Plastic surgeon entrepreneur blends innovation with business

Michele Shermak, MD
02/25/2011 at 5:30PM

GurtnerGeoffrey Gurtner, MD, Stanford, Calif., has emerged as an archetype for the new generation of plastic surgeon leaders propeling innovation as both a scientist and entrepreneur. He has launched start-up companies in the aesthetic, wound healing and cardiovascular fields - and he has several devices and biotechnology products currently in clinical trials. His experience in securing funding for - and developing his ideas into - commercially viable products became the driving force behind the popular Technology Innovation in Plastic Surgery (TIPS) symposium (the second annual TIPS meeting is slated for June 17-19 in San Francisco).

As a researcher - an aspect of his career that Dr. Gurtner nearly abandoned during residency - his NIH-funded lab at Stanford University continues to hold enormous promise for advances in wound healing and has led to the development of new technologies that are the foundation of several early stage start-up companies. To date, he has contributed more than 100 peer-reviewed articles to the medical literature and, in April, Dr. Gurtner became the first back-to-back recipient of the James Barrett Brown Award, which is presented annually by the American Association of Plastic Surgeons for the best plastic surgery-related paper published during the previous calendar year.

PSN: Coming out of medical school at the University of California-San Francisco, did you know that you wanted to be a plastic surgeon?
Dr. Gurtner:
I knew pretty early that I had an interest in the surgical side of things - I tried to like other things, but at the end of the day I really liked surgery. I thought I would go into cardiac surgery. During the summers after my first and second years of medical school, I would return to Baltimore to work with Bruce Reitz, MD, chief of cardiac surgery at Johns Hopkins. I fell in love with surgery and surgical science. The bench-to-bedside emphasis of the Hunterian labs where I worked every day during the summer really grabbed me. I got that at Hopkins - it was so much fun to work with people who were very excited about advancing the science of clinical medicine. I still hold onto my Hopkins temporary badge to remind me where this all came from.

PSN: What would you be doing if you didn't become a plastic surgeon?
Dr. Gurtner: I'd probably be an engineer. I love writing and literature, but that's a harder nut to crack.

PSN: When were you introduced to plastic surgery?
Dr. Gurtner: I went to Massachusetts General Hospital for general surgery training. I first rotated through plastic surgery at the beginning of my second year of residency. When fellows went on vacation, the third-year general surgery residents filled in for the vacationing fellow. Jim May, MD, the hospital's chief of plastic surgery, brought me on and was the best surgical teacher I ever had. Dr. May actually took me through surgery cases where we were operating side by side. It got me really excited about plastic surgery.

I took three years off during residency. I knew I wanted to do research, and I needed more surgical training. I researched what surgical rotation would give me the most clinical experience because, up to that point in my training, I did not get much of an opportunity to operate. I decided to go to Hong Kong for a year to serve as a senior registrar in thoracic surgery. I performed esophagectomies, gastrectomies, head and neck cancer resections, and other big operations. I operated all the time and got the need to constantly operate out of my system. I then spent two years in a basic science lab at Brigham & Women's Hospital (Boston) performing hard-core basic science on knockout mice. After two years in the lab, I was fed up with research. I understood the game of how to become a famous scientist, and it didn't grab me.

By my fourth year of residency, I would serve as a first-year cardiac surgery fellow in a private practice for part of the year. I found myself every day looking at the same caselist, almost wishing there would be no more than one operation. I was not the right personality for cardiac surgery - there was not enough variety. They performed one operation and tried to do it perfectly. I preferred doing 20 different surgeries and doing the best I could.

PSN: Ultimately, you studied plastic surgery under Joseph McCarthy, MD, at NYU.
Dr. Gurtner: I went so far as to apply for fellowships in cardiac, plastic and pediatric surgery, and I decided to go to NYU for plastic surgery. Dr. McCarthy is a highly charismatic speaker about the future of plastic surgery, so I went to NYU with the aim to become a master surgeon and I expected after that to apply my trade somewhere. Two former Massachusetts General residents, Charlie Thorne, MD, and John Siebert, MD, were MGH graduates with great reputations, and they were junior faculty there. They were very happy.

PSN: How did you make your way back to the lab after losing interest?
Dr. Gurtner: I was originally aiming to become a craniofacial surgeon, but I became more interested in microsurgery, and went to M.D. Anderson for a micro fellowship. Steve Kroll, MD, was doing perforator flaps, and that was an exciting time. He reignited my interest in the lab. I saw that lots of patients have problems we need to fix, and the goal of a translational lab was to find solutions to real-life problems. I found a project that grabbed me - investigating gene therapy in flaps. There were ongoing gene therapy trials at M.D. Anderson at the time. For the big head and neck cases, the otolaryngologists were injecting viral vectors providing chemotherapy into the floor of the mouth or margins of resection depending on the resection, and we, the plastic surgeons, would come in and put a free flap there. I thought that we could make flaps that would produce proteins to fight cancer and cut down on the steps. I got a grant to study this.

PSN: And then you went back to NYU to start your professional career.
Dr. Gurtner: I talked to Dr. McCarthy about returning to NYU as junior faculty, and I proposed the research project to him. He offered to help finance the work. I moved back to NYU, and I overlapped Mike Longaker, MD, for two months. His departure left a big void in the lab at NYU, and I stepped into that vacuum. I took the lab in a different direction that was more conducive to my skills. I was not clinically overwhelmed and doing the cases no one else wanted to do: tertiary trauma, disastrous cases, infectious diseases requiring complex reconstruction - and that was good. I was successful in getting NIH grants where surgery meets science, and developed ideas that translated to real world problems.

I tried to get more funding through venture capital, but nobody in New York knew how to do this. It wasn't in their culture. I submitted patents and talked to companies.

I discovered that if you want to be a banker, you go to Wall Street. If you want to do entrepreneurial things, you need to be in Silicon Valley. After two years in New York, I moved to the Bay area and helped Mike Longaker expand his research lab, since I was doing something different. This was 2005.

I pitched ideas to venture capital investors and began to understand what it is that makes a scientific idea a good commercial business, and how to set up things to be more commercially viable and successful. I started several companies with various funding sources and have devices and biotech products in clinical trials. I feel like I can make a difference in real-world problems through discovery.

PSN: And that led to the inaugural TIPS meeting last year.
Dr. Gurtner: With the TIPS meeting, everyone doesn't have to move to Silicon Valley and reinvent the wheel. Plastic surgeons are busy clinicians, and it's very difficult to figure out how to translate scientific ideas to the real world. There are bureaucratic obstacles and conflict-of-interest issues that create difficult obstructions, particularly in academics. The TIPS meeting allows us to share the ability we have with the whole field.

PSN: Who are your personal mentors?
Dr. Gurtner: Mike Longaker has been a great mentor to me since I was at Stanford - he is a wonderful friend and colleague. I've never had that level of mentorship before. Jim May ignited interest in me. He's the kind of plastic surgeon I wanted to be - rigorous and the smartest surgeon in the hospital.

PSN: What are the most important leadership lessons you learned?
Dr. Gurtner: Don't be afraid to take on big issues or to say things that might be outlandish. Follow your convictions, and go for it. Do it with energy. I'm not a case study in excellent leadership skills - there are many different ways to approach problems, and I usually approach them with intensity and urgency, but this is not always best. I like to listen to hear how others approach problems.

PSN: How do you lead your group?
Dr. Gurtner: My style is to give resources, opportunity and a fair amount of leeway to go in different directions with projects. Let them go and they will do the right things. I loved that during my training. I was provided a pile of money and expectations that I would do something with it. Some need more day-to-day guidance and mentoring. It's important to nurture the skills to be independent.

PSN: What are qualities in individuals that impress you the most?
Dr. Gurtner: Creativity, really asking the beginner's questions about things we all accept, seeing things freshly, are qualities that impress me. I respect people who have some degree of altruism in everything they do, who can understand if you set out to do things to help others, you will get something back in return. An intense, good work ethic is very impressive.

PSN: What are the qualities that you can't tolerate?
Dr. Gurtner: I can't stand selfishness, those who singlemindedly focus on maximizing their own position at the expense of others. Sycophants who butter you up don't work for me either.

PSN: What do you think will be the next big innovations in plastic surgery?
Dr. Gurtner: There is so much pseudoscience in aesthetic and reconstructive surgery, much of it driven by financial interests. We need efficacious therapies. As plastic surgeons, we have a great deal of opportunity to lead aesthetically and reconstructively. We are better than the competing specialties. The tradition is that we are the ones doing the more innovative things first. We are now figuring out the commercialization piece - taking our good ideas and figuring out how to drive them into the clinic. This is how we will maintain our premier position.

There is a lot of interest in fat, including fat as large-volume filler for augmentation. Scientific advances will make us more comfortable to jump in the pool. Right now, fat grafting is a "niche-y" procedure. We need better tools and technology to make the majority of us feel more comfortable.

Aesthetic rejuvenation and correction of rhytides is a short-term innovation goal. We are using tools that are decades old to address aesthetic problems. The core technology - lasers, breast implants - have not changed much in the past 30 - 50 years. We have a huge opportunity to develop transformational tools in cosmetic medicine, even better than developing new operations.

Surgeons who understand problems and develop tools better than surgery to answer those problems will stay ahead of the curve. Look at our cardiac surgery colleagues. Cardiac surgeons are in full retreat because cardiology came up with better and safer ways to do the same things. Wouldn't you choose a stent over having your chest cracked? This is how plastic surgery can outcompete: We are in the best position over the ancillary disciplines to innovate.

Long-term innovations that I see are cell-based therapies for both reconstructive and aesthetic applications; tissue engineering of whole organs; and genetic therapy of flaps. In the long term, we will be leaders in applied regenerative medicine, stem cell and translational medicine. We will excel in bringing the first tools to clinic for disease states we can really impact.

PSN: What are some of your favorite pastimes outside of work?
Dr. Gurtner: I love the outdoors since moving out West: Hiking, camping, going to the beach, skiing. I've developed a taste for wine. I dabble in these. I enjoy doing all of the above with my wife and children. Well, except for the wine tasting.