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Dr Pakeman’s practice is before anything, down to earth. When I say down to earth, I mean you walk out with a result on your face you like, so you can go on to enjoy the results and live your best life, and that’s what ultimately matters. No amount of glossy floor or marble top is going to do the surgery itself except for puffing up the surgeon’s ego and marking up the price that gets passed down to you, as I personally experienced with some other surgeon in New York. They had all the facade of a fancy office to impress, but not the actual cosmetic skill and medical ethics to impress - no amount of a fancy front is going to make up for their mediocre knowledge, sloppy attitude and penchant for expediency. Dr Pakeman pours all his energy and focus instead into actually doing the cosmetic work: he worked closely with me to understand all my thoughts and give me his, so we were on the same page about every detail I would like to achieve. He went through the details again before surgery, making sure again we were a team set to achieve the common goal. He has great understanding of anatomy and techniques, and explained them to me with great patience, never condescending, which gave me confidence and my share of control. One thing interesting that struck me was that he doesn’t have a clock in his operating room, which is peculiar but extremely telling - so he can concentrate fully and take however much time, to achieve the sufficient result. The whole process from consulting to surgery to post checkup was easy, transparent and efficient. He doesn’t judge what you wear, what your background or profession is (believe me, some surgeons, especially here in New York, do. In fact their whole office of employees do, as if their snobbish personal agenda is more important than the actual work they do), he cares about the actual work and results. That’s why I call his work philosophy down to earth - prestige should come from the immense experience, knowledge and care a surgeon has to give. At one point I was so disillusioned with New York plastic surgeons that I brought my business to Florida (thankfully the surgeon I had there happens to be great). This time I decided to give New York another chance, since I am in New York most of the time and logistics would be much easier, and I am glad I did. I will update on details of what I had done in time, after I am healed more.