Obstetrics, Gynecology, and Plastic Surgery w/ Dr. Daisy Ayim

Episode Information

March 21, 2022

OB/GYN and cosmetic surgeon Dr. Daisy Ayim talks about her journey to specializing in both OB/GYN and plastic surgery, her movie-like birth experience, how much she loves going to the gym every day, the importance of nutrition, Cameroonian cuisine, and more.

Topics Include:

• Moving to the US from Cameroon when she was 15
• Her journey to specializing both as an OB/GYN and a plastic surgeon
• Going back to study plastic surgery while still running her own OB/GYN practice
• How her artistic ability is so important when it comes to being a plastic surgeon
• Laparoscopic gynecology, robotic gynecology, and the difference between the two
• How getting an epidural does not reduce a mother’s womanhood
• Going into labor while she was delivering other women’s babies and her whirlwind trip to the hospital
• Her own emergency c section under general anesthesia
• Running a successful hybrid medical practice and how she feels hybrid doctors will become the norm in the future
• How she strongly urges her plastic surgery patients to go to the gym after surgery for sustainable changes
• How useful it is to have a biochemistry degree and work as plastic surgeon because she understands all of the ingredients in the products
• How Doctorpedia is a fantastic idea – an ecosystem where anyone can get reliable medical information from doctors

Highlights

• “I will tell you the funny story of the first time someone handed me a bag of potato chips and said it’s potatoes. And of course, what I know about potatoes is whole potatoes, so it was strange to get that. And then she said, “Taste it.” I’m like, this is not potatoes. And I still remember that I put it in my mouth and literally spit it out. And I was like, “What? That is not potatoes.”
• “I always tell my patients, ‘You are not gonna be considered less of a woman if you choose an epidural, by all means.’ There are women out there that do it naturally and do it beautifully and there are women who scream throughout the whole process, whatever it takes to get to the end. No one is going to put your womanhood in question if you tap out or if you go all the way to the end. If you do it naturally five times, you’re not a better woman than someone who had five epidurals.”
• “Pain is such a subjective matter – everyone’s reaction to pain is different. And it’s not a judgment thing on how pain feels. So that’s what I tell my patients, ‘If you want to do a natural birth, listen, I’ll be there right with you to the end. If you want an epidural, I’ll be right there with you to the end.'”
• “I can professionally say, ‘I know you love this, but how about this?’ Ultimately though, they make the choice and if they make a choice that they are completely happy with, and it doesn’t really put anything in check as far as safety is concerned, that’s fine with me. Or if it doesn’t align with my own moral standpoint, then that’s fine with me. If I truly have a moral standpoint that I don’t know if I want to do this, I will also let them know and likely just excuse myself from the process.”
• “For me, listening is very important in my relationship with my patient and understanding the patient as a whole. And what that means is not only why are they there, but who accompanies this patient? Where do they live, where are they from, what is their background? What is their culture? All those things impact their relationship with me. So I really value that because it creates a natural trust and it creates a natural feeling like I care, which I do. But conveying that to a patient is important because I think ultimately we all just want to go to a doctor that feels like they care about us.”
• “It took me four years to get a degree in biochemistry. And then when I got to medical school, we actually had to take a biochemistry class in basic sciences. And that took about a semester. So I remember in medical school joking, ‘Wow, I took four years to get a degree in Mexico. You learn it in a semester.’ But it comes in handy now as a cosmetic surgeon or in that world because everything is about ingredients. What is the ingredient of that skincare line? What was the ingredient in that product? And with that background, the first thing I’m always in before anything else is I turn to the back and look at the ingredients and see what’s in it.”
• “I receive a lot of products to look at or to partner with and the one thing you notice in my social media, I haven’t done any of these, partly because I truly feel that it has to be completely truthful. Yeah, sure it’s a popular product, sure everyone knows about it. Sure everyone likes it, but is it really doing what it says it is going to do or is it just barely touching the surface, but then you’re marketing it as the greatest and next best invention.”
• “When I came to the US, I was foreign and my accent was huge. Like I’d say, ‘Hi’ and people would start laughing. And when I was in high school, I really didn’t have friends or my own circle.”
• “I remember growing up in my house, we had a TV, but we did not have cable partly because our parents were that way. And Miss Fitness USA came on at that time. And it was really random. It showed on a regular basic channel. And I remember watching it and thinking, ‘Oh, they’re so beautiful. I want to look like that.’ And here I am at 15, you look at things when you’re younger, the things you want to copy and I remember watching that show, I thought, ‘God, I want to look like that. They’re so nice.’ So I started going to the gym at 15 because of that show. And out of something simple like that, here I am in my forties. I still go to the gym just about every day because I went into it wanting to be something, but then I actually loved it. And then it became a lifestyle.”
• “As a surgeon, when I talk to my patients about cosmetic surgery, you’re going to hear my talk about how to work out. You’re going to hear my talk about doing a hundred sit ups after that liposuction 360 Degree Body Contouring. You will hear it because I really push sustainable cosmetic results. It’s not about getting an instant fix because after what I do, you’re going to look great. But are you going to look great a year from now, two years from now, five years down the road? So working out is really a big part of my conversation with patients.”
• “Nutrition is the foundation of everything in medicine, in staying healthy, having a long life, nutrition can prevent most elements that we have in our society right now. And it’s very difficult because the lifestyle we all have involves working and childcare and running around and really forgetting the basics, which is what are you eating? Fast food or restaurants around the corner? It just makes you like the food, but what are you eating?”

Relevant Links

• Dr. Ayim’s Practice Website

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:24)
Hello and welcome to the Doctorpedia podcast. I am your host, Daniel Lobell and today I’m honored to be joined on the line by Dr. Daisy Ayim. How are you, Dr. Ayim?

Dr. Daisy Ayim: (00:35)
I’m wonderful. Thank you for having me.

Daniel Lobell: (00:38)
It’s a pleasure. Where does the name Ayim come from? That’s a cool name.

Dr. Daisy Ayim: (00:43)
Well, thank you. It is Cameroonian by birth. I was born in Cameroon, so that’s my father’s name and yes, that’s where I came from.

Daniel Lobell: (00:53)
Wow. Do you remember it at all?

Dr. Daisy Ayim: (00:56)
I grew up there. I left when I was 13, so I remember a whole lot.

Daniel Lobell: (01:02)
Oh, please tell us.

Dr. Daisy Ayim: (01:02)
It’s exciting. It’s a fun country to grow up in. It was the most amazing thing ever in my lifetime and life there is easy, simple, happy, the basics of life.

Daniel Lobell: (01:19)
Sorry. If you heard any noise, I was packing a suitcase to move to Cameroon and you had me completely convinced at easy, simple, fun. Why did you leave? I mean, that sounds great.

Dr. Daisy Ayim: (01:31)
Well, my parents left, so I guess when you’re a child, you go when your parents go.

Daniel Lobell: (01:36)
Yeah, I guess so. I had to go to Long Island, not quite as big a trip from Queens. Cameroon to America. What part did you guys move to?

Dr. Daisy Ayim: (01:47)
My parents moved to Austin. That’s where they were when we first came. So I was in Austin briefly, but I grew up in College Station, Texas, which is not too far away either.

Daniel Lobell: (02:01)
So that must have been a huge culture shock for you at 13 years old. When you said you were born there, I immediately assumed that you’d left when you were very young, which is why I asked if you remembered anything. But if you left when you were 13, that’s a major adjustment, isn’t it?

Dr. Daisy Ayim: (02:16)
Let’s say it’s interesting, high school’s never fun for anyone. Even if you’re born and raised here, imagine coming from out of the country and going straight to high school. So it was an interesting four years.

Daniel Lobell: (02:31)
What was your first impression of America like that? The thing that struck you as the most different when you got here?

Dr. Daisy Ayim: (02:38)
Everything.

Daniel Lobell: (02:39)
Everything.

Dr. Daisy Ayim: (02:41)
Everything. I will tell you the funny story of the first time someone handed me a bag of potato chips and said it’s potatoes. And of course, what I know about potatoes is whole potatoes, so it was strange to get that. And then she said, “Taste it.” I’m like, this is not potatoes. And I still remember that I put it in my mouth and literally spit it out. And I was like, “What? That is not potatoes.” [Laughs.]

Daniel Lobell: (03:17)
[Laughs.] If you would’ve stuck with that mentality, that’s a pretty healthy way to live.

Dr. Daisy Ayim: (03:22)
I would like to think I’ve stuck with it pretty much my whole life, but it was just an interesting moment. And that was the beginning of the journey. Everything was just different.

Daniel Lobell: (03:32)
Yeah. Wow. If I would’ve had to guess, I never would have thought that potato chips would’ve been foreign to you, but that is a big difference if potato chips are a wild trip, I’m sure they have them now in Cameroon.

Dr. Daisy Ayim: (03:47)
I believe so. Time has passed, cultures are intermingling, so they could have had it back then. But yeah, I think now with social media knowledge and travel, I’m sure it’s there.

Daniel Lobell: (04:04)
Do you still have family there?

Dr. Daisy Ayim: (04:06)
Oh yeah, my whole family’s back there. Well, my extended family, aunts, uncles, everyone is there except my immediate family.

Daniel Lobell: (04:17)
Do you go visit?

Dr. Daisy Ayim: (04:19)
Oh, for sure. I go quite frequently, although I have not been in three, maybe four years now. Partly due to COVID, but before that I was in a position where I was planning to go and then life happened.

Daniel Lobell: (04:35)
So growing up as a girl in Cameroon, did you want to be a doctor then? Or did that come about when you moved here?

Dr. Daisy Ayim: (04:49)
I think it’s kind of unclear, growing up back home, I’m not sure I really had a fundamental idea of what I wanted to be. I was just went through life and I don’t recall ever saying, “Oh, I wanna be this or that.” I was exposed to healthcare because my mother was a midwife at the hospital and she was the director. So I saw my first childbirth by accident when I was really young, obviously but I don’t think that really formalized being a doctor. And then when I came to the US, I think what really did it was my parents being the strict African parents, they sat us down, and asked, “Okay, what do you guys wanna be when you grow up?” And before we even had an opportunity to present ourselves, they’re like, “Here are your five options. Pick one.”

Daniel Lobell: (05:44)
What were the other four?

Dr. Daisy Ayim: (05:47)
MD doctor, PhD doctor, pharmacist, lawyer and engineer.

Daniel Lobell: (05:55)
Okay. Well all of those are pretty prestigious options.

Dr. Daisy Ayim: (06:01)
Yeah, the standard immigrant options. [Laughs.]

Daniel Lobell: (06:04)
What did your dad do?

Dr. Daisy Ayim: (06:06)
He’s a PhD professor.

Daniel Lobell: (06:09)
What does he teach?

Dr. Daisy Ayim: (06:11)
He’s in the health department at the Grambling State University.

Daniel Lobell: (06:17)
So in a way they were both in healthcare.

Dr. Daisy Ayim: (06:20)
Yeah. In a way. He’s more on the academic side. My brother is also a PhD professor.

Daniel Lobell: (06:31)
That is one of the five choices. That’s great. Yeah. How many siblings do you have?

Dr. Daisy Ayim: (06:38)
I have a younger sister. She is the one that said, “You guys are just going to have to pick something else.” So she became an MBA.

Daniel Lobell: (06:48)
Wow. So she broke the rules.

Dr. Daisy Ayim: (06:54)
She definitely did, and we joke and we say, “You know, you came to the US when you were six. So you’re definitely more American. And so an American child tells you what they wanna do, you don’t tell them what they’re gonna do.” [Laughs.]

Daniel Lobell: (07:08)
[Laughs.] The culture had already taken its effect on her and she was no longer controllable.

Dr. Daisy Ayim: (07:15)
Yeah, she did her thing.

Daniel Lobell: (07:18)
So I was looking up doing some research on you before the interview. And it’s really interesting. First of all, you’ve got this beautiful business. It looks like a beautiful business from the website in cosmetic surgery. And then you also do obstetrics and gynecology. I wouldn’t think to put those two things together. I don’t know how many doctors would be in both of those specific medical fields. So how did this come to be?

Dr. Daisy Ayim: (07:51)
You’re not alone with that mindset, it’s one of those things where I remember I went to LSU. That’s where we into college.

Dr. Daisy Ayim: (08:01)
And when I was majoring in biochemistry, obviously I was good at science. It came naturally. I didn’t have to struggle to do well. And so I remember when I was applying to medical school and some of my friends were having a hard time getting in. And I got in and I did an English project, and we had to write a thesis paper at that time. And you had to talk about what your next future would be. And it sounds really silly. I wrote a paper on Baywatch and the effect of culture because that’s when it was really a popular show.

Dr. Daisy Ayim: (08:37)
And so that kind of morphed into, “I am interested in plastic surgery, cosmetic surgery.” So I went into med school with that mindset, but I also was exposed to delivering babies as a result of my mom being a midwife. So women’s health was something that was just there too. And when I got to medical school, both were very interesting to me. I discussed with a few people “Hey, can I do both? ” And the normal response I got was a blank stare, like what?! or “No”. But I really like both. And I thought, “How can I do both?” And it was very much like you either go into residency and do plastic surgery or you go into residency and do obstetrics and gynecology.

Dr. Daisy Ayim: (09:29)
So with me being on the fence, I took the plastic surgery route. And at that time, you had to start in general surgery, which I did not enjoy. I didn’t enjoy it enough and I wasn’t willing to go through that just to get to plastic surgery, but I enjoyed women’s health. So I thought, “I’ll just go into what I enjoy because I’m not enjoying general surgery. And I switched to obstetrics and gynecology. So I did that practice and obviously I still had the love for cosmetic surgery. And then I decided to go back to do a fellowship, which existed at that time but really wasn’t in my radar. So when I decided to do it 10 years later, this opportunity presented itself to go back to school and train in cosmetic surgery.

Dr. Daisy Ayim: (10:27)
So I did that and I was already a business owner. It was easy, but yet difficult for me to step out of the business, go back to training and then bring it back into my existing business and create this hybrid ecosystem that is new. But the way I see medicine evolving, this is not going to be a new thing anymore. It’s going to be routine because now more and more doctors are cross branching into different specialties. So although I’m one of the pioneers [of this hybrid practice], I see it as going to be a norm really soon because it makes sense.

Daniel Lobell: (11:13)
Yeah. It’s the same skill set then and dealing with women too. I was imagining that your babies were being born. You’re like, “Let me fix ’em up and make ’em look better before they … ” [Laughs.]

Dr. Daisy Ayim: (11:25)
Yeah. [Laughs]. Well, there’s a little bit of that. And then there’s the standard cosmetic surgery, but cosmetic care and women’s care made sense. I have delivered so many women’s babies and I see the transformation of their bodies and now I get to transform it back to where they were or to a different form. So why not me? I’m enjoying it.

Daniel Lobell: (11:51)
When you put it that way, it’s perfectly intuitive. It is, “Let me give you a tune-up afterwards and you’ll feel better than ever.”

Dr. Daisy Ayim: (12:02)
[Laughs]. And who more to trust than your obstetrician that has taken care of you and delivered not one, not two, not three, maybe four babies? So there’s that trust already. And now it makes sense to add this next level.

Daniel Lobell: (12:19)
My wife (please-god) is due to give birth to our second child any day now.

Dr. Daisy Ayim: (12:24)
Look at that.

Daniel Lobell: (12:25)
So we’re gearing up for any advice because we’ve been through it once, but I think it’s probably different every time to some extent, isn’t it?

Dr. Daisy Ayim: (12:37)
Yeah. I always tell my patients that every pregnancy and every delivery is its own entity. There’s some similarities with what happened in the first pregnancy. You may be lucky and have the same [experience] twice, but if it’s different, it is what it is. The second time obviously there’s less anxiety because you’ve been down that road already, you expect it. Or you’re probably just distracted from the current one that you have that the pregnancy is a priority, but not a pressing matter because your toddler is probably distracting you enough. So the advice I give is just approach it like anything else, fun and exciting.

Daniel Lobell: (13:17)
Yeah. My wife said, “This time I’m just going to go in and be like, “Give me an epidural and let’s get out of here.” ” And I’m like, “Wait a minute.” [Laughs.]

Dr. Daisy Ayim: (13:24)
There you go. She knows what she wants.[Laughs.]

Daniel Lobell: (13:27)
I’m like, maybe she won’t need it this time. Because last time she was trying not to do the epidural. And it just got to a point where she needed it. But I said that maybe it’s easier the second time. I don’t know. Is that correct?

Dr. Daisy Ayim: (13:40)
I don’t think it’s ever easier. I think it’s just like a mindset, “Do I wanna do it or do I wanna challenge myself and get to it?” And I always tell my patients, “You are not gonna be considered less of a woman. If you choose an epidural, by all means. There are women out there that do it naturally and do it beautifully and there are women who scream throughout the whole process, whatever it takes to get to the end. No one is going to put your womanhood in question if you tap out or if you go all the way to the end. If you do it naturally five times, you’re not a better woman than someone who had five epidurals.

Daniel Lobell: (14:20)
Yeah. I think it must be stigmatized to some extent because in the classes that I went to with my wife, I heard women saying, “I’m not going to do it.” And I thought, “Well, if it helps you, [maybe that’s not a bad thing.]”

Dr. Daisy Ayim: (14:38)
Yeah. You know, with that I say pain is such a subjective matter that everyone’s reaction to pain is different. And it’s not a judgment thing on how pain feels. So, and that’s what I tell my patients, “If you want to do a natural birth, listen, I’ll be there right with you to the end. If you want an epidural, I’ll be right there with you to the end.” In some cultures, epidurals are kind of like, “Why?” So you see women doing it for those reasons happily or not. It’s their choice. I in America, but culture does, does play facts for it. I know for me personally, I didn’t even, I didn’t have a thought because I worked so much and I was a resident and I was actually on call delivering other women when I went into labor.

Daniel Lobell: (15:32)
Really? You were doing deliveries for other women when you went into labor.

Dr. Daisy Ayim: (15:36)
Yes. I was 39 weeks and four days still working because I was a resident and back then, you were allowed just a limited time off. Otherwise you had to make up that time to graduate. And I wanna delay my graduation from residency. So I just chose to work to that last minute so I could use the little time I have off when my baby’s born. So I was 39 weeks and four days, I had delivered three women and I was waiting on the fourth one to deliver. And I walked back to the call room just feeling really tired. And I thought, “Gosh, this is such a brutal call. Let me just lay down.” And I was feeling restless and then it dawned on me and I thought, “You know, maybe I should go. Maybe I should check myself.” So I grew up on the nurses and we went to the other room and I was like, okay, check me. And she was checked. She was like, “Oh my gosh, Dr. Ayim, you are four centimeters dilated.” I was like, “No way.”

Daniel Lobell: (16:33)
Like, can I just finish this other one first?

Dr. Daisy Ayim: (16:35)
I know, but here’s a kicker, which was really poor judgment. And when you’re a patient slash doctor, I really wanted to deliver in another hospital for personal reasons because my family back home knew of this hospital and I just wanted them to feel part of it. And that was the plan. So I told her, “Hey, I wanna go to the other hospital to deliver”. She was like, “What?! You’re in the hospital bed right now. You want to leave?” Just, I was like, “Yeah, you were just checking me. You don’t know how far I am. I’m gonna go.” And she was like, “Okay, I’ll drive you.” Very bad idea. Both of us, we’re about to leave and she has to go somewhere. And then the other nurse was like, “Well, I’ll take you.” So we’re driving to the other hospital again, poor judgment on my part. I went into full blown labor. I’m like contracting and she’s driving and I’m screwing my head. So then I called the hospital. I know like, this is a mess. This is like a movie. [Laughs.]

Daniel Lobell: (17:31)
It really sounds like one.

Dr. Daisy Ayim: (17:38)
So I called the other hospital. I’m like, “Hey, this is Dr. Ayim. I’m on my way. I’m in labor. I would like an epidural. I’ll like all these things”. I’m like giving my order. And the nurse is like, “You can’t get your order. You’re a patient.” [Laughs.]

Daniel Lobell: (17:52)
You’re calling like it’s a takeout restaurant or something. [Laughs.]

Dr. Daisy Ayim: (17:55)
And she’s like, “Do we need to call the attending?” Oh my gosh. I said, “Yes, I’m coming.” She’s like, “But you are there.” I said, “Don’t ask too many questions. I’ll be there in three minutes.” And literally she drops me in front of the hospital. I’m hauling myself upstairs through the elevator, by myself and contracting my butt up. And I’m like, “Why did I do this to myself?” And I showed up in the unit and they were like, “What In the world?” [Laughs.]

Daniel Lobell: (18:22)
It’s certainly not type B personality. Right? [Laughs.]

Dr. Daisy Ayim: (18:26)
[Laughs.] No. And to cut a long story short, I ended up with a C-section because by the time they put on the monitor, the baby’s heart rate was in the one sixties or something like that, it was just bad.

Daniel Lobell: (18:40)
Wow.

Dr. Daisy Ayim: (18:40)
And it was an emergency C-section under general anesthesia. And that’s how I had my daughter. [Laughs.]

Daniel Lobell: (18:48)
[Laughs.] Well, they say doctors make the worst patients.

Dr. Daisy Ayim: (18:52)
[Laughs.] Yes. I’ll have to agree. I was definitely that doctor.

Daniel Lobell: (18:58)
Wow. [Laughs.]

Dr. Daisy Ayim: (18:58)
But she’s doing good, she’s well, but at that time it was not the wise thing to do. So if anyone is hearing this story, please don’t do that.

Daniel Lobell: (19:10)
Somebody told me that there are doctors that tell women to get C-sections just because they can bill more for that. Is there any merit to that?

Dr. Daisy Ayim: (19:17)
Oh my God. I could not imagine an obstetrician offering that. Gosh, no.

Daniel Lobell: (19:28)
I mean, the person who told me it might have absolutely no merit to what they’re saying. I right. I took it with a grain of salt when I heard it. But …

Dr. Daisy Ayim: (19:36)
Yeah. When I think about the reasons to do C-section – that’s not even on the list for reimbursement because the amount of work and risk involved for the few dollars, it’s not worth it. Yeah. Honestly.

Daniel Lobell: (19:52)
Yeah, I was shocked. It’s not worth it. Do you do gynecology and then you do cosmetic gynecology? Is that just what it sounds like? It’s just like tidying it up afterwards?

Dr. Daisy Ayim: (20:03)
No, it’s more than cosmetic gynecology. I did a fellowship in facial plastic surgery, aesthetic and general body.

Daniel Lobell: (20:11)
Under the OB/GYN section of your website, you have gynecology listed and then cosmetic gynecology and then laparoscopic gynecology. So what is laparoscopic gynecology and also what is the distinction between gynecology and cosmetic gynecology?

Dr. Daisy Ayim: (20:33)
So laparoscopic gynecology is a technique we use to enter the pelvic cavity or the abdomen to do procedures like removing the uterus or the ovaries. And so that technique is called laparoscopic. Now you have robotics, which is a similar type of pattern to get into the abdomen. And it’s just less invasive, better recovery, shorter hospital stay.

Daniel Lobell: (21:00)
Do you do robotic gynecology as well?

Dr. Daisy Ayim: (21:03)
I am not a robotic gynecologist. I am a straight stick. I’m laparoscopic. And robotic gynecology came in play really right when I was finishing my residency like a year or two prior, like 2005 ish. And I graduated in 2007. So it was very, very much in this interesting state when I completed my training. So in my private practice, it became the sort of thing that you’re hearing about, but in my humble opinion, and most gynecologists would tell you this, the difference between robotic and laparoscopic gynecology is really the entry. The access is about the same, the type of skills and surgery you would do with it is the same. The slight advantage of robotic gynecology is if you’re in a very tight space and you need that extra dissection, then it comes in handy just because the hand is easily maneuverable as opposed to laparoscopic where it’s a straight stick, it’s almost like a straw, so you can really bend and flex. But if you are great as a laparoscopic gynecologist, you can do just as well as a robotic gynecologist. So it’s not really superior security. If you do robotic with a laparoscopic, however, both are superior to do your standard gynecology procedure.

Daniel Lobell: (22:26)
Interesting.

Dr. Daisy Ayim: (22:27)
Yeah. So that’s laparoscopic gynecology.

Daniel Lobell: (22:30)
So what’s cosmetic gynecology then?

Dr. Daisy Ayim: (22:33)
Cosmetic gynecology is dealing with anything that is not medically needed. So if you have excessive labia, for example, which is one of the outer anatomy of the woman’s vulva area, if it’s excessive, if you wanna reduce it, that’s more for a cosmetic procedure. It’s not anything, there’s no medical harm to it. It’s just more of how you would like for it to look or let’s say you’ve had multiple childbirths and the vaginal opening is just rather loose. And so intimacy does not feel the same. And you wanna have it narrowed, then we can do what’s called vaginoplasty. Or if you have excessive redundant tissue on the outside between the vaginal opening, and anus and you want that improved, that’s like a perineoplasty. So all those procedures are not medical integrated. It’s more of how you want it to look, type of thing.

Daniel Lobell: (23:31)
Is it common?

Dr. Daisy Ayim: (23:34)
Yeah. I do enough of it to say it’s common, but no one talks about it.

Daniel Lobell: (23:41)
I can’t imagine when it would ever come up in conversation.

Dr. Daisy Ayim: (23:45)
It’s not the dinner conversation you have, but it’s one of those things that, in a relationship or marriage or in context, the changes that happen to women it’s real and these changes are not discussed. And I feel that it needs to be talked about more openly. So that women do not feel like they’re alone and sort of feel shame in their limitation because of what happens naturally.

Daniel Lobell: (24:14)
Yeah. So I’m not going to be the one to talk about it more openly. You’re going to get me in trouble. I’m not going to do that. I’ll be thrown out at dinner parties. [Laughs.]

Dr. Daisy Ayim: (24:25)
[Laughs.] Exactly. As a comedian, probably.

Daniel Lobell: (24:29)
Yeah. So I want to talk a little bit also about the cosmetic surgery that you do. How are you with pencil and paper? Can you draw well?

Dr. Daisy Ayim: (24:45)
I think I can draw well to appreciate my drawing. Am I a great artist? I will not put myself on the list of great art, but I appreciate my artwork.

Daniel Lobell: (24:57)
I would think you’d have to have some kind of visual skills just to be able to work in that field. It’s not like regular medicine where there isn’t a lot of art, it’s sculpture to some extent, isn’t it?

Dr. Daisy Ayim: (25:10)
Absolutely. So you asked about drawing, which is one form of art. And there’s sculpting, like you just mentioned, and then there’s visual art and then there’s molding. So there are different types of artistry. Now that involves your hand. Am I good with my hands in design? Absolutely. Do I have a visual art appreciation of how things need to be. So to be an artist, to be a cosmetic surgeon, those two things do matter.

Daniel Lobell: (25:43)
Do you sit in a restaurant and look around and think, “I know I can make that person better looking and that person and that person … ?” [Laughs.]

Dr. Daisy Ayim: (25:49)
No, I never do. And at least for me, the reason why I never do is because it’s such a personal decision and it’s a personal choice what somebody wants. So what I see and what someone wants may not be in alignment. So I always allow it to be a conversation where it is brought up to me.

Daniel Lobell: (26:16)
That’s interesting to me, because it raises the question of do you have patients come in and they want certain things done and you think that won’t look good at all? Do you weigh in on that or do you think, “Well, that’s just their taste.”

Dr. Daisy Ayim: (26:32)
No, I give them my honest feedback because at the end of the day we are humans, we want what we want, but also when you come to an expert, you are expecting some expert opinion on what you want. And so it’s a very delicate subject because if I truly believe that what someone is wanting is not going to be a good fit, I will state my opinion. Because it’s sort of like that good girlfriend you have, your good guy friend, would you just sit there and let your friend go down the tubes just because you’re not going to tell them?

Daniel Lobell: (27:12)
Right.

Dr. Daisy Ayim: (27:13)
So yes, I can professionally say, “I know you love this, but how about this?” Or I will not recommend it and I give objective reasons, but ultimately they make the choice and if they make a choice that they are completely happy with, and it doesn’t really put anything as far as safety concerns in check, that’s fine with me. Or if it doesn’t align with my own moral standpoint, then that’s fine with me. If I truly have a moral standpoint that I don’t know if I want to do this, I will also let them know and likely just excuse myself from the process.

Daniel Lobell: (27:55)
Yeah. So there are times when just say, “Look, I don’t want to be a part of this.”

Dr. Daisy Ayim: (28:02)
Yeah, I have. Absolutely.

Daniel Lobell: (28:04)
So what are the more challenging cosmetic surgeries and why are they more challenging than others?

Dr. Daisy Ayim: (28:11)
I think the most challenging ones are clients that have unrealistic expectations because it’s no longer a question of my talent. It’s more of a mindset, right. And that becomes a whole different level to convince that man or woman of this unrealistic expectation, like, it’s just not going to happen. For example, now I’m just being completely left with this. Let’s say you are size two and you want to have a butt that is like someone that’s a size 10, that is not realistic. It’s just not gonna happen. I guess it could happen if you use implants and all those things, but it has to make sense. So patients with unrealistic expectations are probably the hardest type of clients to deal with because sometimes it just doesn’t make sense.

Daniel Lobell: (29:13)
Right. But in terms of the face or the body or skin, are they all equally difficult or easy to perform?

Dr. Daisy Ayim: (29:22)
Every area has its own unique challenges and ease, skin quality matters, whether it’s in the face or the body, as far as what the final look is going to be, someone’s natural, bony architecture really matters because how the fat and the skin lays on their skeleton frame really determines their outlook. So if someone comes with a picture or an idea of what they want, I have to assess them from inside out, starting with a bony architecture and then all the tissues that are on top of it to see if I can give the patient the results that they’re imagining. And so that is the art of what I do. And applying science and knowledge to visual art.

Daniel Lobell: (30:22)
Are there situations where people have inflamed tissue that you can remove through cosmetic surgery? And I’m just thinking in terms of people maybe with rheumatoid arthritis, you are removing tissue, is that sort of along the same lines?

Dr. Daisy Ayim: (30:43)
No, that’s now medical. So when you’re coming for a cosmetic procedure, truly speaking words, speaking with things that are purely elective, meaning things that you don’t need, but you want, right. I call it fantasy medicine. You are not sick. You just want it. If you want to have breast augmentation, you just want it because that’s what you want. Is it a necessity in your everyday life? Not necessarily, but is it going to make you feel great? Absolutely. So if you have an underlying medical condition, obviously depending on the extent of it, you may need medical clearance whether it’s from a cardiologist or your internal medicine doctor. And so when I’m going to do this cosmetic surgery, I am purely elective. There’s nothing medical out of it.

Daniel Lobell: (31:34)
There’s no combining medical with elective in any situation, it’s really one or the other.

Dr. Daisy Ayim: (31:41)
Yeah. It’s really one or the other. But I’ll tell you a funny story, being that I am a hybrid surgeon, I have patients that, for example, may have bleeding problems due to fibroid or whatever the reason. And they’re like, “Hey, I need a hysterectomy. Can you, at the same time, do my tummy tuck?” Now those things can be done in combination, obviously the proper pre-op workup will be done. And if you’re a good candidate, a hysterectomy and a tummy tuck can be done simultaneously. On the other hand, I have pregnant women that would say, “Hey, when you’re doing a C-section, can you just cut off the excess skin or suck out this fat? Of course, you know, it’s jokingly, but I know they’re also serious. And that’s when I have to say, “No, I cannot do both simultaneously because medically you’re not healed from delivering. You’re still very swollen. You’re edematous. We just need your body to get back to where it was. And the ideal time is after four months, and then we can visit the idea of cosmetic surgery.”

Daniel Lobell: (32:53)
Yeah. I understand why women would want to get it all done at one, but I think you’re right. Obviously the body needs to heal.

Dr. Daisy Ayim: (33:04)
Yeah.

Daniel Lobell: (33:05)
You talked about liposuction. Is it this still common practice, and is it just for little amounts of fat or do people who are very overweight get liposuction?

Dr. Daisy Ayim: (33:34)
Everyone is getting liposuction from your small patient to your more obese patient, but I get it all, every state has this recommendation of how much fat can be removed at one session here in Texas, five liter is the limit. So, you know, if someone has excessive fat and it looks like we’re gonna take out more than five liter, then we see I state agent, you know, if she, or he wants multiple errors done and just visualize, I eyeball that if I do all of this, I’m gonna need more than five liter, less stages. So we do this part of your body first in one session. So we maximize that, and then come back in a few weeks into part two.

Daniel Lobell: (34:25)
How safe is liposuction?

Dr. Daisy Ayim: (34:30)
It’s quite safe. You can do liposuction awake, you can do it under local anesthesia. You can do it under general anesthesia. It’s a safe procedure. And like anything else, there’s always risks and complications [which can arise], but generally speaking it’s a routinely safe procedure.

Daniel Lobell: (34:50)
Interesting. Let’s shift gears for a minute and talk a little bit about the doctor-patient relationship. What are the most important things for you in the doctor-patient relationship?

Dr. Daisy Ayim: (35:10)
For me, the most important thing is communication and also listening. I find that in my years of what I do, walking into the room and just getting a visual of the patient gives me an impression already. And then just asking the patient, “How may I help you?” Or “How are you doing today?” “Well, how’s it going?” This is a very simple lead on question which can also set the mood of what to expect. So for me, listening is very important in my relationship with my patient and understanding the patient as a whole. And what that means is not only why are they there, but who accompanies this patient? Where do they live, where are they from, what is their background? What is their culture? All those things impact their relationship with me. So I really value that because it creates a natural trust and it creates a natural feeling like I care, which I do. But conveying that to a patient is important because I think ultimately we all just want to go to a doctor that feels like they care about us.

Daniel Lobell: (36:31)
Absolutely.

Dr. Daisy Ayim: (36:32)
And that’s a very simple thing to do. And so those things are not taught in medical school. No one can teach you how to care. You either have it or you acquire it or you don’t have it. So just approaching it as a human, what would you want for yourself? And that’s how I doctor my patients – what would I want for myself? It goes down to how I designed my practice, how I wanted a woman to feel when she walks into my practice, all of that says a lot about who I am. And I think creates an atmosphere that I am trying to convey to this patient.

Daniel Lobell: (37:19)
Interesting. Do you also see men or do you only see women?

Dr. Daisy Ayim: (37:23)
I take care of male clients in that sector.

Daniel Lobell: (37:29)
Is it as common with men though to go in for cosmetic surgery?

Dr. Daisy Ayim: (37:34)
It is common. Obviously women are still number one, but with men it has become common. Culture has shifted so that grooming yourself as a man is a normal thing and women also bring in their husbands or their boyfriends or significant other.

Daniel Lobell: (37:56)
Get rid of his extra chin or something like that.

Dr. Daisy Ayim: (37:59)
It’s nowhere near as much as women, but I think it’s changing.

Daniel Lobell: (38:05)
Cool. So this interview is for Doctorpedia, which is an online website. So I’m going to ask you a little bit about the online health space. What do you think about it? Do you recommend patients to go online before they come and see you? And what are your general thoughts about Doctorpedia?

Dr. Daisy Ayim: (38:26)
I think online is a good tool if it’s used appropriately. And I really appreciate patients that go online to research their symptoms or research their diagnosis or research what to do before their visit. I think it is very informative and engaging. And in some ways, I actually enjoy how the conversation flows. The downside is sometimes too much information gives a false perspective on expertise. And every now and then you get a conversation that is a little rough to try to debunk some of the things that the patient has read online, because there’s not a lot of credible sites online. Dr. Google is amazing. In fact, Dr. Google gets more facts than me and the physicians. So you’re fighting Dr. Google when you’re trying to consult or manage your patients.

Dr. Daisy Ayim: (39:32)
Doctorpedia is just a fantastic idea to create an ecosystem, a place where patients, anyone can go and get some reliable information from physicians, because we are on the frontline. We know the stuff, we see stuff. So creating videos, educational videos, and content is just fantastic. There are other online sites, there are academic centers that have online space that you can access, but even then the information tends to be vague because they don’t want to come across as giving medical advice. So they’ll always tell you to consult your physician. But I really love it. I think that’s the future of medicine. When I went into private practice, it was your standard brick and mortar model. You open shop, you get on insurance, you start seeing patients, they tell their friends, their sisters, their family, and then they come and you grow and voila. That has changed. You have social media, you have online that is just telemedicine and with the pandemic last year, it has just become a real thing. So you find that a lot of practices, including myself, are pivoting to online medicine to tap into that source of providing care from the online space.

Daniel Lobell: (41:11)
Has the pandemic discouraged people from doing elective surgeries or have you found it pretty much the same?

Dr. Daisy Ayim: (41:18)
I think it’s the same. I don’t think it changed anything. I think it just created a little hiccup as far as what patients wanted, but I don’t think it deterred a lot of stuff. What did deter a lot of stuff is insurance plans and some of the changes in coverage that comes with it. And that’s a whole different conversation. It’s a love/hate relationship with the insurance plans.

Daniel Lobell: (41:46)
Yeah. I imagine that with elective surgeries, it’s hard to get things covered.

Dr. Daisy Ayim: (41:51)
I’ve just seen it change. I have been in this field for over a decade. I see how it has changed and it’s a very interesting change. When you talk to physicians that have been practicing for 30 years, they say, “Oh my gosh, it’s changed so much since I first started.” When I first started working, I didn’t know what that meant. But now, looking back 10 years, I see that it has changed. And it’s concerning.

Daniel Lobell: (42:25)
Yes.

Dr. Daisy Ayim: (42:26)
An example of the way it has changed is that when I first started, if I called insurance to get authorization for a hysterectomy, patients could stay in the hospital for three or four days if needed, there really was not much of a back and forth with that. But now, you get one day approval, 23 hours, two days max, and you have to go home. And sometimes the patients need longer than 23 hours. In fact, they do need 23 hours if you’re doing some bigger cases, like if I do a laparoscopic hysterectomy in the morning, I can feel comfortable sending my patient home by the end of the day, less than 23 hours after, if it was just straightforward now, no hiccup, but at least keep on 23 hours observation, some cases you do need two or three days, but it’s just a process to call and get authorization and to be an advocate for a patient, it’s just a longer process now. And sometimes you’re declined, sometimes you’re given but restricted. Whereas when I first started, it was much easier, you didn’t really have that back and forth.

Daniel Lobell: (43:48)
So it’s gotten worse, much worse.

Dr. Daisy Ayim: (43:51)
It’s gotten more difficult.

Daniel Lobell: (43:54)
It’s a shame.

Dr. Daisy Ayim: (43:56)
Yeah. It’s gotten difficult and the unfortunate thing is the patients are the one stuck in the middle of all of this.

Daniel Lobell: (44:05)
It’s always the patients that suffer in these things. It’s unfortunate, but I guess businesses don’t see the humanity in what they’re doing. They’re just looking at the bottom line.

Dr. Daisy Ayim: (44:17)
It must be because I can tell what they’re not paying as a physician, our pay rate is not going up. So that bottom line is not for us. It’s for them.

Daniel Lobell: (44:27)
Yeah. Unbelievable. I hope it changes for the better

Dr. Daisy Ayim: (44:41)
I’m not sure, it needs some big fixing. It needs to change. I’m not sure of the power of being really want to do something to make that change.

Daniel Lobell: (44:57)
I hope someone comes along and is able to do that. I read that you’re also a biochemist and I wanted to ask you a little bit about that.

Dr. Daisy Ayim: (45:05)
Yeah, it’s funny. I majored in biochemistry and I really loved it. When I went to college, I had to pick a major of the student sciences at the time, if you’re thinking about medical school and it was funny because I did really well in chemistry in high school. But when I got to college, when I heard about chemistry I thought, “Oh, that’s a nice way to learn chemistry.

Dr. Daisy Ayim: (45:35)
Yeah. So I decided to major in it and you know, I, now, when I was in it, most of my colleagues, you know, my class college students did not major in biochemistry to go to med school. It was more like microbiology, biology, chemistry – they call it softer sciences, which in some ways is different. And the reason people didn’t major in biochemistry is because there was one class called P-chem, physical biochemistry. That was a class that most people flunked and most people switched their major. So if you made it through P-chem, [Laughs] you were guaranteed to graduate with a biochemistry degree. [Laughs.]

Daniel Lobell: (46:27)
[Laughs.] So does your knowledge of biochemistry play a role when you’re working in cosmetic surgery or in obstetrics and gynecology?

Dr. Daisy Ayim: (46:36)
The joke of all of this is it took me four years to get a degree in biochemistry. And then when I got to medical school, we actually had to take a biochemistry class in your basic sciences. And that was like a semester. So I remember in medical school joking, “Wow, I took four years to get a degree in Mexico. You learn it in a semester.” But it comes in handy now as a cosmetic surgeon or in that world because everything is about ingredients. What is the ingredient of that skincare line? What was the ingredient in that product? And with that background, the first thing I’m always doing before anything else is turn it to the back and look at the ingredients and see what’s in it. Is it a bunch of fluff on a bunch of packaging that seems like it’s great, but it’s all nothing, and it’s very humorous to see how great marketing and packaging sells like wildfire. And there’s just nothing in it, really nothing.

Daniel Lobell: (47:42)
That’s a useful skill to have. I would now like all my doctors to know that stuff. It’s really useful that you’re able to have that knowledge base when looking at these things, because I think a lot of people, even in the medical industry, don’t know what they’re looking at without that.

Dr. Daisy Ayim: (48:14)
No, they really do not. I receive a lot of products to look at or to partner with and the one thing you notice in my social media, I haven’t done any of these, partly because I truly feel that it has to be completely truthful. Yeah, sure it’s a popular product, sure everyone knows about it. Sure everyone likes it, but is it really doing what it says it is going to do or is it just barely touching the surface, but then you’re marketing it as the greatest and next best invention. [Laughs.] So I just humbly look at it and I just take the sideline on that.

Daniel Lobell: (49:06)
[Laughs.] Good to know. You can decide between what’s snake oil and what’s real out there. That’s a very useful thing to be able to do.

Dr. Daisy Ayim: (49:18)
It is.

Daniel Lobell: (49:20)
Dr. Ayim, it’s been an absolute pleasure getting to speak to you over this past hour. I want to ask you the question that I round off all these interviews with, which is what do you personally do to stay healthy?

Dr. Daisy Ayim: (49:34)
It’s very easy for me to stay healthy. I think it’s a lifestyle that I clung onto when I was 15 years old. Going back to when you first started asking me about how it felt like coming to the US. I was foreign and my accent was huge. Like I’d say, “Hi” and people would start laughing. That’s how it was. And when I was in high school, I really didn’t have friends or my own circle. And everybody has that clique. I really didn’t have that.

Dr. Daisy Ayim: (50:17)
And so I remember growing up in my house, we had a TV, but we did not have cable just partly because our parents were that way. And Miss Fitness USA came on at that time. And it was really random. It showed on a regular basic channel. And I remember watching it and thinking, “Oh, they’re so beautiful. I want to look like that.” And here I am at 15, you look at things when you’re younger, the things you want to copy and I remember watching that show, I thought, “God, I want to look like that. They’re so nice.” So I started going to the gym at 15 because of that show. And out of something simple like that, here I am in my forties. I still go to the gym just about every day because I went into it wanting to be something, but then I actually loved it. And then it became a lifestyle because it was my habit and it was my lifestyle. So what I do to stay healthy is just that working out because I truly enjoy it. It’s as easy as brushing my teeth and my patients would tell you, I push that a lot.

Dr. Daisy Ayim: (51:25)
As a surgeon, when I talk to my patients about cosmetic surgery, you’re going to hear my talk about how to work out. You’re going hear my talk about doing a hundred sit ups after that liposuction 360 Degree Body Contouring. You will hear it because I really push sustainable cosmetic surgery results. It’s not about getting an instant fix because after what I do, you’re going to look great. But are you going to look great a year from now, two years from now, five years down the road? So working out is really a big part of my conversation with patients. Then the next thing is nutrition.

Daniel Lobell: (52:01)
Stay away from potato chips. [Laughs.]

Dr. Daisy Ayim: (52:02)
More important than working out.

Dr. Daisy Ayim: (52:08)
[Laughs.] It’s so funny because that potato chip incident happened with my brother and we still talk about it and laugh about it. Because we came to America at the same time. So what you eat does matter. And so nutrition is the foundation of everything in medicine, in staying healthy, having a long life, nutrition can prevent most elements that we have in our society right now. And it’s very difficult because the lifestyle we all have involves working and childcare and running around and really forgetting the basics, which is what are you eating? Fast food or restaurants around the corner? It just makes your life easy, but what are you eating? So nutrition is so important. And being Cameroonian, I cook and most of the food I cook comes from my country. So by default, those foods tend to be very healthy and nutritious. So it makes it easy for me to be healthy.

Daniel Lobell: (53:12)
Do you have a nutritional plan that people can find somewhere? Because I want to eat it

Dr. Daisy Ayim: (53:17)
I’m not that sophisticated. It’s like you watch your grandparents, your aunts, your uncles, people cook around you and your parents cook and then you just grow up and start cooking. And it’s just like that art thing, and there’s no cookbook telling you how much of each ingredient you put in that stuff you made. You just put it in.

Daniel Lobell: (53:42)
Well, I’ll tell you what, when you come out with the Cameroonian cookbook and nutrition advice, I am picking up a copy of that because I’m intrigued.

Dr. Daisy Ayim: (53:52)
Yeah. That’s the one thing about our country: the diversity of our food. It is impeccable and it’s so delicious and highly nutritious.

Daniel Lobell: (54:02)
So what’s your favorite dish from Cameroon and give me one thing that I wouldn’t know,

Dr. Daisy Ayim: (54:09)
I don’t know the English name of this, but there’s one called do. It’s basically a type of vegetable mixed with a type of what we call goofy. I don’t know the English name of that. You can prepare it with meat or with chicken and you can eat that with yams, there’s white yams, yellow yams, or the equivalent of Yuca roots here. We have it back there, but it’s ground and then wrapped into these leaves and then it’s cooked and then you eat it with it. So that’s always good.

Daniel Lobell: (54:48)
It sounds good to me. I’m coming over. [Laughs.]

Dr. Daisy Ayim: (54:53)
[Laughs.] You’re welcome any time.

Daniel Lobell: (54:56)
[Laughs.] That’s very kind of you. Thank you so much, doctor. I appreciate it.

Dr. Daisy Ayim: (55:00)
Absolutely. It’s been my pleasure. And thank you for taking your time to interview me.

Daniel Lobell: (55:10)
I enjoyed it thoroughly. I’m looking forward to seeing more from you on Doctorpedia and hopefully we get to talk again sometime.

Dr. Daisy Ayim: (55:26)
Absolutely. Thank you so much.

Daniel Lobell: (55:28)
Thank you.

Daniel Lobell: (55:30)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.