Speaker 1: My man, what Alan, how are you?
Speaker 2: I'm good?
Speaker 1: This week on between Us, I have a very special
Speaker 1: guest and a co host instead of Heather, she's busy
Speaker 1: doing the housewife thing. Okay, my best friend of over
Speaker 1: forty years, doctor Robert Schwartz. Doctor Schwartz, how are you.
Speaker 2: I am so excited to be here doing this with you.
Speaker 2: It is the culmination of forty years of friendship.
Speaker 1: Yeah, it's a long time coming.
Speaker 2: You know.
Speaker 1: It's funny. When I told i Heeart that I wanted
Speaker 1: to do this with you, they looked you up. And
Speaker 1: you're known as the best breasts, best boobs in Dallas,
Speaker 1: and you are. You're a very gifted plastic surgeon and
Speaker 1: a phenomenally smart guy. I just want to spend a
Speaker 1: couple of minutes talking about how I know you are,
Speaker 1: friendship in our background, and a little bit about what
Speaker 1: we're going to talk about today. Okay, so very briefly,
Speaker 1: if you've ever met anybody who's a true genius, you
Speaker 1: know that they're different than the rest of us. Okay,
Speaker 1: and doctor Robert Schwartz is a true genius. I met
Speaker 1: him at Yale where I was which is a joke.
Speaker 1: His mcat instructor when he was a junior at Yale
Speaker 1: Buckunn apply to med school, and I'm teaching him how
Speaker 1: to take the missions test for medical school. When you
Speaker 1: think about it, it's such a joke. And you I remember
Speaker 1: him asking me a question that was kind of a
Speaker 1: complicated physics question because this guy graduated summa cum lauti
Speaker 1: from Yale University in physics. Okay, and he's a true genius.
Speaker 1: You asked me a question. I went, what the hell
Speaker 1: is he? Tom? Thinking, what the hell is he talking about?
Speaker 1: And I and you to this day, you remember how
Speaker 1: I sort of answered in kind of this filibuster, like
Speaker 1: I have no clue. Do you remember that?
Speaker 2: I remember that. I don't remember exactly what the questions
Speaker 2: are what you answered, but I remember sitting there thinking, no,
Speaker 2: that's not right. So anyway, remember do you remember what
Speaker 2: you said in the first five minutes of that class?
Speaker 1: No?
Speaker 2: Okay, So you started you introduced yourself when we started
Speaker 2: talking about the MCAT and how it works and how
Speaker 2: you know there's six sections each is out of fifteen
Speaker 2: and then so the total is ninety, and so you
Speaker 2: know you can get a maximum score of ninety, and
Speaker 2: that you want to get. You know, a sixty would
Speaker 2: be considered a good score on that and will make
Speaker 2: you very competitive for med school. And then there's like
Speaker 2: the standard Terry pause where you just go.
Speaker 1: I got to something too, What did you get? Come
Speaker 1: on eighty three? Oh my god, which is of course
Speaker 1: ninety nine PERCENTA anyway, left Yale and then we both
Speaker 1: went to Ucilly Medical School. I was a year ahead
Speaker 1: of you, and we caught up again.
Speaker 2: You got me to go to UCLA.
Speaker 1: I know he could have gone anywhere obviously, and he
Speaker 1: decided to go to sile A. And the cell was
Speaker 1: look at this weather, look at these chicks. Yeah, was
Speaker 1: that pretty much the cell.
Speaker 2: Yeah. We walked outside and it was I don't know
Speaker 2: what December, I don't even remember what it was, and
Speaker 2: you look up at the sky and it's like seventy
Speaker 2: five degrees and you just go huh. And then we
Speaker 2: walked to the edge of Westwood and you go and
Speaker 2: then you go one more thing, and you walk me
Speaker 2: back to the BioMed library.
Speaker 1: Oh yeah, across from Sorority Row.
Speaker 2: Yeah, the physically closest library to Sorority Row. And so
Speaker 2: it's just filled girls with girls, and you just go,
Speaker 2: so Okay.
Speaker 1: Plus it was like the third or fourth best med
Speaker 1: school of the world at the time, so that wasn't
Speaker 1: you know, that wasn't bad either. But anyway, very easy, Yeah,
Speaker 1: very easy. So you came out and we both graduated
Speaker 1: medical school and then we don't need to get into
Speaker 1: the details of the whole general surgery thing, but we
Speaker 1: went through the very traditional way that we used to do.
Speaker 1: Before you could be a plastic surgeon in our era,
Speaker 1: you had to complete a full general surgery training, which
Speaker 1: is the most difficult by far and away training that
Speaker 1: you can go through after med school. It's like seven
Speaker 1: years long. Every other night, you're awake all night, tons
Speaker 1: of independent operating between and we're both chief residents. Between
Speaker 1: midnight and six am. You are the doctor, the boss
Speaker 1: of the hospital doing nothing but trauma. You're awake all
Speaker 1: night doing trauma. It was the most intense and let's
Speaker 1: be honest, awesome training that they don't get today because
Speaker 1: they have a lot more controls over you're not allowed
Speaker 1: to sort of operate independently anymore. The way we did, right,
Speaker 1: it was really the wild wild West. Yeah, So we
Speaker 1: graduate a super difficult general surgery program and we're both
Speaker 1: in the same laboratory doing research and reconstructive surgery and
Speaker 1: plastic surgery. And I went onto UCLA's Plus surgery program,
Speaker 1: and you went on to one of the, if not
Speaker 1: the top plastic surgery program in Dallas, right, yeah, ut.
Speaker 2: Southwest, Yeah, okay, I mean both super high level.
Speaker 1: Yeah, super high level. Yeah. And so we then were
Speaker 1: chief residence in plastic surgery and we graduate and you'd
Speaker 1: weirdly decided decided to stay in Dallas to practice plastic
Speaker 1: surgery and raise your family. Well, it's weird when you
Speaker 1: consider who you were going to Dallas and who you became. Okay,
Speaker 1: Dallas changed you completely, and I stayed here in Los
Speaker 1: Angeles that open up my practice and the rest is history.
Speaker 1: But we've remained. Truly, You're my closest friend for all
Speaker 1: these years, and you everybody has their person they go
Speaker 1: to when they're in trouble, Okay, like if I have
Speaker 1: an extraordinarily difficult case or even in my my life
Speaker 1: in general, something threatening or I'm very worried about it,
Speaker 1: that you call, you know, is your sort of your
Speaker 1: go to chat tee GPT person human And You've always
Speaker 1: been that guy for me because your advice is not
Speaker 1: only brilliant, but sound and reasonable and moral and ethical.
Speaker 1: And you know, we've just remained and we we're like
Speaker 1: a couple of sorority girls the way we talk on
Speaker 1: the phone even to this day.
Speaker 2: Right, well, let me let me throw those back at you, okay,
Speaker 2: and then we can get the sentimentality out of this.
Speaker 2: We could stop asking each other another yeah, another episode.
Speaker 2: You are, unquestionably to me, the older brother I never had.
Speaker 2: You are that guy. To me, you are the guy
Speaker 2: I've always since I was twenty years old, basically my
Speaker 2: entire adult life. You're the guy I've always looked up to.
Speaker 2: You're the guy I've always gone to for advice. You
Speaker 2: are the guy who has never once given me bad
Speaker 2: advice of any significance on anything that I can think of.
Speaker 2: And in fact, the times that I ignored your advice have
Speaker 2: which we don't need to go into right now, have
Speaker 2: cost me dearly.
Speaker 1: Right, but you've done well despite that. Yeah, Well, I
Speaker 1: appreciate you saying that. And what's great about you is,
Speaker 1: you know, you have such an amazingly intact ego that
Speaker 1: even you know you're not everybody's great with when their
Speaker 1: friends become successful, and you've become very successful. I've obviously
Speaker 1: done okay, and you know we're happy for each other.
Speaker 2: Yes, I believe you've done okay.
Speaker 1: Yeah, we've done okay. But I can I can tell
Speaker 1: you this is going to be a very different podcast
Speaker 1: than just two plastic surgeons talking about health, wellness and beauty, okay,
Speaker 1: because Rob and I are very different kinds of doctors.
Speaker 1: First of all, we're at advanced stage of our career
Speaker 1: and very successful, and we really don't need to operate anymore.
Speaker 1: And we operate because we're it's interesting and we still
Speaker 1: like to do it. But we're just I think, extremely honest.
Speaker 2: We want to just sort of I think tell this
Speaker 2: like it is because I think you would agree with
Speaker 2: me that we're blessed to be in this specialty. There's
Speaker 2: a lot of great things that, you know, as plastic
Speaker 2: surgeons we get to do. There's a lot of it's
Speaker 2: really I'm still excited about doing this every day I
Speaker 2: come to work. I'm still I still enjoy operating, I
Speaker 2: still enjoy interacting with patients. And I don't think many
Speaker 2: people get that in life. But they get to be
Speaker 2: excited about their jobs and still want to do it,
Speaker 2: you know, decades into it. The problem though, is that
Speaker 2: plastic surgery is these little beautiful nuggets of gold that
Speaker 2: are unfortunately buried in like just a mountain of bullshit.
Speaker 2: And so I think what we're going to do in
Speaker 2: this podcast is show you what the gold is and
Speaker 2: scrape away everything else. Well, that's what my hope is
Speaker 2: for this.
Speaker 1: Well, I think I want to also put a bright
Speaker 1: light on the bullshit, right because when you typically see
Speaker 1: two plastic surgeons on a podcast, it's really just a
Speaker 1: thinly veiled marketing tactic to get patients in their practice
Speaker 1: and talk about how wonderful plastic surgery is, and to
Speaker 1: put down the competitors, the cosmetic surgeons or the dermatologists
Speaker 1: who may take away from some of their business. We're
Speaker 1: going to put it all down that we feel deserves
Speaker 1: to be put down, and I think we're just going
Speaker 1: to be extraordinarily honest. And I really want us to
Speaker 1: talk about, you know, what the red flags are when
Speaker 1: you go to meet a plastic surgeon and what you
Speaker 1: should really look out for, but what they're really trying
Speaker 1: to do. I think the first example in my mind,
Speaker 1: and I of course want to hear what you say
Speaker 1: is when we attach these cute little advertising labels to
Speaker 1: things like ozambic face right, or other things nanotechnology, other
Speaker 1: things that we sort of put out there that you
Speaker 1: and I both know is a load, right, And I
Speaker 1: think one of the first things that comes to mind
Speaker 1: that's really out there is the deep plane base lift. Okay,
Speaker 1: let's talk about a little bit briefly, because you and
Speaker 1: I could do this for four hours, right, Well, we
Speaker 1: could probably do this for longer than that.
Speaker 2: But we could do a four part series on the
Speaker 2: DP plane facelift. We could, but no one wants to
Speaker 2: hear that.
Speaker 1: But the Chris Jenner of it all really amplified everyone's
Speaker 1: interest in facelifts. In fact, it's driving younger people into
Speaker 1: plastic surgeon's office to have facelift now, and they're thinking,
Speaker 1: everybody thinks it's a deep plane face lift. Well, first
Speaker 1: I can tell you she didn't have a deep plane
Speaker 1: facelift because I know the surgeon who did it. Okay,
Speaker 1: he did a very amazing job. She looks amazing, but
Speaker 1: he didn't even have one. And the Beverly Hills guy
Speaker 1: I know very well who does a lot of these
Speaker 1: sort of higher end celebrities that everyone's heard of. He
Speaker 1: doesn't do a deep plane facelift either. So what is
Speaker 1: in your mind? What's the story with this sort of
Speaker 1: advertorial term DP plane facelift, And how can patients sort
Speaker 1: of avoid falling into the trap of trying to find
Speaker 1: someone who does a DP plane facelift, which is in
Speaker 1: fact a harder procedure with greater complications closer to the nerves.
Speaker 1: And if you happen to find a surgeon who's just
Speaker 1: sort of learning, which most of them are, how to
Speaker 1: do a deep plane, you could be on their learning
Speaker 1: curve and really be complication rather than a good result.
Speaker 2: Well, first of all, I think we need to define
Speaker 2: what a deep plane facelift is, and to me, what
Speaker 2: a deep plane facelift currently means. It's the term you
Speaker 2: use to describe whatever facelift you've been doing for the
Speaker 2: last twenty years, which is now suddenly a deep plane.
Speaker 2: The idea that all these guys are suddenly doing the
Speaker 2: deep plane facelift after having done something different their entire lives.
Speaker 2: Suddenly everyone is the master of the deep plane. By
Speaker 2: the way, by the way, it's the same plane.
Speaker 1: No, no, no, no, I'm going to go I'm deep. Okay,
Speaker 1: I'm gonna turn I'm gonna turn the volume to eleven.
Speaker 2: Yeah, it's it's so deep you're coming out the other
Speaker 2: side of the face. It's it's ridiculous.
Speaker 1: I think the TAKEO message here is, you know, let's
Speaker 1: not fall into the I must find someone who does
Speaker 1: a deep plane facelift, and I must go to a
Speaker 1: surgeon who's telling me that they do a deep plane
Speaker 1: facelift and it's the only facelift to have, because it's
Speaker 1: just not true. And one person's deep pain facelift is
Speaker 1: another person's more superficial facelift or skin only or smass.
Speaker 1: I think the takeo message there is you want to
Speaker 1: go to someone who does facelifts all the time?
Speaker 2: Yeah, you want to do someone who's a good Go
Speaker 2: to someone who's a good facelift surgeon.
Speaker 1: Yeah.
Speaker 2: Period. Because it's not so much what name you give
Speaker 2: the technique. I mean, all these techniques have pretty much
Speaker 2: a lot of the same things in common. There's sort
Speaker 2: of variations on a theme, and what matters the most
Speaker 2: is the skill in judgment of the surgeon that's doing it,
Speaker 2: absolutely far more than it, and the care that they're
Speaker 2: going to take in doing this because, particularly if someone
Speaker 2: is truly doing what is accurately described as an extended
Speaker 2: deep plane face, which by the way, it's really very
Speaker 2: few people truly doing that, you got to understand that
Speaker 2: what you're doing to do that is you're separating the
Speaker 2: layers of the face, where if you go half a
Speaker 2: millimeter too deep, you're cutting the nerves that move the
Speaker 2: muscles in your face, right, And so yeah, it's it's
Speaker 2: you know it. Yes, a good surgeon can do this consistently.
Speaker 2: Although even the very best guys at this will tell
Speaker 2: you that they get at least five percent temporary nerve
Speaker 2: injuries with this. Yeah, and by the way of plastic
Speaker 2: search are telling they get five percent temporary nerve injuries.
Speaker 2: They get more like fifteen percent temporary nerve injuries. Just
Speaker 2: know that because there's no studies of this, right, any
Speaker 2: studies of this is what some guy reported about his
Speaker 2: own work historically.
Speaker 1: But well, that's a good point. This is a question
Speaker 1: I get asked all the time. When's too young to
Speaker 1: have a facelift? When's a proper time to be considering
Speaker 1: a facelift. It really has nothing to do with age.
Speaker 1: It's more of anatomy. Let's be honest, because a thirty
Speaker 1: eight year old who lost one hundred and fifty pounds
Speaker 1: may be a perfect candidate for a facelift, and a
Speaker 1: fifty year old who's got minimal laxity is not really
Speaker 1: a good candidate for a facelift. But what do you
Speaker 1: think about this whole emphasis and enthusiasm or face of
Speaker 1: driving people at younger ages when it's just starting to
Speaker 1: loosen up into our offices for a facelift. What do
Speaker 1: you say to your patients?
Speaker 2: Well, you know, I don't. I'm not, at least in Dallas,
Speaker 2: I'm not seeing people in their twenties or early thirties
Speaker 2: coming in for this yet. But I can tell you
Speaker 2: what I tell patients who are even older than this,
Speaker 2: where you're looking at them and they have very fairly
Speaker 2: early changes of facial aging. I always look at this
Speaker 2: as sort of a risk reward ratio in that we're
Speaker 2: doing surgery, so there's guaranteed to be some risk involved. Now,
Speaker 2: you know, in well performed surgeries on appropriate patients, the
Speaker 2: risks are really low because they sort of have to be,
Speaker 2: because if you had a procedure in cosmetic surgery that
Speaker 2: was highly risky. No one in their right mind would
Speaker 2: ever do it.
Speaker 1: What about the Brazilian budlift.
Speaker 2: No one in their right mind. Whatever, No, that's not
Speaker 2: really true. I mean the way some people do it. Yeah,
Speaker 2: the way sometimes that's performed. It's insane.
Speaker 1: But remember in the old days, for years and years
Speaker 1: and years, over a decade, we were instructed to do
Speaker 1: it the proper way, which was the dangerous way, injected
Speaker 1: into the muscle. Remember that, until after what was it, ten, twelve, thirteen,
Speaker 1: fourteen years we figured out, m, maybe we don't want
Speaker 1: to inject the fat into the muscle because it's going
Speaker 1: to get into those short, big blood vessels of the
Speaker 1: buttock muscle and get into the vena kiva and go
Speaker 1: to the lungs and oh, it's over, And that happened all.
Speaker 1: It turns out to be the most fatal elective procedure
Speaker 1: in all of surgery, A cosmetic procedure done to make
Speaker 1: your butty bigger. It took Margue that.
Speaker 2: With the science of plastic surgery is after years of research,
Speaker 2: we concluded that no matter how great your buttocks end
Speaker 2: up looking, if you're dead, it's not probably worth it.
Speaker 2: Unless they're gonna do an open casket, face down funeral.
Speaker 2: It's just, you know, not to be glib about this,
Speaker 2: but it's like too late. This is okay, this is okay.
Speaker 2: There you go, there's plastic surgery science for you. We're
Speaker 2: doing something that is you know, not entirely rarely killing people. Ergo,
Speaker 2: we should stop doing this. Wow, wow, Nobel prize material
Speaker 2: stuff there.
Speaker 1: I know, well, I remember do you remember when, Okay,
Speaker 1: so fat transferred to the butt to the bread is
Speaker 1: a thing now, right, it's an acceptable thing to do,
Speaker 1: just like fat transfer to the buttock is an acceptable thing,
Speaker 1: although now there's some sort of new ways to minimize
Speaker 1: the chance it goes to the lungs and knocks you off.
Speaker 2: Yeah, not putting in a blood vessel.
Speaker 1: Right, But do you remember how our society and plast
Speaker 1: Survey felt about the dermatologists doing fat They called it
Speaker 1: a Bambi procedure, doing fat transfer to the breast. We thought,
Speaker 1: that's dangerous, never should be done. That's fat's gonna calcify,
Speaker 1: and they're gonna think it's breast cancer and you're gonna
Speaker 1: have a mestectomy for dead fat. And then all of
Speaker 1: a sudden, the dermatologists started to take business away from
Speaker 1: plastic surgeons and breast augmentations using silicon with fat transfer,
Speaker 1: and we went, maybe we should start doing that one.
Speaker 2: You know what, maybe we should I don't know, check
Speaker 2: with radiologists and see if it's causing them to overread
Speaker 2: on mammograms and it looks like cancer. And it turns
Speaker 2: out they said, no, Now there's other issues with fat
Speaker 2: trans yes, like that. It ends up that that's not
Speaker 2: really an issue. But for years, based on nothing, plastic services,
Speaker 2: oh never do this.
Speaker 1: Well, I remember, I go back far enough in the game.
Speaker 1: I remember when it went from liposuction was being done
Speaker 1: by dermatologists and we plastic surgeons thought it was dangerous
Speaker 1: and shouldn't be done. To all of a sudden we went, uh, oh,
Speaker 1: they're taking away our tummy tucks. They're taking away a
Speaker 1: lot of our operations. We better learn how to do
Speaker 1: this lep bo suction thing. Because it was really popularized.
Speaker 1: Despite what you might say about iloise in Brazil or
Speaker 1: Prance or whatever, it was really popularized by a dermatologist
Speaker 1: in this country.
Speaker 2: True, Yeah, it was. Yeah, he went I think it
Speaker 2: was developed in France and he went over there and
Speaker 2: learned it. Yeah, and started doing.
Speaker 1: It, and we criticized the heck out of it, saying,
Speaker 1: oh my gosh, why are dermatologists operating? What's this? Putting
Speaker 1: this tube underneath the skin and sucking fat Out's so dangerous.
Speaker 1: They're going to get fat enbaloie. It's horrible. And then
Speaker 1: we went, oh, gosh, we better really learn how to
Speaker 1: do that. Other words, we're going to miss out on
Speaker 1: all that surgery.
Speaker 2: Yeah, it's like that. You could sneeze at the American
Speaker 2: Sydio Plastic Surgery meeting and missed the moment where we
Speaker 2: went from liposuction is terrible, terrible, terrible, terrible, terrible, terrible.
Speaker 1: Great exactly, and this is how you do it, and
Speaker 1: this is how you do it, and listen to us
Speaker 1: because we're board certified plastic surgeries. Now, you know, a
Speaker 1: couple of board certified plastic surers like you and me
Speaker 1: typically would get on a podcast and say, only go
Speaker 1: to someone who's certified by the American Board of Plastic Surgery.
Speaker 1: And of course we do feel that way. But being
Speaker 1: being board certified the American Board of plast Surgery in
Speaker 1: and of itself, what does it mean to you.
Speaker 2: It's a very low bar to set. It's like saying,
Speaker 2: you know, so the guy who drives your for Formula
Speaker 2: one race car should have a driver's license. It's that
Speaker 2: It's like, yeah, okay, but that doesn't exactly necessarily mean
Speaker 2: you're a great driver. It's the minimum. Yes, it means
Speaker 2: you've been properly trained, you've gone through the right programs,
Speaker 2: taking the test, you're taking the tests. Yeah, it should
Speaker 2: be a minimum threshold. But if you think that all
Speaker 2: board certified plastic surgeons are of equal standard, no, right,
Speaker 2: it's still a bell shaped curve. It shifts the bell
Speaker 2: shaped curve a little bit to one side. Right, so
Speaker 2: you tend to get better people than those who didn't
Speaker 2: even bother with the training, obviously, but there's still a
Speaker 2: wide dispersion of ability in this and then so you
Speaker 2: can still get a horrible surgery. There's a lot of
Speaker 2: bad surgery done by board certified plastic surgeons.
Speaker 1: I always tell people if you pulled back your face
Speaker 1: with two fingers on each side, you know your middle
Speaker 1: finger and your thumb, and look remarkably better. Yeah, I
Speaker 1: think you might be a canon no matter what your
Speaker 1: age for a facelift. To me, that's a good starting
Speaker 1: point to figure out, because if you go in for
Speaker 1: a facelift to a cosmetic or facial or regular plastic surgeon,
Speaker 1: they're probably unless they're very busy, they're probably gonna want
Speaker 1: to do a facelift on you. Would you agree with that?
Speaker 2: Yeah, sadly, yes. I can tell you. What I tell
Speaker 2: patients and consultations, okay, is that there's a risk benefit
Speaker 2: analysis to this, okay, And the risk is always going
Speaker 2: to be there to some degree. The question is what
Speaker 2: is the benefit? And if you have very minimal early
Speaker 2: facial changing, you can only get so much better, and
Speaker 2: so if there's barely anything going on, yeah, it might
Speaker 2: be you might notice something, But do you really want
Speaker 2: to undergo a surgery and spend tens of thousand dollars
Speaker 2: to get an end result where you go like, yeah, look,
Speaker 2: you don't want to wait until it's horrible, right, because
Speaker 2: you can only get so much better, and you know,
Speaker 2: as you get past a certain age, the skin loses
Speaker 2: its elasticity, nothing works quite as well. So you want
Speaker 2: to have enough visible that there's a meaningful change to make,
Speaker 2: and that's that's the time. If you're before that point,
Speaker 2: it's just silly to do it, and certainly someone in
Speaker 2: their twenties, you know who has other than massive weight
Speaker 2: laws or something, or just horrible genetics or early thirties,
Speaker 2: come on, there's very little that can be a changing.
Speaker 1: Plus, I feel there's no science behind this, and we
Speaker 1: all have our feelings about this. You know, anecdotal experiences.
Speaker 1: But I feel if you start too young and then
Speaker 1: you have too many facelifts, once you get past a
Speaker 1: certain unknowable point, it starts to relax because they all
Speaker 1: relax a little bit, and it relaxes in a potentially
Speaker 1: unnatural way or angle or sweep. And once it does that,
Speaker 1: now you're into altered. And once you get to altered
Speaker 1: slash weird. No matter how good you look, if there's
Speaker 1: a weirdness, it's kind of like a hair in your
Speaker 1: salad or smell in the kitchen. It's just like, no
Speaker 1: matter how good the food is, if there's kind of
Speaker 1: this rancid something smell in there, it's over. The whole
Speaker 1: meal's ruined, the whole face result is a disaster once
Speaker 1: you get too weird. And by the way, even with
Speaker 1: the best surgeons, we can have it heal even with it.
Speaker 1: If it's not even without a complication, we can have
Speaker 1: it heal in a slightly weird way. And I think,
Speaker 1: I don't know if you agree with this. I think
Speaker 1: if you have too many facelifts, your chance of getting
Speaker 1: a slightly weirdness to your face is significantly elevated.
Speaker 2: Oh look, I think I don't even think it's like
Speaker 2: it's almost guaranteed.
Speaker 1: Yeah, if you do too many, you.
Speaker 2: Only get But first of all, you know, with most
Speaker 2: cosmetic surgers, but particularly facelifts, your first one is your
Speaker 2: best one, and you want that one done properly at
Speaker 2: the right time, because everyone after that is diminishing returns.
Speaker 2: Because the things you can really affect with a facelift meaningfully,
Speaker 2: you just can't do over and over again. Because you ye,
Speaker 2: facelift is a simulation of youth. So when people come
Speaker 2: in and they go, well, you know, then they're sixty,
Speaker 2: they go, well, I don't want to look twenty again,
Speaker 2: and I'm thinking, don't worry, it's not gonna happen. Okay,
Speaker 2: So well, first of all, the first thing that is
Speaker 2: that's not true, because you do want to look twenty again,
Speaker 2: because if there was an operation that would make me
Speaker 2: look like I look when I was twenty, I wouldn't
Speaker 2: be on this podcast right now. I'd be getting it
Speaker 2: done right, right, Yeah, I'd love to look twenty again. Unfortunately,
Speaker 2: we can't do that. We can do a simulation of it.
Speaker 2: We can move you in that direction, right. So it's
Speaker 2: not a perfect simulation. It's like a virtual reality or something.
Speaker 2: So it's not exactly right. And so every time you
Speaker 2: do it, you're deviating a little more and more from
Speaker 2: where you really were into something that never existed.
Speaker 1: Right.
Speaker 2: But the more you get into never existed, the more
Speaker 2: it looks like a face.
Speaker 1: Look right, So I not to Let's switch gears a
Speaker 1: little bit, because again, you and I we literally could
Speaker 1: talk for two hours about anything in this field because
Speaker 1: we love it so much. But I just did a
Speaker 1: podcast which I guess is getting some there's some virality
Speaker 1: to some of the things I said. And I was
Speaker 1: discussing male plastic surgery on celebrities, Okay, yeah, and you
Speaker 1: know why are the female celebrities looking so amazing and
Speaker 1: the male's looking so weird? And you know they're being
Speaker 1: done by the same surgeon. Okay. And I posited a theory, okay,
Speaker 1: and the theory is this, and I want to see
Speaker 1: if you agree with this, and I, well, the things
Speaker 1: I love about you, besides effect your incredible genius, is
Speaker 1: that you're completely honest. You'll call me out on any
Speaker 1: bs and you won't agree with me just to you know,
Speaker 1: just agree with me.
Speaker 2: Oh that's going to be half of this podcast. And
Speaker 2: you're doing the same to me because you know.
Speaker 1: That's what we do for each other.
Speaker 2: Yeah, exactly.
Speaker 1: So I have this theory, and that is, if you
Speaker 1: do the typical baselift that you would do on a
Speaker 1: female on a male, it really only works with feminine males.
Speaker 1: And that's why. And I don't know about any of
Speaker 1: these people, whether they've had plasters or not. But they
Speaker 1: talk about the Brad Pitt, I don't know if he's
Speaker 1: had anything done. He looks great. They talk about Bradley Cooper.
Speaker 1: I have no idea if he's had anything done. And
Speaker 1: then they're asking me a lot when I walk out
Speaker 1: of restaurants about Jim Carrey. So why are they sat
Speaker 1: setting things aflame in terms of their results? And my
Speaker 1: theory is this, if you're a feminine looking person, if
Speaker 1: you're a pretty guy like a Brad Pitt, a John
Speaker 1: Stamos or a Rob Low, you can pretty much have
Speaker 1: more feminine looking, feminizing regular female plastic surgery, because you're
Speaker 1: just making you look pretty. But once you go from
Speaker 1: rugged okay, with heavy brows and putted upper eyelids and
Speaker 1: maybe some wrinkles on the forehead to a sort of
Speaker 1: feminized version of that, if that's your thing. You know,
Speaker 1: like a Ryan Gosling could probably look good with feminizing plaster.
Speaker 1: It's kind of a pretty dude, right. But you take
Speaker 1: a George Clooney, although he's not not feminine, but he's
Speaker 1: much more masculine looking, and you do that kind of
Speaker 1: surgery on a George Clooney, it's gonna scream facelift. Don't
Speaker 1: you agree with that?
Speaker 2: I think that's absolutely true. But I also think that
Speaker 2: what you're saying really applies to every man in that
Speaker 2: if I think part of what's going going on is
Speaker 2: it's men or you know, plastic surgeons doing facelifts on
Speaker 2: men and doing facial rejuvenation, filler, eyelid surgery, brow whatever
Speaker 2: it is, doesn't matter, and they're doing it the way
Speaker 2: they would on a woman. Yeah, and the aesthetic is
Speaker 2: totally different because you know, I I'm not fascinated particularly
Speaker 2: with celebrities, and I'm not fascinated by celebrity plastic surgery either,
Speaker 2: but you know, my patients ask about it, so I
Speaker 2: try to stay up with it, right, right, So you
Speaker 2: get aggressive on any of these things. On a man,
Speaker 2: it doesn't matter where they started off, and it's going
Speaker 2: to look feminizing, and in some ways it's going to
Speaker 2: look less handsome. Less is more on a man. A
Speaker 2: male facelift is a very different surgery from a female facelift.
Speaker 2: If you're gonna air one way or another, if you're
Speaker 2: gonna air one way or another, and one obviously you
Speaker 2: don't want to air at all. But if you're gonna
Speaker 2: it's okay to maybe overdo just a little bit. It'll
Speaker 2: be fine. Okay, it may take a little longer to
Speaker 2: get there, but it'll be fine. If you're gonna air
Speaker 2: one way or another. On a man, you should underdo it.
Speaker 1: You can always take.
Speaker 2: More anything well, and anything overdone starts to look feminized.
Speaker 1: Well. Remember, you know, it's funny people seem to plastic
Speaker 1: surgeons now somehow seem to forget who Kenny Rogers was
Speaker 1: or Robert Blake. Do you remember of course, I know
Speaker 1: you know who Robert Blake was. He had clearly very weird,
Speaker 1: feminizing plastic surgeon. And Robert Blake was a very handsome guy,
Speaker 1: but a very rugged guy, and he was massively feminized.
Speaker 1: And yet we still don't seem to understand the lessons.
Speaker 1: But I think the scariest operation that a man can
Speaker 1: undertake in plastic surgery is an upper eyelid blephoplastic, because
Speaker 1: you just take a little too much skin and not
Speaker 1: only is there no going back, but you're completely for
Speaker 1: the looking person. And if you're a guy and you're
Speaker 1: going to have your upryland is done, just tell him
Speaker 1: to take one or two millimeters. You can always take
Speaker 1: a couple more later, right, and you.
Speaker 2: Know what, you're not going to need to because you
Speaker 2: don't want to look that refined as a man. You
Speaker 2: just don't, you know. So look, Brad Pitt is obviously
Speaker 2: a great looking guy. I think you could make the
Speaker 2: argument that whatever he's had done, I don't know, he's
Speaker 2: still great looking. He had good work done, whatever, he
Speaker 2: looks great. Yeah, I don't think there was a problem
Speaker 2: that needed to be addressed there. And whoever did it
Speaker 2: obviously did subtle which is good, but you know, a
Speaker 2: little craggy, the lines in the face in a man,
Speaker 2: the aesthetics for him. That's the other thing is that
Speaker 2: the aesthetics for a man and a woman are very
Speaker 2: different as we age. It's fair, not fair, it's just
Speaker 2: what it is. Let's just let's as they get older
Speaker 2: and you know, more rugged looking, it just works in
Speaker 2: terms of what society likes.
Speaker 1: It's true. Let's let's be honest. Brad Pitt never looked bad.
Speaker 1: He never looked like he needed work done now the day.
Speaker 2: Honestly, he actually I think he looked even better as
Speaker 2: he got older, which was just so painful to walk.
Speaker 1: I hate that that guy. Remember him in the Legends
Speaker 1: of the Fall, Yeah, I mean he was the best
Speaker 1: looking actor bar non female or male on the set
Speaker 1: of that. I mean, he's just you know, it's.
Speaker 2: Like painfully good looking and like inglorious bastards and fury,
Speaker 2: and you know, it's just he can't look bad.
Speaker 1: It's funny to get not to get too personal about this,
Speaker 1: but you've embraced getting older with the beard and having
Speaker 1: the gray. But you, let's be honest, you were a
Speaker 1: very pretty slightly slightly as being generous to you because
Speaker 1: you were more than slightly feminine, feminine looking guy. I mean,
Speaker 1: you were a classic blue eyed, dark thick, black haired
Speaker 1: model when you came to UCLA. It's funny because when
Speaker 1: I knew you at Yale, you were kind of this
Speaker 1: skinny I remember, not very tall, nerd genius. And then
Speaker 1: a few years later I see US medical school and
Speaker 1: you're like this super fashion model perfect. What the fuck
Speaker 1: happened between Yale and ucllly medical School? Did you just
Speaker 1: wake up and you were like this feminine, gorgeous looking
Speaker 1: guy overnight? And did it mess with your head? And
Speaker 1: I know we're getting way off topic here, but it
Speaker 1: was weird.
Speaker 2: Yeah, there's a lot to reveal on the first episode,
Speaker 2: but I don't know. I know we've talked about it.
Speaker 2: I'm pretty sure we talked about this. I had a
Speaker 2: very weird, like teenagehood. You know. Well, first of all, okay,
Speaker 2: I went to Yale to become a physicist. Okay, okay,
Speaker 2: let's let's be real here. Dork, seriously dork, right, So,
Speaker 2: and when I started freshman year in September, how tall?
Speaker 2: I was five ft four inches fall Wow?
Speaker 1: How tall?
Speaker 2: Chubby and chubby sixty. Yeah, sixty. I grew six inches
Speaker 2: out of nowhere in my freshman year of college and
Speaker 2: it completely changed my look, and honestly it was Yeah,
Speaker 2: it did mess with my head because suddenly.
Speaker 1: Girls they paid it. They oh attention, dude, you were killer.
Speaker 1: I remember you gave me to UC med school. We're
Speaker 1: going med school ahead, you're going girls, and it was like, wait, wait,
Speaker 1: that's a college thing. You're going now. And you took
Speaker 1: a year off to go model in Europe?
Speaker 2: Yeah, yeah, not the best use of the year, but
Speaker 2: I took a year off to model in Europe but
Speaker 2: not model successful.
Speaker 1: Aren't you glad you did it? Though?
Speaker 2: Yeah, I'm glad because the modeling didn't really work out.
Speaker 2: So after about two months, my buddy and I who
Speaker 2: we went over there, we just said, you know, screw it, and.
Speaker 1: We backpack through Europe and let's go back.
Speaker 2: He only stayed like another month or so, but I
Speaker 2: stayed there like six seven months, right on my own,
Speaker 2: backpacking through U and it.
Speaker 1: Was like, let's go back and be doctors. Let's leave
Speaker 1: people with the what to look out for when you
Speaker 1: go for a plastic surgery consultation? Can you go in
Speaker 1: to a plastic surgery's office, and they've got all the
Speaker 1: good looking furniture and the art on the wall and
Speaker 1: the degrees hanging. Okay, so they have pretty offices. We
Speaker 1: spend a lot of money in our offices to entice
Speaker 1: people to have plastic surgery. All right, but what should
Speaker 1: you look for that's good and not so good that
Speaker 1: may be a red flag in a consultation?
Speaker 2: I think. Okay, so you know we said before, usually
Speaker 2: this discussion begins and ends with look for a board
Speaker 2: certified plastic circuit. And yeah, obviously, but the next thing is, Okay,
Speaker 2: before you've even gone there, you should have looked at
Speaker 2: their web and looked at them before and afters. Okay,
Speaker 2: Now that is only so useful because anyone on their
Speaker 2: website it's like their greatest Hits album.
Speaker 1: But just you know, by the way, if I can
Speaker 1: add to this, just you know, it's now that's primarily
Speaker 1: and more broadly replaced by Instagram. Now they're showing amazing
Speaker 1: before and afters on Instagram, and that's the main catch
Speaker 1: point for getting patients at their office. And boy, there's
Speaker 1: no more bs than an Instagram before and after.
Speaker 2: Yeah, be really careful with that because I can tell
Speaker 2: you what I've started seeing in the last year or so,
Speaker 2: not so much on plastic surgeons in this country, although
Speaker 2: definitely happening. It's results that have clearly been doctor right,
Speaker 2: clearly altered, aside from the usual tricks of the you
Speaker 2: know face of the before.
Speaker 1: Oh I know and they know that thing. So but okay,
Speaker 1: so the patient comes in and you meet.
Speaker 2: So anyways, the photos I think are useful only in
Speaker 2: the sense is if you look at their photos and
Speaker 2: you go like on any of them.
Speaker 1: You're like, right done, because that's their best.
Speaker 2: If their best stuff is not meeting your approval, don't.
Speaker 1: Right, But what about what about the general demeanor, Like
Speaker 1: how much time they spend with you? I think ten
Speaker 1: minutes is not enough. You know, there has to be
Speaker 1: a get to know you. You have to have a
Speaker 1: cocktail with them first, and they have to learn. I
Speaker 1: think it's important they learn a little bit about you,
Speaker 1: to get to try to get a feel for you,
Speaker 1: because you know, you may have red flags that they're
Speaker 1: that they're not even looking for because they just want
Speaker 1: to get you on the operating table. And you know,
Speaker 1: for me, I say, my big thing is I want
Speaker 1: to know why you're thinking about doing it now, like
Speaker 1: you're forty three years old, coming for a breast augmentation. Why,
Speaker 1: I'm very nice about it if I really want to
Speaker 1: get at the why. Because if your marriage is failing
Speaker 1: and you're doing breast implants, you can still do breast implants,
Speaker 1: but it's good to know you're you know that you're
Speaker 1: maybe expecting something that's going to really change everything about you,
Speaker 1: and your expectations are overwhelmed by the results. So that's
Speaker 1: what I do. I spend at least thirty forty five minutes.
Speaker 1: I try not to spend an hour, but I'm willing
Speaker 1: to if they want to talk that much. But I
Speaker 1: want to get to know the person. I think your
Speaker 1: plastic surgey should get to know you.
Speaker 2: I think your plastic surgery consultation should be done primarily
Speaker 2: by your plastic surgeon and not by a coordinator or
Speaker 2: a salesperson or right whatever it is. That's a red flag,
Speaker 2: you know, it's total red flag. First of all, aside
Speaker 2: from the fact that this is surgery. This is serious business.
Speaker 2: You know, people forget that. You know, the second half
Speaker 2: of plastic surgery is surgery. It's real, it's very real.
Speaker 2: It's a real thing. It's real surgery. Yeah, and so
Speaker 2: you should know the person who's going to be cutting
Speaker 2: open part of your body and putting it back together.
Speaker 1: It's a good point of that because if you meant
Speaker 1: the coordinator, it's almost like going in for the car.
Speaker 1: The guy goes put a cigarette down and goes, let
Speaker 1: me go talk to my manager. And the manager in
Speaker 1: this case is the plastic surgery is going to come
Speaker 1: in and do the clothes right.
Speaker 2: Right, right right. So yeah. So and second of all,
Speaker 2: you're purchasing, aside from the fact that it's surgery and
Speaker 2: it's your face or your body, and in some ways
Speaker 2: there's no going back from this. You're purchasing a very
Speaker 2: expensive luxury service, and you deserve to be treated like
Speaker 2: someone who is receiving a luxury service. And that means
Speaker 2: I have all the time in the world that you
Speaker 2: need me to spend with you to make sure that
Speaker 2: you're comfortable. I'm sitting there and we're chit chatting. And
Speaker 2: we're chit chatting for two reasons. One because it's just
Speaker 2: good manners to walk in and I ask people about,
Speaker 2: you know, what they did or something that you know
Speaker 2: has come up something that you know, I noticed what
Speaker 2: they do for a living or whatever one because part
Speaker 2: of what's a blessing about being a plastic surgeon is
Speaker 2: we're not beholden to whatever Blue Cross blue Field is
Speaker 2: going to pay us for the visit. So that's not
Speaker 2: what it's about. And so I have that luxury. Right,
Speaker 2: I can spend an hour with a patient if I
Speaker 2: want to. You know, your intern is can't do that, right,
Speaker 2: They can't make a living doing.
Speaker 1: Do you agree with this? They? Okay, So we discussed
Speaker 1: they should take a januarine interest to you. Really, they
Speaker 1: should try to understand you to determine whether they can
Speaker 1: meet your expectation. Number one. Number two, I think it's
Speaker 1: important that every procedure you talk about doing, they discuss
Speaker 1: the pros and they all discuss the cons because every
Speaker 1: procedure you're considering has cons. Like the first when a
Speaker 1: patient comes in for a breastlift, first thing I say
Speaker 1: to them, I go, let me ask you a question,
Speaker 1: how do you feel about breast cars? Now I've started
Speaker 1: with breast scars. That's not a good sales tactic because
Speaker 1: now I've highlighted the thing that they would turn them
Speaker 1: off to. Signing up for the procedure, right, the scars.
Speaker 1: But if I can see right away whether they go scars, Oh,
Speaker 1: you didn't know they were scars, let's talk about it.
Speaker 1: And some people in the middle in the very beginning
Speaker 1: of that consultation will go, I'm not doing it if
Speaker 1: there's scars. You go, yeah, there's scars. There's scars for sure,
Speaker 1: and they're permit, you're gonna see them. And they go, yeah,
Speaker 1: I don't want that. You go great, I go, maybe
Speaker 1: there's other things you can do, but I highlight and
Speaker 1: you don't have to necessarily do this, but I think
Speaker 1: it's important every single procedure they offer you should come
Speaker 1: with various options, and they should highlight every one of them,
Speaker 1: not necessarily all the risks, but the cons the cons.
Speaker 1: The cons are a tummy tuck, for example, That is
Speaker 1: a big recovery, big recovery, and it hurts, and it
Speaker 1: has more risks than any of the other plastic surgery procedures.
Speaker 1: I start with that. Now. I don't care if people
Speaker 1: have surgery with me anymore or not. I don't care,
Speaker 1: you know what I mean, And you don't either, because
Speaker 1: you're you know, we both have these advanced practices now.
Speaker 1: But I care that I've told them all this stuff,
Speaker 1: and if anything untoward happens, I look at them and go.
Speaker 1: But remember we did discuss this. But I know that
Speaker 1: they made the decision based on having heard that they
Speaker 1: can never say. My patients can never say. Boy, had
Speaker 1: I known, I would not have done this. So I
Speaker 1: think pros and cons. Would you agree?
Speaker 2: I one hundred percent agree, And I don't even look
Speaker 2: you said. It's not a good sales tactic. It's not
Speaker 2: a good sales tactic. But it is a good doctor tactic,
Speaker 2: and aside from just the medical legal aspect of it,
Speaker 2: it's just the right thing as a human being to do.
Speaker 2: And so you know, I'd like to I try to
Speaker 2: walk my patients backwards from what they're trying to get
Speaker 2: out of this operation. And it took me a long
Speaker 2: time in practice to really understand the psychological aspects of this.
Speaker 2: What are we really doing with any of these operations.
Speaker 2: We're taking a part of someone's face or body that
Speaker 2: they feel self conscious about, rightly, wrongly, whatever, Okay, they
Speaker 2: feel self conscious about it, and ideally want to move
Speaker 2: it from a place where they feel self conscious, ideally
Speaker 2: to a place where they feel proud of it, or
Speaker 2: at least a place where they feel a lot better
Speaker 2: about it. And so if you discuss something like a
Speaker 2: breast lift without talking about the scars and without having
Speaker 2: them in their head asking themselves, Okay, if my nipples
Speaker 2: are in the perfect position, or my breast no longer
Speaker 2: a hang down, but I do have some visible scars
Speaker 2: around my nipple on the lower part of my breast,
Speaker 2: do I feel better about my breasts or do I
Speaker 2: feel worse about my breasts? Because unless the answer is
Speaker 2: I truly feel better about my breast despite the scars,
Speaker 2: shouldn't do it? I agree, because ultimately you're not going
Speaker 2: to achieve what the goal is, which is feeling good
Speaker 2: about your breast. No one's goal is to have nipples
Speaker 2: that are twenty centimeters from their sternal notch, you know,
Speaker 2: the things that often blasphic. No one comes in going
Speaker 2: like I don't like my external notch to nipple distance.
Speaker 2: They don't like their breasts. They don't always know why
Speaker 2: they don't like their breasts, but they want to be
Speaker 2: proud of their breasts again or maybe for the first
Speaker 2: time in their lives. Right, And so if you can't
Speaker 2: do that in a way. That's me. If you just
Speaker 2: make them self conscious about something else, you've achieved nothing.
Speaker 1: Well, you and I could talk forever about this, but
Speaker 1: I do want to make one final point. So people
Speaker 1: have a practical red flag. I think if they've say
Speaker 1: it's easy, if they use that's easy, that's a chip shot.
Speaker 1: Oh my gosh, it's going to be so easy, that's
Speaker 1: a red flag. I think. Don't you agree completely?
Speaker 2: This comes up a lot where PA goes this an
Speaker 2: easy operation, and I always say, it depends what you
Speaker 2: mean by easy.
Speaker 1: Yeah, Okay, A.
Speaker 2: Lot of things in plastic surgery, strictly speaking, not that hard.
Speaker 2: It's not like taking a tumor out of the base
Speaker 2: of the brain. You know, it's not the technical aspects
Speaker 2: that aren't that hard. But it's hard in the sense
Speaker 2: that you have to get everything exactly right right. So
Speaker 2: it's easy in some sense to do breast implants. It's
Speaker 2: hard to get the very best breast augmentation result time
Speaker 2: after time after time, given all the differences between patients
Speaker 2: and even between their own breast. That takes a lot
Speaker 2: of work, a lot of judgment, and a lot of right.
Speaker 1: I mean, we have this thing we say, you know,
Speaker 1: among us plastic surgeons in the lounge, the only easy
Speaker 1: operations and operation done on somebody else. Yeah, right, well, listen,
Speaker 1: I mean, there's so many more and we're going to
Speaker 1: do this again. I loved doing this with you, and
Speaker 1: we have so much more to talk about, and I
Speaker 1: hope you'll do this again with me many more times.
Speaker 1: And by the way, by the way, I just want
Speaker 1: the audience to know that there will be a bonus
Speaker 1: episode to look forward to, okay, where we'll talk more
Speaker 1: about this. And I can't tell you how much I
Speaker 1: appreciate you, know. I love you, you know, and you
Speaker 1: know you're like one aside from my wife and my kids,
Speaker 1: well some of my kids, you're like most important people
Speaker 1: in my life, my life, and I adore you and
Speaker 1: thank you for doing this. And I hope, I know
Speaker 1: and hope that the audience will get to hear more
Speaker 1: from you and me about this in the future. All right,
Speaker 1: So thank you for joining me.
Speaker 2: I would love to do this again and again. At
Speaker 2: the risk of us sounding maudlin, I love you like
Speaker 2: the older brother you've always been to me. Thank so,
Speaker 2: thank you for having me on at anytime. Thank you