0:05

A plastic surgeon , dr Catherine Roxanne

0:07

Grah , 44 years old , also known

0:09

as Dr Roxy , who was well

0:11

known for live streaming operations on TikTok

0:14

, had her medical license permanently

0:16

revoked in Ohio a few days ago . Coverage

0:19

on the news and social media has been heavy of

0:21

the so-called TikTok plastic

0:23

surgeon , and why not ? When

0:25

you show clips of her TikToks , such as

0:28

this one where she's dancing and poking

0:30

away during liposuction procedures , it

0:32

definitely draws eyeballs . Here

0:34

is a tosy , a YouTube commentator with 1.3

0:37

million subscribers , commenting on Dr Grah

0:39

on a video that got 775,000

0:42

views . Very

1:14

impressive , but that's not the reason why

1:16

I chose to talk about the sensational news

1:18

item of the suite , or at least not the main

1:21

reason . Maybe it wouldn't be awful to

1:23

get more views , but I definitely don't

1:25

have the style of a tosy . It

1:27

does seem that almost every week , there are breathless

1:29

items about botched plastic

1:31

surgery where patients are seriously injured

1:33

or even die under horrific conditions

1:35

, often in other countries or under

1:37

extremely questionable circumstances . However

1:40

, this particular case drew my attention

1:42

because it was in my hometown of

1:44

Columbus , ohio . I don't know Dr Grah

1:47

personally , but I actually do know someone

1:49

who was on the state medical board who ruled

1:51

on this case , so I took a closer

1:53

look at the situation and while I

1:55

initially wrote this off as a situation

1:57

where a horrible person had gone rogue

1:59

letting people die while dancing

2:02

in the operating room , there are some

2:04

surprising lessons I think potential patients

2:06

could learn , not only about choosing

2:08

a surgeon for your cosmetic procedure

2:10

, but how plastic surgeons , including

2:12

me , should also think about marketing

2:14

themselves to patients as well . And the lessons

2:17

are not just never choose a dancing

2:19

surgeon although that might not be the worst advice

2:21

in the world or , for me

2:23

, never dance in the OR , although

2:25

that isn't such awful advice either . But

2:28

let's dig a little bit . The first thing

2:30

is that I was a little hesitant to talk about the

2:32

situation because it's not one of the more common

2:34

news cases in which it happened

2:36

in another country , or the person involved

2:39

is a cosmetic surgeon and has no actual

2:41

plastic surgery training . This

2:43

is a case against a board certified plastic

2:45

surgeon , which is what Dr Catherine Roxane

2:47

Grah is . But I didn't hesitate because

2:50

our specialty is like the mafia , where we

2:52

take an oath of silence or we are a

2:54

band of brothers or some other nonsense . My

2:56

cause for hesitation is because medical liability

2:59

litigation is everywhere in medicine

3:01

. Abs physicians cannot escape

3:03

this reality . According to the AMA

3:05

, one in three physicians have had a medical

3:08

liability lawsuit filed against us

3:10

, and over 50% of physicians

3:12

55 and older have been sued

3:15

at least once . Almost every

3:17

plastic surgeon I know if they've been working

3:19

long enough have been sued at least

3:21

once , and these are some of the most

3:23

skilled and caring surgeons that I

3:25

would trust with my body or life

3:27

if need be . So talking about an

3:29

actual plastic surgeon that is facing legal

3:31

action unfortunately is not news , particularly

3:34

for elective cosmetic surgeries . All

3:37

of us , as patients , know intuitively there's always

3:39

risk with every action , including surgery

3:41

, and unanticipated or unfortunate

3:44

outcomes can happen even under the

3:46

best care . However , we

3:48

also know that negligent care is never

3:50

acceptable , and that is where our

3:52

responsibilities and duty of care lie as

3:54

plastic surgeons . And while medical

3:56

malpractice litigation is a critical part of

3:59

regulating and upholding the standards of our profession

4:01

, the perspective on both sides of

4:03

the courtroom can get emotional , ugly

4:05

and warped , so most physicians

4:08

, or at least sane people in general

4:11

, have no desire to delve into any

4:13

quagmire where lawyers take over

4:15

the situation . So why would I even

4:17

bother ? Looking at this case ? Well , in

4:19

the past I have talked about social media and

4:21

plastic surgery , both on this podcast Botox

4:24

and Burbees with plastic surgeon and ethicist

4:26

Dr Christian Verkler , as well

4:28

as on three plastic surgeons and a microphone

4:30

with Dr Sam Jajerkar and Salvatore

4:33

Pichella . In those episodes

4:35

we're really interesting dives into what

4:37

constitutes appropriate marketing for plastic

4:40

surgeons , what social media is

4:42

actually good for in terms of educational

4:44

content and what kind of posts

4:46

are purely for entertainment value . Are

4:49

the Dr Miami's of the world good

4:52

role models for us as plastic surgeons

4:54

? Is live streaming operations

4:56

okay ? What about dancing in the OR

4:58

? What about patient consents

5:00

? There are many gray areas that

5:02

I think will only increase as the line between

5:04

medical entertainment and medical education

5:07

continues to blur . So how did Dr

5:09

Catherine Roxane-Graw , otherwise

5:12

known as Dr Roxy , get to this point

5:14

? According to her LinkedIn profile

5:16

, dr Roxy graduated from SMU

5:18

, southern Methodist University , in 2000

5:21

with a BA and then got her medical

5:23

degree at UTMB or University

5:25

of Texas Medical Branch of Galveston in 2005

5:28

. She then completed a plastic surgery

5:30

residency at Ohio State University College

5:32

of Medicine in my hometown of

5:34

Columbus , ohio . She did pass her

5:36

board exams and she was certified in plastic surgery

5:39

. She opened up her own practice immediately

5:41

after graduating , calling it Roxy

5:43

plastic surgery and med spot in Powell

5:46

, ohio , which is about 10 minutes from

5:48

where I grew up in Columbus . She was

5:50

also medical director of breast services

5:52

at Mount Carmel Health System , which

5:55

is where my father now retired , but

5:57

who was an internist used to work . I

5:59

actually wonder if my father knew her , and I'm

6:01

going to have to ask him the next time I see him . Dr

6:04

Graw stated she started on social media

6:06

right out of residency in 2010 . She

6:08

became extremely popular on social media , going

6:11

by Dr Roxy on TikTok , amassing

6:13

over 825,000 viewers

6:16

and almost 15 million

6:18

likes . Her practice became

6:20

extremely popular and she performed

6:22

, by her report , up to five surgeries

6:25

a day , tolling well over a thousand

6:27

surgeries a year , which included

6:29

blood lifts , breast augmentations

6:31

and mommy makeovers . The first

6:33

sign of trouble was a letter from the

6:35

Ohio State Medical Board in October of 2018

6:38

, where they told her she needed to maintain patient

6:40

privacy while sharing photos or videos of her

6:42

patient's medical procedures on social media

6:45

. She then got a second warning in 2021

6:47

from the state medical board , again about patient

6:49

privacy concerns , and this letter

6:52

also mentioned that Dr Roxy

6:54

caused avoidable complications

6:56

which required additional surgeries for some patients

6:59

. She was instructed to undergo remedial courses

7:01

on professionalism and ethics , which

7:03

she claimed to have completed , but Dr

7:05

Roxy kept posting videos including

7:07

patient interviews , photos and live streams

7:09

of procedures . She also answered

7:12

TikTok viewer questions live

7:14

while surgery procedures were still ongoing

7:16

. Finally , in November of 2022

7:19

, the state medical board suspended Dr Graus license

7:21

after three patients filed complaints with the state medical

7:23

board . According to the medical board

7:25

, in one case , the surgery was actually live

7:27

streamed . Dr Roxy looked and

7:30

spoke to a camera while she performed

7:32

liposuction of the abdomen . A few

7:34

days later , the same patient was hospitalized

7:36

and found to have a perforated small

7:38

bowel and soft tissue infection . The

7:41

holes and the intestine were presumed

7:43

to have been caused by liposuction cannulas

7:45

hooking through the patient's muscle straight

7:47

into the abdominal cavity , which is

7:49

obviously a pretty horrendous complication

7:51

. A couple days ago , after a hearing

7:54

where Dr Graus argued her case in

7:56

front of the state medical board , the members

7:58

of the board , including Dr Jonathan Feibel

8:00

, who is actually a high school classmate

8:02

of mine and who is now a foot and ankle

8:04

surgeon in Columbus , voted to

8:06

permanently revoke her medical license

8:08

. Here is a video of him handing

8:10

down the decision . Dr

8:34

Ross said in her defense she made social media

8:36

videos because she loved teaching and

8:38

wanted to explain cosmetic surgery to people outside

8:40

of the medical field . Here she is

8:42

responding to the board , and sometimes

8:44

I did silly or fun videos simply

8:47

to make people smile in this world

8:49

, which is often negative , and did a little bit

8:51

of nothing . Dr Graw now has two

8:54

weeks to appeal the decision . So what

8:56

can we take away from this situation ? First

8:59

of all , social media is obviously an

9:01

extremely powerful marketing tool for plastic

9:03

surgeons . Simply by making entertaining

9:05

videos , she amassed a tremendous

9:08

following and a patient base which trusted

9:10

her . I get patients every month asking

9:12

about the latest tick-tock trends . One

9:14

month it's buckle fat reduction , another

9:17

month it's ear pinning , another month

9:19

it's trap talks , which I talked about in an earlier

9:21

episode . So let's face it all

9:23

aesthetic plastic surgeons , including me

9:25

, would love to have that kind of media

9:27

presence driving patients into our offices . The

9:30

Dr Miami's of the world are financially doing

9:32

extremely well , probably beyond

9:35

any of our specialty's wildest dreams

9:37

, and , honestly , a rising tide

9:39

lifts all boats . All of the social

9:41

media that potential patients are consuming

9:43

both legitimizes cosmetic procedures

9:46

and builds demand . Even for us

9:48

who don't do much media work , we

9:50

still benefit from all of this exposure

9:52

. We can't poo poo what botched

9:54

Dr 90210 and Nip Tuck

9:56

initially started and what's grown today

9:58

into the tick-tock and snapchat videos

10:01

on our phones , and many of us plastic

10:03

surgeons have also dabbled with social media

10:05

entertainment . I've eaten pizza and donuts

10:07

on a cheat day and posted it , chugged

10:10

to 16 ounces of water , hosted

10:12

video clips and pictures of me working Not

10:15

dancing in the OR , and even all

10:17

the podcasting I do is , in part

10:19

, an attempt to establish a social media presence

10:21

with potential patients . But , as I discussed

10:23

with my colleagues in my previous episodes

10:25

, these are gray areas

10:27

that we navigate as plastic surgeons

10:30

. We each have our own lines

10:32

to draw , which may be different from

10:34

other lines that other surgeons draw

10:36

. Mine has always been no dancing in

10:38

the OR or anything else that might distract

10:40

me from focusing on patient care . I

10:42

would never live stream a surgery because of the distraction

10:45

it would pose for me , although I do know

10:47

of other surgeons who do so , usually

10:49

for live teaching conferences or seminars

10:51

, which is fine for them . But

10:54

I've never done it and I don't want to start now . But

10:56

I know what the draw is for social media

10:58

. Some of the most liked

11:00

and watched posts that we have in

11:02

our practice Are the ones where I'm

11:05

working in the OR with a quick cut

11:07

cool music , overlay , tick-tock Production

11:10

that my staff has been experimenting

11:12

with , and there's always the temptation

11:14

to more and more of that , because when

11:16

you're scrolling on your phone , that's what

11:18

draws your attention , not a static

11:21

, boring talking head Like

11:23

I'm doing right now , actually . So

11:25

I don't know exactly where this line is , but

11:27

for me , the lesson here is that sacrificing

11:30

myself on the altar of social media

11:32

is definitely something I wish to avoid

11:34

. I might actually be swinging

11:36

too far the other way , but I'm okay

11:38

with that . However , I wonder for the

11:40

young , savvy plastic surgeons who are just

11:42

starting to practice what they may do

11:44

. The success that they see on

11:46

tick-tock is seductive , and their perspective

11:49

may be different and their gray areas

11:51

may be different than my gray areas , and

11:53

that's not wrong , but I do think

11:55

we are trending more and more

11:57

into sharing everything , for

11:59

both good and bad . I

12:02

will continue to follow this with great interest

12:04

. The second lesson is that surgical

12:06

skill and focus on patient care

12:08

always counts . That's

12:10

boring and old-fashioned , especially in

12:12

a trendy specialty such as aesthetic surgery

12:14

. I know I sound like my older mentors

12:16

who used to tell me never to post before

12:19

and after pics online . These were the

12:21

same surgeons who told me anyone could do liposuction

12:23

, and why would you want to do something so trivial ? But

12:26

the bottom line is that responsibility for your

12:28

patients , striving to achieve the

12:30

best results possible , appreciating

12:33

the trust that they have in you with the goal of Looking

12:36

better and feeling better about themselves

12:38

. As Hokey as that sounds

12:41

, that Becomes more meaningful

12:43

for me as the years pass . Where

12:45

at once was about how many cases I did , how

12:47

many cool cases I did and how

12:49

much of a big shot surgeon I could be , those

12:52

considerations are meaningless when

12:54

you think about the impact you can have on every

12:56

patient who work with . That means

12:59

being the most Skillful and knowledgeable and

13:01

caring provider , whether it be

13:03

aesthetic surgery or any other specialty

13:05

, is what matters . That will

13:07

never change , even if the medium

13:09

of communicating with patients does . What

13:12

thoughts do you have about social media consumption

13:14

in this day and age , not just about plastic

13:16

surgery , but in your life ? Does

13:19

it influence your opinions and choices that you make

13:21

in a positive or negative way ? Let

13:23

me know . My weekly

13:25

thankful is my whoop , a

13:27

wrist fitness tracker that I've used for the

13:29

past couple of years . It's not anything

13:31

special . If you have an Apple watch or

13:33

a garment or a Fitbit , it can do the

13:36

same things , more or less , that I use my whoop

13:38

for . The main thing I use it to track

13:40

is my sleep . I've been wrestling

13:42

with trying to get better sleep . I know my

13:44

sleep hygiene needs a lot of work . I

13:46

need to decompress better mentally before I go to

13:48

bed , stop looking at my phone

13:50

and computers at a certain hour and fix

13:52

other habits which ding my sleep schedule

13:55

. Some of it I know I'll probably

13:57

never fix it's just part of my personality

13:59

and job and mindset over many years but

14:02

some things I know I can definitely improve

14:04

. I also share my whooped data with

14:06

a group of friends who keep me accountable by razzling

14:09

me about how little sleep I get , and that actually

14:11

helps me to keep working on my health . The

14:14

whooped gives me numbers and feedbacks which

14:16

help me experiment and do better with my sleep

14:18

. For example , one of the biggest reasons I stopped

14:20

drinking , even socially , years ago was because

14:22

the whooped clearly showed me how much it

14:24

impacted my sleep , as well as other health markers

14:27

. Just like anything else in your life that you want to

14:29

improve , you have to know what it is

14:31

before you can take steps to make

14:33

it better , and that's how this fitness

14:35

tracker has helped me . Let

14:37

me know if you use a fitness tracker in your life

14:39

to improve yourself . Please DM me

14:41

at Botox and Burpees podcast on Instagram

14:44

or leave a comment at youtubecom

14:46

. Slash at Botox and Burpees . Thank

14:49

you for listening .