EPISODE Twenty two｜The World's Great Doctors with Prof. Giunta

In this episode of The World's Great Doctors, Gloryren invited Prof. Giunta for a special interview. Prof. Giunta now works as the Director of Hand, Plastic, and Aesthetic Surgery at University Hospital of Munich and the President of the European Society of Plastic, Reconstructive, and Aesthetic Surgery (ESPRAS).

In the interview, Prof. Giunta shared his experience from narrowly getting a position as a surgeon in the early period of his career to growing into an excellent hand, plastic, and aesthetic surgeon. Plastic surgery not only restores aesthetic appearance and body function, but also has an artistic aspect, which is aspiring and made him firm about his dedication to this field. When talking about problems in aesthetic surgery industry, Prof. Giunta shared his experience as the President of the European Society of Plastic, Reconstructive, and Aesthetic Surgery (ESPRAS) on formulating regulations for the industry in Germany and Europe, which is of high value for fellow doctors to learn from.

1. Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in the hand surgery, plastic surgery and aesthetic surgery? 

Well, thank you. That's an interesting question. Of course, how you develop your career and how it gets started. So when I remember back in school, I was fascinated by science. My main focus was on scientific subjects like physics, mathematics. And then I had to decide what to do in studies. And I thought of doing maybe mathematics or architecture. And I also applied for medicine. At that time, it was not easy to get a post in medicine. It was very difficult. And I was successful getting a post here in Munich for the medical studies that time. I didn't know a lot about medicine, that medicine is a science where you not only answer scientific questions, but you treat patients, you can do research, and you might also be a teacher in your future career. So this package fascinated me, and this is why I started to study medicine here in Munich. 

Then during the first years in medicine, you study human anatomy. This was really a fascinating part of the medical studies here. It’s a very traditional subject and more than 700 students are working in a hall together to learn about human anatomy and practice. Especially for a surgeon, this is really important. So this fascinated me and I proceeded the whole studies here in Munich. At the end of the studies, in our final year, we have a year of working in the hospital. So we do surgery, we do internal medicine and we do a subject of our choice. At that time I was here in the Department of Hand Surgery for a period of three months. And one of my predecessors was the Head of the Department and I was so fascinated by hand surgery and plastic surgery, since we are doing a lot of work, not only at the hands but in the whole body. And we're using different operative techniques like very rough techniques for bone repair, but even very delicate techniques like microsurgery. So the complete package was really fascinating for me. 

I then got also the post here after my studies, the first year, at that time it was called Arzt im Praktikum (medical intern), I was again in hand surgery for the first one and a half years and did my ICU term here for a year. After that, there was no place for becoming a surgeon at the hospital and the Former Director of the whole Surgery Department here at the inner city hospital sent me to human anatomy again for a year. And he said “you will get a post when you've done that”. At first glance, it looked like a defeat, but then I was really again fascinated. And I had to teach myself students at that time. And I did a lot of research. We also did the fundamental research for our first book, the first book I published in 1997 about flaps in hand surgery. And I met also one of my most fascinating teachers, which I will talk later, Professor Putz, at that time the Head of the Human Anatomy Department. Afterwards I didn't get the post here, nevertheless, at the university. And again this looked not nice for my career, but I knew that the biggest department for hand surgery in Germany at that time was located at Bad Neustadt an der Saale. And Prof. Lanz, world famous hand surgeon at that time who is now a friend of mine, was there the director. They had over 100 beds for hand surgery. So I went there and I could intensify my knowledge in hand surgery for over a year with him and also met very interesting person during my career. 

Nevertheless, hand surgery is not a specialty in Germany yet, so if you want to become a surgeon, a hand surgeon, you have to be either a plastic surgeon or an orthopedic surgeon. And I had chosen plastic surgery at that time, because plastic surgery was closer also to hand surgery. Also, microsurgery was key to be successful in plastic surgery and I went to Axel-Mario Feller’s and later also to Edgar Biemer's place, where we did a lot of breast reconstruction, pioneering breast reconstruction with autologous tissue in Germany. The DIEP flap was, this was in the early 1990s, newly introduced to the world. So I became a plastic surgeon at the end. And I'm very happy that I went into this field, because it's so fascinating. We operate on the whole body from the nose, the face to the breast, and the extremities, so the human trunk. And it's not only that we restore function, but we restore also the aesthetic appearance of a person. So in that way, you also have an artistic aspect of the specialty, which gives you an additional fascination for plastic surgery. To summarize, this was my way to plastic surgery and I think that’s very inspiring. What I've learned from it is that, it's not always the direct way to get into a specialty. You have to see the opportunities, and a little detour might be the right way to improve your own skills sometimes.

2. Who have been your greatest influences? What have they taught you and how have they inspired you?

I had the privilege to meet a couple of very famous doctors in Germany and personalities who really changed their subjects. The first whom I met was the Head of the Department of Human Anatomy here at the LMU Hospital, Prof. Reinhard Putz. He was the Director of the department at that time. The teaching of human anatomy is key for all medical students. We have around 700 to 800 students at that time. I think nowadays it's even more than a thousand in a semester and they all have to be taught human anatomy to become good doctors. So Prof. Putz was really a personality because before becoming a doctor, he was a teacher. He was a really excellent teacher to me and also to all the students. He taught me how to teach. That was not his only ability as a great personality. And he was also an excellent researcher. He taught me also how to present, how to do talks, how to raise scientific questions and solve them in an academic way. He was probably one of the most influences of my career since he taught me the fundamental of an academic plastic surgeon. We also published a book together about flaps in hand surgery. At that time, I was a young doctor in the first three years or so when we were working together. This was an excellent experience also to publish a book because he taught me all the logical steps, how to do it and we had a lot of discussions in our group.

The next excellent teacher was in hand surgery. That was Prof. Ulrich Lanz, also a friend of mine nowadays. They are all retired, we become older. He was the at that time one of the most famous hand surgeons in Germany and he introduced hand surgery as a specialty in Germany. His father was also the Director of Human Anatomy at the LMU Hospital. We shared the interest for human anatomy and especially at the hand. Human anatomy is key because we have a lot of anatomical structures in a very close relationship and they all have to function to give you a good function of the hand at the end. He not only was a good and excellent hand surgeon, introduced a lot of new techniques, but he was also an excellent networker around the globe. So he at that time was working for a year in the United States. And we traveled a lot around the world on congresses and I learned how important international exchange is to improve your own knowledge and skills.

Then from plastic surgery, I think the most important mentors of mine was Edgar Biemer, together with Axel-Mario Feller, both excellent microsurgeons. Edgar Biemer was the pioneer in microsurgery in Germany. He introduced it in the 1970s. At that time he was also in China multiple times, met Professor Yang, for example, who was the developer of the Chinese flap was called Chinese flap in the western world. Also, he taught me a lot about microsurgery and also about the relevance of international exchange. Later I was working with him for nearly ten years. We also did the first human bilateral arm transplant at the Recht der Isar Hospital at that time, which was one of the real milestones for plastic surgery and hand surgery. This was in 2007, just before he retired. And he was one of the most well known microurgeons in the world and he's still active now at our microsurgical basic course, as you can see the column in the back, which we perform once a year. Over thirty participants participate in this course from all German-speaking countries. He's teaching the history of plastic surgery to the participants. 

The last plastic surgeon, whom I want to mention, Prof. Ursula Schmidt-Tintemann, was one of the pioneers in plastic surgery in Germany. She was a generation before Edgar Biemer. She reintroduced plastic surgery into Germany, because, you might know that, plastic surgery is a long standing surgical discipline. For example in the 1840s, a book was published in Germany nearly 200 years ago, which was named Handbook of Plastic Surgery by Eduard Zeis. Already at that time, more than 2,000 references were gathered together about plastic surgery. Nevertheless, plastic surgery did only very late become a specialty in Germany, and this was with the help of Prof. Ursula Schimidt-Tintemann, who founded also the "Association of German Plastic Surgeons" (VDPC) in the end of 1960s. She was really a grande dame, we say, the French word, grande dame for plastic surgery in Germany, and she had also a very excellent and robust ethical attitude to plastic surgery, to present our strength of our subjects also in the surroundings of other medical subjects which might sometimes think they are more important since they maybe treat life threatening illnesses. Nevertheless, with the development of surgery, the improvement of quality of life, also in reconstructive surgery, for example, for a patient, it makes a lot of difference if you can save his leg or amputate it. And plastic surgery makes it possible to maintain, for example, a leg for a patient by free flap transfer. So it's very relevant to make this also obvious to other surgeons in your surroundings and not only to other surgeons but also to the public. Prof. Ursula Schmidt-Tintemann was a pioneer in this at that time. This is why I am very privileged that we were in close contact with her. We even did a nice meeting with over 200 participants for her 90th birthday some years ago. So I consider her also one of the most important influences of my career.

3. From 2017 to 2019, you served as the President of German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC), and in 2023 you were elected as the President of European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS), could you please talk about the importance of these two societies to the plastic surgeons?

Yes, of course. A national society represents all plastic surgeons in the country. So its duty is to protect and also further develop the interests of all plastic surgeons, no matter they are in private practice, working at a smaller hospital, or at the tier-one hospital, like a university hospital. So it's an important duty you get when you become a President, because there are multiple facets of our specialty, from education to research, but also to everyday clinical practice. The German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) at that time had nearly 2,000 members. It was rapidly growing. So it was a big duty, of course, but we have an excellent back office for the DGPRÄC. I was serving as a President after having done the National Congress in 2014 here in Munich with over 1200 participants. For the plastic surgeons, it is important to improve also their visibility in public and also for other doctors and surgical disciplines. I was happy that at that time the Society celebrated its fiftieth birthday, so we had to arrange a lot of things in the context of the anniversary. For example, we developed the online timeline where you can watch the history of plastic surgery in the last 2,000 years, starting from the first reconstruction of the nose in Indian literature. And many other things like national meetings and also international relations were, at that time, very important. For example, we also worked on a code of conduct for social media, which at that time was rapidly growing. In aesthetic surgery, sometimes it's very difficult and ethically questionable what is done not only by non-plastic surgeons but also by plastic surgeons, so it was necessary to introduce a code of conduct. And we did that during my presidency. In Europe, the DGPRÄC is the biggest with 2,000 members nowadays, and I was asked to also contribute to the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). The ESPRAS is a gathering of all national societies in Europe. We have 37 national societies from smaller countries like Malta, which might only have ten members, up to big countries like the UK, France, Italy, Spain, and Turkey which has between 500 and 1,500 members. Since everything is similar in each national society but we just speak different languages, it makes sense to have an European umbrella society to gather all information we have from the national societies, bring it together and spread it again all over Europe. This is, at the end if you want to summarize it, the function of the ESPRAS to gather information and strengthen plastic surgery in Europe. As a whole, we have more than 7,500 members, which makes it one of the biggest societies in the world. Therefore, it is important to position plastic surgery also in the public and also among doctors. Since I had two-year’s experience of the DGPRÄC, it was only logical to use this knowledge and serve as a President to the ESPRAS.

4. As a university professor, chief physician, members of many professional societies, how do you balance the administration, clinical practice, research activities, teaching and personal life?

That's not not easy, but it does not come at once. In your medical career, you grow with your duties. Of course, at the beginning of the career, you are overwhelmed only by treating patients. But once you have learned that, there are new challenges. You might also do academic research, then you become a researcher. You work at a university hospital, then you also need to become a teacher...This whole package is a slowly growing process of developing skills and knowledge. So it's not, I think, too much work, which one might think at the first glance, if you're doing so many things. I think it's challenging and that's what makes it rewarding for yourself to develop your personality on a long term basis. So one challenge, one after the other is to develop the skills over the years and over the decades. And there's a lot of things which you improve when your knowledge makes it possible to do all these duties. 

For example, the motto for being a President in the ESPRAS is, “Stronger together in Europe.” So the sharing of knowledge makes you also as a personality better. You learn from others, and this is a big improvement also for yourself. 

Of course, private life also is important. I want to say to the young doctors that, “carefully select your partner”. Your partner strengthens you in your life and you also strengthen him or her. In the case of my wife, she's also a pediatric doctor, a very successful pediatric doctor, and I'm very happy that I have her. So I think the balance between private life and professional life is very important. And it's important not to focus only on your own professional career, but also on your private interests. This widens your horizon and also anchors your professional life better if you have a fulfilled private life. This will strengthen your professional life.

5. Plastic surgery is a clinical specialty that usually requires interdisciplinary collaboration, for example, a breast cancer patient may require a reconstruction surgery after a tumor resection surgery. As the director, how do you organize the interdisciplinary collaboration in your department? 

Well, interdisciplinaryity is key to plastic surgery. As I said before, we are working on all places of the body, on the surface of the body. And we are doing also some techniques like microsurgery, which might need in many disciplines. 

We once did a diagram which involved all the other medical disciplines where plastic surgery might be needed, and it included more than twenty disciplines. So it's key to promote this as a director of a department and some cooperation were already well established when I came, but most of them had to be established and this was one of the key functions I did in the last nearly fifteen years now to improve collaborations with other departments. You mentioned gynaecology and breast reconstruction. We have excellent gynaecologist and they’re doing excellent therapy of breast cancer and we are organized in a Breast Cancer Center altogether, as you might know that in Germany it is compulsory that also the plastic surgeon is involved in treating breast cancer, especially of course, for reconstruction. And this is how we usually share it. 

If you’re doing autologus breast reconstruction with microsurgical flaps like the deep flap, the gynecologist will do the tumor section and in the same time the plastic surgeon is already harvesting the flap.

So we save time for the patient and reduce the operating time by working in two teams. And this is key to many other disciplines also. For example, tumor patients, they are in a big hospital like ours, we have one of the biggest hospitals in Germany and also in Europe, we have multiple tumor boards and tumor boards means that doctors from various disciplines work together in a group and they discuss individual cases with all radiological aspects but also chemotherapy, radiation aspects, but also, of course, surgical aspects. 

And for that, plastic surgery of course widens by far the possibilities of maintenance, for example, of extremities, sparing amputations because you can do larger sections by using free flap reconstruction, immediate free flap reconstruction or delayed free flap reconstruction, and plastic surgery is really key in all that issues.

We have also nowadays a lot of degenerative cases. The population is getting older in Europe, I guess the same will be in China the case. 

For example, sores, ulcers, decubitus ulcers or for example diabetic foot syndrome nowadays are also interdisciplinary cases where plastic surgery can really help by far to maintain extremities in case of diabetic food syndrome for example, or restore quality of life at the end of a patient's life when there are big decubitus pressure sores or decubitus ulcers which has to be reconstructed by flaps. So, this is the collaboration and interdisciplinary of plastic surgery. 

We also serve as a referral hospital for other smaller hospitals in Munich and also in Bavaria, and so we are building up video boards and also as they are currently also establishing cooperation with smaller hospitals where our doctors, our specialist doctors, might go there once a month and serve as a plastic surgeon to improve the abilities. And of course, severe cases from smaller hospitals which don't have the infrastructure, for example to do microsurgery because nowadays you need a lot of expensive surgical instruments like a microscope and things like that. 

Patients with severe cases then are referred to our hospital bodies. So interdisciplinaryity is key and plastic surgery has to search for exchange, professional exchange and improvement of treatment together with other surgical disciplines and also non-surgical disciplines.

6. Your department welcomes international visiting fellows and doctoral students to the University Hospital of Munich (LMU) for study and exchanges, for example the doctors from China or Arab countries. How do you think these international exchanges could contribute to the personal growing of doctors and how would it benefit your department?

I think international exchange is key, and this was what I learned from my mentors, that in every region of the world, there are special requirements and interests in plastic surgery and I visited a lot of hospitals and international congresses, during my continuing education, I visited a lot of departments both in Asia, America, South America, and you always take a little piece with you, and this improves your personality as a plastic surgeon.

What I've learned and received, I want also to give back to the doctors which are working with me and who are coming from other countries, or also from global, hospitals. So for example, as you mentioned, we have an excellent cooperation with China, for a long term, I think something like fifteen years. 

We have doctors coming for doing the medical doctorate in Germany and we talked before this interview about my first visit to China, which was I think something like fourteen years ago to Wuhan. And from that on, I had a strong exchange with Chinese doctors and cooperation and nowadays we have two and a third medical doctor will come to our department to do a thesis in our department, doing research. And of course, as what I understood, it is very important to a doctor in China to have also an international experience and a medical doctorate, of course, is something which qualifies you further as an upcoming plastic surgeon or hand surgeon. 

So, we benefit of course from the doctors, bringing to us knowledge from other countries and for example, we have an excellent doctor who's working at the Ninth People’s Hospital. He did his medical thesis here in our hospital. And the Ninth People’s Hospital in Shanghai is one of the biggest hospitals for plastic surgery in China with over 200 doctors. And he has now published, I think he's in the fifth year of his residency, or maybe in the last years over thirty publications, academic publications, and he initiated his academic work here in Germany.

So we are doing this with not only with China but also with other countries. For example, we have a lot of Arabic guest doctors. They are coming here for the full continuing education, their country pays for them for the six years program. They are paid by their own country and they're going back as a specialist plastic surgeon back to the Arabic country. And we had excellent doctors as well. For example, the one who finished last year. He is now doing a specialty fellowship starting from June of this year in the Hospital for Sick Children (HSC) in Toronto, Canada, doing plastic surgery in children. And for one, possibly two years, he will be there to improve his skills and then bring it back to his home country.

The third aspect of this is that we also have research cooperation with other countries also around the world.  We’re doing cooperation for Wuhan and for Shanghai in China, but we also have strong cooperation in the United States, for example with Prof. Indranil Sinha from Harvard Medical School in Boston. 

We have regular lab meetings where we exchange our knowledge and exchange our work in progress and we exchange also students, for example, at Harvard Medical School we had two medical students there for a research project who started there for several months and they're working now in our lab and, this international exchange, I think no matter what politically happens in the world, is very important for the development of science. 

And science is independent of course, from other things. So I am a strong promoter of scientific cooperation around the globe. I also organized meetings, for example, international meetings and I did it also in other countries. For example, also, I headed a delegation of hand surgeons in Qingdao for the triennial hand surgical meeting in 2016.

We had a very nice meeting, for example, in Jerusalem, in Israel, together with the hand and plastic surgeons there, about war injuries. So I think this international exchange is key and it's beneficial to all sides who are participating. So I want to strongly promote it in the future.

7. With the economic development and improvement of living standards in China, the medical aesthetic industry is developing rapidly, and more and more people are choosing medical aesthetics services, but problems such as illegal practice of medicine, increasing number of fake products, false ads, and fraud on price also appear frequently. According to an official report, the customer complaint cases in Chinese medical aesthetic industry totaled 90,769 which were collected from January to May 2023, and the complaints about medical qualification, injection surgery, and liposuction surgery were the most. One of the major reasons for the chaos in Chinese medical aesthetic industry is that there is a group of very unprofessional people doing such a professional job, they haven’t received any professional training in scientific research, clinical practice or multidisciplinary collaboration. What do you think about the chaos in Chinese medical aesthetic industry and do you have any suggestions for us?

Well, the aesthetic industry became an industry in the last decades because of course there's a high economic interest in that and this led also to the misuse in many times of the professional plastic surgeries. 

This is not only true for China, it’s a global problem that plastic surgery especially aesthetic surgery is not only done by plastic surgeons which have for example in Germany a six-year education. 

The doctors work for half a year on the ICU, the intensive care unit, for also being able to treat emergencies. They have to do an operative catalog to perform operations in all parts of the body and at the end they of course have an examination, so like other doctors in other disciplines they have a multi-year program which qualifies them to act as a plastic surgeon, nevertheless, also in Europe and from the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS), we did the questionnaire, in the European countries. 

And the most important question was how to protect the plastic surgery from other medical disciplines and from even paramedics. And this is what I think is a global problem and especially in Asia, there might be non-professionals like so called “shadow doctors” which are then performing the injection therapy or also surgery. 

The problem, the key problem is that the term for example aesthetic surgery or beauty surgeon in most countries are not protected, so anybody can claim to be a beauty surgeon, surgeon no matter what qualification they have and you have to look at it in a step wise manner. 

So of course there are doctors and surgeons who have certain qualifications and are also able to do plastic surgery. For example, we have specialist ENT surgeons, or maxillofacial surgeons who were trained in the face. Of course they are able also to do aesthetic surgery in the face, able to do a rhinoplasty, able to do a face lift maybe or a lipoplasty but they were not trained, for example to do breast surgery and for example in Germany this is really a problem because many of these are also doing the rest of the body.

Then we have a second group, doctors who might be surgeons but never been trained in plastic surgery at all. So this is true, for example, for visceral surgeons, for trauma surgeons. They've never been trained in plastic surgical techniques and have no experience in the whole body. But at least they are trained as surgeon and in Germany and also in Europe, some of them claim to be a plastic surgeon without having the qualification.

The next group is the non-surgeons and we have for example in Germany when I was the President and later a lot of problems with other disciplines which never had a surgical training and it's important to have a surgical training in terms of treating also complications. So for example, we had a case of a cardiologist in a private practice who did Brazilian butt lift with fat transplantation in his private practice and two people died from that operations and this was a big scandal because of course he never had a plastic surgical training but only did weekend courses.

So the patients are often not aware of these facts and the last group of course are then, doctors who have no qualification and have just medical studies and we have also paramedics who are doing plastic surgery, for example, for injection techniques where even big complications may arise today. 

For example, one of my coworkers, Nicholas Möllhoff , won the patient safety award for injection therapies in the face, and he gave an overview about complications, blindness globally, about hyaluronic acid injected to the face and becoming blind on one eye or even with fat grafts, and this often happens also by treaters, I have to call them treaters because they are not plastic surgeons. They are not qualified for doing that and when they cause complications, this is a big legal problem. So, as plastic surgeons, our interest of course is patient protection and we have to make this visible to the patient themselves because most of them are not aware if they're going to a beauty doctor. 

They think this is a professional beauty doctor and they don't know maybe that he never did his specialty and never finished his exam. So I can only advise the medical community in China to go directly to the public and make it visible that the board certification of being a plastic surgeon is a key fact that gives the best possible quality. 

Of course, it does not mean that the plastic surgeon doesn't have complications, but in return he has the best fundamental for treating aesthetic procedures. 

The European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) published several papers on this. You can download them from https://espras.org/#, the site of the ESPRAS under the category publications, where this topic is well documented in a peer reviewed journal published.

The second thing are the medical products you were talking about and one good example are, for example, breast implants. You might know that we had a lot of scandals with not certified breast implants, using fraud silicone, for example. They had to be recalled from the market and now for example, currently we are treating with a malignant disease BIA-ALCL, which is a breast implant associated large cell under plastic lymphoma, which occurs very rarely but occurs with implants with the textures surface. 

One big company had to recall their products from the market globally, it's very rare. I think we have something like 2000 cases globally but also lethal cases. And in Germany we have around fifty. We don't have any lethal cases luckily. But of course, it's important for patient safety to early detect problems with medical products. Globally, registries are introduced and also the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC). 

We started it when when I was President, introducing a registry for all breast implants, which I implanted in every patient in Germany in the hope that in future we will be able to earlier detect problems related to implants and I think this is the only way to regulate and early detect diseases which are associated with medical products to carefully monitor the problems we have with it. 

It's not easy to install registry because it has many legal requirements, especially data protection of the patient is very relevant in Germany. So a compulsory registry is difficult to establish, but since it is in the interest of every patient, I think it's worth doing the effort and doing it as a national society. So these are the two components which I think are very important, especially the visualization of the competency of the professionality of a certified plastic surgeon to the public will increase safety in aesthetic surgery.

8. Have you ever had the darkest moment of your life? And how did you overcome it?

Okay, of course, a life of professional life is not only success, you always have also defeats. And I think it is key that you see that a defeat might also be a chance. 

Well, I had many defeats, not successes in my career, as I mentioned before, for example, when I went to the Institute of Anatomy for one year, as my former director suggested me and I didn't get the post at the end despite I did what he suggested me to do, so this was a big disappointment of course for me and I even thought I might not become a surgeon also.

But in the end it was a big success not to remain here, but to go to a different hospital and learn even more. So I think it is key that a young doctor has to understand that the professional career is not only success, the success comes if you have a defeat.

And you're standing up again, which I think it’s very important to learn this process, that a defeat might also be a chance or a new opportunity for something new and might even be better than the original way you thought would be the best. So when I would have to advise younger people. I think it's important to accept the defeat and analyze why you weren't successful. But you have to stand up again and try to do it better or proceed your way. 

And sometimes what people call luck might be only the ability of a person to see the chances or opportunities a new way offers. So carefully analyze the possibilities, the options you have and choose the best. And then you certainly will also have the opportunity to improve yourself and to further develop your professional career.

9. What is your proudest career achievement to date and why?

Well, when we look at the good things, I think the best thing is, in my professional life, that I developed an excellent team here at the LMU. It took some time. But, now I'm nearly fifteen years here as a director of the Department of Hand Surgery, Plastic and Aesthetic Surgery, and it gives you a lot of satisfaction when you develop people from a medical student to a director of a hospital in plastic surgery and you were something like the teacher, the educator, somehow also the father of them, in brackets, of course. You develop personalities who have a high academic profile and an ethical, robust frame for themselves. I think this is the most successful part of my job. I like to bring pieces of a puzzle together. If you have a lot of excellent doctors in your team, which we have in our department, the, whole thing gets even bigger than the little small part. We have a lot of doctors all specialized in parts of plastic surgery, but when they work together here in our department, it's beneficial for all of us and we are stronger together. This is the most satisfying part of my job, that I'm bringing this puzzle somehow together to make this effect of becoming bigger in a team successful. And I think I'm happy that many of our co-workers, nowadays became heads of department. Recently, two months ago, one became head of department in a university. It was a private university hospital, but nevertheless he became director of a university department, which is also a big success for the whole team here. And these I think are the greatest victories of my job.

10. What advice would you give to young surgeons working in plastic surgery?

Well, I think dedication is the key.You are only successful when you like what you do. And I think the fascination of plastic surgery is so enormous that it can only fascinate a young doctor, and this is what I observe also when I have, for example, pupils from school, from friends of mine doing, which is  compulsory in Germany, professional visits during school time. The subject is so fascinating that I think you can only be happy with doing that and so I'm a strong proposal of my specialty. But nevertheless, nothing comes from nothing, as we say in Bavarian. “Von nichts kommt nichts”, I have to say it in Bavarian. You have to continuously improve, and therefore, you have to exchange your knowledge. You're doing this by, of course, studying, but also, in return, by traveling, exchanging knowledge in other countries, and so you become a real good academic surgeon. ,Maybe last but not least, it's important that you're not disappointed if you're not successful with one thing, there might be another thing which you are more successful. At the end, I think plastic surgery is not a work, it's a passion. If you bring that passion with you, you also will become a successful academic plastic surgeon. 

11. What would you have been if you had not been a medical doctor?

Well, as I said in the beginning, I plan to study mathematics or architecture, I might have been successful. As I said before, as an advice for the young doctors,  I think it's really key that you do the things with passion of what you're doing and with dedication, so called grit. And I think people who are successful in one discipline, they might also be successful with that concept in a different discipline. So it's not the content, but I think the attitude is relevant. And if you have fun and you have passion for architecture, you will be an excellent architect. If you have passion for mathematics, of course you will be an excellent mathematician. And I think the important thing is that what you are doing, you are doing it with passion.

12. What are your interests and hobbies outside medicine?

Well, I'm trying to have also some spare time for myself and for my family and for my friends and doing, of course, sports. Race biking is one of my passions in sports, race biking and mountain biking. I'm also doing a lot of skiing. Since Munich is close to the alps, we are going very frequently for skiing, and this is also one of my passions during winter time. I like to do water sports. Since I'm half Italian half German, my father owns a house in Italy and I like also sailing and water sports there. And last but not least, from a cultural side, I'm very fascinated to opera. I have a lot of friends in opera, and I'm happy to have them. This kind of artistic performance is something which I think shows also a lot of synergies between music and play., This is fascinating to me as well. Opera is also a passion of mine, and in Munich we have one of the best operas in the world. We have everyday performances and I am very privileged to live in this city.