Arlington, Texas Board Certified Plastic Surgeon
"I work with my patients one-on-one to understand their goals and formulate a realistic plan to achieve them."
James W. Ward, M.D. has been in private practice in Arlington, Texas since 1985 and is a certified Diplomate of The American Board of Plastic Surgery.
He provides a wide range of cosmetic surgery procedures, specializing in cosmetic and reconstructive surgery of the breast, abdominoplasty (tummy tuck), body contouring, and facial rejuvenation.
Dr. Ward is a graduate of Texas Christian University (B.A., Biology). He received his M.D. degree from the University of Texas Medical Branch in Galveston, Texas in 1979. He completed General Surgery training at the University of Texas Health Science Center in San Antonio in 1982, followed by Plastic Surgery residency at the University of Texas Medical Branch in Galveston. There, he served as Chief Resident of Plastic Surgery from July 1984 through June 1985.
Dr. Ward is currently President of the Medical Staff at USMD Hospital at Arlington (2012 – 2014), having held that position from 2006-2010 as well. He also served as Chairman of the Department of Surgery at Arlington Memorial Hospital (2000-2002). In 2010, he was voted a top doctor by a panel of physicians for the annual publication, "Top Docs in Tarrant County."
Dr. Ward holds active memberships in the American Society of Plastic Surgeons, American College of Surgeons, Texas Society of Plastic Surgeons, Texas Medical Association, Tarrant County Medical Society, and the Fort Worth Society of Plastic Surgeons. His hospital affiliations include USMD Hospital of Arlington, Arlington Memorial Hospital, and the Medical Center of Arlington. A native of north Texas, Dr. Ward resides in Arlington with his wife and two children.
A Conversation with James Ward M.D.
Dr. Ward, how did you decide to become a plastic surgeon?
I wanted to be a doctor from the time I was in high school, having a strong interest in the sciences and in anatomy. In medical school, I soon realized that I was drawn to the immediacy of surgery: there’s a procedure that can be identified and done and it can be life changing. In my plastic surgery rotation, I found that I was in the right place. They let me do a lot of surgical procedures and I came to understand that there’s a great deal of diversity within the plastic surgery specialty: a wide range of procedures and a mix of cosmetic and reconstructive work that feels right to me.
Plastic surgery is a highly visual specialty. You can see the problem, make a diagnosis, develop a treatment plan, and correct the problem. It’s straightforward, and yet it requires tremendous precision and the ability to know what will yield the best outcome for each patient. It's not like removing the appendix: every face and every body are unique and every patient is unique as a person. It makes doing both cosmetic and reconstructive surgery challenging and highly rewarding.
What differentiates plastic surgery from cosmetic surgery and reconstructive surgery?
Plastic surgery encompasses both cosmetic and reconstructive surgery and we perform a wide variety of plastic surgery procedures in our practice. Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. Cosmetic surgery is usually not covered by health insurance because it’s elective. Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It's generally performed to improve functions, but may also be done to approximate a normal appearance. Reconstructive surgery is generally covered by most health insurance policies, although coverage for specific procedures and levels of coverage can vary greatly.
I will point our here that there are a number of "gray areas" in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involve surgical operations, which may be reconstructive or cosmetic, depending on each patient's situation. For example, eyelid surgery (blepharoplasty) - a procedure normally performed to achieve cosmetic improvement - may be covered by insurance if the eyelids are drooping severely and obscuring a patient's vision. Certain reconstructive surgical procedures, such as breast implant removal, may also be covered.
What is your focus during a consultation with a new patient?
I don't have a patient coordinator in part because I want to do consultations with new patients myself; I don’t want to put that responsibility into the hands of anyone else. It’s important to me that I am the one who talks directly with patients, finds out what concerns them, and enables them to make an informed choice, because I’m the one who will be performing the surgery. I’m the doctor, and I want to earn their trust, make sure they get correct information, and determine which options are best for them to consider.
Communicating one-on-one with new patients also enables me to ask the questions needed to understand their goals and then formulate a realistic plan to achieve those goals. Essentially, my goal is to establish a good rapport with my patients. Each is unique, and each person’s appearance goals are specific. They deserve more than generalities. Time spent in consultation is well spent: the patient has time to ask questions, we have time to discuss choices, and that equips me to develop a plan of treatment that will serve them well.
What are the advantages of having plastic surgery in a hospital setting rather than an outpatient setting?
All of my surgical procedures are done here at the USMD Hospital at Arlington, which is a fully accredited, physician-owned surgical facility that specializes in outpatient and short-stay, inpatient surgery. Only board-certified physician anesthesiologists provide anesthesia, which means my patients receive the best possible care in that regard, as well. In addition, each patient is monitored in a fully staffed post-anesthesia care unit by highly trained medical staff. Our facility works closely with Press Ganey, the renowned organization that conducts patient satisfaction surveys for hospitals throughout the country. Our scores are always 95% or higher, making us one of the best in the country for offering a superior quality of care, and we take pride in that.
Because we're a physician-owned hospital, we are personally invested in identifying and correcting any deficits in our facility. If something isn’t up to par, we address the issue quickly and resolve it so the standard of care remains high. Also, it's not a cold environment: it's an upscale facility that allows me to offer my patients the aesthetics of an outpatient office setting with all the advantages of a hospital.
The combination of a state-of-the-art fully accredited facility and the most qualified medical professionals means an unsurpassed level of safety and quality of care for patients - before, during and after surgery. They go through a pre-assessment with one of our nurses, who does a checkpoint health workup to make sure they are physically equipped to undergo a surgical procedure. I find that the whole set-up is a tremendous comfort to my patients - knowing that they are in the best hands and in the safest possible environment, and knowing that I take their surgical experience as seriously as the results I want them to have.
How do you define beauty or physical appeal?
In essence, what’s most important here is to understand how my patient defines beauty, which I derive from how he or she defines looking good. There are objective measures, of course, such as symmetry and a balance of the facial features or parts of the body. A harmonious balance, in which no one feature or part of the body overwhelms the others, enhances physical appeal. And it’s a fact that the human eye is definitely drawn to symmetry.
Sometimes a patient isn't sure what’s "wrong;" there's just dissatisfaction with an aspect of his or her appearance that troubles them and a desire to correct it. For instance, I see many patients who come in asking for breast implants. During the consultation, I often find that my patient’s dissatisfaction lies not with size of her breasts but with the position of the breasts on her body. For women who are comfortable with the size of their breasts, but unhappy with sagging, a breast lift will solve the problem, rather than breast implants. Educating patients to understand what they are seeing and how the problem can best be addressed is an important part of the consultation process.
Are patients more educated these days about their cosmetic surgery options?
Yes and no. Certainly, people shop around more now than in the past and they feel comfortable exploring the Internet to learn about their cosmetic surgery options. And it’s true that some of the content available online these days is excellent. However, it’s also true that there’s a good deal of misinformation on the Internet and that can, and often does, cause confusion. Some of the cosmetic surgery message boards are an example of this, because many post-surgery patients use these forums to write about their experiences. The problem is that each person’s circumstances are unique and what one individual experiences before and after surgery often has little to do with what another person can expect to experience from the same procedure.
The Internet also has a good deal of content about the so-called "new" or "best" cosmetic techniques or procedures, but much of this information is put there by companies who have an agenda – to sell a particular laser, for example. Just because something is new doesn’t mean it’s better; in fact, in many cases it isn’t.
What is your stance on new procedures and technologies that we learn about in the media? Do you offer your patients the latest techniques?
There’s always something new that comes along and gets picked up by the media and it’s no different in the plastic surgery arena. My view on the hype about the latest and so-called best new thing is that it goes through predictable phases. I call the first the zealot phase, when the manufacturers of a new product or laser put their reps out there to sell it. They make claims about what it can do, and many consumers run out to get it, but over time it becomes clear that what’s being sold isn’t all they say it. Then the next phase – call it a plateau phase - kicks in, when the value or usefulness of the procedure or piece of equipment finds its level (usually about 50% or less of what was originally intended) and people become disenchanted.
Some doctors, who have invested in expensive equipment, will continue to offer it and others stop because they don’t like the results they’re getting. For many of these things, the third and final phase arrives when the media hype is over and you just stop hearing about it completely. Why? Because most doctors are no longer offering using the product or procedure and eventually it disappears from the marketplace. Of course, the next "new and best" thing always comes along and the process starts all over again. Classic examples of this are Endermologie and thigh creams – products that claimed to do away with cellulite, but had no actual value. If it doesn’t work, it shouldn’t be used and if it hasn’t been thoroughly tested it shouldn’t be offered to patients. That’s the bottom line.
I often say, "If you want the newest gizmo on the market, I’m not the doctor for you." New technologies emerge all the time, but I’m a scientist and a thorough researcher. I’m also a pretty conservative guy and don’t feel a compulsion to be the first one on the block to offer the so-called new best thing. Until I see the efficacy studies and know that a procedure or product actually works, I’m not going to use it on my patients. I tell my patients that I do what’s "tried and true," because I’m interested in what’s actually going to work for them, not in what the media tells them they should ask for.
Give us a few of your thoughts on 3 or 4 procedures you perform most frequently.
Sure. Many of my patients are in their 30s and 40s, have had their babies, and are reclaiming their pre-baby bodies by choosing tummy tuck and breast enhancement surgery. They want to feel good about the way they look and they make a commitment to that, which I respect. I’m also seeing a lot more women in their 50s who are choosing breast implants. Fifty is young these days for those who are healthy, and many of these patients feel they have the resources and time to do something nice for themselves. Silicone implants are chosen by 9 out of 10 of my patients, because they give a natural, beautiful result and exhaustive studies have proven that they pose no health risk, despite the critics who continue to argue to the contrary.
The mini tummy tuck is overestimated, and is suitable for only a narrow range of patients – those with a small amount of excess tissue. It’s a simple matter of geometry. To remove a significant amount of excess skin that goes from one side of the waist and abdomen to the other requires a traditional tummy tuck in order to taper the mid-body in a way that gives you a desirable result. If you’re going to have elective surgery, it’s only appropriate to do the procedure that will give the best result.
Finally, for those who aren’t ready to commit to a surgical procedure but want to look and feel more refreshed and youthful, facial fillers give an excellent result. Patients often ask about permanent fillers, but the few that are out there can be problematic and if you don’t like the results, you’re stuck.
The best fillers are hyaluronic acid-based. Why? If you decide you want your lips to be smaller, you can have less filler put in the next time around – you don't have to live with a result that doesn’t please you because the hyaluronic fillers are very forgiving and will dissolve over time. Hyaluronic acid is a substance that’s found in the body already, so it's well tolerated, gives a great result, and allows you to adjust the volume to decide how much or how little is required to get the desired outcome.
Among the awards and prestigious positions of your career, what do you consider to be the most significant achievements?
When I think about achievements, I think about the fact that each day I think about how I’m going to practice the very best medicine possible and to take good care of my patients. And I think about how I’ve earned the trust of my patients who, in turn, refer their friends, co-workers, and family members to me. I consider playing a part in the care of breast cancer survivors - with the breast reconstruction part of my practice - to be one of my most meaningful achievements. To that I would add my 30-year marriage (and counting), and being able to stay out of the way while our twin daughters grew from cute little kids to beautiful, intelligent young women.
Thank you so much, Dr. Ward.