The hardest part of becoming a plastic surgeon isn’t always the operating room, it’s building a career that still feels like yours once training ends. We sit down with Drs. Ashley Amalfi and Smita Ramanadham  to talk candidly about early career plastic surgery, why both started in academic medicine, and what ultimately pushed them toward private practice. 

We get specific about the decision points that don’t show up in residency: board case collection, the underrated value of colleague support, and the real-world friction that can come with red tape, weak mentorship, and misaligned RVU compensation. Dr. Amalfi shares how a group practice model can create freedom through shared resources and reliable partners. Dr. Ramanadham breaks down the solo private practice reality, from HR and operations to the discipline of not discounting and instead building a boutique patient experience that matches your brand. 

We also dig into plastic surgery marketing and branding, including why social media matters for modern aesthetic patients, how to stay authentic and professional, and what a thoughtful consent process looks like. From private equity trends to the idea that it’s okay to change your mind after your first job, the big takeaway is simple: your practice model should fit your priorities, your personality, and your life outside surgery