the brand in Los Angeles County. There was no way we could compete with the big players in Beverly Hills retail. At the time, Prada was already carried in small amounts at Maxfield's, a very avante-garde fashion boutique, and at I. Magnin, an elegant women's department store. Because their agreements predated ours, they would remain exempt from our exclusivity.

Fortune was on our side. Amazingly, I Magnin went out of business shortly after we opened our store, and Maxfield's had so many other brands that they weren't that interested in carrying very much Prada. So it came to happen that our little store, around the corner from but not ON Rodeo Drive, became the only outlet for Prada in the entire county. I'm not sure that the company realized how large LA County was, but it meant that Saks, Neimans, and Barney's couldn't carry the line. We were IT.

Once the agreement had been reached, we were invited to go two weeks later to Milan for their first fashion show, to be followed by our ordering of merchandise for the store. Things were happening so fast…I couldn't believe that I was actually going to Milan, the epicenter of Italian fashion, to a real fashion show. Here I was, a doctor, a serious one, and although I had been interested in dressing nicely (for a guy) since college days, I never in my wildest dreams would have thought I'd be sitting on one of those little gold chairs at a real Milanese event.

The Prada headquarters at that time was a three-story house on via Melzi d'Eril, an elegant mostly residential street. The main floor had a few large rooms, one of which displayed the clothing on racks. The second floor had many interconnected rooms, lined by shelves filled with handbags of all sizes, shapes and colors. A smaller room was reserved for accessories; wallets, card cases, etc. The third floor, which was a nicely finished attic with dormer windows, was where the shoes were displayed.

There was a finished basement for offices and a lunchroom, where the most delicious home made food was served daily at communal tables. Lunch was my favorite time there, not just because it was so amazing, but because it was a life-saving break from the stressful, tedious, and exhausting process of gambling on our huge open-to-buy selection.

The fashion show took place on the ground floor. The larger rooms were lined with Charivari folding chairs, and the models strode purposefully around the different rooms as models do on the much more expansive runways we would see in the years to come: tall, skinny, elegant, with expressionless faces. The clothing that first season was to my unpracticed eye, unwearable. It seemed to be all about long tunics worn over short shorts. It turned out that customers pretty much agreed with that initial assessment…we sold almost none of it that first year.

After the show, we were invited by Miuccia and Patrizio to have dinner at their home on Via Porto Romano. This, we would learn later, was a rare event…they were exceptionally private people. The home was where Miuccia had been raised, and was a beautiful combination of traditional architecture and ultra-modern interior design. Brilliant contemporary painting, sculpture, and furnishings complemented the shelves of books. The Prada family lived elegantly and well. Their commitment to culture was everywhere.

A word about Miuccia background: she grew up as an intellectual and a member of the Italian Socialist party. Yet she dreamed of haute couture…Correges was one of her idols. This philosophical dichotomy has worked to shape her esthetic…many of her most elegant fashion statements hint at a proletariat, almost militaristic style, and her fabrics are often modern synthetics rather than silks and rich woolens, and sometimes trimmed with luxe furs. Conflict often produces beauty.

The buying process was pretty unnerving, and it didn't get mush easier over the next ten years. We were spending an enormous amount of money, gambling that our customers would like this new brand and like our selection of the merchandise from that brand. We ordered much more than our business plan had outlined, in an effort to carry more of what we knew was already selling very well: the backpacks and the quilted nylon chain bags.

We took out a second mortgage on our house to build the store. We had found a beautiful little 1600 square foot storefront boutique on Brighton Way, off Rodeo (and about 75% cheaper than the rents on Rodeo) and, as per our agreement, summoned architect Roberto Bacciochi, Patrizio's old school friend from Arrezzo to do the design. The exisitng space had a staircase on the left side, leading to a mezzanine around three of the walls, with beautiful skylights in the tall ceiling. We cautioned Roberto that we really wanted to do very little in the way of structural changes, just the necessary remodeling to make it look like a Prada store.

Roberto took the measurements carefully, made some sketches, then flew back to Italy to make the drawings. After about three weeks, Roberto returned and rolled out his blueprints with a flourish. "Ecco!" I immediately saw that my words of caution were never seriously considered.

"Roberto, you've got this wrong. The stairs are on the left side…you've drawn them on the right."

"No no, we must move them to the right side!" he said emphatically. I don't have a clue why that was, but we had agreed that Prada did have the right to design the store. I could see that this was going to be much more expensive than I had originally planned…the two million dollar comment was beginning to sink in.

Another expensive problem was that Roberto's drawings were all in the metric system. American builders need their measurements in feet and inches, so we ad to hire another architect, and American one, to transpose all those figures…at a substantial additional cost.

A third bunch of more expense came because all the shelving and furnishings were to be made in Arezzo and shipped to Beverly Hills for installation. And because the construction was taking so long, the opening of the store would miss the Christmas season unless we air-shipped all the construction, and paid for four of their carpenters to come and put it all together. I still have the mid-five figure FedEx bill somewhere in my files.

Despite all odds, the store opened its doors the first of December. That first very short season met its numbers, as did most of the seasons after that. And by the third year, the PRADA brand was becoming very respected among fashionistas and Japanese tourists. At times busloads of Japanese tourists would crowd the store. To avoid running afoul of the fire department regulations, we needed to lock the front door, only letting in a small group when an equivalent number of shoppers had left. And to avoid becoming totally dependent on our Asian tourists, we would let some of our regular locals in through the back door.

The success of the little store is still talked about amongst retail experts in the Beverly Hills area. Projections for retail sales are usually linked to the square footage of the store. Because PRADA was such a hot commodity, those projections were completely inadequate. We sold more merchandise per square foot than any other store in Beverly Hills.

I was even able to integrate the experience with my plastic surgery practice. Most times when I went to Milan for the collections, I would bring a small amount of Botox or filler with me. Models always needed something. And closer to home, I would give nylon make-up bags to my facelift patients with their before pictures and some skincare products in them at the three-week post-op visit.

All good things eventually come to a close. The restrictive clause in our agreement was preventing Prada's expansion in the community, and after some negotiations, they agreed to buy out the remainder our contract. We had an extraordinarily successful ten-year run, had worked and dined with famous and infamous luminaries at the highest level of the fashion world, and made some remarkable friends that I'm still close to today.

We did pretty well for novices, and obviously PRADA has done very well...I doubt there's anyone over the age of twelve in the country who hasn't heard of the brand. I'm proud and actually pretty amazed that we were there at the beginning, and were responsible for bringing the brand to Southern California.

Needless to say I have kept my 'day job' doing what I love and what I do best. PRADA continues to grow creatively and commercially; if you're interested in following their progress, here is the Fall-Winter 2015 Fashion Show, straight from the showroom in Milan.