Medical Aesthetics From San Diego To D.C. With Insight Along The Way

These examples are intended to provide information and inspiration for your journey and are not a recommendation or endorsement.

Admiring his grandfather, a highly respected OB-GYN, paved the way for Paul G. Ruff IV, MD, FACS, to become a surgeon.

Dr. Ruff intended to become an OB-GYN, too, practicing general surgery for five years in ICU and critical trauma fellowships, until a serendipitous two-week rotation at Eastern Virginia Medical School in Norfolk, Virginia introduced him to plastic surgery and all its possibilities. 

Fast forward two decades, and Dr. Ruff owns a busy private plastic surgery practice, offering a full range of surgical and nonsurgical aesthetic treatments to patients in the Washington, D.C. area. 

Read on to see how he transitioned into Medical Aesthetics and built the plastic surgery practice he has today.

Leveraging a chance rotation into a fellowship.

After that life-changing stint in plastic surgery at Eastern Virginia Medical School, Dr. Ruff went on to pursue a plastic surgery fellowship in San Diego, where there are many plastic surgery practices. There, he was exposed to a wide range of different practices and practice types, as there’s a large aesthetic component to the University of California San Diego program. “That’s really where I started to develop my interest,” he says. “My understanding of what an aesthetic practice should be, what it could be, and where I fit into that paradigm.”

Discovering a passion for Medical Aesthetics.

In his first 10 years of practice, with a partner at Washington Hospital Center, D.C.’s largest hospital and biggest trauma center, Dr. Ruff focused on general surgery and critical care fellowship. Much of his practice was reconstruction-based procedures, and he developed a microvascular program as well as a Wound Care Program all while he began to build the aesthetics side of his practice. 

“I had this thought that I would continue to maintain somewhat dual roles over time,” he states. But after 10 years, his business was about 60% to 70% aesthetic and about 30% to 40% reconstructive. “And as I considered what my next 20 years of practice could look like, I felt that if I wanted to have the control I sought, and to be able to continue to evolve the science and the things that I was passionate about, it was the aesthetics side of plastic surgery that would allow me to do that,” Dr. Ruff says. So, over the next two to three years, he transitioned out of reconstructive work to focus primarily on aesthetics.

Matching aesthetic style to patient demographics.

Though Dr. Ruff trained in San Diego, where the aesthetic side of plastic surgery is openly talked about, his hometown of Washington, D.C. is the opposite.  

“It’s the Hollywood of the political world, but people here don’t want anything in their background that could be used against them—and that includes plastic surgery, despite the fact that the stigma of plastic surgery is much less than in the past,” Dr. Ruff explains. 

Guided by that insight, the brand he’s developed is really “more about discretion than anything else,” he says. “We’re forced to be super creative and super good because people want to be elevated, rejuvenated, and improved, but never ever obvious.”

Remaining true to guiding principles.

When Dr. Ruff decided to strike out on his own, his biggest question was: “Can I do it? Did I have what it takes to run this, to manage staff, manage the medical-legal aspect, all of that insurance?” 

One answer came in the form of advice from his CPA: “Get comfortable with being uncomfortable.” That tip gave Dr. Ruff the courage to forge on with his practice. “At the end of the day, not only do I own a business and everything that comes with that, but it is still medicine,” he explains. “It has real risks, real complications, and there's a tremendous amount of expectation.” One of his biggest challenges is combatting the impression, created largely by social media, that “major surgery is just a spa treatment.” 

His D.C. clients, along with valuing discretion, also have a mindset that values Dr. Ruff’s high regard for health and safety.

Cultivating community amid a competitive landscape.

Even though there were tons of plastic surgeons in San Diego, where Dr. Ruff trained, they viewed one another as community rather than competition. “We socialized with each other, we relied on each other, we referred patients to one another, we depended on each other,” Dr. Ruff recalls. “And by being unified, it really gave plastic surgery an elevated awareness within the community. And that stuck with me a tremendous amount.” 

The atmosphere in D.C. was nearly the opposite. When Dr. Ruff opened his practice, the city had one of the highest ratios of surgeons per capita in the entire country and was therefore “highly competitive,” he says. He remembers a patient coming in for a second opinion who said that another plastic surgeon had bad-mouthed him, “for no reason other than she was trying to get that patient to see her instead. But in doing so, she left a bitter taste in that patient's mouth,” he notes. Dr. Ruff, who was still young and just starting out, knew at that moment he preferred to build community.

“I don't see anybody as competition—that denigrates who we’re supposed to be as physicians, as plastic surgeons, as aesthetic medicine providers.” 

Collaborating with fellow professionals through active memberships.

Dr. Ruff values his memberships in various professional societies—both the multi-specialty and the core societies. “Learning at various society meetings is probably the only way we will continue to maintain our individuality as specialty physicians,” he notes. “Looking at the different areas that we work in, whether it's reconstruction, aesthetic, or microsurgery, they’re not exclusive endeavors. That’s part of what drew me to plastic surgery—the breadth of what we do, and the only way we can maintain that importance of specialization is to stay part of our societies.”

Local societies are great for staying on top of regulations. “They continue to provide excellent content as far as just local regulations from a general healthcare standpoint,” he notes. Dr. Ruff also attends the top plastic surgery conferences. “There’s an interplay of ideas, new technology, and new thoughts,” he says. “Without that interaction, without that cohesiveness,” he adds, “things will get diluted very fast. I think it is really important to stay connected to society and stay connected to your community of plastic surgeons.”

Always taking a patient-first mindset.

In the operating room, Dr. Ruff always asks: Who’s the most important person in this operating room? “It’s funny when students say the doctor,” he says. “Nope, the patient is the most important person in this OR. And each one of us is here only for the patient.” For Dr. Ruff, that puts him and the entire staff—the anesthetist, the nurses, the scrub technicians, and the person turning over the room afterwards—all essentially on the same plane.

Dr. Ruff’s philosophy—that “our whole reason for being is our patients”—governs his approach to every client who comes into the office, whether for a surgical procedure, an injectable treatment or just to buy skincare products. “Each one of us is here for that person, no matter where we touch that person along their journey through the practice,” he explains. “Understanding that we are all the same is the first place I start, because each one of those touches is equally important. Each one of those touches is critical to the patient’s experience and ultimately the patient’s outcome.”

Being driven by passion and community.

There’s a number one requirement for a job in Medical Aesthetics, according to Dr. Ruff. “You really have to have a passion for it,” he says. “Those who are really, truly passionate about it, who will dive into it, understand that ultimately, we don't do this for the money. It’s got to start with that passion. And if passion isn’t the foundation of it,” he adds, “anything that comes after that is going to be difficult.” 

Secondly, community: “whether it’s the community of people that you have within the office or the wider community that you're working around,” he says. He sees competition as a way to better educate the public. “If we're good, there’s going to be more than enough people for us to treat,” he states, adding, “If the community of practitioners is cohesive, we can rely on each other and really improve the awareness of what we would do, what we can do, and how well we do it in the greater community.”

Dr. Ruff took what he learned from his San Diego-based fellowship and adapted it to best suit his patients in Washington, D.C. Feeling inspired by his journey? Explore other SPARK content to learn more about the versatility of Medical Aesthetics.