Dr. Siamak Agha, Plastic Surgery’s Nips and Tucks

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/01/26

Dr. Siamak Agha, a Cambridge-trained MD/PhD and pioneer in plastic surgery, has spent over 20 years transforming the field with innovative techniques like the three-dimensional facelift and high-definition tummy tuck. His research in gene therapy earned two international patents, and his surgical expertise was honed during a seven-year residency at the University of Pittsburgh Medical Center. As the founder of The Aesthetic Centers in Newport Beach, California, Dr. Agha caters to local and international patients, offering state-of-the-art care and virtual consultations for those seeking transformative, natural results. He has been featured in People Magazine, E News, Bravo TV, and Yahoo Entertainment. Agha shared insights on his holistic approach to plastic surgery, emphasizing the artistry and science required for optimal outcomes. He highlighted advancements like high-definition tummy tucks, circumferential thigh lifts, and innovations in three-dimensional techniques for natural results. Dr. Agha discussed AI’s potential in analyzing aging and the evolving patient trends toward refinement and natural aesthetics. Addressing scarring, cultural variations, and patient motivations, he stressed the importance of balance, patient-centered care, and realistic expectations.

Scott Douglas Jacobsen: Today, we’re with Dr. Agha, MD, PhD, from Cambridge University. You completed your residency at the University of Pittsburgh Medical Center. You are a board-certified plastic surgeon with over 20 years of experience. You specialize in aesthetic rejuvenation, breast reshaping, and body contouring. Is that accurate?

Agha: Absolutely.

Jacobsen: So, Dr. Agha, why did you specialize in plastic surgery?

Agha: It’s an interesting story. My father was an obstetrician-gynecologist and a devout Christian. He was always busy, and I rarely saw him. From an early age, I knew I didn’t want to pursue OB-GYN because I saw firsthand how he was never home.

However, I was exposed to plastic surgery during medical school and quickly realized how unique and versatile the field is. Plastic surgery is the ultimate form of general surgery. As a plastic surgeon, you perform reconstructive procedures, assist trauma surgeons, and collaborate with other specialists, such as cardiac and orthopedic surgeons.

Nearly every medical discipline may involve or require plastic and reconstructive surgery at some point. The ability to help people feel better about themselves, improve their self-confidence, and enhance their quality of life is immensely rewarding.

Plastic surgery is also incredibly comprehensive—genuinely “head-to-toe” surgery. We operate on the face, hands, breasts, body, and even toes. We incorporate elements of orthopedic surgery, soft tissue surgery, oncologic surgery, and more. It’s a fascinating field because it blends creativity with technical precision.

Jacobsen: What do you find most exciting about the field?

Agha: The constant evolution of the field keeps it exciting. New techniques and technologies are emerging all the time. Even after completing my formal training 20 years ago, I’ve had to stay up-to-date with innovations. There’s always something new to learn, whether it’s surgical techniques, advancements in transplantation, or minimally invasive procedures.

Jacobsen: Since completing your training, what are the most significant advancements in plastic surgery?

Agha: Plastic surgery has seen remarkable progress over the years. For example, hand and face transplants are now possible, which was science fiction just a few decades ago. These procedures require immense collaboration and expertise, but they’ve transformed lives.

We’ve also seen significant advancements in post-weight-loss body contouring surgery, breast reconstruction techniques after mastectomy, and minimally invasive procedures like injectables and laser treatments.

Another area of innovation is regenerative medicine. Plastic surgeons now use stem cell therapies and tissue engineering to restore form and function in ways we couldn’t before.

It’s worth noting that many people need to realize how integral plastic surgeons are to other fields. For instance, the first successful kidney transplant was performed with the help of a plastic surgeon. Plastic surgery is foundational to many life-changing procedures and continues evolving incredibly.

Jacobsen: That’s fascinating. Have you noticed other disciplines incorporating elements of plastic surgery?

Agha: Absolutely. For example, ENT (ear, nose, and throat) specialists increasingly perform facial plastic surgeries, such as rhinoplasty and facelifts. Dermatologists are also becoming more involved in aesthetic procedures, like Botox and fillers. While this collaboration is great for advancing patient care, it also underscores the importance of proper training and expertise in achieving the best outcomes.

You have ophthalmologists performing oculoplastic procedures, oncologic surgeons specializing in breast cancer and breast reconstruction, and other disciplines venturing into cosmetic surgery. But truly, a board-certified plastic surgeon is also a board-certified reconstructive surgeon. As you mentioned, numerous reconstructive advancements, such as hand and face transplantation, have been making headlines. 

Jacobsen: That brings us to the present moment. In many fields today, we see jargon terms thrown around, and artificial intelligence (AI) is becoming a major part of the conversation. For example, AI detects diseases through scans or images to assist medical doctors. How do you see AI influencing plastic surgery, particularly on the cutting edge of where the field might evolve through the rest of the 2020s?

Agha: AI plays a role, but it may take time to impact the surgical side of plastic surgery. Instead, AI will likely contribute more to understanding the process of aging and rejuvenation. For instance, AI can help identify genetic differences in how people age. Why does one person’s skin age faster than another’s? What nutrients or components do they need to maintain healthy skin, organs, and overall health?

AI will also help us understand the role of the microbiome and how it affects aging and general health. Right now, AI is geared toward analyzing the biology behind aging and how we can reverse or slow it.

Regarding surgery, the role of AI will depend on the advancements in robotics and whether patients will accept robots performing procedures. AI and robotics excel in some types of surgery, such as tumour removal, because they are more mechanical: determining precise dimensions and executing minimally invasive incisions to remove the tumour.

However, plastic surgery is different. It’s as much an art as it is a science. The artistic element involves making nuanced judgments based on cultural variations, aesthetics, and an innate sense of design and proportion. Unless we can teach robots that artistic sensibility, AI won’t fully replace the human plastic surgeon.

Artistic ability plays a major role in plastic surgery outcomes. Only some plastic surgeons may excel in that area. All plastic surgeons are trained to perform the surgery. Still, not everyone will become a great surgeon because the artistic element is harder to teach. Every surgery involves artistic decisions: shaping, proportioning, and contouring to meet the patient’s unique goals.

Jacobsen: Let’s discuss the artistic and cultural variations you mentioned. If you travelled to different regions, what differences in desired aesthetics would you typically observe?

Agha: Oh, there’s significant cultural variation regarding aesthetics. For example, in Korea, calf reduction surgery is very common. Koreans, generally speaking, may have more developed calf muscles, specifically the gastrocnemius muscles. A popular procedure in Korea involves resecting part of the muscle to create a slimmer calf.

In the Middle East, rhinoplasty is extremely common among men and women. Countries like Turkey and Iran are renowned for having some of the world’s top rhinoplasty surgeons, and the demand for nose-reshaping procedures is very high.

Even here in North America, I see cultural differences. For instance, when patients come to me for buttock enhancement, preferences often vary based on cultural background. My Latino patients, for example, often desire a lower, heavier buttock shape—what I refer to as the “J.Lo butt.” In contrast, my Caucasian patients typically want a more centrally heavy buttock, while my Black patients may prefer a different aesthetic altogether.

These preferences highlight how cultural beauty ideals can shape surgical goals, even for specific parts of the anatomy. It’s fascinating to see how diverse these desires can be.

It underscores the importance of understanding plastic surgery’s science and cultural artistry.

Jacobsen: That is super interesting. Has that trend changed much over your working years, or has it been fairly consistent?

Agha: No, it changes all the time. Right now, I’m seeing a significant shift in patient preferences. Many people are opting for implant removal and smaller breasts. The trend is moving from large breasts to smaller, more natural sizes. Similarly, there’s a shift from bigger to smaller buttocks, though patients still want them to look perky.

One issue with standard plastic surgery, which I have been working to evolve in my practice for the past twenty years, is that most procedures are treated as two-dimensional. In plastic surgery, you often lift and tighten, but humans are not two-dimensional.

We have vertical skin, horizontal skin, and projection, the third dimension. As people gain weight or age, their skin expands three-dimensionally—it stretches vertically and horizontally and increases in depth. However, most traditional plastic surgery techniques address only vertical or horizontal laxity. The third dimension, projection, is often overlooked, and there aren’t many methods to create it.

Most of my practice has been focused on incorporating that third dimension, especially for female patients. For men, this matters far less. Men generally want to look linear, masculine, and V-shaped and prefer a flat chest and a defined structure. They don’t want large breasts or prominent buttocks, so those procedures are relatively straightforward.

However, women aim to create curves, projections, and natural contours. We aim for a nice projection of the breasts, well-shaped buttocks, and overall balance. That’s where the third dimension comes in, and many of the procedures I perform focus on creating that three-dimensional result.

Jacobsen: So, what specific patients are coming to you for these days?

Agha: A big trend I’m seeing now is implant removal. When implants are removed, the breasts look flat because the implants stretch the breast tissue over time. Let’s talk about how implants work.

For example, when you place a large implant in someone with an A-cup or small breast, it stretches the breast tissue horizontally and vertically, but it also thins it out. Over time, the breast tissue becomes like a pancake sitting over a large implant. While this can look great for many years, removing the implant leaves you with a stretched, deflated pancake sitting flat against the chest.

If you approach this issue with standard techniques, you would typically remove the excess skin and pull the tissue together. However, this does not recreate projection; it flattens the tissue further.

I do breast reshaping instead. I take every element of the excess breast tissue and strategically pull it together. Imagine the breast tissue as a wide, stretched-out area. You create projection by narrowing the tissue, shortening it, and bringing it together in a specific way. It’s about reshaping and suturing the tissue to achieve depth, contours, and natural projection.

So it’s far more refined than standard lifting procedures. Anyone can lift a breast, but creating projection, depth, and shadows requires a specialized approach. That’s what differentiates my practice from others. Patients come to me specifically for these refinements because they know I can achieve superior results. I often get patients travelling from Canada, the UK, and other parts of the world for these advanced techniques.

My practice’s evolution focuses on pushing beyond standard procedures. It’s about lifting and creating natural projections, balanced proportions, and aesthetically pleasing results.

Jacobsen: When performing sutures, I assume one concern in surgery is the risk of scarring. How do you minimize the appearance of scars when performing sculpting and aesthetic procedures?

Agha: Scarring is an inevitable part of surgery. For instance, you can sculpt a patient using liposuction, but if the patient is older, has lost significant weight, or has skin laxity, the skin won’t shrink properly after liposuction. In such cases, you have to remove the excess skin, which means making incisions, which results in scars.

Scars are permanent—there’s no way around that. My philosophy is that since a scar is unavoidable, we should place it perfectly. Proper placement makes all the difference.

I position the scars meticulously when performing body or reverse gravity lifts. For example, I tell my patients, “I guarantee you’ll be able to wear a thong, and your scars will be hidden.” I ensure the scars are placed strategically. For a butt lift, I position the scar precisely at the junction between the lower back and the upper buttocks—exactly where a thong would naturally rest.

For a tummy tuck, I design the scar so low that it includes part of the pubic skin, allowing for a pubic lift. Patients often ask, “Will my scars be visible?” I respond, “Yes, when you’re naked and looking in a mirror or when your partner sees you. But otherwise, no—they’re positioned low enough in the pubic area to remain hidden.”

You can’t eliminate scars, but you can make them symmetrical, thin, and strategically placed at anatomical junctions. For instance, scars can be placed at the junctions between the abdomen and the thighs, the abdomen and the breasts, or the lower back and the buttocks. This careful positioning hides a significant portion of the scar, making it less noticeable.

When scars are well-placed and minimal in appearance, patients are generally more focused on the correction than the scars themselves. Scar placement and symmetry are critical. A jagged, asymmetrical, or uneven scar detracts from the overall result, and patients understandably don’t appreciate it.

Another philosophy I follow is what I call “naked beauty.” My goal is for my patients to look good when they’re naked. When they see themselves in front of a mirror, they should feel confident and say, “Wow, I look great.” That’s the ultimate aim of my work.

They may have an incision, but if it’s symmetrical, thin, and placed at the right junction, patients often don’t notice it anymore. 

Jacobsen: What about complications during surgery? I imagine they don’t occur often with skilled surgeons, but what types of complications might happen in rare cases when they do arise?

Agha: Complications depend on the type of surgery being performed. For example, facelift patients typically have fewer complications compared to someone undergoing their seventh or eighth breast surgery—and yes, I’ve had those cases. I’ve even had patients come to me for their ninth buttock or breast surgery.

In such situations, the tissues are disrupted and damaged multiple times, and the normal anatomy is distorted. This significantly increases the risk of complications.

One thing I’ve learned from my mentors—universal across surgical residencies—is the saying, “If you don’t want complications, don’t operate.” The reality is that if you operate on enough patients, complications will eventually occur. However, with proper training and experience, complication rates remain low.

During my residency, my mentor insisted that we know at least six ways to perform every surgery. Before every procedure, we had to write these approaches on a whiteboard and discuss them. This training instilled the habit of planning surgeries meticulously the night before, thinking through every possible scenario.

For straightforward surgeries like breast augmentations, complication rates are very low in the hands of a well-trained surgeon. However, revision surgeries or complex procedures like anti-gravity lifts inherently carry higher risks. These risks often depend on factors like the patient’s ability to heal.

Healing is incredibly individualized. Everyone’s ability to heal, fight infections, or recover from surgery varies. Healthy patients tend to heal better, which lowers the likelihood of complications. Larger surgeries, like full-body makeovers or extensive revisions, depend more on the patient’s overall health and ability to heal properly.

So, complications are not solely dependent on the surgeon’s skill and training. They also hinge on the patient’s ability to follow postoperative instructions and their body’s capacity for optimal healing. When all these factors align—skilled surgery, patient compliance, and good healing ability—complication rates are significantly lower.

Jacobsen: What about patients who might benefit from counselling or self-esteem support instead of surgery? For example, someone who wants a breast reduction, breast enhancement, or buttock modification for reasons tied to self-esteem. It’s their body, choice, and money in a private clinic. But have you ever encountered cases where counseling could have addressed their concerns instead of surgery?

Agha: Yes, that’s an important consideration. For some patients, plastic surgery might not be the best first step. If their concerns are primarily tied to self-esteem or emotional challenges, a conversation or counselling could help them gain confidence without surgery.

However, surgery can help others meet their personal goals and improve their quality of life. It’s essential to assess each case individually. During consultations, I spend significant time understanding why a patient wants a particular procedure. If I believe their motivations are not rooted in realistic expectations, or if surgery doesn’t truly address their concerns, I recommend taking more time to reflect or even seek counselling first.

For many patients, achieving their desired physical changes can boost their confidence and align their appearance with how they see themselves, positively impacting their lives. Ultimately, it’s about helping patients make informed decisions that suit their unique circumstances and goals.

Jacobsen: When it comes to plastic surgery, is there a conversation around who truly needs it versus those who might not?

Agha: Absolutely, there is. Some people don’t require surgery but still desire it. Fortunately, those cases are rare, especially in this country, where plastic surgery is a cash-based, self-paid service. It’s a luxury surgery. I always tell patients, “This is luxury surgery. Do you have to have it? No. Do you need bigger breasts? No. Do you need smaller breasts, a flatter tummy, or a brow lift? No.”

Most patients don’t need plastic surgery—they desire it. If they’re willing to pay for it and it will benefit them, then we do it. However, I sometimes have to say no if I believe it won’t benefit them, if the issue is minor, or if their expectations are unrealistic.

Jacobsen: So you turn people down?

Agha: Yes, I do. I have frank conversations with patients. I tell them, “The risk-to-reward ratio doesn’t justify doing a big surgery to achieve a very small improvement.” For example, just yesterday, I spoke with a physician who looked great already. I told her, “This will be a significant surgery for minimal improvement.” Ironically, she still wanted to move forward, and that’s her prerogative.

If patients feel strongly that the procedure will make them feel better about their body, improve their confidence, or help their relationships, it’s their decision. In those cases, plastic surgery becomes a quality-of-life decision.

Jacobsen: How would you define what is more necessary versus more frivolous regarding aesthetic surgery?

Agha: That’s a difficult question because these surgeries aren’t for me—they’re for the patients. If it makes someone feel good about themselves, helps them wear a bikini for the first time in years, or lets them feel comfortable being naked in front of their spouse, then it’s worth doing.

The more interesting question is this: What part of plastic surgery is “vanity surgery,” and what part is “quality-of-life surgery”? There’s a big difference.

Jacobsen: What would you consider vanity surgery?

Agha: Vanity surgeries are procedures like making a slightly smaller nose or slightly bigger breasts—changes primarily about appearance. However, some patients have a different story.

For instance, someone might come in after losing 200 or 300 pounds and have loose skin everywhere. They tell me they’re embarrassed to be naked in front of their spouse, they haven’t had a sexual relationship in over a year, they experience chafing, or they even deal with skin infections.

When you remove that excess skin, it’s life-changing. People feel confident, start dating at 55 for the first time, or their marriage improves. These are real stories I’ve witnessed. That’s not vanity surgery anymore—that’s quality-of-life surgery.

Jacobsen: That’s powerful.

Agha: It is. These procedures have a profound impact on people’s lives.

Jacobsen: Let’s talk about how you approach plastic surgery differently.

Agha: Right now, plastic surgery, as it’s traditionally trained in residencies, is still largely two-dimensional. We’ve evolved those techniques to focus on creating projection, profile, and a true three-dimensional result.

For example, when patients come to me for a mommy makeover, most people think that means breast surgery and a tummy tuck. I don’t look at it that way. I don’t look at patients as just a list of procedures.

I focus on what we can do to create a more refined version of the body. Often, I assess the patient holistically—the front, back, and sides—because patients tend to fixate on their front. However, the sides and back are integral to the overall result. For example, if someone looks great from the front but their sides are too wide or too full, it will affect the overall appearance.

My philosophy is 360-degree enhancement and refinement, especially for the female body. I emphasize creating projection, curves, and fullness where desired. Over the past 20 years, I’ve worked to evolve various surgeries to achieve this comprehensive approach to shaping the body.

Jacobsen: American television, and even Canadian to some extent, is filled with doctor-focused talk shows. Shows like The Doctors are popular. Do these shows accurately portray plastic surgery in terms of how it’s done, experienced, and its overall impact?

Agha: Not at all. Shows like these are designed for entertainment, not education. Television prioritizes drama. They focus on patients with dramatic backstories because that keeps audiences engaged. The surgery is often just one aspect of the show, and the storytelling takes center stage.

My issue with these shows is that you rarely see the truth after. You’ll see the patient’s “before” story, the drama around their life, and perhaps a glimpse of the immediate postoperative result. But you don’t see the patient three or six months later or how the surgery impacted their long-term life.

Plastic surgery is about transformation, and that transformation takes time. Television doesn’t show that—it’s not about educating people; it’s about selling ads.

Jacobsen: That’s a good point. Television is ultimately a business, and producers decide what makes the final cut.

Agha: The goal is ratings and revenue, but it does not accurately depict the field.

Jacobsen: Do you have any final thoughts or reflections on our conversation today?

Agha: I’d love to talk more about aging.

Jacobsen: Sure, let’s dive into that—it’s a great topic.

Agha: Thank you. Aging is something we see more and more in my practice. Many patients start with facial work as they age—facelifts, for example. They often have already had breast and body work done, such as a mommy makeover earlier in life.

By the time they come to us, especially those travelling from out of state or overseas, they’re not looking for basic breast or tummy procedures anymore. Instead, they present with an aging body that no longer matches their face. For instance, they may have a beautifully rejuvenated face, but their body shows signs of aging.

This mismatch can be particularly frustrating for patients and is a common issue. Since many plastic surgeons don’t perform larger, more comprehensive body refinement surgeries, these patients often come to us for solutions that involve addressing the entire lower body.

Jacobsen: So, your practice is seeing a demand for full-body refinement surgeries to complement previous procedures like facelifts or breastwork?

Agha: These patients want their bodies to reflect the same level of youthfulness as their faces. It’s about achieving harmony between all aspects of their appearance.

Regarding those surgeries, I often perform some of our pioneering procedures, such as the circumferential thigh lift. This procedure lifts the thigh’s front, outer, and sometimes inner aspects while incorporating buttock refinement, lift, and sculpting. It’s designed to rejuvenate the entire lower half of the body.

I want to highlight this because many people aren’t even aware of these procedures. Traditionally, these surgeries were reserved for patients who had significant weight loss and excess skin. However, more and more, I’m seeing patients seeking body refinement—thigh, buttock, and overall lower-body sculpting—not because of extreme skin laxity but because they want a body that matches their face, aspirations, goals, and self-esteem.

By combining comprehensive procedures—such as the circumferential thigh lift, butt lift, sculpting, tummy tuck, and high-definition tummy tuck—we can achieve these goals for patients.

Jacobsen: High-definition tummy tuck? That’s interesting. What is it?

Agha: Of course. A high-definition tummy tuck is a procedure I pioneered in 2007. I submitted the technique for publication in the Plastic and Reconstructive Surgery Journal to share it with other surgeons, but it wasn’t accepted. As a result, I trademarked it instead.

The concept behind the high-definition tummy tuck is to create a natural-looking abdomen. In a standard tummy tuck, the skin is completely lifted off the muscle, releasing all the attachments between the skin and the muscle. While this smooths the abdomen, it also eliminates the natural contours and shadows that define a toned abdomen.

We preserve those natural attachments with the high-definition technique, allowing the skin and fatty tissue to maintain their original placement. This preservation creates a natural appearance with defined contours and shadows, giving the abdomen a more athletic and aesthetically pleasing look.

Jacobsen: Does the technique maintain the natural structure rather than flatten everything?

Agha: Exactly. By preserving these attachments, we avoid the overly flat, unnatural appearance that sometimes results from traditional tummy tucks. The high-definition tummy tuck delivers a more sculpted, realistic outcome that aligns with the patient’s body shape and aesthetic goals.

Jacobsen: Thank you for the opportunity and your time, Dr. Agha.

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