Speaker 1 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today I want to welcome on the podcast Dr. Johan Brahme. He's a plastic surgeon here at La Jolla Cosmetic, one of the expert surgeons that we have on staff. Welcome Dr. Brahme.

Dr. Johan Brahme (00:31):
Thank you, Monique. Nice to be here.

Monique Ramsey (00:34):
So tell everybody, how did you find your way to La Jolla Cosmetic, and how long have you been with us?

Dr. Johan Brahme (00:41):
Okay. Well, I'm happy to be here, I must say. This has been the longest place I've practiced in my career. So I've been in practice for 30 years now, and that's 30 years after finishing my training. It's shocking. It happened last year and I was just going, "Oh, 30 years. Wow." And 18 of that I've spent with La Jolla Cosmetic Surgery.

Monique Ramsey (01:04):
Wow.

Dr. Johan Brahme (01:05):
So the first job I had out of my training, and the training was after medical school I did a full general surgery training, and then I did surgical oncology, which is cancer surgery. Then I did a year of hand surgery training, and then I did a full plastic surgery training. And then my wife said, "You've got to get a job now."

(01:34):
So one of the premier plastic surgeons in town asked if I wanted to join his practice. His name was Gary Nobel, and everybody loved him, and he was the guy in town, and I was so honored that he asked me to join him. But after a couple of months, it became clear to me that he just wanted somebody to share the rent. I thought he was going to be my mentor, but he wanted somebody to pay half the rent. I learned a lot from him nevertheless, and I was with him for two years, and my practice grew pretty quickly because I grew up in San Diego. I was born and raised in Sweden, but in high school we immigrated to San Diego, and I graduated from La Jolla High and went to UCSD and all that stuff. So I wanted to stay in San Diego.

(02:27):
But I grew, and so I built my own office over by Sharp Hospital, and I had my own operating room, and I knew nothing about business, and I had a great time growing my practice, and learned through trial and error and pain and happiness, and at some point I said, "I am really lonely sitting here in my office, just practicing by myself. I'd really like to be with somebody," because I'm a people person. So I joined Two Brothers, and I was with them for five years. And then in 2004, a position opened up at the La Jolla Cosmetic Surgery, which was in the same building as I was already. So I just moved down two floors and I've never looked back.

(03:29):
It has been the most satisfying professional experience for me, because I got to give up all the administrative hassles, and all of the management issues that I really didn't want to deal with anyway. I really just wanted to be a doctor and see patients and operate. And that's what I do now. And my practice has evolved, and my patients have gotten older as I've gotten older. I guess your clientele ages with you, but it's almost now like an old time family practice. Because I'm seeing patients that I saw 25 years ago and they're coming in, or they're bringing their children, or the children are bringing their mothers. So it's really fun.

(04:19):
And in difference from a regular medical practice where the doctor has five minutes to spend with each patient, I can take as long as I want. So I can sit there and talk to them about, "Oh, where's your daughter going to school now?" Or, "How was your trip to Italy?" I have the luxury of spending time, and I really like people, in addition to operating and all that, and we become very well acquainted. And my patients know me really well, and I know them really well. So I've been around long enough now that I have a lot of patients, but it's really fun. It's really fun.

(05:06):
That was probably more than you wanted to know.

Monique Ramsey (05:10):
Well, I'm going to ask more. So on your biography page on our website, there's the cutest photo of you as a little tyke. I don't know if you're two or three or something, and I think you're playing with a stethoscope. So what made you want to be a plastic surgeon, and when did you realize you were interested in being a surgeon in the first place?

Dr. Johan Brahme (05:33):
Well, my grandfather was a doctor. He was a GP in southern Sweden, in the third largest city in Sweden. And that was in the '20s and '30s and '40s. And then my father was a physician as well. He was a radiologist, and at his clinic in Sweden they had a lot of American visitors. And so they sort of lured him over here for a sabbatical year in the late '60s, and we all came and spent a year here, and I was in sixth grade and we loved it. We had a great time. It was in Indianapolis, and then we moved back to Sweden, and a few years later they called and said, "Would you like to come back permanently?" And we had a big family discussion and we had had such a great time before, so we said, "Great, let's do that." And my mother had several sisters who lived in the US, so we had family here too.

(06:46):
And so we immigrated in 1970 and lived for a couple of years in Indiana, and then the family wanted to move because the weather in Indiana is not the greatest, shall we say. So he had a choice to go from there to Philadelphia or La Jolla, and everybody voted for La Jolla, not surprisingly. And so we moved here when I was a senior in high school, and hard to believe that I have my 50th high school reunion this year. So we've been here ever since, pretty much. But I didn't really know that I wanted to be a plastic surgeon until I did cancer surgery, and I did mostly breast cancer surgery. And I saw the relationship that my patients, where I would do the mastectomy, and then the relationship that they developed with their plastic surgeon who really gave them their life back. And I said, "I want to do that. I don't want to do the removal of the breast. I want to give them that back."

(07:58):
And so I transitioned to plastic surgery, and the plastic surgery program at UCSD is really unique because we have a very active international program. So I got to go to Mexico and do a lot of charity surgery all through Mexico, and I continued that for many years after I finished. That was what it was all about. You just went down and did surgery for free on these patients who needed help, and that was wonderful. And then gradually, as most plastic surgeons do, they transition at some point in their life to more cosmetic surgery. And then when I joined La Jolla Cosmetic Surgery, I'm doing strictly cosmetic surgery now.

Monique Ramsey (08:50):
Versus reconstructive.

Dr. Johan Brahme (08:52):
We still do some skin cancer reconstruction and so on, but it's mostly aesthetic. Yeah.

Monique Ramsey (08:58):
And when you were doing the cases in Mexico, what types of cases would you be focusing on?

Dr. Johan Brahme (09:06):
It was everything from tumors to cleft lips and cleft palates. In the United States, you never see patients walking around with a cleft lip because they're all fixed by the time they're about three months old. In Mexico, I would see people who were 25 years old who'd never have their cleft lip fixed, and they were sort of shunned and outcasts. And to give somebody their life back, their lip, their face, it's just an amazing feeling. And so it was really a worthwhile thing. And the program at UCSD in plastic surgery had a lot of training at Children's Hospital, so we got a higher exposure to cleft lip and palate, and so even though we were in training, we were independently capable of going down and doing the surgery, which was really a gift.

Monique Ramsey (10:14):
So how would you describe your style of patient care?

Dr. Johan Brahme (10:20):
That's an interesting question. My style of patient care. I would say highly involved. I don't sell things. I listen to the patient, what their problem is. I may walk into a room for a consultation with a patient I've never met in my life, and they may have a huge nose, and they're saying, "Doctor, I'm really concerned about my eyelids." And, you know, it's about what they want to feel good. Occasionally somebody will say, "Tell me what I need," and I hate that question because people don't need anything. It's what bothers them. But my approach to analyzing is when I look at say a face, is there something about the phase that bothers me, that stands out, that steals the attention from the rest of the face? And so those things I think are really worth addressing.

(11:34):
There are some things that I will suggest, minor procedures like maybe lifting the lip a little bit, maybe putting in a little chin implant, or doing a little lipo. So yes, there are some things that I will suggest, but never assume what the patient's concerns are. I listen to them intently, try to figure out what it is they want, and also give them a realistic expectation of what they can expect. Because some people come in and say, "Well, I want to look like this." Well sorry. That's not the way your body is. I can make you look like this, but I can't make you look like that.

(12:19):
And that's something that comes with experience, because early in your career when you have less experience, you think you can do anything sometimes, and you find out very quickly that you can't. And so a lot of my time is spent managing patients' expectations so that they have a good idea of what they're going to get. And if a patient really has an expectation that's not congruent with what I can deliver, then I tell them that. I say, "I am not the guy for you." Because the worst thing is for me to do my very best work, have a nice result, and it's not at all what the patient wants. We've both lost then. And so fortunately, at this stage of my career, I can say to people, "I think you should see somebody else." And that's very liberating for me, and I think good for my patients too.

Monique Ramsey (13:30):
And in terms of procedures, what kinds of things do you love to do?

Dr. Johan Brahme (13:36):
Oh, I love it all. I really do. I love doing big body surgeries that totally change the way people look. I had a patient come in yesterday, and she's a year out from her breast and her extended tummy tuck. And she says, "This was life changing." She said, "I went from a size 10 to a size four. I love my body." So that's really fun.

(14:10):
Doing noses, very challenging, but very satisfying. When you take that splint off at a week, I've had patients just break into tears, say, "I never expected that this could be possible." To do a facelift on somebody who is maybe in their late 50s and competing for a job. We're working longer, we're healthier longer, we're in the job market longer, and to say, "This was life changing. I feel like I'm on par with my coworkers, and it's given me my confidence back," that's incredibly satisfying. The woman who was born with strange, funky looking tubular breasts, and to be able to give them something that's normal and pretty, that's an amazing feeling too. It's a blessing.

Monique Ramsey (15:20):
Now, thinking back a bit in your career, have there been any innovations or techniques that have been really influential for results of your patients?

Dr. Johan Brahme (15:33):
Well, you go to meetings, the big plastic surgery meetings where people talk about all the new things. And I think that if I were to pick one, I would say that probably fat transfer has made the biggest change in my practice in the last 15 years or so.

Monique Ramsey (15:57):
When you see your patients at their consultation for the first time, what can they expect from you

Dr. Johan Brahme (16:03):
That it's not going to be scary. Christina and I, and Nancy and I ... Christina and Nancy are my nurses, and they usually go in and talk to the patient first and get a feel for what they want, and then I come in and I try to connect with the patient as a person. Because that makes it interesting, I think, for both of us. I like to talk to people, and I like to find out what they do and what their passions are. And so we talk, break the ice a little bit, and then I let them talk about what bothers them.

(16:42):
And I usually spend about a half an hour with a patient, and if we're talking breasts, maybe we'll do some sizing. If we're talking noses, maybe we'll do some imaging, and then we sort of finish it up. I've been in practice long enough now that I know 90% of the questions that people are going to ask, so I sort of preempt that by going through everything. But every so often, somebody will have an interesting question afterwards. So we talk about that and I make sure that they're comfortable. And a lot of patients see multiple surgeons for consultations, and I always tell them that if it's their first consultation and they're seeing me, if you see other people and you have questions after it, feel free to come back and talk again.

(17:43):
Plastic surgery is not rocket science. It should be understood by any prospective patient. And if it sounds strange or too good to be true, it probably is.

Monique Ramsey (18:00):
That's a really good point. Last question for you is what do you like to do outside of the office? You mentioned you play music, so tell everybody what you like to play and what genre, what instrument or instruments.

Dr. Johan Brahme (18:16):
Well my grandfather was a doctor, as I said, and he was a consummate violinist. My daughter has his violins now. And he wanted to be a violinist, but his father, who was a farmer, said, "No, you're going to be a doctor." So he became a doctor. And my father was a near prodigy pianist, and he wanted to be a pianist, but his father said, "No, you're going to be a doctor." And I played rock and roll since I was in junior high, and I saw how difficult it was for musicians. So I didn't really want to be a musician. I wanted to be a doctor. But I've played music ever since junior high. Still do. Play guitar, play bass guitar. I have a band. And I'm also on the board of a group called Mainly Mozart, which is a classical musical production company that puts on concerts in San Diego. So I love all forms of music and performing and ... Yeah, that's my passion.

Monique Ramsey (19:26):
Your passion. Well, you're really good at it. Because I was fortunate enough to get to see you when the Aesthetic Society meeting was here in San Diego.

Dr. Johan Brahme (19:34):
Oh, yeah.

Monique Ramsey (19:35):
They did a party on the USS Midway for everyone, and had you, along with some of your colleagues from all around the US and the world, up on stage doing a whole concert for us. A whole jam session. And people were dancing, you were behind the bass, you were a guitar, you were on drums at one point, I think.

Dr. Johan Brahme (20:00):
No, no. Drums are not my ...

Monique Ramsey (20:01):
Okay, a bongo drum, something. You were hitting something.

Dr. Johan Brahme (20:03):
Yeah.

Monique Ramsey (20:03):
And do remember that. But it was really, really fun to see you enjoying that other side of your life. And I could just tell, as you mentioned earlier, you love making those transformations that bring people joy in surgery, but then you're also doing that when you're doing music. So that's a really wonderful gift that you have, and obviously the talent is in the genes.

Dr. Johan Brahme (20:32):
Yeah.

Monique Ramsey (20:32):
Well everyone, thank you so much for listening. Thank you, Dr. Brahme for getting to sit down with us and chat about who you are and your background. Is there anything else that I didn't ask that you might want to share?

Dr. Johan Brahme (20:47):
I love what I do, and I'll be doing it for a few more years, God willing. I have no plans of retiring quite yet. No, I feel like I love what I do, I'm at the top of my game, and I really love my patients, and it would be hard for me to end this at this point, so I've got more time to go.

Monique Ramsey (21:16):
Oh, good. That's good news. Thank you so much again, and we will see you all later.

Speaker 1 (21:27):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I5 San Diego Freeway in the XiMED Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com, or follow the team on Instagram @LJCSC. The La Jolla Cosmetic Podcast is a production of The Axis. the axis.io.