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Perseverance, Problem Solving, and a Patient-First Philosophy

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LOUISVILLE If you have preconceived notions about plastic surgery, you should check those at the door before stepping into the practice of Dr. Banis Plastic Surgery. This is not one of those glitzy, high-gloss, Hollywood nip-and-tuck practices often portrayed on TV. Joseph Banis, MD, admittedly, is not a showman. In fact, at the heart, he is a family practice man who was drawn to the precision and problem-solving of reconstruction and microsurgery.

Having practiced the whole of his career, some 30+ years, in Louisville, Banis’ longevity is, in part, attributable to his ability to adapt. At a time when many of his colleagues are retiring, Banis continues to operate and take on difficult cases because no one can or is willing to do it quite like he can.

Ironically, Banis grew up in southern California, the unofficial plastic surgery capital of the United States, intending to pursue family practice. “Once I got going, I realized I really needed to be a surgeon,” says Banis. He attended medical school at the George Washington University School of Medicine in Washington, DC, and did an internship at Los Angeles County/USC Medical Center, one of the busiest in the country. He intended to pursue his residency in ear, nose, and throat surgery at UCLA but changing program requirements meant his “rotating” internship did not meet the surgical internship requirement.

So, Banis followed the advice of a friend and went to the University of Hawaii in Honolulu to do a year of general surgery training under Dr. Thomas Whelan. “My first rotation was in plastic surgery and I absolutely fell in love with it,” says Banis. At the end of his year, Whelan asked him to stay on for four years, and he did and completed his general surgery residency.

Banis then traveled to Eastern Virginia Graduate School of Medicine in Norfolk, Va., for his plastic surgery residency. “Midway through my plastic surgery training I had an opportunity for a fellowship with world-renowned microsurgeon Dr. Robert Acland at the University of Louisville (who recently passed away) and learned the technique of microsurgery, a field that at that time didn’t exist. I was right on the frontline of this brand new superspecialty,” says Banis. After completing his residency in Virginia, Banis returned to Louisville to work in the new microsurgery program. He was on staff at U of L from 1981 to 1995, when he left to start his own private practice. He has had several partners over the years, but has been on his own since 2010.

Adapting for Survival

Banis describes plastic surgery as “two totally separate but integrated spheres” – reconstruction (for congenital defects, trauma, cancer, and functional repair) and cosmetic surgery. In the early days, Banis’ practice was almost solely focused on reconstructive and microsurgery. “I love problem solving. The older I get, the more I realize why I’m in this specialty. It’s all about figuring things out in real time,” he says. “Every other specialty works with situations where they open a wound, and they can close it. In our specialty, we are asked to close things that previously could not be closed.”

However, over the last decade Banis’ practice has transitioned from reconstruction to the aesthetic. Abbey Helton, BSN, RN, a plastic surgery nurse and Banis’ de facto office manager, estimates, “When I joined him 17 years ago, he was probably 90 percent reconstructive and 10 percent cosmetic.” Today the practice is 80 percent cosmetic and 20 percent reconstruction. This is the trend in plastic surgery and not unique to Banis. “You can barely sustain yourself with the economics of what the reimbursement on reconstruction is,” says Banis. While only 20 percent of his revenues are from reconstruction, he estimates it takes 40 percent of his time.

One thing that has remained constant is Banis himself, says Helton. “Our whole team works really well together. There’s a very good synergy. We see how much his patients mean to him and how much he means to them,” she says.

Perseverance is Paramount

If Banis could name the most important trait that has contributed to his success, it would be perseverance. “One thing my dad taught me, and my mom, is you don’t have to be sharpest tack in box, but if you have a lot of tenacity and perseverance, you’ll beat most problems,” he says. It’s a trait he believes all great physicians have, and it’s something he looks for in patients as well.

In November of 1988, 50-year-old Dale Klaber was a heavy equipment operator. He always ran the remote-controlled tower crane from a small four-foot-by-four-foot cabin set high up on the edge of the building. On this particular day, the wind was gusting 30–35 miles per hour. Klaber had a big elevator panel on the hook and was waiting for someone to come get it off, but a strong gust of wind picked the panel up and launched it into the cabin above Klaber’s head. “I was on the ninth floor. It knocked the cabin and me off of the building. I was falling headfirst 90 feet to the concrete,” he says.

Although it sounds unthinkable, Klaber’s life was saved by 1 1/8-inch rebar sticking out of a column. Banis, who was on-call in the emergency room, remembers the case vividly. “He fell at an angle where it went through his face first and then went underneath the skin of the chest and then exited his groin, missing the internal chest – heart, lungs, abdomen – which would have been critical. He used up five of the seven feet of the rebar. That friction stopped him. If he had gone another two feet, his skull would have been crushed against the concrete,” says Banis.

Klaber’s nose, part of his lip, and his jaw bone were torn off by the rebar, but part of the tissue was recovered at the scene and brought to the hospital. Banis proposed something experimental – burying the facial tissue in his arm and reattaching it to his blood supply so they could transplant it at a later date. Klaber says Banis initially told him there was only a 10 percent chance it would work, but Klaber replied, “Now listen, for some people it may only be 10 percent but with me it’s 90 percent at least.” The tissue stayed in Klaber’s arm for six weeks, and, sure enough, it survived.

Banis knew it would take years and numerous surgeries to repair Klaber’s face. “I tell the family the biggest thing is persistence, not losing heart, and the determination to get through it,” says Banis.

Following the accident, Klaber was in the hospital for 28 days and went back to work on the same crane within 90 days. In the first three years, he had an uncounted number of procedures. He would have surgery on Friday and go back to work on Monday. Banis credits Klaber’s attitude for his successful healing.

Of Banis, Klaber says he always asked his opinion on what should be done and followed through. “I think that goes a whole lot to the trust. You have to trust your physician that he can do what he says he can,” says Klaber.

The Puzzle of Problem-Solving

Mary Romelfanger is a gerontological nurse and the associate director of the U of L Institute for Sustainable Health and Optimal Aging. In fact, Romelfanger was interviewed for the cover story of MD-UPDATE Issue #97 on the Institute, but here, she is the patient.

Romelfanger was referred to Banis six years ago for a very rare genetic problem called Brooke-Spiegler syndrome, a condition where tumors grow on skin and skin appendages, such as hair follicles or sweat glands. There are three types of tumors: spiradenomas and trichoepitheliomas, which can be removed by laser, and cylindromas, which must be removed surgically. The tumors most commonly occur on the head and neck, and while typically benign, they can become malignant if not removed. Cylindromas are the most aggressive and disfiguring of the three types.

For 25 years, Romelfanger had surgery once or twice a year to remove the cylindromas from her scalp at the earliest stage possible, but each surgery created more scar tissue, making it more difficult to find healthy scalp tissue to close the wounds. This year, when Romelfanger visited Banis, he proposed a radical approach – “to resect the scalp or remove down to a certain layer, below where the hair follicles start. Ostensibly, you remove the tissue from which cylindromas arise,” says Romelfanger. After Romelfanger got over the initial shock, she researched the procedure and got a second opinion, all of which supported Banis’ proposal.

“Mary gets into the problem-solving aspect of plastic surgery. I’ve never seen the problem Mary presented with. I’d barely even heard about it. There’s no written standards for this,” says Banis. Romelfanger’s first surgery was the resection on February 19, 2016. Three days later she went back into surgery for a tissue graft from her buttock. However, Banis was not able to get enough tissue to cover the entire scalp, so a week later he performed a tummy tuck to complete the graft.

Banis says Romelfanger is a good example of the interconnectedness of everything in plastic surgery. During her scalp resection, Banis actually performed a formal brow lift, something she had been considering. “It was dealing with the physiology, the psychology, the aesthetic, how the aesthetic merges with the reconstructive, and wound healing,” he says.

Romelfanger, whose grafts have healed almost completely, says, “It’s been a partnership with Dr. Banis to work this through with the endpoint being I can go back to my work and function normally and nobody will know what has transpired.”

Putting Patients First, Always

Patient-centered care is one of the buzzwords of 21st century medicine. For Banis, putting patients’ needs above all else has long been his guiding principle, and one that spans both sides of his practice. “Contrary to what the popular thought may be, for me, plastic surgery is not about procedures. It’s basically about identifying what the patient really wants and needs – those are two different things – and it’s about satisfying the patient,” he says.

Rather than always being procedure-oriented, Banis believes in taking the time to listen to patients. On the cosmetic side in particular, he describes what he does as “psychosurgery,” satisfying a psychological need. “Cosmetic surgery is often trivialized. Breast augmentation is probably the most trivialized operation, and yet it is extremely important psychologically to women,” contends Banis.

Tammy York Day, chief operating officer for Delta Dental, had been friends with Banis for years before turning to him for help on her weight-loss journey. Day had always been athletic but went through a period where she became very overweight. Halfway through her 80-pound weight-loss journey, she went to Banis for help.

“One of the things that I appreciate so much with him as a doctor is he really gets to know you as a patient and really understands what it is you’re looking for, what you need, what your capacity is, and helps you understand it. I was still 40 pounds overweight, but liposuction spurred me on and really gave me the motivation to tackle the rest,” says Day. Banis cautions that performing liposuction before patients reach their ideal weight is not the best approach for everyone. Again, it’s all about an individual approach.

Day is also a client of Banis’ medical skin care practice and returned to him when she was ready for surgical intervention to lift the skin on her chin and neck.

For Day, plastic surgery has simply been a means to get her outside to match her inside. “To me, my appearance did not represent how I felt internally, and that was part of that journey,” she says. “I wish as a society it was championed to do the things that make you your best, whatever that is for that person.”

The Safety Clause

As much as Banis prioritizes patients’ needs and wants, he will not sacrifice safety to meet them. “I’ve known Dr. Banis to turn patients away if it’s not the right thing to do,” says Helton. One example is smoking, which Banis uses to barter with patients to get them to quit. He’ll tell them, “I can’t do your facelift, because it is too dangerous if you’re smoking.”

For Banis, his practice is a perfect world. “I think I’ve merged my family practitioner personality with plastic surgery because we’re always talking about fitness and weight loss and health.… So much of life is motivation and self-confidence, and for me, this is where it all comes together in this office,” he says.

At that convergence of tenacity, technical prowess, and helping people be their personal best, Banis has set the bar for plastic surgery with a real-world purpose, and he isn’t going anywhere anytime soon. “That’s why I can’t stand the thought of retiring. I do think I’m as good as I’ve been. I do think I’ve gotten better, and I don’t want to waste that,” he says.