Daniel Cassuto, MD, a plastic and aesthetic surgeon in Milan, Italy, knew for years that his hands would bring him success. “I wanted to be a surgeon because I wanted to use my hands in order to help people,” he says, explaining that he always felt more comfortable using his hands for a living than talking. “Eventually you need both anyway, but I knew I could train my hands to do what I want them to, so I went into surgery.”
Cassuto studied medicine at Hebrew University of Jerusalem’s Faculty of Medicine in Israel, and while in school, did research on burn victims and treatments, finding the subject—and the connected work—fascinating. He sought a medical specialty that dealt with aesthetic work, and also factored in his decision to pursue a line of work that wouldn’t require him to work full-time in a hospital. “I didn’t know if I wanted to work for an institution all of my life, and I was also interested in the possibility of private practice,” he says.
Following graduation from medical school in 1985, Cassuto returned to Italy and worked in university hospitals, as well as at outside private practices in the evenings, and eventually gathered enough support and financial capital to open his own practice in Milan in 1999. During his residency, he had spent time working with lasers in the hospital setting and saw how they would benefit a private aesthetic practice, so he invested in the expensive equipment early on. “When I established my own practice and bought my first laser, I didn’t sleep at night because I was not sure I could make the monthly payments,” he recalls. “That initial laser purchase has led to me having 15 devices in my practice today.”
Cassuto combines surgery, lasers and injectables in his medical style. “I’ve worked correcting congenital defects and doing reconstructive surgeries, but mainly these past few years, I’ve been focusing on treating the aging process, mainly doing facial rejuvenation, breast and body surgery, and body contouring procedures,” he explains. “I find that in terms of the facial area, I’m demolishing it less and less and rebuilding it more and more. It’s not taking away things people see as problems, but instead giving them back what age has taken from them.”
With this rebuilding process, Cassuto sees the necessity in offering patients quality in all of his practice’s available options. “I try to offer my patients whatever aesthetic combinations will work best for the results they are seeking. That’s why it is important to be competent in not just surgery, but also lasers, fillers and other tools of aesthetic work—so I can offer whatever procedure I find most appropriate in a single treatment with equal degrees of competence,” he explains.
Time to talk
Somewhat ironically, offering patients the best results possible also involves Cassuto talking with his patients quite a bit. “Sometimes it is difficult to understand what a patient wants, because it is not always what they are asking me to do,” he says. “The only way I can find out what they are really hoping for is to talk and talk and talk with them. I prefer to speak with my patients myself.
“It is not always about trying to improve the way people look, but the way they feel about how they look,” he continues. “The only way to maintain a principle of real beauty is to create a symphony between what people are and how they feel about what they are.”
Cultivating that appreciation often involves discussion with patients, as well. “Sometimes, the most difficult part of working with patients is convincing them that they are OK and don’t need anything done. In fact, I’ve found two of the hardest lessons to learn are when to refrain from doing anything and how to convince the patient that doing nothing is the right thing to do,” Cassuto explains. “I want to try to take the aesthetic practice back to the practice of medicine. I have patients who see advertising about an injection product and come in and ask me for it—this is bad medicine. I need to know from my patients what is bothering them, not what they’ve heard. Once I am able to understand their desired outcome, I can more accurately make a proper diagnosis and pursue the appropriate course of treatment.”
Cassuto continues his explanation through an example of a patient complaining about upper eye lids, saying the traditional route would typically be to perform a blepharoplasty. “Now I question if this is really what the patient is looking for, what the patient needs, because she may just end up with a higher brow and the rest isn’t changed—she doesn’t necessarily look any better,” he explains. “It would be as if a patient came to my practice complaining of a headache and I just prescribed an aspirin. If she had a deeper problem, the aspirin wouldn’t address it. The headache isn’t the cause of the problem, it’s a symptom. We need to think more diagnostically like this in aesthetic medicine. Once I know the root of the problem, I can figure out more accurately what the patient is looking to achieve. And many times, minimally invasive treatments have a more natural look and cost less than a surgical procedure. This is what I mean by giving back instead of demolishing—this is the real medicine.”
Treating and preventing complications
Cassuto also helps train residents and is a professor at two universities in Italy—the University of Catania in Sicily and the University-Hospital, Policlinico of Modena—and helped open a center that treats complications from aesthetic procedures gone wrong, particularly filler injections. “I’ve been doing this in my private practice for the past six years, and have published papers about this,” he says. “I see it as a kind of a mission for myself—I don’t charge these patients, plus I volunteer to provide corrective services in the hospital once a month. It gives relief to those who could not otherwise afford it, and these are patients who nobody wants to treat because of the complications involved.”
Inspired to help patients who receive botched aesthetic surgeries, Cassuto also is interested in creating a more natural look for patients overall. “If we treat the cause of the problem and do it right, nobody should ever be able to notice work has been done. This is what I would like to see happen and what I’m trying to achieve,” he says. “As a profession, we should all try to learn what, and how many wrinkles, should be left on a patient’s face so it looks better.”
Consequently, Cassuto sees the aesthetic industry moving in a more prevention-inspired direction. “We will be able to treat more people at a young age to maintain their youth,” he theorizes. “With the right lifestyles and the right maintenance, people should be able to avoid having any kind of major rejuvenating procedures because they won’t need them. Within 20 years, I don’t think we should be seeing any more people who have obviously been treated by a plastic or aesthetic physician.”
Results with a natural look and satisfied patients are things Cassuto is eternally interested in. “What keeps challenging me and keeps me happy about plastic surgery is that it is really a field that is evolving all the time, as far as our understanding of how aging and the body works,” he explains. “Now that the lifespan is constantly expanding, we have the challenge of people who want to age more gracefully, healthier, both mentally and physically, and I always want to reflect that in my work.”
To that end, he stays updated on industry developments and happenings through events and seminars. “It’s the best way we as doctors can stay up-to-date on the latest knowledge,” Cassuto states. “Some things take as long as a year to come out in journals, so you need to go to conferences in order to learn about these new things.” He also is often invited as a presenter and lecturer, as he speaks five languages and travels extensively. He is involved in clinical research—mainly with lasers, injectables and the treatment of complications of aesthetic procedures—and writes articles and submits book chapters for professionals texts, as well.
“I always try to do the best I can for my patients at all levels,” he says. “I don’t know if I always succeed, but I will always try, and this is a reward itself.” Also among his proudest achievements, Cassuto counts the fact that, despite that he doesn’t advertise or have a website, he has a steadily busy and growing practice with an expansive number of patients, and that a large portion of those patients are referred to him by colleagues, displaying a recognition of his skill by his peers in the industry.
“If you behave the same way in aesthetic medicine as you would in other fields of medicine, by talking with your patients, diagnosing them, offering them your best medical advice and proceeding with a treatment plan accordingly, they should be your best marketing agents,” stresses Cassuto. “You’ll also find you’ve achieved not only professional success, but also an ethical fulfillment of our mission, which is much more satisfying than anything else.”