The only Hmong plastic surgeon in the world would like to see that change
This story comes to you from Sahan Journal, a nonprofit newsroom dedicated to providing authentic news reporting about Minnesota's new immigrants and refugees. MPR News is a partner with Sahan Journal and will be sharing stories between SahanJournal.com and MPRNews.org.
By Joey Peters, Sahan Journal
Julie Dickerson remembers how unusual it was to walk into Woodbury Plastic Surgery on a Saturday morning and find the place packed.
It was her first appointment, in 2017, and scores of patients, some wearing head bandages, sat in the waiting room. Even more unusual was how Dr. David Thao, the doctor who runs the clinic, personally called her on the phone the night before.
Dickerson, now 47, had just gone through a dramatic personal transformation, losing more than half her body weight in 18 months. A strict dieting and exercise regimen dropped her from 346 pounds to 150 pounds.
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But she wasn’t feeling much better emotionally. Layers of leftover skin dangled from her body. “It was just flopping and hanging, and I felt like a Shar Pei dog,” she says.
Though she was proud of her milestone, Dickerson says all of her excess skin made her feel in some ways more depressed than before. “You would think a person who lost weight would feel more confident,” she says.
She had long planned and saved up money for surgery to remove the excess skin. And she’d shopped around and interviewed six different plastic surgeons in Texas, Florida and the Upper Midwest. Dickerson had set on picking one of them. Then, a friend, whom Thao had just treated with a tummy tuck and breast augmentation, recommended she reach out to him.
“I’m like, ‘No, it’s Friday,’” Dickerson says. “She goes, ‘Hold on.’ In 10 minutes, he gives me a call and tells me to come in tomorrow morning.”
When Dickerson finally met with Thao, she described how the other plastic surgeons planned to perform a full-body lift: All the excess skin would be removed in one full sweep. Dickerson heard a different message from Thao.
“He said, ‘They want to do what to you?’ ” she recalls. Thao asked her to stand up, tuck in her shirt, and size up what needed to be done. What did she want removed and how did she want to look?
“If I do the full body, you’re not going to get all the skin removed that you want,” Thao told her. ”You’re going to look square. You’re going to have saggy skin here and there, because it won’t settle right.”
She opted to do her treatment with Thao, which included several procedures and three surgeries conducted over the course of 12 months: one for her upper body, one for her lower body, and one for her face. In all, the treatment cost Dickerson about $70,000. But to her, the price was more than worth it. On the day she saw her new body, Dickerson says she wept tears of joy.
“I owe him,” she says of Thao. “He helped me gain my confidence back.”
Thao, 48, plays an outsized role in medicine and his community. He is the first Hmong doctor in the U.S. to become a surgeon and, as far as anyone can tell, the first and only Hmong plastic surgeon in the world.
Today, his clinic isn’t full of patients in the waiting room. Many patients instead handle their initial visits online, to comply with social distancing rules and slow the spread of COVID-19. But Thao continues to operate on patients, with everyone involved in the procedure taking a COVID-19 test three days before the operation.
Located on the second floor of a building that also contains a dentist and a real estate office, Woodbury Plastic Surgery feels upscale on the inside — more like a private spa. Natural light illuminates the office, which is decorated with artwork. Before Thao examines patients, they can get scanned by the clinic’s VISIA skin analysis machine for an in-depth reading of their pores and wrinkles.
The procedure room contains an operating chair — much like a dentist’s seat — with two large circle-shaped lights attached overhead. Thao performs bigger procedures, like breast augmentations and tummy tucks, at a shared outpatient surgery center nearby. But during minor procedures, like cleanup work for moles and scars, patients sit here, flanked by several windows, which provide a view of trees and greenspace outside.
David Thao has run Woodbury Plastic Surgery for eight years in this office and it reflects how he sees his work. When Thao and his team designed it, they didn’t want it to feel like a sterile clinic.
Thao has soft features and a relaxed demeanor that disguise the intensity of his practice. As a news photographer takes pictures of him, he jokingly poses for the camera.
“David always made it a point to make himself relatable to other people — that we grew up poor, running from war, and had a lot of tragedy as a people, but could still find joy in life.”
— Tchao Thao, David Thao’s younger brother
“I model on the side, too,” he says, leaning against the wall.
On any given day, friends and followers can see him on social media videos moonwalking to Michael Jackson or sprinkling his steak with salt while making a kissy face, with the blaring tunes of Ricky Martin in the background. He is married with four kids, ages 9 to 18, and you can imagine him relating to them as a peer.
“He is the biggest goofball,” says Theresa Thao Kalugden, his sister. “Don’t let his exterior MD profile fool you.”
As buoyant as his personality can be, Thao can just as quickly turn serious. Since the beginning of the COVID-19 pandemic, he has produced several public-service videos delivering essential information about the virus in the Hmong language to people who may otherwise miss it. He does this outreach in his role as chair of the Hmong Medical Association, an international organization that he co-founded two years ago.
Tchao Thao, David Thao’s younger brother, says David’s personality reflects a sense of responsibility that came with being the oldest sibling in a family of eight kids, and his close exposure to his parents’ generation, who fled during the end of the war in Laos.
“That weighed heavily on David and my older cousins,” Tchao Thao says. “David always made it a point to make himself relatable to other people — that we grew up poor, running from war, and had a lot of tragedy as a people, but could still find joy in life.”
‘Every time you hear about plastic surgery, it’s all about Hollywood and Kim Kardashian’
David Thao’s chosen profession can conjure up all kinds of assumptions and stereotypes in the public imagination.
Some of his most popular procedures include tummy tucks, breast augmentation, and liposuctions. He even does the Brazilian butt lift.
Popular culture simultaneously rewards and shames these practices. On one hand, plastic surgery is one of the most prestigious and highest-paying subspecialties in medicine. It requires seven years of training after medical school, in highly competitive residencies and fellowships. Plastic surgeons work long, hard hours — even by doctor’s standards–and often go to great lengths to stand out from competitors. Thao, for example, frequently opens his clinic on Saturdays for patients who can’t make it in during the standard workweek.
On the other hand, plastic surgery can also be associated with sleazy reality TV doctors, awkward celebrity transformations, and cheap supermarket tabloids.
That’s all just media hype, Thao says. “Every time you hear about plastic surgery, it’s all about Hollywood and Kim Kardashian,” he says. “Plastic surgery is about reconstruction. When you’re doing facelifts, you’re reconstructing someone.”
Plastic surgery’s true purpose is rooted in its very name: It comes from the Greek word “plastikos,” which means to mold and to form.
Each day and each patient brings a fresh challenge. A recent workday, Thao recalls, featured patients who wanted to fix droopy eyes, and remove things like spots, lesions, and a lump on the back. Every procedure is different, even the same ones, because every body is different.
“I’m never bored,” Thao says. “I’m never going, ‘Another earache, again.’”
‘We can fix that’
Thao remembers the moment he decided to become a plastic surgeon. It was the mid-1990s and he was still a medical student at the University of Minnesota. At the time, Thao assumed he would go into a specialty like family medicine. That is, until he saw the young man from Laos.
Thao’s colleagues got a hold of a video not unlike the (in)famous Sally Struthers infomercials about impoverished children in the developing world. This video in particular showed a young man from Laos with a tumor in his neck so large that it was growing out of his mouth.
“It was huge, and he couldn’t eat, and he was crying,” Thao says.
The young man needed immediate intervention to survive. A full medical team, including plastic surgeons, assembled to fly him to Minnesota for treatment. One of these doctors was Xoua Thao, David’s uncle.
At the time, David Thao wasn’t a surgeon and couldn’t operate. But Xoua Thao remembers David helping in every way he could, spending a few days interviewing the man and observing the tumor.
David Thao watched in awe as the team of doctors took on the case pro bono, surgically removing the boy’s massive tumor. Something in him clicked. The surgeons who performed on the boy made an immediate impact.
At the time, no Hmong doctors had become surgeons. “It opened my eyes,” David Thao says. “‘This is what I want to do.”
It’s this type of impact on peoples’ lives that keeps Thao on the job. For example, Thao often gets patients like Dickerson who have lost a lot of weight, retain excess skin, and feel bad about it.
When they first come to him, Thao says, they repeat the same painful self-reflections: “‘Man, Dr. Thao, I wish I would have never lost all that weight because my arms are like bat wings. I look terrible!’” he says. “They lose faith and they feel bad and say, ‘I wish I was fat again, because I would never have this problem.’
“And I tell them, ‘Don’t say that. Losing weight is important because that helps with your heart, your blood pressure, your diabetes, your knees. The stuff we can’t fix. The stuff that you have now that’s left over, that’s stuff that we can deal with. We can fix that, OK?’ ”
He cites the tummy tuck, or abdominoplasty, as his favorite procedure because of the instant gratification patients feel afterward. The surgery usually starts with an incision near the waistline, from hip to hip. Next, the surgeon lifts up the skin. Excess layers of fat can be removed at this stage. Then, the surgeon pulls the skin down, removes any extra, and reattaches what’s left to make a tight fit.
The procedure is most common among women after pregnancy or people who have lost weight. The solution varies by patient. In some cases the procedure requires liposuction; sometimes, the surgeon must create a new belly button.
In total, the tummy tuck takes about four hours. “It’s very instant, and very powerful,” Thao says.
Treating a patient involves convincing the whole family
David Thao credits his father, Za Xiong Thao, for instilling the drive to succeed in him and his seven siblings. In the decades after coming to the U.S. as a refugee, Za Xiong Thao sent three of his children to Ivy League schools: David went to Brown University for undergrad, and Tchao went to Harvard University, for example.
Za Xiong Thao helped the CIA in Laos during the Secret War and fled to the U.S. after communists won. At the time, David Thao was 5 years old. Once in the U.S., the family moved to Milwaukee and lived modestly.
Za Xiong Thao worked all sorts of odd jobs, saving his money to put his children in private Jesuit schools throughout elementary and high school. Today, Za Xiong Thao operates a coin-operated laundry in St. Paul and holds several higher-education degrees himself.
“We were sort of the progressive family,” David Thao says. “We felt that we had to keep the Hmong culture, but at the same time we have to also move forward and progress and learn and grow and be part of this country.”
To help pay for his private high school tuition, David Thao spent his school years doing work-study jobs in the cafeteria instead of extracurricular activities. He and his siblings sometimes fixed up houses for extra family income.
“I never went to camp or anything like that,” Thao says. “I never took one class learning instruments.”
Hmong culture places great importance on the oldest sibling. Tchao Thao, who is 13 years younger, describes David Thao as a second father figure of sorts. Seeing his older brother go to an Ivy League school — then medical school, then residency — encouraged Tchao Thao to pursue a dual medical and law degree. Today, he’s a practicing attorney.
“One of the challenges of being part of a refugee community is that it’s harder to find personal role models that you can look at and say, ‘I can do that too,’ ” Tchao Thao says. “I really had a lot more faith and confidence in myself because my brother did that before I did.”
Theresa Thao Kalugden, who is one year younger than David Thao, recalls that she tried to follow his exact footsteps, including going to Brown.
“When the rejection letter came, he made it real to me that I can get to my dream in my own way,” she says. She settled for Brandeis University, and became a family medicine doctor.
David Thao didn’t have many role models like this growing up. But Tchao Thao remembers him taking an interest in medicine at a young age by accompanying his parents and community elders to the doctor’s office, where he’d translate for them.
David Thao remembers hearing skeptical attitudes about doctors, in his family and in the wider Hmong community. During appointments, elders would often misinterpret things, like when a doctor would have to touch a patient during a physical.
“There was a lot of misunderstanding, a lot of fear,” Thao says. “You’d go to the hospital and Hmong people would say, ‘No way, you’re not going to operate on my kid.’ The doctor would say, ‘He has appendicitis, we’ve got to take it out.’ And the Hmong family is like, ‘We don’t believe you.’”
Deciding whether to take a doctor’s recommendation often proved a battle, Thao remembers. If a doctor proposed diabetes medication to someone, 20 other members of the family would want to talk with the doctor first. And then, at the end of the day, the patient might not take the medicine over fear of side effects.
Thao saw racism play out in these medical scenarios when doctors wouldn’t respect the process that Hmong families would go through to make medical decisions. In other cases, doctors would scoff at the herbal remedies Hmong people brought with them from Laos.
As a result of these cultural misfires, Thao watched people in his family and community suffer a lot of illnesses that could have been prevented or treated at an earlier stage. He suspects it’s one of the reasons conditions like diabetes and hypertension are prevalent in the Hmong community. If the Hmong community had people like him as doctors, maybe they’d receive better care — and seek it out.
Eventually, Thao would find a mentor in his uncle Xoua Thao, who is eight years older than him. Xoua Thao earned a medical degree from Brown University in 1989 — the second Hmong person in the country to become a doctor.
“Even in 2020, people are still nervous. They would rather see a Hmong doctor than a non-Hmong doctor.”
— Dr. David Thao
Like his nephew, Xoua Thao observed the disconnect between his community and the medical field. As a young boy watching medics come into the villages in Laos during the war, he grew curious.
“I said, ‘What the hell are all these pills for?’” Xoua Thao says. “There’s no Hmong physicians in our tradition. It’s all herbal medicine and traditional healings and shamanism. So for me and Dave and the first wave of Hmong physicians in this country, it’s a totally new experience.”
Training more Hmong doctors
While David Thao makes his trade as a plastic surgeon, the community sees him as a dependable source for all kinds of medical issues. His sister says that several Hmong community members call him up for advice on conditions like diabetes and cirrhosis.
For the vast majority of Thao’s medical career, Hmong doctors worked in a kind of cultural isolation. That changed in 2018, when Thao and others formed the Hmong Medical Association, which he currently chairs.
The organization encourages Hmong students to go into medicine. It also exists to address medical issues in the Hmong community. Roughly 100 doctors are members, and while most of them live in Minnesota, members come from across the country and around the world.
“We try to get everyone together and talk about the medical issues that are common in the Hmong community, like diabetes, gout, stroke, kidney failure,” Thao says. “What are the ways that we can reach out and provide care to the community that we grew up with, that we love so much?”
Through networking with Hmong doctors in Laos and Thailand, Thao discovered that he is likely the only practicing Hmong plastic surgeon in the world.
“In Thailand, there’s not even a Hmong doctor,” he says of the country where some 250,000 Hmong people live. “Not just plastic surgery, but a Hmong doctor that people know.”
Thao has heard of just one Hmong general surgeon In Laos, where the Hmong population numbers more than 500,000. It is possible there are Hmong doctors in Thailand, who’ve taken a Thai last name to avoid discrimination, Thao says. But while he takes pride in his singular status, he wouldn’t mind some more professional company.
A couple of years ago, Thao participated in a medical mission to the Philippines, providing free care to people in need. This past June, the Hmong Medical Association hoped to perform its first medical mission in Thailand.
The plan was to treat Hmong patients in the country for free. Thao says it would have been the first medical mission in the history of the Hmong community.
”It would have been amazing,” he says. But like so many other things in the era of COVID-19, it had to be canceled. The plan, for now, is to reschedule the mission for 2021 or 2022.
In the meantime, the Hmong Medical Association is trying to provide opportunities for Hmong people interested in pursuing medicine, through scholarships and shadowing opportunities. It’s also delivering information and resources about the virus to the community.
Thao knows the virus is hitting his community hard. But the information here is incomplete. While the state has released data about how many Asians in Minnesota have been infected and died from the virus, it hasn’t released the numbers specifically about the Hmong community.
It’s a point of frustration for Thao, who constantly gets questions from his community about COVID-19 statistics. Asian people account for around 5 percent of the state’s positive infection rates. Thao suspects Hmong people, some 80,000 people, make up a large portion of that number.
The lack of specific data hides the scope of the problem and makes it harder to communicate the urgency. “It’s hard for me to tell the Hmong community, this is serious,” Thao says.
‘You’re still going to look Asian.’
Today, a significant portion of Thao’s patients are Hmong, and come to Thao partly for this reason. They visit him from all over the country: places like California, Michigan, North Carolina, and even Alaska.
“Even in 2020, people are still nervous,” Thao says. “They would rather see a Hmong doctor than a non-Hmong doctor.”
This is especially true for a procedure like a tummy tuck or a breast augmentation. Sometimes patients don’t tell even their immediate family members that they’re getting one of these operations. The local Hmong community is largely close and familiar, which means patients who speak limited English could end up using medical interpreters whom they recognize from the community.
“If you’re getting a vaginal rejuvination, you don’t want your neighbor who’s going to translate for you in the same room,” Thao says.
In lieu of an interpreter, Thao communicates directly with his Hmong-speaking patients. Building that trust, he emphasizes, is crucial to succeeding as a doctor.
In a way, Thao’s patient base acts as a support group for him. Many of them simply want to go to a doctor from their own community and feel proud of him, which Thao describes as an honor.
Naturally, because so many of his patients are Asian, and because he practices plastic surgery, Thao often finds himself navigating different cultural ideas of beauty. One of his most common procedures is double-eyelid surgery, a type of blepharoplasty. For people born with monolids, the surgery provides them with an extra fold in their upper eyelids.
The surgery is widely popular in countries like South Korea, China, and Japan, as well as among Asian Americans in the United States. It has also sparked debate and cultural critique, with some critics deeming the look a “Westernization” of Asian beauty standards.
Thao doesn’t buy these claims. “What it does is open your eyes a little bit more,” he says. “It makes them a little bit rounder, a little bit more awake.”
In all of his procedures, Thao says he works to preserve his patients’ unique features.
An eyelid crease that’s too big won’t look natural on, say, a Hmong patient, he says. He’ll explain, “‘It’s going to look odd for your facial structure. We’ll go a little smaller with the eyelid crease, or make it look more natural and stay with looking more appropriate for your ethnicity.’”
The point of the eyelid surgery, Thao insists, is not to downplay anyone’s racial identity. “I tell patients, ‘You can change your eyes — you’re still going to look Asian. You’re never going to look white, ever: I can guarantee you that.’”
Beauty itself is a universal feature, one that everybody can recognize. “But it’s the fine details that define one kind of beauty culture from another,” he says. “It’s evolving: Beauty standards are always changing.”
One example is the recent popularization of Brazilian butt lift, which Thao speaks about with a chuckle: “Hmong people, we don’t have big butts, but now everybody wants a big butt!”