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Groundbreaking Surgery Improves the Lives of Flat-Faced Dogs

Done on an outpatient basis, this minimally invasive procedure is dramatically improving the health and quality of life of French Bulldogs and other brachycephalic pets.

Dr. Boaz Man

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  • Today I’m Zooming with a veterinarian in Boca Raton, FL, Dr. Boaz Man, who is using a groundbreaking CO2 laser procedure to dramatically improve the health and quality of life of French Bulldogs and other “extreme” flat-faced breeds
  • Dr. Man is a general practice veterinarian, not a board certified veterinary surgeon, but he has taken it upon himself to learn the skills and techniques necessary to perform this successful life-saving surgery on dogs with a compromised quality of life who struggle simply to breathe
  • The CO2 laser procedure is done on an outpatient basis, is minimally invasive, produces minimal bleeding, and no stitches or “cone of shame” are required; the laser is used to open the nostrils and remove excess tissue from the nose and windpipe
  • Dr. Man is hopeful that many more veterinarians will learn the technique, because French Bulldogs and other brachycephalic breeds are hugely popular in the U.S., and many of them are in very poor health
  • Ultimately, the onus is on breeders and owners/prospective owners of flat-faced dogs to act responsibly and ethically to dramatically improve breeding practices with the goal of returning these deserving dogs to good health and a good quality of life

Several weeks ago, I wrote about veterinarian Dr. Boaz Man of Boca Raton, FL. Dr. Man is using a CO2 laser procedure to dramatically improve the quality of life and potentially lifespan of brachycephalic (flat-faced) dogs. I’m thrilled to meet with him on Zoom today, and so thankful that he’s taken time out of his busy schedule to talk with us.

“It’s my pleasure to be here,” says Dr. Man. “Thank you so much. I always love to connect with open-minded people and help try to educate on how we can help pets.”

Dr. Man Has 20 Years’ Experience With Laser Procedures

As a general practice veterinarian like Dr. Man, I do just basic soft tissue surgeries, and refer more complex cases to a veterinary surgeon. I don’t perform specialized procedures of the type Dr. Man performs on brachy breeds, so I asked him how he gained his training and expertise in soft tissue surgery.

“Well, one of the first things I'd like to say is that you just made a comment that all veterinarians make: ‘I do some soft tissue surgeries, but that's about it. Just the basic soft tissue surgery’,” he replies. “I don’t have a board certification in surgery. I've been in general practice now for 20 years, and I've been doing laser procedures for 20 years, so I have considerable laser surgery experience. However, if you can make an incision and remove a lump with a laser, you can do this procedure.
It's something I'm passionate about because like you, I like to educate pet parents and other vets about things we can do to help these breeds who are suffering. I happened to put up a before-and-after post about a Frenchie I treated that went viral right around the same time it was announced that the Frenchie had become the number one breed in the U.S., displacing the Labrador Retriever who had been number one for 30 years.
So, it was kind of a timing thing that attracted a lot of Frenchie lovers. But it’s not only about Frenchies. The French Bulldog, English Bulldog, and Pug are considered the three most what we call ‘extreme’ brachycephalic breeds, meaning their faces are not only flat, but extremely flat, so they suffer the most with respiratory issues.”

The Three Fears That Set Up a Cycle of Suffering

Most pet parents of brachys, and certainly veterinarians can see and hear how difficult it is for so many of these dogs to breathe. It’s heartbreaking. I asked Dr. Man what prompted him to take the reins and start performing his laser procedure on them. Did it start with a desperate Frenchie owner?

“It's interesting because I had been doing laser surgery for many, many years and I actually, like you mentioned before, had a surgeon that would come in to do other surgeries that I wasn't used to doing,” he says. “So, I had a surgeon who's highly qualified coming to my practice to do these procedures without a laser, and I thought, ‘Hey, I have a state of the art surgical laser in my hospital.’
There are essentially three fears that have prohibited us in general practice from tackling these dogs. We talk about fear a lot — fear, anxiety, and stress, also known as FAS. The first fear is that of the pet parent with a flat-faced dog, who doesn’t even want to visit a veterinary clinic because it makes their dog anxious, and anxiety can trigger respiratory distress. The second fear is that of the poor dog who goes into panic mode at the hospital and starts to have respiratory issues.
The third fear is ours as veterinarians. For so many years we’ve referred these cases out, or even been fearful to refer them, afraid something bad would happen. But because these breeds have become so popular, I believe if we're not trying to do more for them in general practice, we're going to fail both the dogs and their owners. There are so many of these dogs out there now, and only a handful of specialists that have the time to do the surgeries they require.
These dogs are on waiting lists for surgery and they're suffering, especially the ones with extremely flat faces, and their quality of life is compromised. They suffer not only from respiratory issues but secondary issues that are complications of the primary issue. The laser procedure has been proven to help delay or even prevent the onset of numerous secondary complications, such as laryngeal paralysis and gastrointestinal (GI) issues that result from the negative pressure in their airways.
The laser surgeries I perform help alleviate many of these dogs’ problems. There are not many surgeries I’ve performed over the years that I can say are as rewarding in terms of improving quality of life. These dogs walk into my practice barely able to breathe and walk out breathing better. They can smell the world around them, often for the first time. They can swallow without the worry of an obstruction in front of the windpipe. It's really unbelievable. And it has been proven that the earlier the surgery to correct the problem, the greater the improvement in quality of life.”

Precision Incisions That Don’t Harm Surrounding Tissue

Dr. Man’s laser surgery on brachys is a one-day, in-office procedure that takes these dogs from a potentially very poor quality of life to a tremendously improved quality of life. I graduated from veterinary school 25 years ago and wasn’t trained in the use of a laser. I’m now certified in rehab therapy and use cold laser therapy for dogs with back problems and such. But when it comes to a CO2 cutting laser, I have no training or experience, so I asked Dr. Man how he was first introduced to and trained on its use.

“Good question,” he replies. “Before I was a vet, I was going to a vet in Boca who actually had one of the first carbon dioxide lasers out there. That was my first and very early exposure. Medical technology in the last 20 years — I graduated in 2004 — has changed in terms of devices, and carbon dioxide laser is no exception. The difference between the lasers of 20 years ago and now is night and day. We're now able to cut at the same speed as a scalpel blade. We're able to minimize trauma to the tissue with the latest laser technology. There are ‘super pulses,’ which is technology that allows you to make an incision and only affect the tissue exactly where you're making the incision so you're not harming the surrounding tissue.
I work very closely with VetScalpel, which is the manufacturer of the laser in the U.S. Our working relationship came about because I'm passionate about sharing what we do and how we help pets. I was putting things out in the public domain on laser surgery, especially during COVID when pet parents weren’t allowed inside many veterinary clinics. I wanted to show them that, even though they weren’t involved face-to-face, they could still see that we were helping their animals. We love what we do, so let's share that passion. Let's let them see how laser surgery is helping their pets.
But I'm only passionate about things that I know can help pets. A lot of people have approached me about doing other things, sort of like ‘Oh, let's get on this bandwagon,’ but if I can't prove the technology or product is going to help pets in a major way, I'm not going to stand behind it. So that's why I'm so passionate about what I do.”

The use of a “cutting” laser, in terms of blood loss control during procedures involving the nose, mucus membranes, and soft palate seems to me to offer some real advantages.

“This laser seals the blood vessels, it seals the nerve endings, seals the lymphatics,” Dr. Man explains. “So, you're reducing bleeding, you're reducing swelling, you're reducing pain. Going up in the nose to ablate that tissue (of course I have a strong headlamp on), with minimal bleeding and no sutures, is a game-changer. No sutures in the throat is a game-changer. Shorter anesthetic time is a game-changer. The surgeons performing laser procedures out there who are afraid of this need to overcome their fear. I'm actually going out to conventions. I'm going to the yearly veterinary laser surgery symposium. The more of us in general practice using it, the better for these pets.
A lot of these pets don’t travel well, but I do have pet parents that travel to me from different areas. They'll call me and say, ‘Nobody wants to touch my dog.’ And what’s in store for these poor dogs? Hyperthermia (overheating) and pneumonia and a short life? It's horrible. So, we need to try to help them as much as we can.”

Going Forward, Breeders and Owners Must Stop the Suffering

I think a multi-pronged approach is in order. First and foremost, we need to start breeding dogs to have noses. Reparative conformation is what will fix the problem in future generations. Number two, if an animal is in respiratory distress, the vet has to be able to do something. That requires veterinarians to become well-educated but also well-trained in these types of procedures so they can help their patients.

My guess is that Dr. Man has pet parents coming from all over now because they're desperate to offer some relief to their pets who can’t breathe well. I asked him how much of his day is taken up with laser procedures as compared to a few years ago.

“It's really unbelievable, and it's been a paradigm shift,” he replies. “I wish I could put numbers on it. However, I can tell you the demand has always been there, but pet parents are just now finding out about surgical options and laser procedures in particular. We've gone from a reactive situation to the potential for early intervention to help these pets. Frenchies are typically the first to present clinically with respiratory issues at around a year old to up to four years.”

Dr. Man says it’s also important to educate pet parents about what symptoms to look for. For example, it’s not normal for a dog to “smile” as brachys often do — they’re actually just trying to get oxygen because their airway is blocked. The grunting and snoring may be cute, but it’s not normal because these are signs of an airway blockage.

“I'm doing a lot more procedures, to get back to your question,” he continues. “I had no idea there was such a demand until I started putting it out there and sharing how we're helping these pets. I want to be part of the movement that helps to fight this breathing issue. But I can tell you as well that we may be losing the battle. I try to follow as many of these breeders as possible, and they are breeding for the wrong traits. And unfortunately, pet parents are falling victim to misconceptions of what a healthy Frenchie should look like. They used to have a snout, and now there’s none.
We have a responsibility to educate pet parents to not choose dogs with an extremely flat face. Some of these dogs are now being called “big rope Frenchies” because their face is so flat that they have a huge fold of skin right above their nose called a rope. Breeders are claiming the “big rope Frenchies” are super valuable. They’re charging extra for them. These dogs will have persistent skin infections due to the excessive fold of skin above the nose. It’s really sad.”

To my listeners, readers, and viewers: If you can't or won’t rescue a dog, and if you're going to shell out money for a flat-faced dog, you need to own your ethical and moral responsibility to buy a dog that has been bred for reparative conformation, meaning the breeder is doing genetic testing to make sure the genetics are as diversified as possible. They also should be breeding out breed flaws, including the inability to breathe normally. For some guidelines, take a look at my Prospective Breeder Questionnaire. The goal is to stop the breeding of super flat-faced dogs.

Dr. Man’s Laser Procedure

Next, I asked Dr. Man to walk us through his laser procedure.

“I should preface this by saying that every dog is different with different risks for anesthesia,” he explains. “It's important to evaluate dogs undergoing laser surgery just as we would with any other surgery. Are there preexisting issues? Have the appropriate precautions been taken? My practice is a member of the American Animal Hospital Association (AAHA) and we’re also a Fear-Free practice. We always do everything possible to ensure each pet will benefit from the surgery.
Once we've gotten all our pre-anesthetics done and we feel the dog is a good candidate, they’re brought in the morning of the procedure. Since these dogs tend to be a bit more anxious, we make sure they have adequate sedation and anxiolytics on board when they come in. We want to give something immediately that will help relax the dog, and ensure a good experience before, during, and after the surgery.
The procedure itself can be done in about an hour for both the nose and the throat. The nose part actually takes longer because we're not only making the entrance to the nose larger, but we're going inside each nostril to ablate all that excessive tissue. There's something called the Alar fold in there, and there's a bulb that attaches to it all the way in the back. What I've seen happen with traditional surgery, sometimes we call it a wedge surgery, is the vet isn’t able to get all that tissue out. There's so much bleeding that it's not visualized, the entire piece isn’t removed, and there’s still a problem inside the nostril.”

I asked Dr. Man where veterinarians who are interested in learning the procedure can be trained.

“You can find training videos online,” he replies. “There are a lot of things you can do without even leaving your practice. However, I would say, it doesn't replace going to the laser surgery symposium. If you really want to get hands-on experience, you want to meet the people that are actually on the forefront of this technology. You want to make sure that what you're using is the adequate tool. Just having a laser at your disposal can’t turn a bad surgeon into an excellent surgeon. You still have to have technique, you still have to have the basic principles, and all those things can be something you learn at a convention or symposium.
Also, throughout the year, VetScalpel meets with practices that have a laser or want to upgrade their laser, and they can do hands-on training at the practice. They can do Zoom training if someone already has one and they want to learn how to do the procedure. I always tell people to contact me, like I'll get text messages or DMs from Instagram, about the surgery and people that are interested in either upgrading or learning how to do the surgery.”

If you want to learn more about Dr. Man, you can find him on Instagram, as well as at his practice, Boca Midtowne Animal Hospital.

“I'm easily reachable,” says Dr. Man, “and I would say anyone who's interested in learning about it should reach out. There's also a locator tool for those pet parents who may be looking for a laser surgeon through VetScalpel, to find someone in their area.”


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