WEBVTT - Facelifts, BBLs, and Plastic Surgery Red Flags 0:00:05.320 --> 0:00:08.240 My man, what Alan, how are you? 0:00:08.480 --> 0:00:09.000 I'm good? 0:00:09.280 --> 0:00:12.240 This week on between Us, I have a very special 0:00:12.320 --> 0:00:15.800 guest and a co host instead of Heather, she's busy 0:00:15.880 --> 0:00:20.960 doing the housewife thing. Okay, my best friend of over 0:00:21.040 --> 0:00:25.400 forty years, doctor Robert Schwartz. Doctor Schwartz, how are you. 0:00:26.239 --> 0:00:30.479 I am so excited to be here doing this with you. 0:00:31.040 --> 0:00:33.919 It is the culmination of forty years of friendship. 0:00:34.080 --> 0:00:35.400 Yeah, it's a long time coming. 0:00:35.760 --> 0:00:35.960 You know. 0:00:36.000 --> 0:00:39.839 It's funny. When I told i Heeart that I wanted 0:00:39.880 --> 0:00:43.520 to do this with you, they looked you up. And 0:00:43.560 --> 0:00:47.600 you're known as the best breasts, best boobs in Dallas, 0:00:47.640 --> 0:00:51.120 and you are. You're a very gifted plastic surgeon and 0:00:51.159 --> 0:00:54.400 a phenomenally smart guy. I just want to spend a 0:00:54.480 --> 0:00:57.440 couple of minutes talking about how I know you are, 0:00:57.600 --> 0:00:59.640 friendship in our background, and a little bit about what 0:00:59.640 --> 0:01:03.040 we're going to talk about today. Okay, so very briefly, 0:01:03.760 --> 0:01:08.000 if you've ever met anybody who's a true genius, you 0:01:08.120 --> 0:01:10.759 know that they're different than the rest of us. Okay, 0:01:10.800 --> 0:01:14.440 and doctor Robert Schwartz is a true genius. I met 0:01:14.520 --> 0:01:17.199 him at Yale where I was which is a joke. 0:01:17.319 --> 0:01:21.280 His mcat instructor when he was a junior at Yale 0:01:21.319 --> 0:01:24.640 Buckunn apply to med school, and I'm teaching him how 0:01:24.680 --> 0:01:27.319 to take the missions test for medical school. When you 0:01:27.319 --> 0:01:28.920 think about it, it's such a joke. And you I remember 0:01:28.959 --> 0:01:31.120 him asking me a question that was kind of a 0:01:31.200 --> 0:01:34.840 complicated physics question because this guy graduated summa cum lauti 0:01:34.920 --> 0:01:40.560 from Yale University in physics. Okay, and he's a true genius. 0:01:40.600 --> 0:01:42.840 You asked me a question. I went, what the hell 0:01:42.920 --> 0:01:44.800 is he? Tom? Thinking, what the hell is he talking about? 0:01:44.920 --> 0:01:46.640 And I and you to this day, you remember how 0:01:46.680 --> 0:01:49.720 I sort of answered in kind of this filibuster, like 0:01:49.840 --> 0:01:51.360 I have no clue. Do you remember that? 0:01:52.320 --> 0:01:54.800 I remember that. I don't remember exactly what the questions 0:01:54.800 --> 0:01:57.320 are what you answered, but I remember sitting there thinking, no, 0:01:57.360 --> 0:02:01.640 that's not right. So anyway, remember do you remember what 0:02:01.680 --> 0:02:04.840 you said in the first five minutes of that class? 0:02:04.960 --> 0:02:05.160 No? 0:02:06.520 --> 0:02:10.680 Okay, So you started you introduced yourself when we started 0:02:10.720 --> 0:02:13.079 talking about the MCAT and how it works and how 0:02:13.600 --> 0:02:16.280 you know there's six sections each is out of fifteen 0:02:16.440 --> 0:02:19.280 and then so the total is ninety, and so you 0:02:19.280 --> 0:02:21.839 know you can get a maximum score of ninety, and 0:02:21.880 --> 0:02:24.120 that you want to get. You know, a sixty would 0:02:24.120 --> 0:02:27.359 be considered a good score on that and will make 0:02:27.400 --> 0:02:29.800 you very competitive for med school. And then there's like 0:02:29.880 --> 0:02:32.440 the standard Terry pause where you just go. 0:02:33.200 --> 0:02:36.320 I got to something too, What did you get? Come 0:02:36.360 --> 0:02:38.919 on eighty three? Oh my god, which is of course 0:02:39.000 --> 0:02:42.359 ninety nine PERCENTA anyway, left Yale and then we both 0:02:42.400 --> 0:02:44.440 went to Ucilly Medical School. I was a year ahead 0:02:44.480 --> 0:02:46.799 of you, and we caught up again. 0:02:47.040 --> 0:02:48.360 You got me to go to UCLA. 0:02:48.400 --> 0:02:51.280 I know he could have gone anywhere obviously, and he 0:02:51.440 --> 0:02:53.400 decided to go to sile A. And the cell was 0:02:53.440 --> 0:02:57.600 look at this weather, look at these chicks. Yeah, was 0:02:57.680 --> 0:02:58.600 that pretty much the cell. 0:02:59.160 --> 0:03:03.799 Yeah. We walked outside and it was I don't know 0:03:03.960 --> 0:03:07.000 what December, I don't even remember what it was, and 0:03:07.040 --> 0:03:08.720 you look up at the sky and it's like seventy 0:03:08.720 --> 0:03:12.960 five degrees and you just go huh. And then we 0:03:13.040 --> 0:03:17.120 walked to the edge of Westwood and you go and 0:03:17.120 --> 0:03:18.680 then you go one more thing, and you walk me 0:03:18.800 --> 0:03:20.920 back to the BioMed library. 0:03:21.000 --> 0:03:23.679 Oh yeah, across from Sorority Row. 0:03:23.960 --> 0:03:28.400 Yeah, the physically closest library to Sorority Row. And so 0:03:28.480 --> 0:03:31.839 it's just filled girls with girls, and you just go, 0:03:34.360 --> 0:03:35.160 so Okay. 0:03:35.360 --> 0:03:37.600 Plus it was like the third or fourth best med 0:03:37.640 --> 0:03:39.480 school of the world at the time, so that wasn't 0:03:39.720 --> 0:03:42.760 you know, that wasn't bad either. But anyway, very easy, Yeah, 0:03:42.840 --> 0:03:46.120 very easy. So you came out and we both graduated 0:03:48.000 --> 0:03:50.840 medical school and then we don't need to get into 0:03:51.040 --> 0:03:54.680 the details of the whole general surgery thing, but we 0:03:54.760 --> 0:03:57.880 went through the very traditional way that we used to do. 0:03:57.960 --> 0:03:59.920 Before you could be a plastic surgeon in our era, 0:04:00.280 --> 0:04:03.680 you had to complete a full general surgery training, which 0:04:03.760 --> 0:04:07.280 is the most difficult by far and away training that 0:04:07.320 --> 0:04:09.720 you can go through after med school. It's like seven 0:04:09.800 --> 0:04:14.160 years long. Every other night, you're awake all night, tons 0:04:14.200 --> 0:04:18.120 of independent operating between and we're both chief residents. Between 0:04:18.200 --> 0:04:22.400 midnight and six am. You are the doctor, the boss 0:04:22.520 --> 0:04:25.480 of the hospital doing nothing but trauma. You're awake all 0:04:25.560 --> 0:04:28.960 night doing trauma. It was the most intense and let's 0:04:28.960 --> 0:04:32.000 be honest, awesome training that they don't get today because 0:04:32.000 --> 0:04:34.479 they have a lot more controls over you're not allowed 0:04:34.480 --> 0:04:37.240 to sort of operate independently anymore. The way we did, right, 0:04:37.279 --> 0:04:39.919 it was really the wild wild West. Yeah, So we 0:04:40.000 --> 0:04:44.920 graduate a super difficult general surgery program and we're both 0:04:44.920 --> 0:04:48.400 in the same laboratory doing research and reconstructive surgery and 0:04:48.400 --> 0:04:51.799 plastic surgery. And I went onto UCLA's Plus surgery program, 0:04:51.839 --> 0:04:54.640 and you went on to one of the, if not 0:04:54.760 --> 0:04:59.200 the top plastic surgery program in Dallas, right, yeah, ut. 0:04:59.200 --> 0:05:03.000 Southwest, Yeah, okay, I mean both super high level. 0:05:03.040 --> 0:05:06.920 Yeah, super high level. Yeah. And so we then were 0:05:07.000 --> 0:05:10.000 chief residence in plastic surgery and we graduate and you'd 0:05:10.120 --> 0:05:15.120 weirdly decided decided to stay in Dallas to practice plastic 0:05:15.160 --> 0:05:17.760 surgery and raise your family. Well, it's weird when you 0:05:17.760 --> 0:05:22.240 consider who you were going to Dallas and who you became. Okay, 0:05:23.120 --> 0:05:26.880 Dallas changed you completely, and I stayed here in Los 0:05:26.880 --> 0:05:29.440 Angeles that open up my practice and the rest is history. 0:05:29.760 --> 0:05:32.800 But we've remained. Truly, You're my closest friend for all 0:05:32.800 --> 0:05:35.640 these years, and you everybody has their person they go 0:05:35.720 --> 0:05:38.039 to when they're in trouble, Okay, like if I have 0:05:38.080 --> 0:05:42.159 an extraordinarily difficult case or even in my my life 0:05:42.160 --> 0:05:45.480 in general, something threatening or I'm very worried about it, 0:05:45.520 --> 0:05:48.599 that you call, you know, is your sort of your 0:05:48.920 --> 0:05:52.800 go to chat tee GPT person human And You've always 0:05:52.800 --> 0:05:55.760 been that guy for me because your advice is not 0:05:55.800 --> 0:05:59.960 only brilliant, but sound and reasonable and moral and ethical. 0:06:00.760 --> 0:06:04.240 And you know, we've just remained and we we're like 0:06:04.279 --> 0:06:05.960 a couple of sorority girls the way we talk on 0:06:06.000 --> 0:06:07.360 the phone even to this day. 0:06:07.920 --> 0:06:10.440 Right, well, let me let me throw those back at you, okay, 0:06:10.480 --> 0:06:12.800 and then we can get the sentimentality out of this. 0:06:13.360 --> 0:06:17.520 We could stop asking each other another yeah, another episode. 0:06:17.880 --> 0:06:22.880 You are, unquestionably to me, the older brother I never had. 0:06:23.760 --> 0:06:27.360 You are that guy. To me, you are the guy 0:06:27.400 --> 0:06:29.919 I've always since I was twenty years old, basically my 0:06:30.040 --> 0:06:32.240 entire adult life. You're the guy I've always looked up to. 0:06:32.800 --> 0:06:35.279 You're the guy I've always gone to for advice. You 0:06:35.320 --> 0:06:38.680 are the guy who has never once given me bad 0:06:38.720 --> 0:06:42.919 advice of any significance on anything that I can think of. 0:06:43.040 --> 0:06:48.120 And in fact, the times that I ignored your advice have 0:06:49.240 --> 0:06:51.080 which we don't need to go into right now, have 0:06:51.240 --> 0:06:52.239 cost me dearly. 0:06:52.920 --> 0:06:56.520 Right, but you've done well despite that. Yeah, Well, I 0:06:56.880 --> 0:07:01.000 appreciate you saying that. And what's great about you is, 0:07:01.160 --> 0:07:05.279 you know, you have such an amazingly intact ego that 0:07:05.440 --> 0:07:08.400 even you know you're not everybody's great with when their 0:07:08.400 --> 0:07:12.480 friends become successful, and you've become very successful. I've obviously 0:07:12.520 --> 0:07:15.840 done okay, and you know we're happy for each other. 0:07:15.960 --> 0:07:17.360 Yes, I believe you've done okay. 0:07:17.560 --> 0:07:21.040 Yeah, we've done okay. But I can I can tell 0:07:21.080 --> 0:07:23.040 you this is going to be a very different podcast 0:07:23.080 --> 0:07:26.240 than just two plastic surgeons talking about health, wellness and beauty, okay, 0:07:26.240 --> 0:07:29.440 because Rob and I are very different kinds of doctors. 0:07:29.480 --> 0:07:31.440 First of all, we're at advanced stage of our career 0:07:31.480 --> 0:07:34.760 and very successful, and we really don't need to operate anymore. 0:07:35.200 --> 0:07:38.720 And we operate because we're it's interesting and we still 0:07:38.800 --> 0:07:43.640 like to do it. But we're just I think, extremely honest. 0:07:43.920 --> 0:07:45.960 We want to just sort of I think tell this 0:07:47.040 --> 0:07:50.000 like it is because I think you would agree with 0:07:50.080 --> 0:07:54.920 me that we're blessed to be in this specialty. There's 0:07:54.960 --> 0:07:58.679 a lot of great things that, you know, as plastic 0:07:58.720 --> 0:08:01.880 surgeons we get to do. There's a lot of it's 0:08:01.960 --> 0:08:06.120 really I'm still excited about doing this every day I 0:08:06.160 --> 0:08:08.680 come to work. I'm still I still enjoy operating, I 0:08:08.680 --> 0:08:11.240 still enjoy interacting with patients. And I don't think many 0:08:11.280 --> 0:08:13.280 people get that in life. But they get to be 0:08:13.440 --> 0:08:15.760 excited about their jobs and still want to do it, 0:08:16.320 --> 0:08:20.440 you know, decades into it. The problem though, is that 0:08:21.800 --> 0:08:26.920 plastic surgery is these little beautiful nuggets of gold that 0:08:27.000 --> 0:08:30.640 are unfortunately buried in like just a mountain of bullshit. 0:08:31.320 --> 0:08:33.920 And so I think what we're going to do in 0:08:33.920 --> 0:08:36.280 this podcast is show you what the gold is and 0:08:37.000 --> 0:08:40.800 scrape away everything else. Well, that's what my hope is 0:08:40.840 --> 0:08:41.200 for this. 0:08:41.320 --> 0:08:43.160 Well, I think I want to also put a bright 0:08:43.240 --> 0:08:46.760 light on the bullshit, right because when you typically see 0:08:46.760 --> 0:08:51.319 two plastic surgeons on a podcast, it's really just a 0:08:51.360 --> 0:08:54.959 thinly veiled marketing tactic to get patients in their practice 0:08:54.960 --> 0:08:58.600 and talk about how wonderful plastic surgery is, and to 0:08:58.679 --> 0:09:02.319 put down the competitors, the cosmetic surgeons or the dermatologists 0:09:02.320 --> 0:09:05.080 who may take away from some of their business. We're 0:09:05.080 --> 0:09:08.640 going to put it all down that we feel deserves 0:09:08.640 --> 0:09:10.640 to be put down, and I think we're just going 0:09:10.720 --> 0:09:13.520 to be extraordinarily honest. And I really want us to 0:09:13.600 --> 0:09:17.640 talk about, you know, what the red flags are when 0:09:17.679 --> 0:09:20.080 you go to meet a plastic surgeon and what you 0:09:20.120 --> 0:09:22.440 should really look out for, but what they're really trying 0:09:22.480 --> 0:09:24.800 to do. I think the first example in my mind, 0:09:25.040 --> 0:09:26.559 and I of course want to hear what you say 0:09:27.040 --> 0:09:30.720 is when we attach these cute little advertising labels to 0:09:30.840 --> 0:09:37.840 things like ozambic face right, or other things nanotechnology, other 0:09:37.920 --> 0:09:40.440 things that we sort of put out there that you 0:09:40.520 --> 0:09:45.000 and I both know is a load, right, And I 0:09:45.000 --> 0:09:47.320 think one of the first things that comes to mind 0:09:47.880 --> 0:09:52.600 that's really out there is the deep plane base lift. Okay, 0:09:53.559 --> 0:09:56.719 let's talk about a little bit briefly, because you and 0:09:56.800 --> 0:09:58.640 I could do this for four hours, right, Well, we 0:09:58.640 --> 0:10:01.120 could probably do this for longer than that. 0:10:01.040 --> 0:10:03.000 But we could do a four part series on the 0:10:03.040 --> 0:10:05.480 DP plane facelift. We could, but no one wants to 0:10:05.480 --> 0:10:05.839 hear that. 0:10:05.920 --> 0:10:10.040 But the Chris Jenner of it all really amplified everyone's 0:10:10.040 --> 0:10:13.920 interest in facelifts. In fact, it's driving younger people into 0:10:13.920 --> 0:10:17.079 plastic surgeon's office to have facelift now, and they're thinking, 0:10:17.120 --> 0:10:20.000 everybody thinks it's a deep plane face lift. Well, first 0:10:20.200 --> 0:10:21.920 I can tell you she didn't have a deep plane 0:10:21.920 --> 0:10:24.400 facelift because I know the surgeon who did it. Okay, 0:10:24.679 --> 0:10:28.200 he did a very amazing job. She looks amazing, but 0:10:28.280 --> 0:10:31.480 he didn't even have one. And the Beverly Hills guy 0:10:31.480 --> 0:10:34.320 I know very well who does a lot of these 0:10:34.360 --> 0:10:37.560 sort of higher end celebrities that everyone's heard of. He 0:10:37.600 --> 0:10:41.439 doesn't do a deep plane facelift either. So what is 0:10:41.640 --> 0:10:45.000 in your mind? What's the story with this sort of 0:10:45.120 --> 0:10:50.480 advertorial term DP plane facelift, And how can patients sort 0:10:50.520 --> 0:10:53.520 of avoid falling into the trap of trying to find 0:10:53.520 --> 0:10:56.080 someone who does a DP plane facelift, which is in 0:10:56.080 --> 0:11:00.520 fact a harder procedure with greater complications closer to the nerves. 0:11:00.720 --> 0:11:02.679 And if you happen to find a surgeon who's just 0:11:02.720 --> 0:11:05.200 sort of learning, which most of them are, how to 0:11:05.200 --> 0:11:08.280 do a deep plane, you could be on their learning 0:11:08.320 --> 0:11:12.600 curve and really be complication rather than a good result. 0:11:14.800 --> 0:11:18.319 Well, first of all, I think we need to define 0:11:18.400 --> 0:11:23.040 what a deep plane facelift is, and to me, what 0:11:23.160 --> 0:11:27.720 a deep plane facelift currently means. It's the term you 0:11:27.920 --> 0:11:31.160 use to describe whatever facelift you've been doing for the 0:11:31.240 --> 0:11:34.720 last twenty years, which is now suddenly a deep plane. 0:11:35.240 --> 0:11:39.520 The idea that all these guys are suddenly doing the 0:11:39.640 --> 0:11:45.440 deep plane facelift after having done something different their entire lives. 0:11:45.559 --> 0:11:48.240 Suddenly everyone is the master of the deep plane. By 0:11:48.280 --> 0:11:51.040 the way, by the way, it's the same plane. 0:11:51.520 --> 0:11:55.199 No, no, no, no, I'm going to go I'm deep. Okay, 0:11:55.200 --> 0:11:58.720 I'm gonna turn I'm gonna turn the volume to eleven. 0:11:59.280 --> 0:12:01.680 Yeah, it's it's so deep you're coming out the other 0:12:01.840 --> 0:12:05.240 side of the face. It's it's ridiculous. 0:12:05.520 --> 0:12:08.600 I think the TAKEO message here is, you know, let's 0:12:08.640 --> 0:12:10.959 not fall into the I must find someone who does 0:12:11.000 --> 0:12:13.120 a deep plane facelift, and I must go to a 0:12:13.160 --> 0:12:15.959 surgeon who's telling me that they do a deep plane 0:12:15.960 --> 0:12:18.160 facelift and it's the only facelift to have, because it's 0:12:18.280 --> 0:12:21.920 just not true. And one person's deep pain facelift is 0:12:21.960 --> 0:12:26.679 another person's more superficial facelift or skin only or smass. 0:12:27.280 --> 0:12:29.400 I think the takeo message there is you want to 0:12:29.400 --> 0:12:31.240 go to someone who does facelifts all the time? 0:12:32.400 --> 0:12:34.240 Yeah, you want to do someone who's a good Go 0:12:34.320 --> 0:12:36.240 to someone who's a good facelift surgeon. 0:12:36.480 --> 0:12:36.680 Yeah. 0:12:36.679 --> 0:12:41.240 Period. Because it's not so much what name you give 0:12:41.320 --> 0:12:45.000 the technique. I mean, all these techniques have pretty much 0:12:45.360 --> 0:12:47.440 a lot of the same things in common. There's sort 0:12:47.440 --> 0:12:50.320 of variations on a theme, and what matters the most 0:12:50.480 --> 0:12:53.040 is the skill in judgment of the surgeon that's doing it, 0:12:53.240 --> 0:12:55.840 absolutely far more than it, and the care that they're 0:12:55.840 --> 0:12:59.400 going to take in doing this because, particularly if someone 0:12:59.480 --> 0:13:05.280 is truly doing what is accurately described as an extended 0:13:05.320 --> 0:13:08.400 deep plane face, which by the way, it's really very 0:13:08.440 --> 0:13:12.520 few people truly doing that, you got to understand that 0:13:12.640 --> 0:13:16.880 what you're doing to do that is you're separating the 0:13:16.960 --> 0:13:20.880 layers of the face, where if you go half a 0:13:20.920 --> 0:13:23.960 millimeter too deep, you're cutting the nerves that move the 0:13:24.040 --> 0:13:29.120 muscles in your face, right, And so yeah, it's it's 0:13:29.160 --> 0:13:32.520 you know it. Yes, a good surgeon can do this consistently. 0:13:32.600 --> 0:13:35.320 Although even the very best guys at this will tell 0:13:35.360 --> 0:13:38.520 you that they get at least five percent temporary nerve 0:13:38.559 --> 0:13:41.360 injuries with this. Yeah, and by the way of plastic 0:13:41.400 --> 0:13:44.000 search are telling they get five percent temporary nerve injuries. 0:13:44.080 --> 0:13:47.360 They get more like fifteen percent temporary nerve injuries. Just 0:13:47.520 --> 0:13:51.400 know that because there's no studies of this, right, any 0:13:51.440 --> 0:13:53.680 studies of this is what some guy reported about his 0:13:53.760 --> 0:13:55.280 own work historically. 0:13:55.480 --> 0:14:05.080 But well, that's a good point. This is a question 0:14:05.160 --> 0:14:08.080 I get asked all the time. When's too young to 0:14:08.120 --> 0:14:10.439 have a facelift? When's a proper time to be considering 0:14:10.440 --> 0:14:12.480 a facelift. It really has nothing to do with age. 0:14:12.480 --> 0:14:15.840 It's more of anatomy. Let's be honest, because a thirty 0:14:15.880 --> 0:14:17.760 eight year old who lost one hundred and fifty pounds 0:14:17.920 --> 0:14:20.680 may be a perfect candidate for a facelift, and a 0:14:20.680 --> 0:14:24.800 fifty year old who's got minimal laxity is not really 0:14:24.840 --> 0:14:27.680 a good candidate for a facelift. But what do you 0:14:27.720 --> 0:14:32.560 think about this whole emphasis and enthusiasm or face of 0:14:32.720 --> 0:14:37.680 driving people at younger ages when it's just starting to 0:14:37.880 --> 0:14:40.080 loosen up into our offices for a facelift. What do 0:14:40.080 --> 0:14:42.120 you say to your patients? 0:14:43.000 --> 0:14:46.200 Well, you know, I don't. I'm not, at least in Dallas, 0:14:46.240 --> 0:14:49.400 I'm not seeing people in their twenties or early thirties 0:14:49.440 --> 0:14:53.520 coming in for this yet. But I can tell you 0:14:53.560 --> 0:14:56.400 what I tell patients who are even older than this, 0:14:57.200 --> 0:14:59.840 where you're looking at them and they have very fairly 0:15:00.160 --> 0:15:04.120 early changes of facial aging. I always look at this 0:15:04.280 --> 0:15:09.640 as sort of a risk reward ratio in that we're 0:15:09.640 --> 0:15:13.520 doing surgery, so there's guaranteed to be some risk involved. Now, 0:15:13.600 --> 0:15:16.800 you know, in well performed surgeries on appropriate patients, the 0:15:16.880 --> 0:15:19.080 risks are really low because they sort of have to be, 0:15:19.080 --> 0:15:22.360 because if you had a procedure in cosmetic surgery that 0:15:22.480 --> 0:15:24.440 was highly risky. No one in their right mind would 0:15:24.440 --> 0:15:24.840 ever do it. 0:15:24.880 --> 0:15:26.720 What about the Brazilian budlift. 0:15:27.640 --> 0:15:31.160 No one in their right mind. Whatever, No, that's not 0:15:31.200 --> 0:15:33.960 really true. I mean the way some people do it. Yeah, 0:15:34.360 --> 0:15:36.880 the way sometimes that's performed. It's insane. 0:15:37.000 --> 0:15:40.040 But remember in the old days, for years and years 0:15:40.080 --> 0:15:42.680 and years, over a decade, we were instructed to do 0:15:42.720 --> 0:15:47.080 it the proper way, which was the dangerous way, injected 0:15:47.120 --> 0:15:53.360 into the muscle. Remember that, until after what was it, ten, twelve, thirteen, 0:15:53.440 --> 0:15:56.960 fourteen years we figured out, m, maybe we don't want 0:15:56.960 --> 0:15:58.880 to inject the fat into the muscle because it's going 0:15:58.920 --> 0:16:02.360 to get into those short, big blood vessels of the 0:16:02.400 --> 0:16:05.040 buttock muscle and get into the vena kiva and go 0:16:05.080 --> 0:16:08.560 to the lungs and oh, it's over, And that happened all. 0:16:08.760 --> 0:16:11.320 It turns out to be the most fatal elective procedure 0:16:11.680 --> 0:16:15.320 in all of surgery, A cosmetic procedure done to make 0:16:15.320 --> 0:16:17.760 your butty bigger. It took Margue that. 0:16:17.840 --> 0:16:21.680 With the science of plastic surgery is after years of research, 0:16:21.760 --> 0:16:24.520 we concluded that no matter how great your buttocks end 0:16:24.600 --> 0:16:29.040 up looking, if you're dead, it's not probably worth it. 0:16:29.280 --> 0:16:32.840 Unless they're gonna do an open casket, face down funeral. 0:16:34.720 --> 0:16:36.960 It's just, you know, not to be glib about this, 0:16:37.080 --> 0:16:40.360 but it's like too late. This is okay, this is okay. 0:16:40.400 --> 0:16:43.240 There you go, there's plastic surgery science for you. We're 0:16:43.240 --> 0:16:49.600 doing something that is you know, not entirely rarely killing people. Ergo, 0:16:49.600 --> 0:16:54.440 we should stop doing this. Wow, wow, Nobel prize material 0:16:54.520 --> 0:16:55.080 stuff there. 0:16:55.200 --> 0:16:57.960 I know, well, I remember do you remember when, Okay, 0:16:58.000 --> 0:17:00.440 so fat transferred to the butt to the bread is 0:17:00.440 --> 0:17:03.920 a thing now, right, it's an acceptable thing to do, 0:17:03.960 --> 0:17:06.400 just like fat transfer to the buttock is an acceptable thing, 0:17:06.640 --> 0:17:09.200 although now there's some sort of new ways to minimize 0:17:09.200 --> 0:17:11.240 the chance it goes to the lungs and knocks you off. 0:17:11.720 --> 0:17:13.119 Yeah, not putting in a blood vessel. 0:17:13.240 --> 0:17:16.439 Right, But do you remember how our society and plast 0:17:16.440 --> 0:17:20.159 Survey felt about the dermatologists doing fat They called it 0:17:20.200 --> 0:17:24.320 a Bambi procedure, doing fat transfer to the breast. We thought, 0:17:24.840 --> 0:17:28.959 that's dangerous, never should be done. That's fat's gonna calcify, 0:17:29.000 --> 0:17:31.320 and they're gonna think it's breast cancer and you're gonna 0:17:31.320 --> 0:17:34.119 have a mestectomy for dead fat. And then all of 0:17:34.119 --> 0:17:37.760 a sudden, the dermatologists started to take business away from 0:17:37.760 --> 0:17:41.840 plastic surgeons and breast augmentations using silicon with fat transfer, 0:17:41.880 --> 0:17:47.120 and we went, maybe we should start doing that one. 0:17:47.760 --> 0:17:51.680 You know what, maybe we should I don't know, check 0:17:51.720 --> 0:17:56.400 with radiologists and see if it's causing them to overread 0:17:56.560 --> 0:17:59.160 on mammograms and it looks like cancer. And it turns 0:17:59.160 --> 0:18:02.240 out they said, no, Now there's other issues with fat 0:18:02.280 --> 0:18:05.199 trans yes, like that. It ends up that that's not 0:18:05.359 --> 0:18:09.800 really an issue. But for years, based on nothing, plastic services, 0:18:09.800 --> 0:18:10.560 oh never do this. 0:18:10.920 --> 0:18:13.720 Well, I remember, I go back far enough in the game. 0:18:14.880 --> 0:18:19.920 I remember when it went from liposuction was being done 0:18:19.920 --> 0:18:23.400 by dermatologists and we plastic surgeons thought it was dangerous 0:18:23.400 --> 0:18:26.200 and shouldn't be done. To all of a sudden we went, uh, oh, 0:18:26.920 --> 0:18:29.600 they're taking away our tummy tucks. They're taking away a 0:18:29.600 --> 0:18:32.000 lot of our operations. We better learn how to do 0:18:32.080 --> 0:18:35.399 this lep bo suction thing. Because it was really popularized. 0:18:36.040 --> 0:18:39.040 Despite what you might say about iloise in Brazil or 0:18:39.600 --> 0:18:42.439 Prance or whatever, it was really popularized by a dermatologist 0:18:42.440 --> 0:18:43.120 in this country. 0:18:43.240 --> 0:18:46.760 True, Yeah, it was. Yeah, he went I think it 0:18:46.920 --> 0:18:49.959 was developed in France and he went over there and 0:18:50.040 --> 0:18:52.800 learned it. Yeah, and started doing. 0:18:52.640 --> 0:18:55.120 It, and we criticized the heck out of it, saying, 0:18:55.160 --> 0:18:58.680 oh my gosh, why are dermatologists operating? What's this? Putting 0:18:59.000 --> 0:19:03.200 this tube underneath the skin and sucking fat Out's so dangerous. 0:19:03.240 --> 0:19:06.600 They're going to get fat enbaloie. It's horrible. And then 0:19:06.880 --> 0:19:09.600 we went, oh, gosh, we better really learn how to 0:19:09.640 --> 0:19:12.199 do that. Other words, we're going to miss out on 0:19:12.320 --> 0:19:13.359 all that surgery. 0:19:14.080 --> 0:19:19.159 Yeah, it's like that. You could sneeze at the American 0:19:19.200 --> 0:19:22.159 Sydio Plastic Surgery meeting and missed the moment where we 0:19:22.200 --> 0:19:26.600 went from liposuction is terrible, terrible, terrible, terrible, terrible, terrible. 0:19:26.280 --> 0:19:29.639 Great exactly, and this is how you do it, and 0:19:29.680 --> 0:19:31.000 this is how you do it, and listen to us 0:19:31.000 --> 0:19:34.560 because we're board certified plastic surgeries. Now, you know, a 0:19:34.600 --> 0:19:36.639 couple of board certified plastic surers like you and me 0:19:36.800 --> 0:19:39.720 typically would get on a podcast and say, only go 0:19:39.840 --> 0:19:43.280 to someone who's certified by the American Board of Plastic Surgery. 0:19:43.320 --> 0:19:45.560 And of course we do feel that way. But being 0:19:46.200 --> 0:19:48.439 being board certified the American Board of plast Surgery in 0:19:48.480 --> 0:19:50.080 and of itself, what does it mean to you. 0:19:50.200 --> 0:19:53.480 It's a very low bar to set. It's like saying, 0:19:53.840 --> 0:20:00.359 you know, so the guy who drives your for Formula 0:20:00.440 --> 0:20:05.360 one race car should have a driver's license. It's that 0:20:05.800 --> 0:20:09.639 It's like, yeah, okay, but that doesn't exactly necessarily mean 0:20:09.680 --> 0:20:13.840 you're a great driver. It's the minimum. Yes, it means 0:20:13.880 --> 0:20:16.800 you've been properly trained, you've gone through the right programs, 0:20:17.480 --> 0:20:20.760 taking the test, you're taking the tests. Yeah, it should 0:20:20.800 --> 0:20:24.520 be a minimum threshold. But if you think that all 0:20:24.560 --> 0:20:29.639 board certified plastic surgeons are of equal standard, no, right, 0:20:29.800 --> 0:20:32.280 it's still a bell shaped curve. It shifts the bell 0:20:32.359 --> 0:20:35.760 shaped curve a little bit to one side. Right, so 0:20:36.560 --> 0:20:39.040 you tend to get better people than those who didn't 0:20:39.040 --> 0:20:43.040 even bother with the training, obviously, but there's still a 0:20:43.160 --> 0:20:47.239 wide dispersion of ability in this and then so you 0:20:47.280 --> 0:20:49.320 can still get a horrible surgery. There's a lot of 0:20:49.359 --> 0:20:52.120 bad surgery done by board certified plastic surgeons. 0:20:52.160 --> 0:20:55.960 I always tell people if you pulled back your face 0:20:56.040 --> 0:20:58.320 with two fingers on each side, you know your middle 0:20:58.320 --> 0:21:02.679 finger and your thumb, and look remarkably better. Yeah, I 0:21:02.720 --> 0:21:04.600 think you might be a canon no matter what your 0:21:04.640 --> 0:21:07.440 age for a facelift. To me, that's a good starting 0:21:07.440 --> 0:21:11.440 point to figure out, because if you go in for 0:21:11.560 --> 0:21:16.959 a facelift to a cosmetic or facial or regular plastic surgeon, 0:21:17.359 --> 0:21:21.520 they're probably unless they're very busy, they're probably gonna want 0:21:21.520 --> 0:21:23.359 to do a facelift on you. Would you agree with that? 0:21:23.840 --> 0:21:26.000 Yeah, sadly, yes. I can tell you. What I tell 0:21:26.119 --> 0:21:31.400 patients and consultations, okay, is that there's a risk benefit 0:21:31.440 --> 0:21:34.879 analysis to this, okay, And the risk is always going 0:21:34.920 --> 0:21:36.480 to be there to some degree. The question is what 0:21:36.600 --> 0:21:39.520 is the benefit? And if you have very minimal early 0:21:39.640 --> 0:21:43.560 facial changing, you can only get so much better, and 0:21:43.640 --> 0:21:47.560 so if there's barely anything going on, yeah, it might 0:21:47.640 --> 0:21:51.440 be you might notice something, But do you really want 0:21:51.440 --> 0:21:54.640 to undergo a surgery and spend tens of thousand dollars 0:21:54.720 --> 0:21:58.000 to get an end result where you go like, yeah, look, 0:21:58.240 --> 0:22:01.040 you don't want to wait until it's horrible, right, because 0:22:01.840 --> 0:22:03.879 you can only get so much better, and you know, 0:22:03.920 --> 0:22:05.960 as you get past a certain age, the skin loses 0:22:06.000 --> 0:22:09.080 its elasticity, nothing works quite as well. So you want 0:22:09.080 --> 0:22:11.720