Since 1995, Dr. Sam Assassa has been exclusively practicing aesthetic medicine in Beverly Hills, California. He is an associate member of the American College of Physicians, a member of the American Mesotherapy Association and the American Academy of Anti-Aging Medicine as well as serves on the advisory committee of the American Aesthetic Medicine Association. He is also a member of the American Society of Aesthetics and Mesotherapy (ASAM) and lectures on aesthetic techniques at ASAM's conferences worldwide. Dr. Assassa is board certified in internal medicine and received his medical degree, with honors, in 1980, then held a series of internships and residencies in Chicago at Loyola University-affiliated hospitals, and in Cleveland at Case Western University-affiliated hospitals.

Dr. Assassa was in Bulgaria for a course led by the country's ace Dr. Nikolay Serdev.

Sam Assassa talked with SNA Deputy Editor-in-Chief Petya Bondokova.

Q: Where does non-invasive surgery stand at the moment?

A: First of all, medicine is always developing, and that's what's nice about it. The more you learn, the more you like it. In aesthetic medicine in particular things are developing so fast. Even the same techniques that we used a year ago have actually improved. It's just because you always look to improve your technique to improve the results.

Why am I here? We're here with Dr. Serdev, he's very well known for his technique and sutures. The beauty about his skills is that he thinks in three dimensions. It's very hard to see things in thee dimensions. That's his forte.

Q: Could there be any risks to non-invasive aesthetics surgery that have not been studied well?

A: When you do a procedure in non-invasive, or let's call it minimally invasive surgery, you have to understand what you're doing. Know your enemy, understand what the problem is, analyze it and try to find a solution. That's how you come up with ideas for new techniques and procedures.

I think we're still in the beginning, and there are so many things you could do without doing what we call the open-style surgery, without the exposure, without big scarring. The recovery is much, much shorter. Can you afford being off work just because you want to make your face more beautiful? Nobody wants to do that. We are in a society where you are expected to look at your best, yet they want you to be functional. When you do an open surgery there is a social isolation. It's the time for you to recover. And the more you minimize that, the more it becomes attractive to people. As long as you are able to deliver a hundred percent close to the results you would have with open surgery.

Q: Can non-invasive surgery achieve the same results as with the traditional methods, for example in breast enhancement?

A: When it comes to breast enhancement, the technique has changed so much. They used to have a big scar under the breast, in the armpit or areola. Now they insert the implant through the belly button.

There is a certain limitation with minimally invasive surgery as compared to the traditional plastic surgery, but there is a way around. The bottom line we would like to create is "The results you want with no scarring."

Q: And what do you think about silicone, is it safe?

A: There have been so many problems with silicone because of the body reaction to it. It's a foreign body, and when you have a foreign body in your body, your body tries to encapsulate to limit the spread of that foreign body.

When they started doing the implants the texture was great, but there have been so many problems with leakage of the silicone, with or without perforation. Sometimes the implant breaks, and sometimes because of the silicone particles are so fine they actually seep out slowly through the capsule and cause a big problem.

I think so far from what we've seen we shouldn't be using silicone implants because of the possible serious complications.

Q: Do you think that sometimes people are going too far in their desire to look better?

A: There is about 5% of the population that become really obsessed. They start with one procedure and end up with 50, 60, 70 procedures...But the majority want to defeat aging, or need to adjust body proportions. I think it's worth the effort to go though that.

Q: Are there still any American celebrities untouched by aesthetic surgery?

People are looking at the package, not looking at them as singers or actors/ actresses. That puts a lot of pressure on the professional artists, but is also making people compare themselves to them and use them as models.

The cosmetic surgery is booming - and is the beginning.

Q: What people are mostly influenced by that tendency?

A: Actually it's turning to even younger, and younger, and younger population. In the past patients were doing it because of aging. Now it's not a matter of age, it's about looking perfect. It's psychological healing. If you know your body is perfect you feel confident. If you apply for a job, the beauty could replace a good resume (laughs). It's a tool that makes you successful in this life, as long as you combine it with a brain. If you have beauty, brain and talent - you are, let's say, a star.

Q: Are you talking juts about the USA, or globally?

A: I think it's worldwide. Maybe the pace is not as fast, but even in the Third World countries people start making their favourite star their model.

Very few of those people go to a surgeon and say "I want to look like her." Mostly, it's just the social pressure, and the peer pressure.

Q: Did you get more vain because of your profession?

A: I want to give you an example. If I was promoting hair transplant, you come to me as a patient and I'm totally bald, you would think "If he didn't do it for himself how is he going to do it for me?" You need to be aesthetically acceptable to provide those services. It doesn't make you vain - is part of the job requirement.

Q: Has that changed the way you look at women?

A: Definitely. When you look at people you look at them to see what are their features that bring the beauty out. The most important is the beauty triangle. The eyes, cheekbones and the lips and chin. If your eyes are small, or the upper, middle and the third part of the face are disproportional, if they are not equal it will be looking not as beautiful as if they really matched.

Q: What is the biggest satisfaction you get from this job?

A: The most rewarding part of cosmetic surgery is the reward you get from changing the patient's life.

My background is not in aesthetic surgery. I used to save lives in "real" medicine. I didn't have as much "thank you" as I have now.

Some of the patients think you're second to God - I didn't have that when I was saving lives. Sometimes when you save somebody's life as the "real" doctor they might say "thank you," they might just say "It is his job." Here it is different. You remove some wrinkles and it's like "Wow! He is my hero!"

You make people feel good about themselves. That's much better than spending thousands and thousands of dollars on a psychiatrist. Remove a little wrinkle and have their skin improved and that will make them a different person. That really outmatches any psychological treatment (laughs). There is nothing better to improve low self-esteem than improving their physical look.