Dr. Guimarães is a father of four and a cosmetic and plastic surgeon in the UK. He was trained in medicine and surgery in Europe. He has completed several fellowships specialising in reconstruction in Japan, Egypt, and Sweden. He has a passion for ethics and using a holistic approach when treating patients, and advocates for combining non-surgical and surgical ways to treat a patient. He is now focusing on his next project of the Integration of Longevity, Natural and Genetic Medicine with the Aesthetic and Cosmetic Surgery.
Could you give me a backstory on your career?
I went to med school in 1997, where I started my research MD as a European medical student. I studied at the University of Libre de Bruxelles in Belgium, and I finished my graduation with a master's in the science of medicine and surgery in 2006, in the University of Porto. I did a lot of fellowships, so I knew very early on that I wanted to do plastic surgery, so I ended up doing a couple of fellowships in that area. I was in Japan for three months, in Kawasaki City, doing reconstruction of ears, and it was a really good opportunity. I worked in Egypt as well for three months in a fellowship for reconstruction, especially face and hands. That was very interesting as well, very different from Japan. I did another fellowship in Sweden, in Växjö University, and it was more about the business side of medicine and design of hospitals. So a little bit more on the admin and managing side of things. I started my residency in Porto, in IPO, an oncologic hospital in plastic surgery in 2007 and I did, in plastic surgery, a couple of fellowships that I already mentioned. One of those was the hand trauma in Manchester's and in Burns in Manchester Children's and then that's why I decided to go back to the UK because my wife is a BICU paediatric doctor and she found it was very interesting to continue our careers in the UK. Since then, I did a couple of masters inside my field to make it a little bit more robust. I have a masters in laser, fellowship in cosmetic surgery, and another masters in microsurgery, specialising in hand reconstruction. Then I decided to change my career a little bit, and go to more of the private side of things, so I was trying to use the tools that I had from before and trying to mix the surgery and the non-surgical side of plastic surgery, aesthetic and cosmetic. I am the CEO of one of the companies I have. We have now 6 clinics, it’s more about health and wellbeing, and beauty.
When applying to university, what made you decide to do medicine?
I was completely in doubt when I got to year 10. I was divided between medicine and architecture. I wanted to do something related to art, but at the same time, the medical field or the science side of things was very appealing to me. So my dad had a friend who was a plastic surgeon and I spent a couple of days with him in summer and I got fascinated about plastic surgery and reconstruction and what we could do with the tissues and help patients. So that’s what made me decide to go to med school. A couple of summers after that, I was helping out in the back room, cleaning instruments at 6AM to try to have a little bit of a pick in theatres.
Why did you choose to be a plastic surgeon?
It was some way in the medical field that I could be more artistic, and not being very rigid on the type of techniques that we could use. This is what is amazing about this field, every patient is different, every problem is different, and the ways that the patients see that problem are different as well. We not only need to be someone who is there when patients have a problem, but also, we need to be there to prevent the problems and I think that that was lost in the last 10,15 years. I think there will be a challenge to go back to prevention and education of the population.
What do you like most about your job and why?
I think it’s the challenges. I think what makes me like medicine itself, is trying to have a holistic approach to someone's problem and having tools to actually solve the problem. Where other people may try to understand the problem, they may try to make the problems fade away, as doctors, we have the skills and the knowledge to solve problems. I think that’s very important, and we have the responsibility as well to try to avoid those problems in the first place.
What is most challenging about being a doctor?
The biggest challenge to expect for someone your age is that you’re going to work 10 times more, you’re going to spend 20 hours more doing your job than you’re supposed to. You’re then going to have 20 times more problems than any other person from your age group in a different career and after all that, people will not acknowledge that you need to pay your bills, your loans, your rent, your mortgage, your car. People expect that because you’re a doctor, you already have a lot of money so you don’t actually need to be paid. So you love your work and that is more than enough. The biggest challenge is yes, we love our work, but we need to have a balance between life and training and work. I think my generation has completely lost it, we work and work, without thinking about stopping. I will admit, I was trying to learn in A&E when I wasn’t supposed to be there, I was trying to be in theatre when I wasn’t supposed to be there. I think for your generation you need to get the balance back, to have some sort of life besides being a doctor, it is important to have a life. My advice for you and other students entering medical school is to keep the balance right.
Having experienced many other healthcare systems, what are the differences the UK has, what are your opinions?
The NHS has changed a lot in terms of how they deliver healthcare in the last 15 years. I think there was a lot of bureaucracy in the system that wasn’t necessary. That is my belief. It is still one of the best systems in the world, I completely agree. But, it is getting worse by the minute. There are other systems in Europe that are better, there are some that are worse. I think the systems that are better are the ones which still have the patients as the central piece in it, they are not centred on numbers and the economic part of medicine. So the Scandinavian are a little bit better, the southern mediterranean like Portugal, Spain, Italy, and Greece are improving. They are improving because they mix the private and the public sector, they’ve got the balance although there are still some issues. I think everyone should have the right to healthcare and so the American system does not really fit my beliefs. However, if you have great insurance, the Americans probably have the best system, because the money is there, and they will definitely do what is best for the patients. I love the Japanese way, I think when I was there, I found that there was the right balance. Things were done in a very patient-centred way. I felt that there was a good work-life balance even though I was spending long hours in the hospital. In Egypt I worked in both the private and public systems and there was a huge difference between the two. They were trying their best with what they had and it was a very different scenario and setting. I would say that I would love to have a system that is centred on patients. That would work without having numbers as targets and results, but instead the average of health in the population. Having more prevention, having doctors educating the public, having appointments without problems. That would be the system I would appreciate in the future and hopefully we will get there.
I read from your LinkedIn profile that you are ‘motivated to restore a healthier, natural happier, younger look’; do you think it is worse to refuse a surgery for someone who wants something that you think wouldn't look natural, than giving them what they want?
I have 3 rules that I tell the patient the first time I meet them. The first rule is, if we are doing something, whatever it is, it needs to have a long term positive impact on that person. I will not do something for now if later, the impact will be negative. The second rule is, it needs to be something that through the journey, it does not change who that person is. Obviously for a transgender patient, it is a different situation and a different concept. It needs to be something that looks as natural as possible and that will give the confidence back to that person. The last and most important one is that ‘no’ is in my vocabulary. So if I don’t agree, I will say no. Honestly, I think in most of the cases I say ‘no’, the people will come back to me and understand what I was trying to talk about - even if it takes a couple of years. Honesty is the most important. I might say no because I am not the right person to talk to, or I may say no because I don’t want to assist them in going down a certain path. I think as medical professionals we need at most, to know how to say no to people. We need to be the best advocates for that patient even if it means saying ‘no you should not have that’. I also said that everything needs to come from inside you. What I mean by that is that we need to support the patient to their best and healthiest point. We should not be giving them medicine to suppress a problem but rather understanding where it came from and why. We should be able to prevent, without drugs, using a holistic point of view. We should continue to explore areas such as stem cell therapy, diet, and gut health.
Could you tell me about the projects you are a part of?
One of the projects is longevity clinics, so one of the things that I think the future will be is you go to a doctor that will understand all the sides of having a holistic approach. They would look at wellbeing, diet, wellness, beauty, medical side, medication, food supplements, gut health, and trying to have a plan to make your life better and longer. Part of it is another project that I am also trying to push, having more stem cell treatments available for the patients. There is a lot of legal opposition and laws created by the pharmaceutical industry that do not allow us to use blood or body products in our cells. Something that I am proud of is mixing non-surgical with surgery. What I mean by that is doing facelifts with silicone tracts and fillers instead of a fat transfer. It is mixing all of the tools instead of just thinking one way. There is a lot of specialisation in our field and we need to know more about each other's fields. It is very important to talk to each other in between fields of medicine.
What do you wish you would have known at my age/ do you have any advice for people in high school wanting to go into medicine?
Since year 10 I have lost all my summers until I was in my speciality. I do not regret it because I did a lot of things and I enjoyed them. I would say that you need to use your time wisely to get to where you want to be, but don't use it only for your career. Use it for your own enjoyment of life. Travel the world, know different perspectives on medicine, know different perspectives on life, understand different cultures, understand different ways of thinking, and try to find that balance between the academic side and life into your normal schedule. It is important to have more than one dream and to have more passions besides the passion of medicine, that always helps. You will regret more not doing things than doing things.
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