Maxim Safonov
Safonov Maxim Sergeevich is an international economist, a major specialist in the field of banking services. For a long time he dealt with practical problems of the development of banking and non-banking financial organizations located in Russia and abroad. He has several dozen publications on problems of national economic security, regulation of the financial system, and anti-crisis management of financial organizations. Professional experience
2013 - present - Advisor / Deputy President of the Russian Academy of Sciences
2011–2014 — doctoral student, doctoral studies at the Russian Academy of National Economy and Public Administration under the President of the Russian Federation (with a break from production).
2001 - present - senior lecturer / associate professor / professor at the Academy of National Economy under the Government of the Russian Federation / Russian Academy of National Economy and Public Administration under the President of the Russian Federation
1999–2002 — Chief Consultant of the Board of Directors / Head of the Department of Analysis, Forecast and Strategic Planning / Head of the Development and Planning Department of the Bank for Foreign Economic Affairs of the USSR (Vnesheconombank).
1998–1999 - Director of Corporate Finance / Deputy General Director of CJSC UNICON / MS Consulting Group.
1998–1996 - study and work abroad
1994–1996 — Advisor on special projects, St. Petersburg City Hall.
1991–1992 — General Manager, Russian-American JV “Hermitage Marketing Company”.
Education
1982–1987 — Leningrad State University named after. A. A. Zhdanova, Faculty of Oriental Studies, “Country studies of the countries of the Foreign East”, orientalist-historian.
1992–1994 — Joseph H. Lauder Institute of Management and International Studies the Wharton School of Business, University of Pennsylvania; School of Advanced International Studies, Johns Hopkins University, International Affairs, PhD Related Program.
1996–1998 — John F. Kennedy School of Government, Harvard University, Continuing Education Program, Business to Government Relations
1998–2000 — / Faculty of Finance and Banking, Academy of National Economy under the Government of the Russian Federation, “Finance and Credit”, “Banking”, economist.
2007–2009 — Competing at the Diplomatic Academy of the Ministry of Foreign Affairs of the Russian Federation, “World Economy and International Relations”, the topic of the candidate’s dissertation is “Development of approaches to increasing the competitiveness of the national economy in the conditions of attracting international capital.”
2011 - 2014 - Doctoral studies at the Russian Academy of National Economy and Public Administration under the President of the Russian Federation, “Management and Economics of the National Economy”, doctoral dissertation on the topic “Transformation of the mechanism for managing financial resources in the national economy using the example of modernization of state corporations.”
Moskvich
Plastic surgeon, head of the department of plastic surgery at the MedLaz clinic and employee of the department of oncology, radiotherapy and plastic surgery at Sechenov University Vladimir Safronov told Olga Darfi about the history of attitudes towards gender reassignment operations, the difference between transsexuality and body dysmorphic disorder and why every man should help the mother of her children neutralize the damage that pregnancy, childbirth and breastfeeding cause to her body.
Was there plastic surgery in the USSR?
There was, of course. It was practiced by a very small number of doctors, mainly for the elite, at the Institute of Beauty. In the USSR, there were two competing organizations - the Institute of Beauty (it was called the First Cabinet of Medical Cosmetics), which was located on Novy Arbat (then Kalinin Avenue), and the Institute of Cosmetology and Plastic Surgery on Olkhovka. In general, the USSR had a good school of plastic surgery, despite the fact that the industry lived on a residual principle and did not particularly master new technologies. Plastic surgery has existed for thousands of years - the first plastic surgery, not counting trephination to change the shape of the skull, done 8 thousand years ago, was the so-called Indian flap - a method of reconstructing the nose using the skin of the forehead, and this was practiced 3 thousand years ago. Then the “Italian flap” method appeared, when the nose is reconstructed with tissue taken from the hand.
Did students in the USSR study to become surgeons and then specialize in plastic surgery?
No, there was no such specialization in the USSR, it was an experimental direction, they studied on the basis of specialized institutions. Even when I was studying, I had to first complete general education, and my residency was the first in Russia specialized in plastic surgery (2012). But modern plastic surgery is a separate field; a student studies for six years to become a doctor, then undergoes a specialized residency as a plastic surgeon. It is planned to increase the residency period to five years.
Are there a lot of gender reassignment surgeries being done now?
What is gender reassignment surgery? Let's figure it out. Gender reassignment is an incorrect term. People who undergo what is called gender reassignment are people who have been diagnosed with transsexualism, and it is a specific condition. A person is born, grows and, as he becomes aware, feels like a person of the other sex. Unfortunately, this cannot be treated with behavior modification or medication. Medicine tried everything - education, shock therapy, hormonal, insulin comatose therapy. The diagnosis of “transsexualism” appeared in the 1960s, then psychiatrists could afford to do whatever they wanted, there were no restrictive laws, but they did not achieve success in treating this diagnosis. And at the beginning of the 20th century, such people were simply diagnosed with “schizophrenia”, and they were threatened with hospitalization in a psychiatric clinic for the rest of their days. Well, since this disease cannot be treated, in order to alleviate human suffering, they began to perform gender correction. The first described sex reassignment surgery occurred in 1930 in Berlin, when the famous Danish artist Einar Wegener became Lili Elba. The fact is that the dissonance between what is in a person’s head and his body leads to a very high risk of suicide. In order to save a person, he must be helped.
First, the patient undergoes a psychiatric examination - he is given a diagnosis confirming his gender incongruity. Then endocrinologists treat him with hormone replacement therapy, and only then surgeons do their stage - what is called surgical gender reassignment. As a result, we get a person who is closest to what he imagines in his head. In other words, we match a person’s physical appearance with his gender identity.
I had a patient who, at the age of 62, began to bring his body into gender conformity.
Transsexualism does not have a clearly established cause - it may be related to hormonal levels during pregnancy, genetic factors, the coding of hormone receptors, and there is also a material substrate... In transsexuals, certain areas in the brain are more consistent with the gender to which they identify are assigned, and not to the one to which their sexual characteristics correspond. This is a very interesting medical scientific problem.
Do you feel like there are a lot more transsexuals now?
Have you ever encountered people who change gender?
Yes! The Wachowski brothers!
They performed a series of operations, and everyone immediately began to talk about it, society simply learned that there is this problem, there is such a diagnosis and there are people who suffer from it. But the prevalence of this phenomenon is low. On average, in the world, in the case of women who want to become men, there is one in 38 thousand people, in the case of men - one in 13 thousand people. This is a rare prevalence of the disease, an extremely rare pathology, the prevalence is less than that of cystic fibrosis. In your neighborhood, there is a high probability that you will not meet a single transsexual. This is not a fashion, the disease existed before it got a name. But now people experiencing gender dysphoria have begun to know more about their illness and, so to speak, are coming out of hiding. But the majority of Russian transgender people do not boast about it, do not appear somewhere in the press and do not go to gay pride parades, they simply disappear into society and that’s it.
Over time, some taboo topics become open, and society becomes tolerant. Now transsexualism is on the list of diseases recognized in Russia. And before, people lived and suffered all their lives, hid everything, and then they found out that it was a disease and something could be done about it. I had a patient who, at the age of 62, began to bring his body into gender conformity.
What if a person does not voice his gender identity problem and does not go to the doctor? Or are there no such people now?
The more opportunities to receive information, the more people realize that this problem exists, the more patients will turn to a psychiatrist to accurately understand whether they have this problem or not. Because there are types of mental illnesses that can lead people to different states, including when they think that they need to change their gender. Of course, these conditions need to be differentiated.
If you have doubts about your gender identity, should you go to your local psychiatrist?
Fundamentally, gender identity is not something you can question from time to time, no! Most stories of people who have gender identity disorders are people who have had manifestations since childhood. For example, a girl has been friends only with boys since childhood, wears only trousers, plays with cars and pistols, she only likes short haircuts, and then puberty happens, and her hormonal background changes, and she begins to realize that she is not like everyone else other girls. She begins to experience gender dysphoria, which can lead to suicide. Such children should definitely be taken to a psychiatrist, yes. Transsexuals experience suicidal thoughts. According to scientific literature, somewhere around 40% of suicide attempts are successful, and without medical help, almost all patients experience suicidal thoughts.
Does gender non-conformity appear mainly during adolescence?
As a rule, people experience it throughout their lives, but in adolescence they feel it especially acutely. If a teenager comes to his mother and says that he feels like a being of a different sex, you need to pay attention to this, and not brush it off, get scared and assume that he is saying nonsense. And with a trusting relationship, a child can say this to his parents. Many transsexuals who have adapted well to life are warmly supported by their parents.
Is it possible that a teenager says that he is of a different gender to attract attention? Is he so unusual?
In order to accurately diagnose these conditions, there are specialized psychiatric institutions and commissions that deal only with transsexualism. They observe the person, talk with him and already establish an accurate diagnosis.
Does it happen that a person had an operation and then decided that he was mistaken?
Again. For me, the filter is the psychiatric commission, which consists of several board-certified psychiatrists and psychologists. They conduct a serious diagnosis, a whole investigation, so to speak, and weed out all doubtful and dubious patients. This allows us to minimize possible errors. As a rule, people who are already absolutely transsexuals reach the surgeon and need help.
Have there really been no such cases in the world?
When they started doing such operations, everything happened. According to the data available in the scientific literature, there are 2% of errors and regrets. Now the diagnostic principles themselves have become more advanced, and it is almost impossible to miss a situation when a person suffers from another mental illness, but mimics transsexualism.
Is it possible to change everything back surgically?
If you really want it, it is possible. We, in fact, do not change gender, it is impossible. There are ways to reconstruct the genitals, you can make very high-quality imitators, you can make the human body as similar as possible to the opposite sex. And if he decides to change his gender back, then we make his body as similar as possible to what he wants. I repeat, now, thanks to high-quality diagnostics, this almost never happens.
What stages of operations does a person go through when changing their gender?
For example, the stages of gender correction operations from female to male are as follows. The first is the masculinization of the soft tissues of the anterior chest wall by removing the mammary glands, reducing the nipple, and positioning the areolas where they are in men. Then the removal of the reproductive organs, uterus, ovaries, fallopian tubes. Then comes a complex of genital surgery - removal or closure of the vagina, formation of the phallus and scrotum, prosthetics of the testicles. All this is done simultaneously or in several stages, there are three-stage methods, it depends on different schools, on the country, on the surgeon, in a word, this is a whole separate topic. Well, then there are complexes of aesthetic correction that can be done endlessly - correction of the figure, silhouette, liposuction, chin augmentation, calf muscles, changing facial contours, hair transplantation, and so on.
What are the criteria for a successful operation and an unsuccessful one?
Medicine is a science, not gambling. When we throw the dice... “successful”, as you say, is when we are lucky, so it is correct to say “successful” about operations.
A plastic surgeon must love people and should not love money.
An operation can be considered successful when we did no harm, got a good result, with which the patient is satisfied and for which we ourselves are not ashamed.
Are there times when you think you did everything well, but the patient is unhappy?
No, extremely rarely. Most patients who are dissatisfied with a successful operation are people with dysmorphophobia - fear of their own body, their own appearance. Michael Jackson, for example, suffered from this disease. This is a mental illness, and, as a rule, we screen out such patients at the consultation stage; we do not work with them.
By what signs do you understand that a person has body dysmorphic disorder?
I’ll tell you now, and then it will be much more difficult for me to identify such people based on these signs. No, this is a professional secret. You're laughing in vain. By the way, an interesting fact - most of the transgender people who change their gender from female to male work as trolleybus or tram drivers, or as IT specialists - these are the two most popular professions. There's no explanation for this, just a fun fact.
Are gender reassignment surgeries performed under compulsory medical insurance?
Unfortunately, they are not included in the compulsory medical insurance system. Such patients have to work hard to pay for gender reassignment surgery. They often do the surgery in stages until they are happy with the result. But we do not have a goal to do the maximum number of operations. A person who suffers from gender dysphoria has a choice when to stop, he himself determines what result he wants to achieve in the end. You can limit yourself to simply changing clothes and hairstyles or documents. If he wants to stop after one stage, for example, just to change documents, then the state does this for free.
Gender correction itself involves many different operations, there can be an infinite number of them - at least three, maximum - until you get tired of it, because our gender is determined not only by primary sexual characteristics (if a person goes through a “transition”, we shape them surgically), but also secondary. A woman differs from a man (and vice versa) in the structure of her face, the presence of hair in certain places, the absence of an Adam's apple, her bite, her nose, and the shape of her forehead. This is such a comprehensive story that in some countries they even want to create a separate specialty so that people are treated by one professional who deals only with these issues. A person is reassembled like a puzzle. There is no such thing in Russia yet. But to the extent that a person wants to work on himself and get closer to his ideal, to the extent that he has the financial capabilities and time to do all this, to the extent that surgery is possible, we can help him.
How many such operations do you personally perform per year?
About 40–50 patients a year, not many. For example, I perform at least 300 blepharoplasty operations.
Wow! It seems to me a lot. Can you highlight some special qualities that are necessary for a plastic surgeon?
He must love people, must want to help them, be careful, and constantly learn. And he shouldn't love money. When a person works only for money, it is very bad. I believe that in this case he cannot be a doctor.
I heard plastic surgeons earn much more than other doctors. This is true?
No. Any good specialists in private medicine earn good money.
Are there many clinics in Moscow that perform gender reassignment surgeries?
Less than ten - all of them are widely known in narrow circles.
About facial plastic surgery. Many young ladies start doing plastic surgery and then can’t stop. In a way, it's a drug addiction. Has this happened in your practice?
Plastic surgery helps people improve their quality of life. Every person has some shortcomings, and he wants to get rid of them. In some cases, plastic surgery can correct this, and then the person may want to improve something further with other operations. If we are talking about girls, then girls should look beautiful, we live in Russia, we have a cult of beauty.
If we have the risk of harming a person, we should not do anything.
In Moscow you walk down the street, and all the girls are beautiful - this includes care, nail services, hairdressing salons, aesthetic dentistry, we have very developed aesthetic medicine and beauty at all levels. Creating a beautiful image. Therefore, in Russia there is a particularly strong school of plastic surgery; we have beauty, beautiful appearance - one of the national ideas.
There have been cases when a person comes to you, tells you what he wants, but you do not advise him to do it.
Of course! I try to perform operations depending on the feasibility and indications. If we can't do better, then don't. If we have the risk of harming a person, we should not do anything.
Beauty is a subjective concept.
But surgery is objective; we, plastic surgeons, understand perfectly well what we can do. Plus there is such a thing as “realistic patient expectations.” If the patient wants something that the surgeon cannot do, the two entities are at odds. Surgery is a medical specialty, and we understand the limits of our technical capabilities, the limits of the human body, the limits of blood supply, and our task is not to harm the patient.
How do you know that a person has unrealistic expectations?
Experience. A person wants a square nose or chest shaped like a five-pointed star. So this is not possible yet. Joke. This is a professional secret.
What is your favorite operation as a specialist?
I really love blepharoplasty (eyelid surgery, an operation that involves lifting and removing excess skin and fatty tissue of the eyelids in order to improve the appearance of the area around the eyes and eliminate bags under the eyes). Is it true. I have three favorite areas - one concerns blepharoplasty, because it is a rewarding operation. It significantly changes a person's appearance. If we are talking about which operation will give the greatest effect and at the same time is the least difficult in terms of rehabilitation and the least traumatic, then this is blepharoplasty. After it, a person becomes younger, fresher, in a word, looks great, and no one will say that he did anything there, everyone says: “Oh, how well you rested, it’s clear you had a great vacation!”
Another rewarding operation is mammoplasty (plastic surgery to change the shape and volume of the mammary glands). A woman gives birth to heirs, the body suffers some damage, stomachs stretch, breasts sag, childbirth is a test. And when we give a woman back what she had, it’s very cool. I believe that every man’s duty is to help the mother of his children neutralize the damage that her body receives during pregnancy, childbirth and breastfeeding.
Well, third. Various facial plastic surgeries can greatly improve the quality of life of people for whom facial appearance is very important. And these operations are difficult for the surgeon because more can be done than is required. This is the most difficult task in plastic surgery - to do everything exactly as needed, neither more nor less, so that no one understands that something has been done, but everyone understands that the person began to look better. We work like miners. “How refreshed you are! Probably a new lover” - this is a good review of the operation. And “How did you get twisted, what did you do to yourself?” - this is bad.
Do you draw or visually imagine what needs to be done to your face to make it more beautiful?
These are the secrets of craftsmanship; we know how to explain to a person what he is supposed to look like. We have a flow of people here, there’s no crowding, they’ve cleared time for you.
Using my example, can you tell me what I need to do to make myself more beautiful?
What worries you?
Uh-uh... Nothing, in general.
Well then you don’t have to do anything. First, we find out what worries a person and work with this data. If a person doesn’t understand what exactly is bothering him, but just wants to look better in the abstract, I’ll tell him: find a good hairdresser, get enough sleep, eat right, follow a sleep schedule, exercise. You definitely need to find a good cosmetologist, get injections, and it should be a real doctor, and not a primary school teacher who decided to become a cosmetologist, and you will be beautiful and well-groomed, I guarantee you that.
How does a person’s age correlate with plastic surgery? How much can you help a person at 80 years old?
If everything is fine with health, then a person can have surgery at any age. If a person has health problems at the age of 30, then we do not operate on such a patient, even if he (she) offers us a lot of money. People come to any doctor with some kind of health problem, and he should help solve it. But people come to us completely healthy, and we must make them look better than they looked before our interventions. Therefore, plastic surgeons have a huge responsibility.
Photo: Alexander Lepeshkin
